Oxygenation & Perfusion Flashcards
Arrhythmia
No heart rhythm
Dysrhythimia
A FIB– atrium does not have contractile force
If symptomatic –> SOB
Chest Pain
Check for clotting
Why more worried about V- fib?
Blood pressure is decreased, less blood to lungs and body
What organ is responsible for gas exchange in the body?
Alveoli
What is myocardial ischemia?
Lack of blood flow to heart –> turns off nutrition to heart –> tissues dying
Interventions: get to cath lab as fast as can to decrease tissue loss and scar tissue formation
What is angina?
Chest pain.
Men- present with chest pain and SOB
Women- presents differently, maybe not pain
Why is retaining fluid a problem in heart failure?
Heart isn’t pumping it out
What needs effect cardiopulmonary?
Blood thinners
Inhalers
What factors are different in infants?
Airways short
RR = rapid and abdominal. (36)
Crackles normal
Landmarks less prominent
Respiratory function in older adult
Bonylandmarks less prominent Kyphosis Barrel chest Tissues and airways more rigid Increased risk for disease esp. Pneumonia (from decreased pneumonia
Vesicular Breath Sounds
Bronchial
Bronchiovesicular
Low-pitched, soft sounds during expiration
B: High pitched and longer. Over trachea
Bronchioles ocular: upper anterior chest
Difference between crackles and wheezes
Crackles = fluid. Inhalation
Wheezes= expiration from constriction of airway
To promote comfort in Resp patients
Position- full fowler so Maintain fluid intake--> thins out mucus Good nutrition Pacing physical activities --> Humidified air --> less dry and irritating
Metered dose inhaler
Gives certain dose of medicine each puff
Types of artificial airways
Oropharyngeal Nasopharyngeal Endotracheal- Tracheostomy- for long term vent patients -cuff less & cuffed
What is the process of ventilation?
Movement of air in and out
- active inspiration (diaphragm contracts and descends –> lengthens cavity –> increases lung volume –> decreases lung pressure –> air goes to lower pressure from outside lungs)
- passive expiration (diaphragm retracts, pressure increases)
What is respiration vs internal respiration?
Resp: Process of gas exchange. O2 in –> CO2 out via diffusion
Internal: exchange in circulating blood and tissue cells
Os to Toes
Hypoxemia
Deficiency of O2 in blood (usually from decreased respiration)
Hypercapnia
Excess Co2 in blood
- exhilaration
- decreased respiration
What can amuse alveolar hypo ventilation
Spinal cord dysfunction (MS, ALS, Injury) Respiratiory Dysfunction (CNS depression) Upper airway structural problems (obstructions or swelling) Lower airway structural problems (ribs, obesity, emphysema/asthma)
What causes Ventilation and Perfusion mismatching? (V/Q)
Ex breathing fine but alveoli not working
Either blood flow is limited or blocked but airway is proficient
Air flow block but blood flow fine
Pulmonary edema- fluid accumulates in alveoli
Atelectasis (collapse of lung –> won’t get air to blood)
Pneumonia– lungs filled with puss, alveoli can’t work well
COPD- alveoli not working
Asthma -
Diagnostic Tests * LOOK UP*
Chest X-Ray Bronchoscopy Chest CT Spiral chest CT V/Q scan
What are clinical manifestations of
Restlessness Agitation Confusion Impaired judgement Tachycardia Bounding pulse HTN Dysrhythmias Cool clammy skin Active accessory muscles/ Cyanosis
A nurse caring for a patient with COPD knows that hypoxia may occur in patients with respiratory problems. what are the signs of this serious condition?
Dyspnea (difficulty breathing) Small pulse pressure with elevated BP pallor Cyanosis increased pulse rate increased respiratory rate
- hypoxia may occur from problems with ventilation, respiration, or perfusion
- inadequate amount of oxygen is available to cells
What condition would a nurse anticipate the need for a nasal trumpet while suctioning the Nasopharyngeal airway of a patient to maintain patency?
