Oxygenation Flashcards
What does pulmonary ventilation consist of ?
Inspiration - active phase
Expiration - passive phase
What does respiration consist of ?
Gas Exchange
During inspiration ………….
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
During expiration …………..
the diaphragm contracts and expels air.
During gas exchange
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
Critical factors for ventilation
Patent Intact CNS and PNS Mobile Thoracic Cavity Intact Pleura Adequate Lung compliance and recoil
Critical factors for ventilation
Inflatable alveoli
Surface area on alveolar capillary membrane
Intact and patent pulmonary vessels
Respiratory diseases are the ______________ leading cause of death in the US
fourth
Respiratory problems develop _____ ; difficult to _____
Easily; manage
Age Related factors that influence respiratory function
Upper respiratory functions
Thicker mucous
Stiffening of trachea
Blunted cough and laryngeal reflexes
Atrophy of laryngeal nerve endings
Age related factors that influence decreased gas exchange
Decreased elastic recoil
Expiration requiring use of accessory muscles
Fewer functioning capillaries and more fibrous tissue in alveoli
Decreased skeletal muscle strength in thorax
Nursing strategies to better enhance respiratory function
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)
Age Related changes that influence respiratory function
chest wall and musculoskeletal functions
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
Age Related changes affecting lung structure and function
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
Immunological changes influencing respiratory function
Alteration in T-Cells
Affects immune system
Contributes to increase risk for lung disease and infectious respiratory infections
Functional outcomes of age related changes
Less elastic chest wall and airways Decreased muscle strength Decreased ciliary action Drier, more fragile mucous membranes More energy needed for respiratory efficiency
Environmental and Lifestyle factors that influence respiratory function and wellness
Air pollution
Occupational exposure to asbestos, mold
Tobacco smoking and second hand smoke
Health Status Factors influencing respiratory function and wellness
Vagus nerve or neuro impairment
Renal failure
Anemia
Pain
Medications influencing respiratory function and wellness
Anticholinergics
Narcotics & sedatives
Other factors influencing respiratory function and wellness
Lack of vaccinations
Bedrest
Obesity
Chronic Illness
How can the nurse promote respiratory health ?
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.
Chronic obstructive pulmonary disease(COPD)
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
Discuss asthma
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.
Discuss Chronic Bronchitis
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.
Discuss Emphysema
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.
Discuss Lung cancer
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
Discuss Lung Abscess
May result from pneumonia, malignancy, tuberculosis and aspiration
Decreased pharyngeal reflexes put older adults at increased risk for aspiration
Respiratory conditions can affect ……….
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
What is hypoxia ?
Deficiency in the amount of oxygen reaching the tissues
Common manifestations of impaired respiratory function
Hypoxia
Altered breathing patterns
Obstructed or partially obstructed airway
What is Pulse oximetry ?
Measures the % of hemoglobin saturated with O2
its a measure of arterial oxyhemoglobin saturation (SaO2 or SpO2)
Normal measures are between 95-100%
What is PEFR?
Diagnostic test measuring the airflow through bronchi
Degree of restriction in asthmatics
High numbers are best
What are other diagnostic tests of respiratory function ?
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
Arterial Blood Gas Analysis
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.
Diagnostic Imaging Tests
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
Changes in character of sputum (amount, color, odor, thickness) - should this require prompt medical attention ?
Yes, it should.
Prompt medical attention is needed with signs of respiratory infection or pulmonary decompensation.
Complications R/T Obstructed or PartiallyObstructed Airway (Airway Patency)
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
Signs and Symptoms of Hypoxia
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)
Nursing Interventions to Promote Respiratory Function
in terms of Promoting Lung Expansion
Promote lung expansion Positioning Ambulation Frequent position changes Incentive spirometry
Nursing Interventions to Promote Respiratory Function
in terms of mobilizing secretions
Mobilize secretions Coughing & deep breathing Hydration Humidified O2 Suctioning Postural Drainage Chest PT
Other Nursing Interventions to Promote Respiratory Function
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
Maintaining Good Nutrition in Patients with Compromised Pulmonary Status
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.
Providing Supplemental Oxygen - what kind of delivery methods are there ?
What supply methods?
Nasal Cannula Mask Simple Venturi (“venti mask”) Nonrebreather Face tent
Supply Wall outlet Cylinder Liquid Concentrator
Does supplemental oxygen require a prescribers order ?
Yes, except in cases of emergency
Ordered by provider as:
Flow rate
Percentage
Titrate to maintain SpO2 level
OXygen Therapy - nasal cannula?
Lpm and FiO2?
Nasal Cannula (NC)
25%-45% FiO2
2-6 Lpm
Drying/Irritating
Simple Face Mask
40%-60% FiO2
6-8 Lpm
Comfort/Fit
Nonrebreather mask
100% FiO2
10-15 Lpm
Keep reservoir bag inflated
Venturi Mask
Precise concentrations
24%-50% FiO2
Color-coded jet adapters that indicate different O2 percentage
Safety Cautions for Oxygen Administration
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).
Ensuring Safe Oxygen Administration
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
Strategies to Promote Proper Breathing
Performing postural drainage
Productive coughing
Incentive spirometry
Performing Postural Drainage - what does it do ?
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
Promoting Productive Coughing
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
Incentive Spirometry
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.
Complementary Therapies for Respiratory Health
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
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
B. Frequent Change of Position
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. Raise the head of the bed to Semi Fowlers Position
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
Incentive Spirometer
A nasal cannula delivers ………..
25%-45% FiO2
2-6 Lpm
A simple face mask delivers …..
40%-60% FiO2
6-8 Lpm
A nonrebreather mask delivers ………..
100% FiO2
10-15 Lpm
A Venturi mask delivers ………
Precise concentrations
24%-50% FiO2
