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Fundamentals of Nursing in the Context of the Older Adult > Oxygenation > Flashcards

Oxygenation Flashcards

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1
Q

What does pulmonary ventilation consist of ?

A

Inspiration - active phase

Expiration - passive phase

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2
Q

What does respiration consist of ?

A

Gas Exchange

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3
Q

During inspiration ………….

A

the diaphragm relaxes to increase the size of the thoracic cavity. The lower pressure means air rushes in from the higher pressure outside the body into the respiratory tract

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4
Q

During expiration …………..

A

the diaphragm contracts and expels air.

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5
Q

During gas exchange

A

O2 diffuses across membrane from alveoli to capillary
CO2 diffuses across membrane from capillary to alveoli
Based on pressure gradient of gases
Diffusion= gas moves from area of higher pressure to area of lower pressure

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6
Q

Critical factors for ventilation

A 
Patent 
Intact CNS and PNS 
Mobile Thoracic Cavity 
Intact Pleura 
Adequate Lung compliance and recoil
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7
Q

Critical factors for ventilation

A

Inflatable alveoli
Surface area on alveolar capillary membrane
Intact and patent pulmonary vessels

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8
Q

Respiratory diseases are the ______________ leading cause of death in the US

A

fourth

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9
Q

Respiratory problems develop _____ ; difficult to _____

A

Easily; manage

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10
Q

Age Related factors that influence respiratory function

Upper respiratory functions

A

Thicker mucous
Stiffening of trachea
Blunted cough and laryngeal reflexes
Atrophy of laryngeal nerve endings

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11
Q

Age related factors that influence decreased gas exchange

A

Decreased elastic recoil
Expiration requiring use of accessory muscles
Fewer functioning capillaries and more fibrous tissue in alveoli
Decreased skeletal muscle strength in thorax

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12
Q

Nursing strategies to better enhance respiratory function

A

Encourage rest periods as necessary
Encourage cessation of smoking
Teach breathing exercises
Instruct avoidance of narcotics and sleeping medications
Prevention and wellness (vaccinations and avoidance of infection)

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13
Q

Age Related changes that influence respiratory function

chest wall and musculoskeletal functions

A 
Ribs and vertebrae become osteoporotic 
Costal cartilage calcifies
Respiratory muscles weaken
Structural changes
Kyphosis: curvature of spine (appearance of leaning forward)
Shortened thorax
Chest wall stiffens
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14
Q

Age Related changes affecting lung structure and function

A

Lungs become smaller and flaccid
Pulmonary artery becomes less elastic
Diminished blood flow and blood volume to lungs
Decrease in capillary blood volume
Elastic recoil decreased - Airway does not stay open as long during inspiration

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15
Q

Immunological changes influencing respiratory function

A

Alteration in T-Cells
Affects immune system
Contributes to increase risk for lung disease and infectious respiratory infections

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16
Q

Functional outcomes of age related changes

A 
Less elastic chest wall and airways
Decreased muscle strength
Decreased ciliary action
Drier, more fragile mucous membranes
More energy needed for respiratory efficiency
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17
Q

Environmental and Lifestyle factors that influence respiratory function and wellness

A

Air pollution
Occupational exposure to asbestos, mold
Tobacco smoking and second hand smoke

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18
Q

Health Status Factors influencing respiratory function and wellness

A

Vagus nerve or neuro impairment
Renal failure
Anemia
Pain

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19
Q

Medications influencing respiratory function and wellness

A

Anticholinergics

Narcotics & sedatives

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20
Q

Other factors influencing respiratory function and wellness

A

Lack of vaccinations
Bedrest
Obesity
Chronic Illness

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21
Q

How can the nurse promote respiratory health ?

A

Assess for and detect lower respiratory infections
Assessing smoking behaviors
Identifying other risk factors
Identifying normal age-related health variations
Ensuring vaccination schedule for Influenza and Pneumonia vaccines are followed, crowd avoidance.

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22
Q

Chronic obstructive pulmonary disease(COPD)

A

group of diseases that impacts more than 40 million Americans, 1 million people between the ages of 40-65 have moderate to sever disability from COPD related diseases

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23
Q

Discuss asthma

A

Inflammation of the mucous membranes lining the airways causing the airways to become inflamed, narrow, and become hyperresponsive when triggered by allergens, cold air, dry air, exercise, medications (Aspirin or NSAIDS), or upper respiratory illnesses.

When asthma is well controlled the airway changes are well controlled and reversible, poor control can result in damage to bronchial smooth muscle.

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24
Q

Discuss Chronic Bronchitis

A

Inflammation of the bronchi and bronchioles caused by exposure to irritants, especially cigarette smoke. Pollution and dust can also be triggers.
The irritant triggers inflammation, vasodilation, congestion and bronchospasm.
Chronic inflammation increases the number and size of mucus glands, causing the bronchial walls to thicken.
Excessive mucous production contributes to a breading ground for microorganisms and chronic low-grade infections resulting in poor gas exchange and airflow.

