Oxygentation Flashcards
physiological factors affecting oxygenation
- carrying capacity of patient (anemia)
- decreased inspired oxygen (resp obstruction, wrong rate of oxygen)
- hypovolemia (shock w loss of fluid)
- high metabolic rate (fever, exercise, pregnancy)
conditions affecting pt oxygenation
- preg
- obesity
- trauma
- neuromuscular disease
- spinal cord injury
developmental factors affecting oxygenation
infants and toddlers - teething, nasal congestion, upper airway problems
school-age and adolescents - second-hand smoke, smoking, asthma
young and middle age adults - occupational hazards, poor diet, stress, cardiac and resp probs
older adults: reduced mobility, lung structural problems
5 behavioral risk factors
- smoking –> vasoconstriction
- diet –> obesity, airway probs
- exercise
- substance abuse
- stress –>increase metabolic rate = increased O2 demand
environmental factors
not using right PPE
pollution
natural decay of uranium causes lung cancer
organic dusk disease seen in farmers
hyperventilation
over-breathing, common with anxiety, fear, infection.
SS - lightheaded, numbness, tingling fingers
hypoventilation
inadequate breathing, causes - COPD, resp depression
Hypoxia
inadequate tissue oxygenation.
SS - cyanosis, increase HR, resp rate increases, confusion, restlessness, skin color change (palor)
cyanosis
blue color around lips, fingers
dyspnea
SOB
Eupnea
normal, 12-20
tachypnea
> 35 bpm
Cheyne-stokes
very deep to very shallow breathing with temporary apnea
bradypea
<10 bpm
kussmaul’s respirations
hyperventilation that accompanies metabolic acidosis
orhopnea
trouble breathing except in up-right position
blood tests you can do
hemoglobin (m - 135-180, f 125)
WBC - 5-10
serum electrolytes - K and Na in relation to diet
ventilation and perfusion scans (v/q)
looking for pulmonary embolism
pulmonary function test (PFT)
looking at lung capacity
sputum samples (culture sensitivity and cytology
C&S - Looking for an organism growing
Cytology - Cells within the sputum
When is the best time to collect a sputum sample?
the morning before breakfast .. Get the patient to do oral hygiene before you get the sample … think about PPE
Arterial Blood Gases • Ph – • PaCO2– • PaO2– • SaO2– • HCO3–
- Ph – 7.35-7.45
- PaCO2–35-45mmHg
- PaO2–80-100mmHg
- SaO2–95-100%
- HCO3–26-26mmol/L
Infectious + Inflammatory Disorders
- Exemplar - pneumonia
- Inflammation of the respiratory bronchioles and alveoli
- Community-acquired or healthcare acquired
- Infectious or non-infectious - could be bacterial or virus or fungal etc.
SS pneumonia
decreased gas exchange, increased exudate, cough, fever, chills, tachypnea, decreased breath sounds
Monitoring Airway Clearance
- Resp status + vs + O2 sat, breath sounds, cough closely
- Positioning
- DB&C + Incentive Spirometer
- 2.5-3 L/day
- Meds + O2
- Pulmonary Hygiene – percussion, vibration and postural drainage
monitoring Breathing Pattern
- Positioning
- Rest
- Assess and document CP
- Reassurance - trouble breathing can be anxiety provoking
- Breathing + relaxation techniques
- Distracting individual s
percussion and vibrations of chest
Percussion
• Rhythmically clapping the chest wall with cupped hands.
• Causes vibrations to loosen secretions
Vibration
• Helps loosen and move secretions into larger airways
postural drainage
gravity to remove secretions from a lung segment
• Certain positions may be contraindication of the patient
activity tolerance
Assess for changes in HR, RR, dyspnea, diaphoresisor cyanosis with activity
• Assist with ADL’s
• Rest
• Assistive devices - turning into better position
• Emotional support/support persons
medications of pneumonia
Immunization
• Pneumoccocal (recommended for the elderly, children those with chronic health challenges)
• Annual influenza (recommended for elderly, children those with chronic health challenges and health care providers)
ABX - antibiotics
Bronchodilators - can expand or open the airway
Expectorants - can help breath up the mucus
obstructive lung disorders
- Secretions • Increase work of breathing + air trapping in lungs
- Walls edematous
- Smooth airway muscle constricts
- Lungs lose elasticity
- Supportive tissue lost
• Increase work of breathing + air trapping in lungs
• Inhaled air mixes with trapped air – less oxygen for gas exchange.
