Oxygenation Key Terms

Question 0

Arterial Blood Gas (ABG)

Answer 0

Provides a direct indication of oxygen and carbon dioxide exchange and the acid-base balance within the blood.

Question 1

Apnea

Answer 1

The absence of breathing -manifested by lack of respiratory effort can lead to respiratory arrest. -NIC: identify/treat underlying cause, & administer respiratory stimulants, as appropriate.

Question 2

Atelectasis

Answer 2

The collapse of lung tissue affecting affecting all or part of a lung, impacting the exchange exchange of oxygen and carbon dioxide.

Question 3

Bronchovesicular

Answer 3

The movement of air within the bronchial tree creates a mixture of sounds of air flowing through a tube and the breeziness of the open alveolar lung fields.

Question 4

Crackles

Answer 4

High-pitched popping sounds. Crackles are heard on inspiration and are caused by fluid associated with or resulting from inflammation or exudates, within the lung fields or localized atelectasis.

Question 5

Dyspnea

Answer 5

Labored breathing or SOB that is uncomfortable or painful, also occurs when breathing is insufficient to meet oxygen demand -manifested by: clearly audible, labored breathing; anxiety, distressed facial expression, & nasal flaring. -NIC: Identify/Treat Cause & administer oxygen if O2 falls below 90%

Question 6

Eupnea

Answer 6

The process manifested by oxygenation

Question 7

Hypercarbia

Answer 7

An increased level of carbon dioxide in the blood. *The drive to breathe

Question 8

Hypoxemia

Answer 8

Decreased level of oxygen. -Chest wall in-drawing is an early indicator. -Cyanosis is a late indicator that it’s occurring.

Question 9

Orthopnea

Answer 9

Difficulty breathing when an individual is laying supine -Manifested by: Dyspnea while laying down -NIC: I/T cause, elevate head,neck, & chest while sleeping.

Question 10

Oxygenation

Answer 10

The mechanism that facilitates or impairs the body’s ability to supply oxygen to all cells of the body.

Question 11

Palpation

Answer 11

To feel the areas related to the body system being assessed.

Question 12

Peak expiratory flow rate (PEFR)

Answer 12

Used to monitor the ability of an individual to exhale a specific volume of air related to the individuals age,gender, height, & weight.

Question 13

Percussion

Answer 13

A method of tapping the chest or back to assess underlying structures; tones heard during percussion determine solid-filled or air-filled spaces at the area percussed.

Question 14

Pneumothorax

Answer 14

A partial lung collapse resulting from air or gas collecting in the lung or pleural space that surrounds the lungs. -Respiratory Emergency -manifested by: chest pain, SOB -NIC: I/T cause, observation, needle or chest tube insertion, surgery.

Question 15

Pulmonary function test (PFTs)

Answer 15

Provide information about ventilation airflow, lung volume, and capacity and the diffusion of gas, and they incorporate spirometry, peak flow meters, and the body plethysmograph.

Question 16

Rhonchi

Answer 16

Is a long, low-pitched sound that continues throughout inspiration. Rhonchi suggests blockage of large airway passages which can sometimes be cleared with coughing.

Question 17

Stridor

Answer 17

A high-pitched sound within the trachea and larynx that suggests a narrowing of the tracheal passage.

Question 18

Surfactant

Answer 18

Controls surface tension and keeps the alveoli from collapsing and sticking to themselves.

Question 19

Thoracentesis

Answer 19

Both an intervention and a test. Performed to drain excessive pleural fluid from between the pleural linings. -fluid drained is often analyzed for blood, fiber, & microbe content.

Question 20

Ventilation-perfusion

Answer 20

The movement of oxygen across alveolar-capillary membrane into a well-perfusing capillary. -the concentration levels of O2 & CO2 dictate the movement of each gas across the alveolar-capillary membrane.

Question 21

Vesicular

Answer 21

The sounds of air moving into & out of the lobes at the alveolar the alveolar level. -they are soft & breezy sounds

Question 22

Wheezing

Answer 22

A high-pitched whistling sound most often heard on expiration and caused by the narrowing of bronchi, but wheezes can also be heard on inspiration. -when inflamed can be low-pitched, grating sound caused by pleural surfaces rubbing together. Occurs more during inspiration, but can also be heard during expiration.

Question 23

Respiratory Rate of 30-60 per minute (normal)

Answer 23

Newborn

Question 24

RR of 20-40 breaths/min

Answer 24

Infants

Question 25

RR of 10-20 breaths/min

Answer 25

Adult

Question 26

Respiratory Acidosis

Answer 26

⬆️CO2➡️vasodilation➡️⬆️ICP & PR Client c/o headache, irritability, ⬇️ LOC, flushed skin. Important in chest trauma, aspiration, pneumonia, & OD Be alert in pt with problems r/t airway clearance, limited ambulation, anxiety or signs/symptoms of ⬇️ O2

Question 27

Pain from ischemic events including: -Cerebral -Cardiac -Shock States -Pulmonary -Pediatric congenital issues such as heart defects -Adult infarcts, CHF, valvular issues, cardiomyopathy

Answer 27

⬇️O2 to tissues manifests as pain -Assess related symptoms such as ⬆️PR, RR, BP, restlessness, anxiety, diaphoresis, reports of discomfort.

Question 28

⬇️Tissue perfusion creates oxygen deficit to organs.

