Oxygenation (Exam 2) Flashcards
Where does the diffusion of gas take place?
alveoli
Describe the mechanical process of the pulmonary system
VENTILATION!
movement of air into and out of lungs
Describe the chemical process of the pulmonary system?
RESPIRATION!
exchange of O2 and CO2
transport in body
exchange of gases between alveoli and capillary membranes
Describe inspiration
VENTILATION, ACTIVE PROCESS
diaphragm and intercostal muscles contract
Describe exhalation
VENTILATION, PASSIVE PROCESS
Lung pressure increases, forcing air out of
Describe external respiration
diffusion of O2 from alveoli into pulmonary circulation across alveoli-capillary membrane
release of CO2 from circulation into alveoli
Describe internal respiration
capillary-tissue gas exchange for tissue oxygenation
CO2 is a byproduct of…
cellular metabolism
What are 6 factors that affect ventilation?
respiratory rate and depth
hyperventilation
hypoventilation
lung compliance
lung elasticity
airway resistance
What is hyperventilation?
rapid and deep breathing resulting in excess loss of CO2 (hypocapnia)
What is hypoventilation?
the rate and depth of respirations are decreased and CO2 is retained
What is lung compliance?
ease of lung inflation
scar tissue, fluid, lower surfactant
What is lung elasticity?
tendency for elastic fibers to return to normal
LOSS OF ABILITY TO RECOIL
What is airway resistance?
resistance to airflow within the airways
NARROWING AIRWAYS
Developmental factors affecting older adults for oxygenation
calcification of heart valves
osteoporosis
changes in size and shape of thorax
declining immune systems
GERD
What are factors affecting pulmonary function?
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)
What are some Upper Respiratory Infections that cause alterations in gas exchange?
colds and the flu
What are some Lower Respiratory Infections that cause alterations in gas exchange?
bronchitis, pneumonia, respiratory syncytial virus (RSV), TB
What does asking about past history also include?
use of oxygen and ventilatory assist devices
demonstrating inhaler technique
taking as prescribed
What are some physical examinations for assessing oxygenation status?
breathing pattern
respiratory effort
pulse oximetry
IPPA
What are some diagnostic testing for assessing oxygenation status?
ABGs (pH, PO2, PCO2)
peak flow monitoring
What are some things to look out for during a physical assessment?
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)
What is a wheeze?
high pitched continuous musical sounds, usually heard on expiration
What is rhonchi?
low-pitched continuous sound caused by secretions in large airways
What are crackles?
discontinuous sounds usually heard on inspiration, and may be high pitched popping sounds or low pitched bubbling sounds
What is stridor?
a piercing, high pitched sound heard primarily during inspiration
What is stertor?
labored breathing that produces a snoring sound
What are some common tests to diagnose lung disease?
chest radiography (CXR)
sputum cultures
complete blood count
skin tests
pulmonary function tests
ABGs
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
What is capnography?
measures CO2, often used with oximetry and used during anesthesia and in ICUs (+ABGs)
PROVIDES INFO ABOUT VENTILATION
35-45
What is spirometry?
measures air in and out of lungs; lung volumes/capacity measurements
varies with body size, age, and exercise
Arterial puncture correlates with…
ABGs
What is a peak flow meter?
amount of air forcibly exhaled; ASTHMA PTS
What are some nursing interventions to promote oxygenation?
positioning for maximum lung excursion
incentive spirometer
mobilizing secretions
pursed lip breathing
emotional support
administer meds
What are 4 ways to mobilize secretions?
turn, coughing, and deep breathing (TCDB)
hydration! encourage fluids
humidify O2 delivery
postural drainage and chest physiotherapy
Supplemental O2
REQUIRES ORDER
caution with CO2 retention (COPD, hypoxia)
DRYING, CAN HUMIDIFY
Nasal Cannula: Oxygen Delivered (FIO2)
MOST COMMON!!
1-6 L/min
1L=24%, 2L=28%, 3L=32%…
Nasal Cannula: Patient
patient can talk and eat
comfortable
dryness
Simple Mask (no reservoir bag): FIO2
5-10 L/min
40-60%
Simple Mask: Patient
need to remove to eat
not tolerated as well
WATCH SKIN BREAKDOWN
Partial Rebreather: FIO2
6-15 L/min
50-90%
Partial Rebreather: Patient
Allows higher O2
PT CAN BE VERY ANXIOUS
Non-Rebreather: FIO2
6-15 L/min
70-100%
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
Venturi Mask (Adapters to control O2): FIO2
24-50%
Venturi Mask: Patient
useful with chronic lung disease
exhalation ports to keep CO2 buildup to a minimum
Face Mask: FIO2
SECOND MOST COMMON!
8-12 L/min
30-35%
Face Tent: Patient
more humidification
less reliable than mask
Tracheostomy Collar/T-Piece: FIO2
4-10 L/min
24-100%
Tracheostomy/T-Piece: Patient
specialized equipment for advanced airways
humidifies
Artificial Airways: Oropharyngeal
ONLY WHEN UNCONSCIOUS
opens airway, keeps tongue away
suctioning upper airway
Artificial Airways: Nasopharyngeal
CONSCIOUS PTS
useful to aid in clearing secretions and suctioning upper airway
Artificial Airways: Endotracheal tubes
advanced airways usually placed by anesthesiology
SHORT TERM MECHANICAL VENTILATION
suctioning lower airway
Artificial Airways: Tracheostomy tube
LONG TERM MECHANICAL VENTILATION
suctioning lower airway
For all artificial airways tubes…
NEED TO MAINTAIN AIRWAY PATENCY
will require suctioning for clear secretions and monitoring
Chest Tubes
INSERTED IN PLEURAL SPACE
PURPOSE IS TO EVACUATE AIR/FLUID (pneumothorax/hemothorax)
3 chamber system (drainage, water seal, suction)
When using chest tubes, assess for…
Vitals
SpO2
Pulmonary
Color
Consistency
Amount
Pain
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
What is postural drainage?
the use of various positions to allow secretions to drain by gravity
RESPIRATORY THERAPIST
What is chest physiotherapy?
percussion and vibration after 10-15 minutes of postural drainage
RESPIRATORY THERAPIST
What is pursed lip breathing?
slows expiration, good for COPD
breathe in through nose and exhale through pursed lips; teach via straw
Yankauer suctioning
removing secretions and maintaining airway patency via oral cavity
What is a nebulizer?
aerosolized medication to open airways
usually takes 5 min. breathing in and out
can be in mouthpiece or mask
