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Oxygenation (Exam 2) Flashcards

1
Q

Where does the diffusion of gas take place?

A

alveoli

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2
Q

Describe the mechanical process of the pulmonary system

A

VENTILATION!

movement of air into and out of lungs

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3
Q

Describe the chemical process of the pulmonary system?

A

RESPIRATION!

exchange of O2 and CO2
transport in body
exchange of gases between alveoli and capillary membranes

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4
Q

Describe inspiration

A

VENTILATION, ACTIVE PROCESS

diaphragm and intercostal muscles contract

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5
Q

Describe exhalation

A

VENTILATION, PASSIVE PROCESS

Lung pressure increases, forcing air out of

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6
Q

Describe external respiration

A

diffusion of O2 from alveoli into pulmonary circulation across alveoli-capillary membrane

release of CO2 from circulation into alveoli

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7
Q

Describe internal respiration

A

capillary-tissue gas exchange for tissue oxygenation

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8
Q

CO2 is a byproduct of…

A

cellular metabolism

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9
Q

What are 6 factors that affect ventilation?

A

respiratory rate and depth
hyperventilation
hypoventilation
lung compliance
lung elasticity
airway resistance

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10
Q

What is hyperventilation?

A

rapid and deep breathing resulting in excess loss of CO2 (hypocapnia)

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11
Q

What is hypoventilation?

A

the rate and depth of respirations are decreased and CO2 is retained

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12
Q

What is lung compliance?

A

ease of lung inflation

scar tissue, fluid, lower surfactant

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13
Q

What is lung elasticity?

A

tendency for elastic fibers to return to normal

LOSS OF ABILITY TO RECOIL

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14
Q

What is airway resistance?

A

resistance to airflow within the airways

NARROWING AIRWAYS

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15
Q

Developmental factors affecting older adults for oxygenation

A

calcification of heart valves
osteoporosis
changes in size and shape of thorax
declining immune systems
GERD

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16
Q

What are factors affecting pulmonary function?

A

LIFESTYLE (occupation, exercise, nutrition, obesity (sleep apnea), substance abuse, smoking and drugs, pregnancy)
MEDS
COMORBID CONDITIONS (CVD, respiratory conditions)
TRAUMA
ENVIRONMENT (stress, allergies, air quality, high altitudes, pollutants and exposure)

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17
Q

What are some Upper Respiratory Infections that cause alterations in gas exchange?

A

colds and the flu

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18
Q

What are some Lower Respiratory Infections that cause alterations in gas exchange?

A

bronchitis, pneumonia, respiratory syncytial virus (RSV), TB

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19
Q

What does asking about past history also include?

A

use of oxygen and ventilatory assist devices
demonstrating inhaler technique
taking as prescribed

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20
Q

What are some physical examinations for assessing oxygenation status?

A

breathing pattern
respiratory effort
pulse oximetry
IPPA

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21
Q

What are some diagnostic testing for assessing oxygenation status?

A

ABGs (pH, PO2, PCO2)
peak flow monitoring

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22
Q

What are some things to look out for during a physical assessment?

A

mental status/LOC
skin
nose (NASAL FLARING)
lips/mouth (CYANOSIS/PURSED LIP BREATHING)
nail beds (CLUBBING, CYANOSIS)
neck (TRACHEAL DEVIATION, VEIN DISTENTION)
chest (ASYMMETRY, STERNAL RETRACTIONS)
lungs
heart (MURMURS, DISPLACED PMI)

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23
Q

What is a wheeze?

A

high pitched continuous musical sounds, usually heard on expiration

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24
Q

What is rhonchi?

