Oxygenation Flashcards
1
Q
Right Lung
A
Three right lobar bronchi
2
Q
Left Lung
A
Two left lobar bronchi
3
Q
Signs of abnormal breathing:
A
Flaring of nostrils
Tachypnea (fast) or bradypnea (slow)
Noisy breathing: stridor, wheezing
Use of accessory muscles: neck, intercostals
Pursed lip breathing
Cheyne Stokes - progressively deeper, and sometimes faster, breathing followed by a gradual decrease that results in a temporary stop in breathing called an apnea
4
Q
Respiration
A
Exchange of O2 and CO2
5
Q
Respiration - three parts
A
Ventilation
Perfusion
Diffusion
6
Q
Ventilation
A
Process of Breathing - Process of moving gases into/out of lungs
7
Q
Perfusion
A
How well cardiovascular system delivers O2 and returns CO2
8
Q
Diffusion
A
Moving respiratory gases from one area to another via concentration gradients
9
Q
Ventilation - location
A
Apneustic center in pons
Voluntary & Involuntary
10
Q
Inspiration
A
Air flows into lungs
11
Q
Expiration
A
Air flows out of lungs
12
Q
altered ventilation
A
Anything that impairs one’s ability to move air in and out of lungs
Asthma attack (bronchospasms and airflow obstruction/constriction)
Head/neck or chest trauma
13
Q
Conditions Affecting Chest Wall Movement
A
Pregnancy Obesity Musculoskeletal Abnormalities Neuromuscular Diseases Myasthenia gravis, Guillain-Barre syndrome, poliomyelitis- hypoventilation
14
Q
Central Nervous System Alterations
A
Disease/damage to medulla oblongata – neural regulation of respiration
Trauma/injury to spinal cord
Phrenic nerve damage/paralysis
Spinal cord injury
15
Q
altered perfusion
A
Low cardiac output SV x HR = CO Confusion/restlessness or ataxia - Reduced flow to brain Vasoconstriction - Pale/dusky skin Central cyanosis - hypoxia
16
Q
Surfactant
A
lipoprotein “film” secreted from epithelial type II cells in alveolus, prevents alveolar collapse, protects from fluid build-up
17
Q
Gas exchange - diffusion
A
O ₂ from inspiration diffuse
from alveoli
CO₂ diffuse from
blood into alveoli.
18
Q
perfusion - oxygen transport
A
Oxygen is carried in the body (perfusion) via plasma and red blood cells
Internal respiration between the circulating blood and tissue cells must occur
19
Q
oxyhemoglobin
A
Most oxygen (97%) is carried by red blood cells in the form of oxyhemoglobin
20
Q
carboxyhemoglobin
A
Hemoglobin also carries carbon dioxide in form of carboxyhemoglobin
21
Q
altered diffusion
A
Inhalation of smoke/chemicals
Acute lung injury/ARDS
Emphysema – alveolar collapse, reduced alveolar surface area
22
Q
Alveoli
A
Air moves through alveoli (ventilation – V)
23
Q
capillaries
A
Blood passes through capillaries (perfusion- Q)
24
Q
V/Q
A
Air moves through alveoli (ventilation – V)
Blood passes through capillaries (perfusion- Q)
V/Q matching is essential for gas exchange
25
Conditions Affecting Chest Wall Movement
Trauma & Chronic Disease
26
Trauma
Instability of chest wall –lung underlying injury contracts on inspiration and bulges on expiration ->hypoxia - not enough oxygen makes it to the cells and tissues in the body.
Incision -> pain -> shallow breathing
27
Chronic Disease
Direct effect
| Secondary consequence
28
Hypoxemia
when your blood doesn't carry enough oxygen to your tissues to meet your body's needs
29
Hypoventilation
alveolar ventilation is inadequate to meet the oxygen dmnd of the body or eliminate enough CO2
->breathing at an abnormally slow rate, resulting in an increased amount of carbon dioxide in the blood.
ex atelectasis - collapse of the alveoli - prevents normal exchange of o2 and co2 - less ventilation
ex COPD - if given too much oxygen (used to low levels), will not breath
30
Hyperventilation
ventilation where the lungs remove CO2 faster than its produced by cellular metabolism. Excessive breathing creates a low level of carbon dioxide in your blood. This causes many of the symptoms of hyperventilation.
