oxygenation exam 2 Flashcards
what is poor oxygenation?
a decreased oxygen level in the blood
oxygen saturation can be used to assess
oxygen level
SpO2 is measured …
measure of how saturated hemoglobin are with oxygen
how is SpO2 measured?
pulse oximetry
often see orders to “keep O2 sats above ?
92%
signs & symptoms of poor oxygenation?
restlessness/confusion- lack of 02 to brain
decreased BP
cool extremities
pallor or cyanosis of extremities
slow capillary refill
ischemia
when oxygen delivery is inadequate to meet metabolic demands of the body - cell death
-starving for oxygen
hypoxia
-low oxygen in your tissues
when your blood doesn’t carry enough oxygen to the tissues to meet the bodys needs
oxygen saturation
used to asses O2 level
SpO2 - SaO2
measure of how saturated hemoglobin are
what is the first sign or symptom of poor oxygenation ?
restlessness that could lead to confusion
pollar
pale extremities
capillary refill
push on your fingernail bed and it will turn white and then it will pink back up
- less then 3 seconds !!!
when a person is getting good oxygen flow
skin and muscous membranes should be a good robust color
lung disease
the lungs have a large surface area that is constantly exposed to the external environment
lung disease is greatly influenced by?
environment
occupational
personal
social habits
trachea
windpipe
alveoli
air sacs
cilia
hair like projections that move particles around. they line out mucous membranes
pulmonary diseases are classified as
often classified as acute or chronic, obstructive or restrictive, infections or noninfectious and is caused by alteration in the lungs or heart
acute
short time
ex: bronchitis
chronic
long lasting
ex: asthma
obstructive disease
Ex: COPD
restrictive disease examples
pulmonary fibrosis
sarcoidosis
infectious disease
most common of the lung-pneumonia
pneumonia
fluid in the lungs
noninfectious examples
athmas, COPD
cough
acute or chronic
dyspnea
SOB, feeling inability to get a good breath
chest pain
not getting good blood flow to heart
hemoptysis
coughing up blood
altered breathing patterns
tachypnea
bradypnea
use of accessory muscles
tachypnea
fast RR
bradypnea
slow RR
cyanosis
bluish discoloration of skin and mucous membrane
clinical manifestations of respiratory alterations
What signs come with respiratory alterations?
cough
dyspnea
chest pain
abnormal sputum
hemoptysis
altered breathing patterns
cyanosis
fever
orthopnea
dyspnea (SOB) with laying down
-pts can breath better when propped up slightly
clubbing
often occurs when in heart and lung disease that reduce the amount of 02 in the blood
- distorted angle of nail bed
- poor o2, poor blood flow
assess: put two fingernails together and there should not be a space in between
hypoxemia
low level of oxygen in the blood
whats the sign and symptom of hypoxia in the brain?
restlessness
what is a sign and symptom of hypoxia in the heart
chest pain
what is a sign and symptom of hypoxia in our skin
pollar
signs and symptoms for the GI tract
nausea, gas, cramping
RAT BED
restlessness
anxiety
tachycardia/tachypnea
bradycarida
extreme restlessness
dyspnea
ventilation
process of gas exchange
breathing in and breathing out
hypoventilation
breathing too shallow or too slow to meet the bodys need for o2
one difference between bradypnea and hypoventilation
the actual gas exchange and the movement of the chest wall
hyperventilation
breathing that is too rapid or too deep. breathing exceeds the bodys metabolic demands
what would cause hypoventilation?
sleep, sedatives,
respiratory depressions
decreased respiratory depression, not breathing adequately
what could cause hyperventilation
anxiety, exercise, metabolic acidosis, pain
atelectasis
collapsed air sacs (alveoli)
prevention of atelectasis
early ambulation, turn cough, deep breathe, incentive spirometry
respiratory too shallow
building up of Co2
when a person hyperventilates (breathing too slow) they develop increase co2 in the body
hypercapnia
aspiration
passage of gastric contents (fluid or solid) into the lungs
when a person hyperventilates what happens to the Co2
they lose too much Co2
hypocapnia
aspiration can cause what?
