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Nursing Process > Oxygenation > Flashcards

Oxygenation Flashcards

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1
Q

Right Lung

A

Three right lobar bronchi

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2
Q

Left Lung

A

Two left lobar bronchi

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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

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4
Q

Respiration

A

Exchange of O2 and CO2

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5
Q

Respiration - three parts

A

Ventilation
Perfusion
Diffusion

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6
Q

Ventilation

A

Process of Breathing - Process of moving gases into/out of lungs

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7
Q

Perfusion

A

How well cardiovascular system delivers O2 and returns CO2

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8
Q

Diffusion

A

Moving respiratory gases from one area to another via concentration gradients

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9
Q

Ventilation - location

A

Apneustic center in pons

Voluntary & Involuntary

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10
Q

Inspiration

A

Air flows into lungs

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11
Q

Expiration

A

Air flows out of lungs

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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

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13
Q

Conditions Affecting Chest Wall Movement

A 
Pregnancy
Obesity
Musculoskeletal Abnormalities
Neuromuscular Diseases
Myasthenia gravis, Guillain-Barre syndrome, poliomyelitis- hypoventilation
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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

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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
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16
Q

Surfactant

A

lipoprotein “film” secreted from epithelial type II cells in alveolus, prevents alveolar collapse, protects from fluid build-up

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17
Q

Gas exchange - diffusion

A

O ₂ from inspiration diffuse
from alveoli
CO₂ diffuse from
blood into alveoli.

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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

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19
Q

oxyhemoglobin

A

Most oxygen (97%) is carried by red blood cells in the form of oxyhemoglobin

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20
Q

carboxyhemoglobin

A

Hemoglobin also carries carbon dioxide in form of carboxyhemoglobin

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21
Q

altered diffusion

A

Inhalation of smoke/chemicals
Acute lung injury/ARDS
Emphysema – alveolar collapse, reduced alveolar surface area

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22
Q

Alveoli

A

Air moves through alveoli (ventilation – V)

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23
Q

capillaries

A

Blood passes through capillaries (perfusion- Q)

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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

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25
Q

Conditions Affecting Chest Wall Movement

A

Trauma & Chronic Disease

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26
Q

Trauma

A

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

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27
Q

Chronic Disease

A

Direct effect

Secondary consequence

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28
Q

Hypoxemia

A

when your blood doesn’t carry enough oxygen to your tissues to meet your body’s needs

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29
Q

Hypoventilation

A

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

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30
Q

Hyperventilation

A

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.

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31
Q

Cyanosis Central

A

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)

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32
Q

Cyanosis peripheral

A

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

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33
Q

hypoxia

A

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

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34
Q

SpO2

A

arterial oxygen saturation - uses oxygen saturation monitor pulse oximeter
normal - greater or equal to 95%

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35
Q

PaO2

A

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

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36
Q

atelectasis

A

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.

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37
Q

Hypoventilation - signs & symptoms

A

mental status changes, dysrhythmias, cardiac arrest - can lead to convulsions, unconsciousness, death

38
Q

Hyperventilation - causes

A

severe anxiety, infection - fever increases metabolic rate, drugs, acid base imbalance - chemical poisoning

39
Q

Hyperventilation - signs & symptoms

A

rapid respiration, signing breaths, numbness and tingling hands/feet, light-headedness, loss of consciousness

40
Q

hypoxia

A

inadequate tissue oxygenation at the cellular level
(low O2 in blood)
PaO2 <80

41
Q

hypoxia - cause

A

deficiency in oxygen delivery or oxygen use at the cellular level

42
Q

hypoxia - cause - hemoglobin capacity

A

decreased hemoglobin level and lowered oxygen carrying capacity of the blood

43
Q

hypoxia - cause - altitude

A

diminished concentration of inspired oxygen - at high altitudes

44
Q

hypoxia - cause - poisoning

A

inability of the tissues to extract oxygen from the blood - cyanide poisoning

45
Q

hypoxia - cause - alveoli

A

decreased diffusion of oxygen from the alveoli to the blood as in pneumonia

46
Q

hypoxia - cause - perfusion

A

poor tissue perfusion with oxygenated blood as with shock

47
Q

hypoxia - cause - ventilation

A

impaired ventilation as with multiple rib fractures or chest trauma

48
Q

hypoxia - signs and symptoms

A 
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
Q

hypoxia - vital signs

A

increased pulse rate
increased rate and depth of respiration
blood pressure is increased (shock)
as worsens, respiratory rate declines (muscle fatigue)