Answer 28

Perfusion -Assess perfusion including pulses, nail beds, color, body position for comfort, orientation. -Administer Oxygen -Pharmacotherapy to improve CO, surgery to correct defect -Monitor ABGs

Question 29

Thoracic Wall Symmetry Assessment

Answer 29

Normal findings: trachea is midline, hand placement on chest is symmetric. Abnormal: asymmetry of movement occurs, decreased expansion, trachea shifts from midline.

Question 30

Muscles of Breathing Inspection

Answer 30

NF: Chest gently rises and falls, neck muscles are relaxed, trachea is midline, intercostals raise the chest up & out with inhalation and calmly relax with exhalation. Abnormal: retraction of intercostals, sternocleidomastoid muscles in neck contract, posturing occurs.

Question 31

Skin Assessment related to Respiratory System Findings

Answer 31

NF: pink skin=adequate oxygenation of the cells thru out body. Abnormal: cyanosis (blue coloring) in fair or. or gray coloring in darker pt.

Question 32

RS: Nail bed Assessment Findings

Answer 32

NF: Nail beds are an extension of the finger & are normally curved with a 160* angle of the nail bed to the finger. Abnormal: Clubbed nail beds have an angle of 180* or greater, depending on the duration of time am individual has had hypoxemia.

Question 33

Arterial Blood Gas Values (ABGs) Normal ranges

Answer 33

pH=7.35-7.45 PaCO2= 35-45mm Hg PaO2= 75-100mm Hg HCO3= 24-28 mEq/I

Question 34

Independent Nursing Oxygenation Interventions

Answer 34

-Deep Breathing Exercises -Positioning -Encouraging Smoking Cessation -Monitor Activity Intolerance -Promoting Secretion Clearance -Suctioning -Assisting pt. with ADLs

Question 35

Collaborative Oxygenation Nursing Interventions

Answer 35

-Improving Nutrition (Diatary, MD) -Pharmacological Therapies (MD, RX) -Non-Pharmacological Therapies i.e. Oxygen admin. & thoracic catheter insertion. (MD) (TCI is used when fluid enters the pleural cavity, causing lung collapse. Emergency conditions treated as surgery.)

Question 36

Nasal Cannula -Flow Rate Setting? -O2 Concentration (FiO2)?

Answer 36

FR: 1-6 L/min FiO2: 24%-44%

Question 37

Oxymizer Flow Rate? FiO2?

Answer 37

FR: 1-6 L/min FiO2: 24%-88%

Question 38

Vapotherm Flow Rate? FiO2?

Answer 38

FR: 1-40 L/min FiO2: 24%-100%

Question 39

Face Mask Flow Rate? FiO2?

Answer 39

FR: 5-10 L/min FiO2: 30%-50%

Question 40

Nonrebreather Flow Rate? FiO2?

Answer 40

FR: 10-15 L/min FiO2: >60%

Question 41

Venturi Mask Flow Rate? FiO2

Answer 41

Venturi is set with jet adapter for FR & FiO2

Question 42

Characteristics of Acute Respiratory Distress Syndrome (ARDS)

Answer 42

1. Initiation of ARDS-alveoli & capillary damage 2. Onset of Pulmonary Edema- alveoli & capillary walls are more permeable, allowing plasma, proteins, & erythrocytes to enter the interstitial space. 3. Alveolar Collapse- protein rich fluid accumulates, inactivating surfactant and damaging alveolar type II cells, as surfactant is lost alveoli stiffen & collapse, increasing breathing effort. -All this interferes with gas exchange across a/c membrane, blood O2 (PaO2) levels fall as well as PaCO2 initially due to rapid expirations. 4. End Stage ARDS- fibrin & cell debris from necrotic cells combine forming hyaline membranes, CO2 can’t diffuse across hyaline mem. PaCO2 levels rise while O2 continues to fall, risk of Respiratory Acidosis r/t ⬆️CO2. If patient doesn’t receive respiratory support, respiratory failure will set in. Even with aggressive treatments almost 50% of ARDS pt. die.

Question 43

ARDS- Initial Clinical Manifestations

Answer 43

Initial manifestations develop within 24-48 hours -Dyspnea -Tachonea -ABGs may be in range -Lab findings are consistant with presenting illness -Chest X-Ray to be clear of infiltrates, with the exception of direct Pulmonary illness. Baseline labs & diagnostic tests aid in identifying change in pulmonary status.

Question 44

ARDS-Progressive Manifestations

Answer 44

-Progressive respiratory distress -⬆️ RR, Intercostal Retractions, Use of muscles of respiration -Tachycardia occurs as the demand for O2 in cells⬇️ -CXR shows interstitial changes w/ patchy infiltrates -Pulse Oximetry & ABG levels reflect Hypoxemia refractory to O2 admin. -Breathe sounds clear initially, with crackles (rales) & rhonchi developing later. -Respiratory failure progresses causes mental status changes: agitation, confusion & lethargy

Question 45

ARDS Diagnostic Testing

Answer 45

-ABGs analysis of O2 levels in blood -Chest Radiography (X-Ray or CT) assessing fluid vol. in lungs. -Blood Tests: CBC, Blood Chemistries, & cultures (help determine cause of ARDS, such as infection.) -Sputum Culture: exact cause of infection

Question 46

ARDS Treatments

Answer 46

-Surfactant Therapies -Mechanical Ventilation -Artificial Airways -Nutrition & Fluids -Treatment of infections or other underlying condition

Question 47

Caring for ARDS patients require constant monitoring of ?

Answer 47

Airway, breathing, & circulation Any changes in perfusion, LOC, or oxygenation require rapid Nursing interventions to maintain life. Focusing on meeting essential needs of the pt.