Epistaxis (nose bleed)
nasal tumpets protet the nasal mucosa from further trauma related to suctioning. epistaxis is a sign
a nurse is inserting an oropharyngeal airway for a pt who vomits when it is inserted. what action would be the first that should be taken?
immediately position the patient on his or her side to prevent aspiration,
- remove the oral airway
- suction the mouth if needed
a nurse is choosing a catheter to use to suction a pt endotracheal tube via na open system. which variable does the nurse base the size of the catheter?
base the size of suctioning catheter on the size of the endotracheal tube.
external diameter of the catheter should not exceed half the internal diameter of ednotracheal tube.
larger catheters can contribute to trauma and hypoxemia
16 yr old male hopitalizedfor an acute asthma exacerbation. which methods might the nurse use to measure the patients Oxygen saturation?
pulse oximetry- obtain baseline information about the patients oxygen saturation level
Peak expiratory flow rate (PEFR)- used for asthma
spirometry- monitor health status of pt with respiratory disorders
PT with COPD cannot complete ADLs. what nursing diagnosis describes alteration in oxygenation as etiology?
Fatigue r/t impaired oxygen transport system.
what measures of teaching would nurse recommend to pt in long term care facility with asthma & COPD
reduce anxiety
eat a high-protein/ high calorie diet
maintain a high-Fowlers position when possible –> most comfortable for people with dyspnea and orthopnea
meals taken 1-2 hours after breathing treatments and exercises
drink 2-3 quarts of clear fluids daily
pace physical activities and schedule frequent rest periods to conserve energy
what position would be best for postural drainage of right lobe of lung?
lying on the left side with a pillow under the chest wall t.
high fowlers to drain apical sections of upper lobes
trendelenburg to drain lower lobes
posterior section of upper lobes– lying half on the abdomen and half on the side.
meter dosed inhaler
continue to inhale when the cold propellant is in throat
only inhale one spray with one breath
active the device while continuing to inhale
what should a nurse expect with a patient recieving oxygen through a nasal cannula with chronic lung disease?
rate is no more than 2-3 L min because it may destroy the hypoxic drive that stimulates repsirations.
o2 delivered at low rates doesnt not always have to be humidified
arteriol blood gases are not required at regular intervals to determine the flow rate
What action would a nurse take if pts endotracheal tube changes depth during retaping.
remove the tape and djust the depth to the ordered depth and reapply tape
*should be maintained at the same level unless ordered by the physician
What is safe technique when using a portable oxygen cylinder
check the cylinder befroe using to ensure enough oxygen is available for the patient.
should not be 500 psi or less –> not enough oxygen reamins for a patient transfer
-if not secured properly –> may injusre patient
-o2 flow is discontinued by turning the valve clockwise until tight
What would be the first action if a pt chest tube has become sparated from the drainage device
put on gloves, put in sterile saline or water
- creates a water seal until new draiage unit can be attached
- THEN assess vital signs and notify physician
How to use manual resuscitation bag
tilt pts head back, pull jaw forward, airway clear, mask held tightly over the patients nose and mouth
-compress at a rate that approximates normal respiratory rate
what interventions does a nurse perform while tracheal suctioning?
- assess patient before, during, and after the procedure
- hyperoxygenate before and after suctioning
- limit application to 10-20 seconds
- take pulse frequently to detect effects of hypoxia and stimulation of vagus nerve
- suction pressure 80-150 mm Hg (prevents atelectasis)
- insert no further than 1cm past the length of the tracheal tube
what are risks associated with traceal suctioning?
hypoxia infection tracheal tissue/mucosa damage dysrhythmias atelectasis loss of cilia edema, fibrosis in trach
What factors are essential to normal functioning of respiratory system?
- integrity of airways system (air to and from lungs)
- functioning alvelolar system (oxygenates venous blood & removes CO2 from blood)
- functioning cardiovascular and hematologic systems(carry nutrients and wastes to and from body cells)
what factors influence diffusion of gases in lungs?
surface area available
thickness of alveolar-capillary membrane
partial pressures
solubility and molecular weight of gas
what makes the right lung easier to intubate?
it has 3 lobes
what happens in lower airway?
production of pulmonary surfactant
muco cilliary clearance