aspiration pneumonia
prevention of aspiration
assess pts ability to swallow
keep head of bed elevated with tube feedings
thorough lung assessment
assessment of respiratory system
- RR
- Use of accessory muscles
- cyanosis
- oxygen saturation
adventitious breath sounds
-clubbing
-dyspnea with activity
diagnostic tests
-chest xray
- arterial blood gas
- sputum culture sensitivity
-ct scans
- magnetic resonance imaging (MRI)
- bronchoscopy
- thoracentesis
promotion of lung expansion
- position changes frequently - every 2 hrs
- keep upright
- increase daily activities
- ensure hydration
- coughing breathing
-deep breathing
Albuterol (proair) MDI
bronchodilator
- rescue inhaler for acute difficulty breathing
-beta 2 agonist (short-acting) SABAs
- stimulates beta 2 adrenergic receptors, relaxing airway smooth muscle
- 2 puffs every 4-6hyrs PRN
- may take 2 puffs 5-30mins before exercise
assessment of respiratory system
- RR
- Use of accessory muscles
- cyanosis
- oxygen saturation
- adventitious breath sounds
-clubbing
-dyspnea with activity
Symbicort inhaler
- Corticosteriod/Branchodilator
- beta 2 agonist (long acting) LABA
- two puffs bid
- treatment for asthma attacks and exercise induced bronchospasm and COPD
** make sure to rinse mouth after inhalation**
common reactions with Symbicort inhaler?
tachycardia, nervousness, palpitations, oral candidiasis
fine crackles (rales)
- higher pitched
- brief, discontinuous, popping sounds -usually fluid in the lungs
coarse crackles (rales)
-more fluid in the lungs
- lower pitched, longer duration compared to fine
- bubbling sound
wheezing
continuous, musical sounds, more common on inspiration, higher up in the lungs
rhonchi
a low pitched wheeze
can be heard over trachea
distant pause between inspiration and expiration
bronchial
hollow
respiratory assessment
vital signs, oxygen saturation, level of consciousness, any s/s of hypoxia, skin
assessing pts on oxygen therapy
equipment
correct oxygen delivery device
flow rate is correct
respiratory assessment
FI02 is percent of oxygen a person is
inhaling
breathing at any given time
room air FI02 is
21%
with supplemental oxygen, FI02 can reach
100%
Nasal Cannula
oxygen delivery - up to 6L/min
FI02 24-44%
advantages to nasal cannula
safe and simple, easily tolerated
increased mobility
disadvantages to nasal cannula
dries membranes
skin breakdown
non-rebreather mask
delivers high concentration of oxygen
treats hypoxia
decreases workload of breathing
10-15L/min
face mask with reservoir bag
has one way valves that open during expiration and close during inhalation to prevent decrease in FI02 or build up of CO2
advantages of a venturi mask
controls exact concentration of oxygen
delivers FI02 of 24-60% flow rates from 4-12L//min
disadvantages of venturi mask
hot and confining
interferes with eating and talking
-commonly used in pts with COPD
venturi mask
needs an exact o2
factors that alter accuracy of pulse ox- Physical
motion/incorrect placement
BP monitoring device
bright lights,polish,acrylics
factors that alter accuracy of pulse ox - physiological
poor arterial flow or edema
cold hands; poor capillary filling
anemia
Incentive spirometry (IS)
helps prevent postop pulmonary complications (atelectasis)
provides voluntary deep breathing
gives visual feedback
-watch volume, sustained breath
-sucking in
- forces air sacs open
- take 10 breaths every 2 hours
oxygen toxicity
can develop when a person breaths 100% oxygen for >12 hrs
oxygen toxicity on CNS and pulmonary systems
pallor, sweating, nausea, vomiting
seizures, vertigo, muscle + twitching
hallucinations, visual changes, anxiety
chest pain, dyspnea