• Exemplars – COPD and Asthma
• Give them SOB, cough, dyspnea
• Got to work harder to breath
What is COPD? what is the biggest cause
• COPD is the most rapidly growing health problem.
• Inflammatory respiratory disease–chronic and progressive obstruction of airflow
• Mostly with over lapping signs and symptoms of 2 distinct disease processes:
Emphysema
Chronic Bronchitis
• #1 cause SMOKING
• Asthma separate disorder but can coexist with COPD.
•Biggest cause: SMOKING
•COPD changes structure and function
meds for COPD
manage and slow progression
• Immunization
• Inhaled bronchodilators–MDI, DPI or nebulized
• Corticosteroids–decrease inflammation and edema
• Cough suppressants and sedatives avoided
• Antimicrobials(as appropriate)
• Drugs for smoking cessation
cascade and huff coughing
Cascade
• Deep breath and multiple coughs
Huff
• Inhale deep sharply say huff
restorative and continuing care coughing
Diaphragmatic breathing
• Belly breathing
• Breathing from the abdomen
Pursed lip breathing
• Blow out slowly through pursed lips
Deep breathing and coughing
• In through the nose out through the mouth
copd and oxygen therapy
- Care needs to be exercised in patients with chronic obstructive pulmonary disease, such as emphysema, especially in those known to retain carbon dioxide.
- These patients may further accumulate carbon dioxide and decreased their body pH.
- In the worst case, administration of high levels of oxygenin patients with severe emphysema and high blood carbon dioxide may reduce respiratory drive to the point of respiratory failure (ie: drive to breath may be knocked out).
- However, the risk of the loss of respiratory drive are far outweighed by the risks of withholding emergency oxygen, and therefore emergency administration of oxygen is never contraindicated.
- Need to be careful with COPD when administering O2 - they usually have a standard order
- Discontinue oxygen when the patient no longer requires it
smoking cessation
- Ask
- Advise
- Assist
- Arrange protocol
children pulm
- Smaller nasopharynx – easily occluded
- Long, floppy epiglottis, vulnerable to swelling–> obstruction
- Larynx and glottis are higher in neck, increase risk of aspiration
- Fewer muscles mature in airway –> less able to compensate for edema/trauma/spasm
- Physically increase of infection
what breathing technique do u use under 6
Under 6 use the diaphragm breathe b/c intercostal muscles immature
children in canada w asthma
1 out o 5
what is asthma
Chronic inflammatory disorder of the airways characterized by recurrent episodes of: • Wheezing • Breathlessness • Chest tightness • Coughing
types of inhalers
MDI
• Meter dose inhaler
• Prime it first by shaking it or rolling it in your hands - make sure it works
• Exhale before you use the medication
• Spacer or air chamber - breaks the medication down so it goes deep in your lungs - better cordination
• Once you inhale - hold for around 10 secs then exhale slowly through pursed lips
DPI
• Dry powder inhaler
• Spray directly into mouth
• Rinse mouth after!!
Peak Flow Meter
• • Device that you blow into to get a reading of how rapidly you can exhale the air from your lungs. This is known as your “peak flow rate”.
• • A peak flow meter can be useful for getting an objective measure of the condition of your asthma - that is, you can assign a number to it.
• • Using a peak flow meter can sometimes help you see that your asthma is starting to get out of control before you might even notice symptoms.
sleep apnea
- Sleep quietly and breathe normally.
- Begin to snore loudly (airway is partly blocked).
- Next, airway closes off. No air reaches lungs. Brain is telling to breathe as usual, but can’t take in a breath b/c airway has closed off (apnea). After a pause of 10-30 seconds or more, brain realizes not breathing, jolts awake to take a breath. Big gasp of air and start breathing again.
when do you need artificial airways
An abnormal condition characterized by the collapse of alveoli, preventing the respiratory exchange of CO2 and O2 in parts of the lung is called atelectasis
• Spiramonitor
chest tubes
A catheter placed through the thorax to:
• remove air and fluids from the pleural space
• prevent air from re-entering
• re-establish intrapleural and intrapulmonic pressures
thoracentetis
Relieves a pleural effusion by inserting a needle into the pleural space to remove fluid