A

low-pitched continuous sound caused by secretions in large airways

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25
What are crackles?
discontinuous sounds usually heard on inspiration, and may be high pitched popping sounds or low pitched bubbling sounds
26
What is stridor?
a piercing, high pitched sound heard primarily during inspiration
27
What is stertor?
labored breathing that produces a snoring sound
28
What are some common tests to diagnose lung disease?
chest radiography (CXR) sputum cultures complete blood count skin tests pulmonary function tests ABGs
29
What is oximetry?
measures O2 saturation of hemoglobin, stated as a percentage and is less accurate at lower volumes LIGHT IS REFLECTED OFF HEMOGLOBIN MOLECULES, CALCULATES AMOUNT OF LIGHT ABSORBED
30
What is capnography?
measures CO2, often used with oximetry and used during anesthesia and in ICUs (+ABGs) PROVIDES INFO ABOUT VENTILATION 35-45
31
What is spirometry?
measures air in and out of lungs; lung volumes/capacity measurements varies with body size, age, and exercise
32
Arterial puncture correlates with…
ABGs
33
What is a peak flow meter?
amount of air forcibly exhaled; ASTHMA PTS
34
What are some nursing interventions to promote oxygenation?
positioning for maximum lung excursion incentive spirometer mobilizing secretions pursed lip breathing emotional support administer meds
35
What are 4 ways to mobilize secretions?
turn, coughing, and deep breathing (TCDB) hydration! encourage fluids humidify O2 delivery postural drainage and chest physiotherapy
36
Supplemental O2
REQUIRES ORDER caution with CO2 retention (COPD, hypoxia) DRYING, CAN HUMIDIFY
37
Nasal Cannula: Oxygen Delivered (FIO2)
MOST COMMON!! 1-6 L/min 1L=24%, 2L=28%, 3L=32%…
38
Nasal Cannula: Patient
patient can talk and eat comfortable dryness
39
Simple Mask (no reservoir bag): FIO2
5-10 L/min 40-60%
40
Simple Mask: Patient
need to remove to eat not tolerated as well WATCH SKIN BREAKDOWN
41
Partial Rebreather: FIO2
6-15 L/min 50-90%
42
Partial Rebreather: Patient
Allows higher O2 PT CAN BE VERY ANXIOUS
43
Non-Rebreather: FIO2
6-15 L/min 70-100%
44
Non-Rebreather: Patient
only mask able to deliver 100% O2 (most effective) MAKE SURE MASK FITS SNUGLY KEEP RESERVOIR BAG AT LEAST 1/3-1/2 FULL
45
Venturi Mask (Adapters to control O2): FIO2
24-50%
46
Venturi Mask: Patient
useful with chronic lung disease exhalation ports to keep CO2 buildup to a minimum
47
Face Mask: FIO2
SECOND MOST COMMON! 8-12 L/min 30-35%
48
Face Tent: Patient
more humidification less reliable than mask
49
Tracheostomy Collar/T-Piece: FIO2
4-10 L/min 24-100%
50
Tracheostomy/T-Piece: Patient
specialized equipment for advanced airways humidifies
51
Artificial Airways: Oropharyngeal
ONLY WHEN UNCONSCIOUS opens airway, keeps tongue away suctioning upper airway
52
Artificial Airways: Nasopharyngeal
CONSCIOUS PTS useful to aid in clearing secretions and suctioning upper airway
53
Artificial Airways: Endotracheal tubes
advanced airways usually placed by anesthesiology SHORT TERM MECHANICAL VENTILATION suctioning lower airway
54
Artificial Airways: Tracheostomy tube
LONG TERM MECHANICAL VENTILATION suctioning lower airway
55
For all artificial airways tubes…
NEED TO MAINTAIN AIRWAY PATENCY will require suctioning for clear secretions and monitoring
56
Chest Tubes
INSERTED IN PLEURAL SPACE PURPOSE IS TO EVACUATE AIR/FLUID (pneumothorax/hemothorax) 3 chamber system (drainage, water seal, suction)
57
When using chest tubes, assess for…
Vitals SpO2 Pulmonary Color Consistency Amount Pain
58
How to use an inventive spirometer?
encourage patient to take deep breaths SLOW BREATH IN THEN BALL GOES UP TO DETERMINE PROGRESSION OF IMPROVEMENT can delegate to LPN/CNA
59
What is postural drainage?
the use of various positions to allow secretions to drain by gravity RESPIRATORY THERAPIST
60
What is chest physiotherapy?
percussion and vibration after 10-15 minutes of postural drainage RESPIRATORY THERAPIST
61
What is pursed lip breathing?
slows expiration, good for COPD breathe in through nose and exhale through pursed lips; teach via straw
62
Yankauer suctioning
removing secretions and maintaining airway patency via oral cavity
63
What is a nebulizer?
aerosolized medication to open airways usually takes 5 min. breathing in and out can be in mouthpiece or mask

PCC (14 decks)

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