Oxygenation Flashcards
Ventilation
cyclical movement of gas into and out of the lungs.
Distribution
process of air traveling to areas within the lungs
Diffusion
Movement of gases between alveoli and blood (gas exchange).
Perfusion
the process of oxygenated blood passing through the tissues of the body.
Oxygen is carried in the body via
plasma and red blood cells
Most oxygen (97%) is carried by red blood cells in the form of
oxyhemoglobin
_____ also carries carbon dioxide in form of carboxyhemoglobin
Hemoglobin
Developmental factors affecting oxygen: Infant
Lungs are transformed from fluid-filled structures to air-filled organs
The infant’s chest is small, airways are short, and aspiration is a potential problem
Respiratory rate is rapid and respiratory activity is primarily abdominal
Synthetic surfactant can be given to the infant to reopen alveoli
Crackles heard at the end of deep respiration are normal
Developmental Factors affecting Oxygenation: Child
Some subcutaneous fat is deposited on the chest wall making landmarks less prominent
Eustachian tubes, bronchi, and bronchioles are elongated and less angular
The average number of routine colds and infections decreases until children enter day care or school
Good hand hygiene and tissue etiquette are encouraged
By end of late childhood, immune system protects from most infections
Developmental Factors affecting Oxygenation: Older Adult (65+ years)
Bony landmarks are more prominent due to loss of subcutaneous fat
Kyphosis contributes to appearance of leaning forward
Barrel chest deformity may result in increased anteroposterior diameter
Tissues and airways become more rigid; diaphragm moves less efficiently
Older adults have an increased risk for disease, especially pneumonia
Lifestyle Risk Factors affecting Oxygenation
Obesity
Smoking
Lack of exercise
Lack of regular health care provider visits
Environmental Factors affecting Oxygenation
Residence
Workplace
Assessment: nursing history
Pain
Fatigue
Smoking
Dyspnea
Cough
Sputum production
Exposures
Respiratory conditions and infections
Allergies
Health risks
Medications
Assessment: Physical examination
Inspection Head-to-toe Skin Mucus membranes Level of consciousness Nail beds AP diameter
AP diameter
Anterior to posterior
Transverse from left to right side
1:2 ratio
Palpation
Excursion
Tenderness
Lumps or masses
Percussion
resonance hyperresonance flatness dullness tympany
Resonance
loud, hollow low-pitched sound heard over normal lungs
Hyperresonance
loud, low booming sound heard over emphysematous lungs
flatness
detected over bone or heavy muscle
dullness
with medium pitch and intensity heard over the liver
Tympany
high-pitched, loud, drum-like sound produced over the stomach
Auscultation
crackles
rhonchi
wheezes
pleural friction rub
crackles
sounds occurring when air moves through airways that contain fluid
Classified as fine, medium, or coarse
Rhonchi
loud, bubbling sounds primarily heard over the trachea and bronchi
Wheezes
continuous sounds heard on expiration and sometimes on inspiration as air passes through airways constricted by swelling, secretions, or tumors
Classified as sibilant or sonorous
Pleural friction rub
dry, grating sound usually heard over the anterior lateral fields
Assessment: diagnostic testing
Pulse oximetry
Sputum studies
Instruct pt to rinse mouth, cough deeply, Use early morning specimen, sterile container Examples: culture and sensitivity, gram stain, cytology
X rays and nursing responsibilities
X Rays:
Chest
Computerized Tomography (CT)
Magnetic Resonance Imaging (MRI)
Nursing Responsibilities:
Remove metal
Same, check allergies
Same, Implanted objects? Tattoos? Very loud noise.
Thoracentesis
Obtain consent Obtain thoracentesis tray Gather collection bottles Position patient in upright position Monitor patient during and after procedure
Implementation
Health promotion
Vaccinations
Smoking cessation
Regular exercise
Environmental pollutants
Promote proper breathing
Deep breathing
Using incentive spirometry
Pursed-lip breathing
Abdominal or diaphragmatic breathing
Promote and control coughing
Voluntary and Involuntary coughing
Use of cough medications
Suppressants
Expectorants
Lozenges
Promote comfort
Positioning
Maintaining adequate fluid intake
Providing humidified air
Performing chest physiotherapy
Maintaining good nutrition
Admin meds
Bronchodilators
Mucolytic agents
Corticosteroids
Bronchodilators
—open narrowed airways
Mucolytic
—liquefy or loosen thick secretions
Corticosteroids
—reduce inflammation in airways
Administer inhaled medications
Nebulizers
Metered dose inhalers
Dry powder inhalers
Nebulizers
disperse fine particles of medication into deeper passages of respiratory tract where absorption occurs
Metered dose inhalers
deliver controlled dose of medication with each compression of the canister. Use of spacer recommended
Dry powder inhalers
activated by the patient’s inspiration
Administer Oxygen
Oxygen is a prescribed treatment.
There are many oxygen delivery systems.
Flow rate of oxygen is measured in liters per minute.
Oxygen delivered at a rate > 2L/M requires humidification.
Transport patients using portable cylinders.
Ensure patient safety.
Nasal cannula
Plastic devise with prongs that fit in nostrils. Patients can eat while wearing. Can be easily dislodged. Causes nasal dryness. May cause skin breakdown
Types of oxygen masks
Simple
partial nonrebreather
non rebreather
venturi
Simple face mask
Must fit snugly
Inhibits eating
Used when increased delivery of oxygen is needed for short periods (< 12 hours).
May cause skin breakdown
Parital rebreather mask
Similar to simple face mask, but has a reservoir bag.
Permits conservation of oxygen.
Tight seal necessary.
Eating and talking are difficult.
Nonrebreather mask
Highest concentration of oxygen.
One way valves prevent rebreathing exhaled air.
Venturi mask
Permits precise delivery of oxygen concentration
nasal catheter
Infrequently used
May cause discomfort
Catheter must be changed every 8 hours.
Oxygen tent
Light, portable, plastic devise.
Delivers cool, humidified oxygen.
Patient’s clothing and linens may become wet.
Difficult to deliver precise oxygen flow.
Suctioning techniques
Oropharyngeal and Nasopharyngeal Considered clean procedures Nose preferred route Use lubricant for nasal route Last no longer than 15 seconds
Suctioning complications
Hypoxemia
Bleeding
Mucosal tears
Bronchospasm
Cardiac arrhythmias
Atelectasis
Chest tube drainage system
Commonly utilized with chest trauma and indicated if patient has a pneumothorax or hemothorax. Chest tube/drainage permits expulsion of air or fluid while allowing lung tissue to re-expand.
Managing chest tubes
Assess respiratory status.
Check dressing.
Ensure patent drainage.
No dependent loops
Look at drainage system.
Keep drainage system below the level of the chest.
Never clamp.
Pt education for chest tube
Range of Motion
Coughing and Deep Breathing – Monitor sputum
Encourage activity – walking (best exercise)
Nutrition and fluids
Avoid crowds and smoking
Flu/pneumonia vaccines