31
Cyanosis Central
Cyanosis is a bluish or purplish tinge to the skin and mucous membranes
around the core, lips, tongue, soft palate, conjunctiva of the eye (high blood flow)
32
Cyanosis peripheral
Cyanosis is a bluish or purplish tinge to the skin and mucous membranes
only the extremities or fingers, nail beds, earlobes - result of vasoconstriction and stagnant blood flow
33
hypoxia
Hypoxia is insufficient oxygen anywhere in the body. An early sign of hypoxia is restlessness, which is caused by the lack of
cerebral perfusion of oxygen
34
SpO2
arterial oxygen saturation - uses oxygen saturation monitor pulse oximeter
normal - greater or equal to 95%
35
PaO2
arterial oxygen tension
= amount of oxygen available (>60 adequate)
>80 PaO2 optimal
stimulus to breathe is a decreased arterial oxygen level
COPD - if given too much oxygen (used to low levels), will not breath
36
atelectasis
complete or partial collapse of the entire lung or area (lobe) of the lung. It occurs when the tiny air sacs (alveoli) within the lung become deflated or possibly filled with alveolar fluid. Atelectasis is one of the most common breathing (respiratory) complications after surgery.
37
Hypoventilation - signs & symptoms
mental status changes, dysrhythmias, cardiac arrest - can lead to convulsions, unconsciousness, death
38
Hyperventilation - causes
severe anxiety, infection - fever increases metabolic rate, drugs, acid base imbalance - chemical poisoning
39
Hyperventilation - signs & symptoms
rapid respiration, signing breaths, numbness and tingling hands/feet, light-headedness, loss of consciousness
40
hypoxia
inadequate tissue oxygenation at the cellular level
(low O2 in blood)
PaO2 <80
41
hypoxia - cause
deficiency in oxygen delivery or oxygen use at the cellular level
42
hypoxia - cause - hemoglobin capacity
decreased hemoglobin level and lowered oxygen carrying capacity of the blood
43
hypoxia - cause - altitude
diminished concentration of inspired oxygen - at high altitudes
44
hypoxia - cause - poisoning
inability of the tissues to extract oxygen from the blood - cyanide poisoning
45
hypoxia - cause - alveoli
decreased diffusion of oxygen from the alveoli to the blood as in pneumonia
46
hypoxia - cause - perfusion
poor tissue perfusion with oxygenated blood as with shock
47
hypoxia - cause - ventilation
impaired ventilation as with multiple rib fractures or chest trauma
48
hypoxia - signs and symptoms
```
apprehension, restlessness, inability to concentrate, decreased level of consciousness, dizziness, and behavioral changes
Rapid, shallow respirations and dyspnea
Flaring of nares
Substernal or intercostal retractions
unable to lie flat
fatigues and agitated
Cyanosis - late sign
```
49
hypoxia - vital signs
increased pulse rate
increased rate and depth of respiration
blood pressure is increased (shock)
as worsens, respiratory rate declines (muscle fatigue)
50
cyanosis
blue discoloration of skin and mucous membranes
| caused by presence of desaturated hemoglobin in capillaries - late sign of hypoxia
51
SaO2
SaO2 = amount of hemoglobin saturated with O2
So, PaO2 of 60 or more is usually considered adequate.
But, at less than 60 mm Hg the curve is very steep, and small changes in the PaO2 greatly reduce the SaO2.
