Oxygenation & Respiratory Function Flashcards
Some chronic conditions result in loss of elasticity of the lungs causing air to get trapped in alveoli. Certain breathing exercises can strengthen the accessory muscles of respiration and result in better oxygenation
Effective Breathing
creates a smaller opening to air outflow and thus increases resistance to exhalation slightly. The end result is that the expiratory phase is lengthened, which helps prevent alveoli from collapsing while maximally expelling air from the lungs. Exhalation should take twice as long as inhalation. Teach patient to breathe in through nose (count “1…2…”) and exhale through pursed lips (count “1…2…3…4…”).
Pursed Lip Breathing
to strengthen the accessory muscles of respiration, which reduces air trapping and promotes complete emptying of the lungs. Have patients exhale with their hand on their abdomen, feeling for the inward motion of the abdomen. Have them work to increase their “push” with the abdomen by tightening the muscles to facilitate complete emptying.
Diaphragmatic breathing
One of the main benefits of Diaphragmatic breathing techniques is helping the patient
to “gain control” over breathing
Breathing is almost always easier in an
upright position
When a patient is having difficulty breathing, IMMEDIATELY
raise the head of the bed
Helps to remove secretions and keep alveoli open
Coughing
may be contraindicated for patients who have had eye, brain, or spine surgery because of the possible increase in intraocular or intracranial pressure.
Coughing
a set of techniques to help loosen and drain secretions from the lungs.
Chest Physiotherapy
is a gentle shaking pressure applied to the chest wall only during exhalation to shake secretions into larger airways.
Vibration
Used in conjunction with postural drainage. Rhythmic clapping on the chest wall over the area to be drained forcing secretions into larger airways so they can be expectorated. Hand is “cupped”
Chest percussion
Most commonly performed by Respiratory Therapist
Chest percussion
You use vibration most often with patients with
cystic fibrosis
A device that encourages deep inspiration (and, consequently, full expansion of alveoli) by providing a visual goal. The most common type is a disposable plastic device in which slow steady inspiration causes a ball to rise in a graduated plastic column.
Incentive Spirometry (IS)
Why are medications given by inhalation
The alveolar-capillary network absorbs medications rapidly
Deliver precise doses of medication directly to the lungs, dispersed through an aerosol spray, mist, or powder that penetrates lung airways. These devices consist of a mouthpiece and actuator into which a medication canist
Pressurized Metered-Dose Inhalers (pMDIs)
Used for asthma, emphysema, COPD, and bronchitis.
Pressurized Metered-Dose Inhalers (pMDIs):
are short acting and provide immediate relief for acute respiratory distress. They are for relief of symptoms.
“Rescue” medications
are used daily at scheduled times to prevent acute respiratory distress. Many of them are corticosteroids. They treat the underlying pathology
“Maintenance” medications
Patients may use a _______ with pMDIs.
spacer
allow the particles of the medication to slow down and break into smaller pieces therefore leading to improved drug absorption in the patient’s airway
Spacers
hold medication in a powdered form and create an aerosol when the patient inhales through the reservoir holding the medication. This requires less hand-breath coordination. The device is activated when the patient breathes; no spacer is needed
Dry Powder Inhalers (DPIs)
releases medication when the patient lifts a lever, but the medication doesn’t flow out until the patient inhales. Useful for patients with hand-breath coordination issues, or patients who have so little hand strength that they can’t push the actuator down enough to release the dose.
Breath-Actuated Inhaler (BAI)
If patient is using a bronchodilator (rescue) AND a steroid inhaler (maintenance), instruct the patient ______________FIRST (to open the airway) and then use the steroid inhaler
to use the bronchodilator
Patients taking inhaled steroids should ___________-after using inhaler to prevent thrush due to local immunosuppressive properties of steroids
rinse and spit
The percentage of oxygen breathed by a person is called is called the
fraction of inspired oxygen (FiO2)
Oxygen can be toxic; therefore, the aim is ________________ to keep arterial oxygen saturation within a normal range
to provide the lowest percentage of oxygen needed
Volume of oxygen delivered is less than the patient’s minute ventilation (amount of air inhaled by a patient in one minute)
Low flow
Mask has lateral perforations to allow exhaled CO2 to escape to decrease the amount the patient re-breaths.
Simple face mask
It fills with oxygen, and when the patient breathes in, he/she mostly breathes the oxygen from the bag, so hardly any atmospheric air is present which results in higher FiO2 results (in excess of 90%)
Partial and nonrebreather masks
Volume of oxygen delivered is in excess of the patient’s minute ventilation.
High flow
This is a relatively new method of oxygen delivery providing heated, humidified oxygen through a nasal cannula at flow rates as high as 60 L/minute while an air-oxygen blender allows for the titration of the FiO2
High-flow nasal cannula (HFNC)
Noninvasive Ventilation
Continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BPAP)
Precautions related to oxygen
Fire, humidification, and flow rate
Use a humidifier (“bubbler”) whenever flow rate is equal to or going to exceed
4L/min
When patients can’t effectively cough out sputum, suctioning may be necessary.
Suctioning
is suctioning of the mouth. It is a clean, rather than sterile, procedure. Often a Yankauer tip is used. It is usually employed when the patient can cough up sputum from the lungs but can’t get it past the oropharynx
Oral suctioning
Suctioning should NEVER be done when the patient is
able to cough effectively
involves the use of a soft whistle-tip catheter to enter the trachea (and perhaps the bronchi). Two current methods of suctioning are: open and closed.
Endotracheal suctioning
sterile technique is maintained with a new sterile catheter for each suctioning event, sterile gloves are worn, and Standard Precautions are utilized during the suctioning procedures
open suctioning
usually performed when the patient requires an invasive mechanical ventilator to support their respiratory efforts – this allows the continuation of oxygen while performing suctioning and decreases the risk of oxygen desaturation during the procedure
closed suctioning
This type of airway is for patients with decreased level of consciousness or airway obstruction and aids with the removal of secretions
Artificial Airways
It is done when there is an airway obstruction above the trachea or when the patient can benefit from decreased work of breathing associated with decreased dead space.
Tracheostomy
ventilation
breathing
Blood flow to lungs and body tissues
perfusion
O2 into blood, CO2 removed from blood
Diffusion
What is used to treat these: Airway obstruction, Neuromuscular problem, Chest wall problems
ventilation
What is used to treat these: Pulmonary embolismand Hypotension
perfusion
What is used to treat these: Pulmonary edema, Mucus, and Destruction of alveoli
Diffusion
low oxygen(not enough oxygen)
Hypoxia
breathing to slow
Hypoventilation
breathing to fast
Hyperventilation
trouble(dysfunctional) breathing
Dyspnea
only able to breathe when upright
Orthopnea
when the alveoli in the lungs collapses
Atelectasis
Different masks and tubing have
different flow rates and different percentages of oxygen
PCT/UAP role for oxygen
cannot start oxygen on all patients, cannot touch flow meter to give patient more or les oxygen
COPD patients should not have _____________ of oxygen unless the provider says so
more than 1 to 2 L
assess the patient for how much oxygen is needed and can adjest how uch oxygen is given to a patient
Nurses role for oxygen
