Oxygenation

Question 1

What does pulmonary ventilation consist of ?

Answer 1

Inspiration - active phase

Expiration - passive phase

Question 2

What does respiration consist of ?

Answer 2

Gas Exchange

Question 3

During inspiration ………….

Answer 3

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

Question 4

During expiration …………..

Answer 4

the diaphragm contracts and expels air.

Question 5

During gas exchange

Answer 5

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

Question 6

Critical factors for ventilation

Answer 6

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

Question 7

Critical factors for ventilation

Answer 7

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

Question 8

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

Answer 8

fourth

Question 9

Respiratory problems develop _____ ; difficult to _____

Answer 9

Easily; manage

Question 10

Age Related factors that influence respiratory function

Upper respiratory functions

Answer 10

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

Question 11

Age related factors that influence decreased gas exchange

Answer 11

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

Question 12

Nursing strategies to better enhance respiratory function

Answer 12

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)

Question 13

Age Related changes that influence respiratory function

chest wall and musculoskeletal functions

Answer 13

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

Question 14

Age Related changes affecting lung structure and function

Answer 14

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

Question 15

Immunological changes influencing respiratory function

Answer 15

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

Question 16

Functional outcomes of age related changes

Answer 16

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

Question 17

Environmental and Lifestyle factors that influence respiratory function and wellness

Answer 17

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

Question 18

Health Status Factors influencing respiratory function and wellness

Answer 18

Vagus nerve or neuro impairment
Renal failure
Anemia
Pain

Question 19

Medications influencing respiratory function and wellness

Answer 19

Anticholinergics

Narcotics & sedatives

Question 20

Other factors influencing respiratory function and wellness

Answer 20

Lack of vaccinations
Bedrest
Obesity
Chronic Illness

Question 21

How can the nurse promote respiratory health ?

Answer 21

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.

Question 22

Chronic obstructive pulmonary disease(COPD)

Answer 22

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

Question 23

Discuss asthma

Answer 23

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.

Question 24

Discuss Chronic Bronchitis

Answer 24

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.

Question 25

Discuss Emphysema

Answer 25

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.

Question 26

Discuss Lung cancer

Answer 26

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

Question 27

Discuss Lung Abscess

Answer 27

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

Question 28

Respiratory conditions can affect ..........

Answer 28

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

Question 29

What is hypoxia ?

Answer 29

Deficiency in the amount of oxygen reaching the tissues

Question 30

Common manifestations of impaired respiratory function

Answer 30

Hypoxia Altered breathing patterns Obstructed or partially obstructed airway

Question 31

What is Pulse oximetry ?

Answer 31

Measures the % of hemoglobin saturated with O2 its a measure of arterial oxyhemoglobin saturation (SaO2 or SpO2) Normal measures are between 95-100%

Question 32

What is PEFR?

Answer 32

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

Question 33

What are other diagnostic tests of respiratory function ?

Answer 33

``` 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 ```

Question 34

Arterial Blood Gas Analysis

Answer 34

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.

Question 35

Diagnostic Imaging Tests

Answer 35

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 ```

Question 36

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

Answer 36

Yes, it should. Prompt medical attention is needed with signs of respiratory infection or pulmonary decompensation.

Question 37

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

Answer 37

``` 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 ```

Question 38

Signs and Symptoms of Hypoxia

Answer 38

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)

Question 39

Nursing Interventions to Promote Respiratory Function | in terms of Promoting Lung Expansion

Answer 39

``` Promote lung expansion Positioning Ambulation Frequent position changes Incentive spirometry ```

Question 40

Nursing Interventions to Promote Respiratory Function | in terms of mobilizing secretions

Answer 40

``` Mobilize secretions Coughing & deep breathing Hydration Humidified O2 Suctioning Postural Drainage Chest PT ```

Question 41

Other Nursing Interventions to Promote Respiratory Function

Answer 41

``` 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 ```

Question 42

Maintaining Good Nutrition in Patients with Compromised Pulmonary Status

Answer 42

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.

Question 43

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

Answer 43

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

Question 44

Does supplemental oxygen require a prescribers order ?

Answer 44

Yes, except in cases of emergency Ordered by provider as: Flow rate Percentage Titrate to maintain SpO2 level

Question 45

OXygen Therapy - nasal cannula? Lpm and FiO2?

Answer 45

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

Question 46

Simple Face Mask

Answer 46

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

Question 47

Nonrebreather mask

Answer 47

100% FiO2 10-15 Lpm Keep reservoir bag inflated

Question 48

Venturi Mask

Answer 48

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

Question 49

Safety Cautions for Oxygen Administration

Answer 49

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).

Question 50

Ensuring Safe Oxygen Administration

Answer 50

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

Question 51

Strategies to Promote Proper Breathing

Answer 51

Performing postural drainage Productive coughing Incentive spirometry

Question 52

Performing Postural Drainage - what does it do ?

Answer 52

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

Question 53

Promoting Productive Coughing

Answer 53

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

Question 54

Incentive Spirometry

Answer 54

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.

Question 55

Complementary Therapies for Respiratory Health

Answer 55

``` 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 ```

Question 56

``` 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 ```

Answer 56

B. Frequent Change of Position

Question 57

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

Answer 57

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

Question 58

``` 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 ```

Answer 58

Incentive Spirometer

Question 59

A nasal cannula delivers ...........

Answer 59

25%-45% FiO2 | 2-6 Lpm

Question 60

A simple face mask delivers .....

Answer 60

40%-60% FiO2 | 6-8 Lpm

Question 61

A nonrebreather mask delivers ...........

Answer 61

100% FiO2 | 10-15 Lpm

Question 62

A Venturi mask delivers .........

Answer 62

Precise concentrations | 24%-50% FiO2