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25
Q

Discuss Emphysema

A

Long term chronic disease resulting in loss of lung elasticity and hyperinflation of the lung.
Over inflation of the alveoli causing ‘air trapping’ which results in decreased recoil.
These changes result in dyspnea and increased respiratory rate.
See this on X-Ray visually-diaphragm will have a more flattened appearance.

26
Q

Discuss Lung cancer

A

Increasing incidence in 65 years and older
Higher incidence in men than in women
Incidence and mortality rate varies in ethnic groups
Incidence in smokers twice as nonsmokers

27
Q

Discuss Lung Abscess

A

May result from pneumonia, malignancy, tuberculosis and aspiration
Decreased pharyngeal reflexes put older adults at increased risk for aspiration

28
Q

Respiratory conditions can affect ……….

A

Patency of airway
Movement of air into and out of lungs
Diffusion of O2 and CO2 between alveoli and capillaries
Transport of O2 and CO2 to tissues

29
Q

What is hypoxia ?

A

Deficiency in the amount of oxygen reaching the tissues

30
Q

Common manifestations of impaired respiratory function

A

Hypoxia
Altered breathing patterns
Obstructed or partially obstructed airway

31
Q

What is Pulse oximetry ?

A

Measures the % of hemoglobin saturated with O2

its a measure of arterial oxyhemoglobin saturation (SaO2 or SpO2)

Normal measures are between 95-100%

32
Q

What is PEFR?

A

Diagnostic test measuring the airflow through bronchi
Degree of restriction in asthmatics
High numbers are best

33
Q

What are other diagnostic tests of respiratory function ?

A 
Arterial blood gases (ABGs)
Complete blood counts (CBC)
Pulmonary Function Tests  (PFTs)
Measure volumes and capacity
Requires cooperation
Bronchoscopy
Fiber-optic scope
Clear secretions or collect specimen
Sedation 
Throat & sputum cultures
34
Q

Arterial Blood Gas Analysis

A

An invasive test used to measure the adequacy of oxygenation, ventilation, and perfusion (pH, PCO2, PO2, HCO3).
Use the radial, brachial or femoral artery (usually the sites of choice).
Perform Allen’s test prior to drawing blood gas.
Must apply pressure to site for 5-10 minutes after drawing blood or longer if on anticoagulants.
Remember to document or note the amount of oxygen support required by patient when drawn.

35
Q

Diagnostic Imaging Tests

A

Chest XRAY or Radiography
Differentiates tissue by density
White=solid
Often done serially

Spiral Chest CT
Multiple cross-sectional images

Ventilation Perfusion Scan (V/Q scan)
Radioisotopes given IV & inhalation
Emissions compared
V/Q mismatch
No additional radiation precautions
36
Q

Changes in character of sputum (amount, color, odor, thickness) - should this require prompt medical attention ?

A

Yes, it should.

Prompt medical attention is needed with signs of respiratory infection or pulmonary decompensation.

37
Q

Complications R/T Obstructed or PartiallyObstructed Airway (Airway Patency)

A 
Partial:
Snoring
Stridor
Adventitious breath sounds
Complete:
Extreme inspiratory effort with no chest movement
Obstruction may be caused by
Secretions (most common)
Tongue
Foreign object
38
Q

Signs and Symptoms of Hypoxia

A

Tachypnea, tachycardia (early signs)
Restlessness, confusion, anxiety (early signs)
Dyspnea, orthopnea, retractions, accessory muscle use (early signs)
Cyanosis, decreased LOC (late sign)
Clubbing (chronic sign)

39
Q

Nursing Interventions to Promote Respiratory Function

in terms of Promoting Lung Expansion

A 
Promote lung expansion
Positioning
Ambulation 
Frequent position changes
Incentive spirometry
40
Q

Nursing Interventions to Promote Respiratory Function

in terms of mobilizing secretions

A 
Mobilize secretions
Coughing & deep breathing
Hydration
Humidified O2
Suctioning
Postural Drainage
Chest PT
41
Q

Other Nursing Interventions to Promote Respiratory Function

A 
Provide supplemental O2 therapy
Ensure a patent airway
Positioning
Artificial airways
Suctioning 
Auscultate breath sounds
Administer medications
Analgesics 
Bronchodilators (MDIs)
Anti-inflammatories
Expectorants
Cough Suppressants
42
Q

Maintaining Good Nutrition in Patients with Compromised Pulmonary Status

A

Consider 6 small meals distributed over the day instead of 3 large meals
Provide frequent oral hygiene and rest periods before and after eating to improve intake
Encourage patients to eat their meals 1-2 hours after breathing treatments and exercises
Patients with COPD require high protein/high caloric diet to counter malnutrition
If wearing oxygen wear nasal cannula during and after meals because eating and digestion require energy.

