Oxygenation (Exam 1) (Sub with JD's FCs) Flashcards
Breathing is what kind of process?
Passive. It is regulated by O2 CO2 and pH of the blood.
-When CO2 increases the body knows to increase rate and depth of breaking to help remove CO2
Lung Volumes depend on
Age, Gender, Height
Tidal Volume
-Amount of air exhaled following normal inspiration
-Tidal volume can vary based on health status, activity, pregnancy, exercise, obesity, and etc
Alveoli Function
Promote gas exchange
Respiration assessment
-Is measuring ventilations. Normal 12-20.
-Watch the depth and rhythm of breathing
Who’s respiration is higher?
Kids and Males. They are abdominal breathers where as females are thoracic breathers
Crackles
Fine to coarse bubbly sounds associated with air passing through fluid or collapsed small airways
Wheezes
High pitched whistling, narrow obstructed airways. Musical
Asthma or allergic reaction
Rhonchi
-Loud low pitch rumbling, rattling, can resolve with coughing
Stridor
Chocking and in children
Pleural friction rub
Inflamed pleural friction rub
Oxygen Saturation Assess
Diffusion and perfusion
Work of Breathing
-Determine by rate and depth. Evaluate accessory muscle use.
-Effort to expand and contract lungs
-COPD (Effort to breath)
Compliance
Ability of lungs to distend or expand in response to pressure changes
Decreased compliance, increased airway resistance, and/or increased accessory muscle use ____________ work of breathing
increases
Factors Affecting Oxygenations: 4 main factors
- Physiological
- Developmental
- Lifestyle
- Environmental
Factors Affecting Oxygenation: Chest wall movement
-Pregnancy, obesity, musculoskeletal diseases, trauma, neuromuscular disease, CNS alterations
-Damage to the Medulla Oblongata
Goal of Ventilations
Normal Arterial carbon dioxide tension and normal arterial oxygenations tension
Labs:
PaO2 = 80-100
PaCO2 = 34-45
EtCO2 = 35-45
O2 sat (SpO2) = > 95%
Hypoventilation Causes and S/S
Medications and Atelectasis
Mental status changes and heart dysrthythmias
Hypoventilation
Inadequate alveolar ventilation to meet demand
Not enough O2 or too much CO2
Hyperventilation
-Removing CO2 faster than it is produced by cellular metabolism
-Anxiety attacks (severe), infection, drugs, pH imbalance, aspirin poisoning, amphetamine use
Numbness/tingling, hands feet, light-headedness, loc
INCREASE WOB
Hypoxia
In adequate tissue oxygenation at the cellular level
Can lead to cardiac problems because the heart needs O2 to function
Hypoxia Causes
-Decreased hemoglobin levels/low O2 carrying capability (Decrease Hemo)
-Diminished O2 concentration of inspired O2 (Altitude)
-Inability of tissues to get O2 from the blood (Cyanide poison)
-Decreased diffusion of O2 from alveoli to blood-infections/pneumonia
-Poor perfusion with oxygenated blood (shock)
-Impaired ventilations from trauma (rib fracture)
Which Cyanosis do we worry about hypoxia
Central Cyanosis.
Chronic Hypoxia
-Chronic Lung conditions (COPD)
-Cyanotic nail beds
-Clubbed nail
-Sluggish Cap refill
-Barrel chest
Important when it comes to coughing
Control the patients pain
Sputum collection
-Collect early morning
-Collect 1-2 hours after patient eats
-Sterile procedure
-Teach patient to cough into the container and get as much expectorate sputum as possible
-May require suctioning if they cant cough anything up
Negative sputum collections means
It was normal and they did not have anything
Sputum for acid-fast bacillus (AFB)
-Screens for presence of AFB for detection of tuberculosis by early morning specimens on 3 consecutive days
Sputum for cytology
-Obtained to identify lung cancer
-Differentiate type of cancer cells
Pulmonary Function Test
-Basic ventilation studies. How well you are breathing
-Determines ability of the lungs to efficiently exchange O2 and CO2.
-Used to differentiate pulmonary obstructive from restrictive disease
Peak Expiratory Flow Rate (PEFR)
-Airway resistance. Asthma and progression of asthma
Bronchoscopy
Checking for normal airways without massess, pus, or foreign bodies
Lung scan
-Nuclear scanning test used to identify abnormal masses by size and location. Used to find blood clots preventing normal perfusion or ventilation
Thick secretions : Nursing Diagnoses
-Ineffective airway clearance
Weak cough : Nursing Diagnosis
Risk for Aspiration
Atelectasis and Chronic lung disease and Infections: Nursing diagnoses
Impaired Gas Exchange
Head position airway maintenance
head title and chin lift
Jaw Thrust (Spinal Cord injury)
Long Term Preventative Measures
-Vaccinations
-Healthy Lifestyle
-Environmental and Occupational exposures
CPR order
Compression
Airway
Breathing
C_A_B
Managing Pulmonary Secretions
-Mobilize
-Hydrate
-Humidification
-Medicaitons
Chest Physiotherapy Contraindications
-pregnant
-Rib/chest
-Increased intracranial pressure
-Recent abdominal surgery
-Bleeding disorders
-Osteropororsis
When is suctioning indicated
-When patients cannot clear secretions on their own through coughing or CPT
-Orotracheal and Nasotracheal NT
Which type of suctioning is most common
-Nasotracheal (NT)
Incentive Spirometer
-Promotes lung expansion through deep breathing
Nasal Cannule
FiO2: 1-6L/min: 24-44%
Use humidification if greater than 4L of flow or more than 24 hours
Simple face mask
FiO2: 6-12 L/min: 35-50%
Short Transportation
Can worsen CO2
Non-Rebreather Mask
Highest non evasive O2
Critical patients
Use before intubation
Pharyngeal airways
Through the mouth or nose and for people still breathing on their own. They may have a decrease in breathing which calls for it
loss of muscle or need suctioning
Tracheal Airways
Unable to breathing effectively on their own
Endotracheal Tube
Ventilator. Tube goes all the way down
Percutaneous
The normal trach
Accidental Decannulation
-Keep orburator at bedside
-Insert orburator into outer cannula
-Extend neck and open tissue. Insert cannula
-Remover obturator
-Check breath sounds
-Secure trach
Signs and symptoms indicating need for suctioning
- Increase restlessness
- Increase WOB
- Noisy congestion when encouraged to cough
- Noisy breath sounds upon ausculation
What is at bedside at all times
Spare inner cannula, spare trach, ambu bag, and obturator
Hyper-oxygentation
With 100% O2 set at 10/15 L/min with 100% humidity for at least 30 seconds. Deep breathe 3/4 times to facilitate hyper-oxygenation
Only suction the patient on the way out
Sucitoning
Allow 1 min between suctioning passes. Limit suctioning pass to no more than 2-3x in one setting.
Inner cannula goes into what solution
1/2 NS
1/2 peroxide
Clean faceplate with
Only NS
Fenestrated vs Non-fenestrated trach
Non-fenestrated patient are very ill and need all the air forced into lungs
Fenestrated is patient we are trying to wean off incubator
