Oxygenation Flashcards
Concept of Oxygenation
- mechanism that facilitates the body’s ability to supply oxygen to all cells of the body
- function is to obtain oxygen from atmospheric air, transport this air through the respiratory tract into the alveoli
- achieved through respiration, processes of inspiration & expiration
- oxygen to alveoli to be exchanged for carbon dioxide which is then expelled from the body
- ventilation is the actual exchange of oxygen and carbon dioxide
- ability to supply oxygen to all cell from the air (this is done by respiration)
How many lobes are in the lungs?
left: 2 lobesright: 3 lobes
Children Lifespan Considerations
- alveoli # is 10% of adults, not fully developed
- airway is shorter and narrower-respiratory rate is faster
- abdominal breathers
Older Adults Lifespan Considerations
- decreases in peak airflow and gas exchange
- decreases in measures of lung function
- weakening of the respiratory muscles
- decline in the effectiveness of lung defense mechanisms=infections (cilla and cough mechanisms)
Eupnea
12-20 bpm normal respiratory rate
Tachypnea
greater than 21 bpm
Bradypnea
less than 10 bpm
Apnea
absence of breathing (abnormal respiration) ex: sleep apnea
Hyperventilation
increased movement of air into and out of the lungs (alveolar hyperventilation)
Hypoventilation
inadequate alveolar ventilation
Dyspnea
difficult breathing
Orthopnea
inability to breath except in an upright or standing position
Hypoxemia
decreased level of oxygen
Hypoxia
-insufficiency of oxygen -restlessness is the first sign
Anoxia
without oxygen
Cyanosis
bluish discoloration of skin, nail beds & mucous membranes
Pneumothorax
lung collapse
Partial obstruction of upper airway
indicated by low pitched snoring sound during inhalation
Complete obstruction of the upper airway
indicated by extreme inspiratory effort that produces no chest movement (other than retractions)
Stridor
a high pitched, harsh sound (like blowing of the wind) heard during inspiration with laryngeal obstruction
Concepts that relate to oxygenation
- Acid-Base balance: respiratory acidosis (low pH level in blood)
- Cellular Regulation: anemia, increases systemic workload
- Cognition: decrease oxygen to brain causes changes
- Comfort: pain from ischemic events, cerebral, cardiac
- Perfusion: decrease leads to oxygen deficit to organs
Nonmodifiable Risk Factors
- genetic effect of hemoglobin and hematocrit: can impact oxygen carrying capacity such as Thallasemia
- women have lower concentrations of hemoglobin and hematocrit
- lower hemoglobin/hematocrit=anemia (reduced oxygen carrying capacity)
- Thallasemia: malformed red blood cells; lower oxygen carrying capacity; genetic disorder
Prevention
- Management of environmental air quality: reduce smoking by the population, work place, smog
- Vaccination: older adults (influenza & pneumonia) & children (pertussis)
Modifiable Risk Factors
- hypertension
- atherosclerosis
- obesity
- type 2 diabetes
- smoking (biggest thing to change)
- stress
- anxiety
Interview Assessment: what to ask
- current respiratory problems-history of respiratory disease
- lifestyle (smoker?)
- Presence of cough (when?)
- Description of sputum (amount? color?)
- Presence of chest pain (what causes?)
- Presence of risk factors (obese? cardiac issues?)
- Medication history
Nasal Assessment
- midline and symetrical
- nares mucosa is pink and moist, no drainage
Respiratory Assessment
regular, depth, effort
Thoracic cavity inspection
anterior/posterior diameter is 1/2 the transverse diameter
Muscles of breathing assessment
- chest wall gently rises and falls
- neck muscles are relaxed
- intercostal muscles
Thoracic Wall Assessment
symertrical hand placement shows symetrical movement of the hands
Vesicular (normal breath sound)
- “gentle sighing” sounds
- air moving through smaller airways (alveoli and bronchioles)
Bronchovesicular (normal breath sound)
-moderate pitched “blowing” sounds as air moves through the larger airways (bronchi)
Bronchial (normal breath sound)
-high-pitched, loud, “harsh” sounds as air moves through the trachea
Normal color of skin, nail beds, and mucous membranes
pink color (well oxygenated blood)
Dusky hue of skin, nail beds, and mucous membranes
poorly oxygenated blood
Cyanosis
- bluish discoloration
- severe oxygen deprivation
Crackles (abnormal breath sounds)
- high pitched, heard during inspiration, not cleared by cough, discontinuous-fluid on lungs
- heard at base of lungs 1st
Rhonchi (abnormal breath sounds)
- coarse sounds like a snore
- may clear with cough or suctioning-upper chest
Wheeze (abnormal breath sounds)
musical noise, louder on expiration, continuous, throughout lungs
Stridor
- high pitched, harsh sound hear during inspiration with laryngeal obstruction
- in the throat
Chest Radiograph
see fluid, air or masses (xray)
CT/MRI
more detail can be seen
Arterial blood gas
provides direct indication of oxygen and carbon dioxide exchange and acid-base balance
Pulmonary function tests
info about ventilation airflow, lung volumes, lung capacity, diffusion of gas
Bronchoscopy
direct visualization of the lungs via bronchoscope
Thoracentesis
drain excessive pleural fluid, then the fluid is analyzed
Sputum Specimen
collect in the morning, identify microbes, inflammation and immunoglobulins.