52
dyspnea
can't catch your breath or get enough air in your lungs
Breathless. Tightness in your chest
shortness of breath - w/ exercise or excitment
associated w/ hypoxia
53
hypoxia - testing
No lab test to confirm
54
eupnea
normal respiration
55
Apnea
not breathing - there is no movement of the muscles of respiration and the volume of the lungs initially remains unchanged. in sleep apena
56
dyspnea - associated w/
hypoxia, pulmonary disease, cardiovascular d, neuro , and anemia, final months of pregnancy
environmental factors - cold, smoking
57
Kussmaul's
greater than 35/min, tachypea pattern, metabolic imbalance, diabetic slow or normal ketoacidosis, metabolic acidosis, renal failure
58
Bradypnea
less and 10/min - results from sleep, respiratory depression, drug overdoes, CNS lesion
59
Tachypnea
greater than 35/min - results from anxiety, pain, fever, shortness of breath, respiratory infection, leads to respiratory alkalosis, paresthesia, tetany, and confusion
60
Vesicular
Periphery of lung
Soft, breezy, low pitched
Inspiration > expiration
normal
61
Bronchovesicular
Between scapulae, over bronchioles at 1st, 2nd ICS
Medium pitched blowing sounds
Inspiration = expiration
62
Bronchial
Only over trachea
Loud, high pitched
expiration > inspiration
63
Crackles
Most common in bases, usually not cleared with coughing
| Heard mostly at end of inspiration
64
Wheeze
Heard over all lung fields
Caused by narrowed/obstructed airway
High-pitched continuous musical sounds (squeaky)
65
Rhonchi
Usually over trachea/bronchi
Caused by fluid/mucus in larger airways
Low-pitched rumbling course sounds sometimes cleared with coughing
66
Pleural friction rub
Heard over anterior lateral lung field
Caused by inflamed pleura
Rubbing, grating, does not clear with coughing
67
SOB
shortness of Breath
68
Airway Patency
Observe patient in various positions.
| Monitor sputum: color, consistency, amount, odor
69
Suctioning
patients are unable to clear respiratory secretions from the airways by coughing or other less invasion procedures
70
Oropharyngeal and Nasopharyngeal
| Suctioning
able to cough effectively but unable to clear secretions by expectorating
71
Orotracheal and Nasotracheal
a patient with pulmonary secretions is unable to manage secretion by coughing and doesn't have an artificial airway
catheter through mouth or nose into trachea
advance farther into trachea
72
Tracheal
through an artificial airway (ET)
73
Artificial Airways
Oral airway
Endotracheal and Tracheal Airway
high risk for infection
74
Suctioning - risks
```
Hypoxia (see causes to follow)
Tissue (mucosal) trauma
Infection
Vagal stimulation and bronchospasm
Cardiac dysrhythmias from hypoxia caused by suctioning
```
75
Fowler’s position
45 degree angle - most successful in lung expansion and reduce pressure from the abdomen on the diagrpham
76
Semi-Fowler's
is a position in which a patient, typically in a hospital or nursing home in positioned on their back with the head and trunk raised to between 15 to 45 degrees, although 30 degrees is the most frequently used bed angle
77
Incentive Spirometry (IS)
An incentive spirometer is a device used to help you keep your lungs healthy after surgery or when you have a lung illness, such as pneumonia. Using the incentive spirometer teaches you how to take slow deep breaths.
78
Chest Physiotherapy (CPT)
Chest physical therapy (CPT or Chest PT) is an airway clearance technique (ACT) to drain the lungs, and may include percussion (clapping), vibration, deep breathing, and huffing or coughing
he person gets in different positions to use gravity to drain mucus (postural drainage) fr
Chest percussion
Vibration
Postural Drainage
om the five lobes of the lungs.
79
Pulmonary Embolism (PE)
S/S: SOB, dry cough, hemoptysis, diaphoresis, sudden CP, hypotension, hypoxemia, loss of consciousness
Call MD immediately
Administer O2, anti-anxiety drugs as available/tolerated
80
Pneumothoration
collection of air in the pleural space
| loss of negative intrapleural pressure causes the lung to collapse
81
Secondary Pneumothorax
result of chest trauma
destruction of surface of the lung caused by emphysema
tearing of the pleura from invasive surgery
insertion of a subclavian iv line
invasive mechanical ventilation
82
Primary Pneumothorax
occurs unexpectedly in healthy individuals
| develop blister-like formations (blebs) on visceral pleura
83
Pneumothorax - symptoms
sharp and pleuritic pain
| dyspnea
84
hemothorax
accumlation of blood and fluid in the pleural cavity
| result of trauma
85
bore chest tube
used to train fluid, air, blood from area of excess
86
Nasal Cannula
Short term, 1-6L/min
87
Simple Face Mask
Short term, 6-12L/min
| Use caution in CO2 retainers
88
Partial or Non-rebreather
Face mask with reservoir bag (make sure at least partially inflated)
10-15L/min *must be humidified*
89
Venturi
Usually 4-12L/min
| Specific amt of O2 + humidity, good for low, constant O2
90
Face tent
Humidified O2, good for mouth breathers
91
Air Warming and Humidification
Air should be humidified if 6L/min or more.
Maintain proper temperature.
Ensure adequate hydration.