43
Q

Providing Supplemental Oxygen - what kind of delivery methods are there ?

What supply methods?

A 
Nasal Cannula
Mask
Simple
Venturi (“venti mask”)
Nonrebreather 
Face tent
Supply 
Wall outlet 
Cylinder
Liquid
Concentrator
44
Q

Does supplemental oxygen require a prescribers order ?

A

Yes, except in cases of emergency

Ordered by provider as:
Flow rate
Percentage
Titrate to maintain SpO2 level

45
Q

OXygen Therapy - nasal cannula?

Lpm and FiO2?

A

Nasal Cannula (NC)
25%-45% FiO2
2-6 Lpm
Drying/Irritating

46
Q

Simple Face Mask

A

40%-60% FiO2
6-8 Lpm
Comfort/Fit

47
Q

Nonrebreather mask

A

100% FiO2
10-15 Lpm
Keep reservoir bag inflated

48
Q

Venturi Mask

A

Precise concentrations
24%-50% FiO2
Color-coded jet adapters that indicate different O2 percentage

49
Q

Safety Cautions for Oxygen Administration

A

Avoid open flames in patient’s room.
Place no smoking signs in conspicuous places.
Check to see electrical equipment in room is in good working order.
Avoid wearing and using synthetic fabrics (builds up static electricity).
Avoid using oils in the area (ignite spontaneously in oxygen).

50
Q

Ensuring Safe Oxygen Administration

A

Prudent use of oxygen
Carbon dioxide narcosis
Monitor blood gases and pulse oximetry

Assessment of oxygen equipment
Home oxygen safety
Evaluate home environment

Assess patient’s ability to use nebulizers and/or oxygen therapy correctly

Make sure you send patient to a study or procedure with a full oxygen tank

51
Q

Strategies to Promote Proper Breathing

A

Performing postural drainage
Productive coughing
Incentive spirometry

52
Q

Performing Postural Drainage - what does it do ?

A

Postural drainage makes use of gravity to drain secretions from the lungs.
Aerosol medications used prior to procedure, only utilized 1-2 hours after a meal to prevent N/V
Consider positioning based on individual patient’s abilities
Discontinue if dyspnea, palpitations, chest pain, apprehension, or other signs of distress occur
Oral hygiene and rest after procedure

53
Q

Promoting Productive Coughing

A

Coughing is important in the removal of secretions (voluntary versus involuntary coughing)
Measures to promote productive cough
Increase fluid intake
Breathing exercises
Use of humidifier
Expectorants
Good handwashing and oral hygiene essential

54
Q

Incentive Spirometry

A

Provides visual reinforcement for the patient during deep breathing exercises.
Assists the patient to breath slowly and deeply and sustain maximal inspiration.
The gauge allows the patient to measure their progress.
Goal: reduce atelectasis and maximize lung inflation.

55
Q

Complementary Therapies for Respiratory Health

A 
Some herbs affect respiratory health
Assess for interactions with other medications
Hot, spicy foods open airways
Avoid mucus-forming foods
Yoga can improve deep breathing
Some herbs affect respiratory health
Assess for interactions with other medications
Hot, spicy foods open airways
Avoid mucus-forming foods
Yoga can improve deep breathing
56
Q 
The nurse is caring for a 79-year-old patient who has decreased mobility. Which intervention is a simple and cost-effective method for reducing the risks of stasis of pulmonary secretions and decreased chest wall expansion? 
A.  Antibiotics
B.  Frequent change of position
C.   Oxygen humidification
D.   Pressure relieving mattress
A

B. Frequent Change of Position

57
Q

The nurse goes in to assess a new patient who is supine in bed. The patient tells the nurse that he feels short of breath. Which nursing action should the nurse perform first?
A. Raise the head of the bed to semi-fowlers position
B. Take the oxygen saturation with a pulse oximeter
C. Take his blood pressure and respirator rate
D. Notify the health care provider of his shortness of breath

A

A. Raise the head of the bed to Semi Fowlers Position

58
Q 
Which nursing intervention is appropriate for preventing atelectasis in the post-operative surgical patient? 
A. Postural drainage
B. Chest percussion
C. Incentive spirometer
D. Nasopharyngeal suctioning
A

Incentive Spirometer

59
Q

A nasal cannula delivers ………..

A

25%-45% FiO2

2-6 Lpm

60
Q

A simple face mask delivers …..

A

40%-60% FiO2

6-8 Lpm

61
Q

A nonrebreather mask delivers ………..

A

100% FiO2

10-15 Lpm

62
Q

A Venturi mask delivers ………

A

Precise concentrations

24%-50% FiO2

Fundamentals of Nursing in the Context of the Older Adult (8 decks)

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