Pulse Oximetry
- a noninvasive procedure that helps measure the client’s arterial oxygen saturation to detect
- sensor is attached to finger, earlobe, nose, or forehead-normal is 95%-100%-less than 70% is critical
- under 90% be concerned-notify physician-each patient will have their own normal
Ineffective breathing patterns
-anxiety and pain as manifested by shortness of breath, orthopnea, nasal flaring, and grunting with a respiratory rate of 32 (adult)
Ineffective Airway Clearance
thick sputum, secondary to pneumonia, and fatigue as manifested by nasal flaring, tachypnea,dyspnea, abnormal breath sounds, orthopnea and cyanosis
Independent Interventions(Positioning)
- Semi-fowlers: 30-45 degrees (tube feeds-decrease aspiration)
- Fowlers: HOB 45-60 degrees (increase comfort during eating etc)
- High Fowlers: HOB 80-90 degrees (feeding, breathing treatment)
- Orthopenic: head and arms over bed table, to facilitate lung expansion
Independent Interventions
- Encourage smoking cessation-monitor activity tolerance
- promote secretion clearance (TCDB and suctioning as needed)
- breathing exercises (for clients with restricted chest expansion–COPD and some abdominal surgery)
- abdominal breathing and pursed-lip breathing
- slow diaphragmatic breathing
- forceful exhalation of air
Incentive Spirometer
- device that stimulates the patient to achieve maximum voluntary lung expansion, prevents atelectasis
- should perform 10 times per hour
- patient should be encouraged to cough and expectorate any secretions loosened by the deep breathing
- place lips over mouthpiece. and inhale as deeply as possible. At maximum inflation there should be a slight pause and the patient then relaxes and exhales.
Collaborative Interventions
- Improve nutrition (nutritionist)
- Pharmacologic Therapy (pharmacist, physician)
- bronchodilators, anti-inflammatory, expectorants and any other medications that improve oxygenation and decrease the workload of the heart
- oxygen therapy (respiratory therapy/physician)
Nasal Cannula
- does not provide exact concentration of oxygen
- do not use with more than 6L/min
- inexpensive
- better tolerated by client, can eat/drink with cannula on
- check every 8 hrs for flow, patency, trauma to ears and nares
- humidifier if greater than 2L/min flow to prevent
Nasal Cannula oxygen %
- room air is 21%
- 1L/min=24%
- 2L/min=28%
- 3L/min=32%
- 4L/min=36%
- 5L/min=40%
- 6L/min=44%
Simple face mask
- provides oxygen at 5-8L/min
- gives 30-60% of oxygen
Partial Rebreather Mask
- not used much
- delivers oxygen from 60-95% at liter flows of 6-10L/min
- oxygen reservoir bag hold first 1/3 of exhaled air
- partial rebreather bag must not totally deflate during inspiration to avoid carbon dioxide build up
Non-rebreather Mask
- used in emergency situations or short term
- delivers highest oxygen concentration possible
- 95-100% with liter flow of 10-15L/min
- one way valve to prevent intake of room air
- no expired air in bag
- bag must not totally deflate during inspiration to prevent carbon dioxide build up
Venturi Mask
- used to be very exact
- delivers oxygen concentrations from 24%-60% at liter flow rates of 4-12 L/min
- color-coded jet adapters correspond to precise oxygen concentration and liter flow
- can be used to administer low or high concentrations
Collaborative Techniques used to mobilize secretions
- often done by respiratory therapists
- chest physiotherapy: group of therapies used in combination to mobilize secretions
- postural drainage
- chest percussion
- vibration
- suctioning