50
Q

cyanosis

A

blue discoloration of skin and mucous membranes

caused by presence of desaturated hemoglobin in capillaries - late sign of hypoxia

51
Q

SaO2

A

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
Q

dyspnea

A

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
Q

hypoxia - testing

A

No lab test to confirm

54
Q

eupnea

A

normal respiration

55
Q

Apnea

A

not breathing - there is no movement of the muscles of respiration and the volume of the lungs initially remains unchanged. in sleep apena

56
Q

dyspnea - associated w/

A

hypoxia, pulmonary disease, cardiovascular d, neuro , and anemia, final months of pregnancy
environmental factors - cold, smoking

57
Q

Kussmaul’s

A

greater than 35/min, tachypea pattern, metabolic imbalance, diabetic slow or normal ketoacidosis, metabolic acidosis, renal failure

58
Q

Bradypnea

A

less and 10/min - results from sleep, respiratory depression, drug overdoes, CNS lesion

59
Q

Tachypnea

A

greater than 35/min - results from anxiety, pain, fever, shortness of breath, respiratory infection, leads to respiratory alkalosis, paresthesia, tetany, and confusion

60
Q

Vesicular

A

Periphery of lung
Soft, breezy, low pitched
Inspiration > expiration
normal

61
Q

Bronchovesicular

A

Between scapulae, over bronchioles at 1st, 2nd ICS
Medium pitched blowing sounds
Inspiration = expiration

62
Q

Bronchial

A

Only over trachea
Loud, high pitched
expiration > inspiration

63
Q

Crackles

A

Most common in bases, usually not cleared with coughing

Heard mostly at end of inspiration

64
Q

Wheeze

A

Heard over all lung fields
Caused by narrowed/obstructed airway
High-pitched continuous musical sounds (squeaky)

65
Q

Rhonchi

A

Usually over trachea/bronchi
Caused by fluid/mucus in larger airways
Low-pitched rumbling course sounds sometimes cleared with coughing

66
Q

Pleural friction rub

A

Heard over anterior lateral lung field
Caused by inflamed pleura
Rubbing, grating, does not clear with coughing

67
Q

SOB

A

shortness of Breath

68
Q

Airway Patency

A

Observe patient in various positions.

Monitor sputum: color, consistency, amount, odor

69
Q

Suctioning

A

patients are unable to clear respiratory secretions from the airways by coughing or other less invasion procedures

70
Q

Oropharyngeal and Nasopharyngeal

Suctioning

A

able to cough effectively but unable to clear secretions by expectorating

71
Q

Orotracheal and Nasotracheal

A

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
Q

Tracheal

A

through an artificial airway (ET)

73
Q

Artificial Airways

A

Oral airway
Endotracheal and Tracheal Airway
high risk for infection

74
Q

Suctioning - risks

A 
Hypoxia (see causes to follow)
Tissue (mucosal) trauma
Infection
Vagal stimulation and bronchospasm
Cardiac dysrhythmias from hypoxia caused by suctioning
75
Q

Fowler’s position

A

45 degree angle - most successful in lung expansion and reduce pressure from the abdomen on the diagrpham

76
Q

Semi-Fowler’s

A

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
Q

Incentive Spirometry (IS)

A

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
Q

Chest Physiotherapy (CPT)

A

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
Q

Pulmonary Embolism (PE)

A

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
Q

Pneumothoration

A

collection of air in the pleural space

loss of negative intrapleural pressure causes the lung to collapse

81
Q

Secondary Pneumothorax

A

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
Q

Primary Pneumothorax

A

occurs unexpectedly in healthy individuals

develop blister-like formations (blebs) on visceral pleura

83
Q

Pneumothorax - symptoms

A

sharp and pleuritic pain

dyspnea

84
Q

hemothorax

A

accumlation of blood and fluid in the pleural cavity

result of trauma

85
Q

bore chest tube

A

used to train fluid, air, blood from area of excess

86
Q

Nasal Cannula

A

Short term, 1-6L/min

87
Q

Simple Face Mask

A

Short term, 6-12L/min

Use caution in CO2 retainers

88
Q

Partial or Non-rebreather

A

Face mask with reservoir bag (make sure at least partially inflated)
10-15L/min must be humidified

89
Q

Venturi

A

Usually 4-12L/min

Specific amt of O2 + humidity, good for low, constant O2

90
Q

Face tent

A

Humidified O2, good for mouth breathers

91
Q

Air Warming and Humidification

A

Air should be humidified if 6L/min or more.
Maintain proper temperature.
Ensure adequate hydration.

Nursing Process (3 decks)

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