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NUR 333 Exam Preps > Oxygentation- Exam 1 > Flashcards

Oxygentation- Exam 1 Flashcards

1
Q

Lung volumes

A

Dependent on age, gender, and height.

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2
Q

Tidal volume

A

Amount of air exhaled following normal inspiration.

Can be affected by: health status, pergnancy, obesity, exercise, COPD, other lung diseases.

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3
Q

Function of aveoli

A

Promote gas exchange. Swap CO2 for O2.

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4
Q

Normal respiration rate/ what affects RR

A

12-20

  • age
  • meds
  • exercise
  • fear
  • anxiety
  • pain!
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5
Q

Normal breath sounds/ pitch/ location

A

Bronchial: high pitch/ heard over trachea
Broncovesicular: medium pitch/ mainstream bronchi
Vesicular: low pitch/ most of normal lung

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6
Q

Crackles/rales

A

Fine to coarse bubbly sounds, associated with air passing through fluid or collapsed small airways.

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7
Q

Wheeze

A

High pitched whistling (musical)

Associated with narrow obstructed airways. (Think inflammation/ allergies)

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8
Q

Rhonchi

A

“Junk in the lungs”

Loud, low pitched rumbling, fluid or mucous in airways. Can usually be resolved with coughing.

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9
Q

Stridor

A

Very high pitched. Associated with chocking and primarily observed in children.

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10
Q

Bradypnea

A

rate of breathing regular but abnormally slow (less than 12 breaths/min)

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11
Q

Tachypnea

A

Rate of breathing regular but abnormally rapid (greater than 20 breaths/min)

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12
Q

Apnea

A

Respirations cease for several seconds. Persistent cessation results in respiratory arrest. RR=0

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13
Q

Hyperventilation

A

Rate and depth of respirations increase. Hypocarbia can occur. (Low CO2)

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14
Q

Hypoventilation

A

Repiratory rate is abnormally low and depth of ventilation is depressed. Hypercarbia can occur (high CO2)

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15
Q

Best way to assess perfusion and diffusion

A

Oxygen saturation

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16
Q

SpO2 vs SaO2

Normal values

A

Peripheral oxygen saturation
Arterial oxygen saturation
Normal: 95-100%

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17
Q

What factors can affect an accurate oxygen saturation measurement

A
  • Providers can prescribe certain limits (88% can be normal for someone with lung failure.
  • nail polish
  • interference from aterial pulsation in people with peripheral vascular disease.
  • hypothermia
  • vasconstrictors
  • extreme edema
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18
Q

Work of breathing

A

Effort to expand and contract lungs
-in a normal person, WOB should be quiet with minimal effort.

Involves inspiration (active) and expiration (passive)

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19
Q

What determines WOB?

A

Rate and depth of breathing.
Use of accessory muscles.
-males: abdominal muscles
-females: thoracic muscles

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20
Q

Compliance

A

Ability to distend and expand the lungs. Dependent on interthoracic pressure changes.

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21
Q

What increases WOB?

A
  • decreased compliance
  • increased airway resistance
  • increased accessory muscle use
22
Q

Factors affecting oxygenation

A
  • Decreased oxygen carrying capacity (hemoglobin levels/ CO2)
  • Hypovolemia (low blood volume)
  • Decreased inspired oxygen concentration (altitude, hypoventilation, increased metabolic demand)
  • Chest wall movement (pregnancy, obesity, muscoloskeletal diseases, trauma, neuromuscular diseases, CNS alterations, abdominal surgeries)
23
Q

Goal of ventilation=

A

Establish normal arterial carbon dioxide tension and normal arterial oxygentation tension.

24
Q

Hypoventilation concept/causes/ SS

A

Inadequate aveolar ventilation to meet demand (not enough oxygen and/or too much carbon dioxide)

Causes:

  • medications (sedatives/ anesthesia)
  • aveolar collapse= atelectasis
  • lung diseases

S/S:

  • mental status changes
  • dysrhythmias
25
Q

Atelectasis concept/ conditions associated with

A

Collapsed alveoli (prevents normal respiratory gas exchange). Can lead to lung collapse- respiratory distress/ pneumonias/ respiratory failure

Conditions:

  • IMMOBILITY
  • obesity
  • sleep apnea
  • chronic lung conditions
26
Q

Hyperventilation concept/ causes/ ss

A

Removing CO2 faster than it is produced by cellular metabolism. Think increased WOB

causes: severe anxiety attacks, infection/fever, drugs, pH imbalance, aspirin poisoning

S/s:
Rapid respirations, sighing breaths, numbness/ tingling of hands and feet, light-headedness, loss of consciousness.

27
Q

Hypoxia

A

Inadequate TISSUE OXYGENATION

Cellular level: not enough oxygen to meet needs. Can be related to a delivery problem.

Untreated can lead to cardiac dysrhythmias (cardiac cells need oxygen to do work)

28
Q

Hypoxia causes

A
  • decreased hemoglobin levels/low oxygen carrying capability.
  • diminished oxygen concentration of inspired oxygen (altitude)
  • inability of tissues to get oxygen from blood (cyanide poisoning)
  • decreased diffusion of oxygen from alveoli to blood (infections/pneumonia)
  • poor perfusion with oxygenated blood (shock)
  • impaired ventilation from traumas (rib fractures)
  • hypovolemia (not enough blood to carry enough oxygen)
29
Q

Hypoxia s/s

A
  • apprehension, restless, inability to concentrate, decreased LOC, behavioral changes
  • fatigued, yet agitated
  • causes increased pulse and RR/depth
  • initially increased BP, then leads to shock/low BP
  • cyanosis (late sign of hypoxia)
30
Q

Cyanosis (peripheral vs central)

A

Central: tongue, soft palate, conjuctiva of eye= hypoxia

Peripheral: extremities, nail beds, earlobes= vasoconstriction/circulation not oxygentation problem

31
Q

RAT BED

A

Early signs:
R- restless
A- anxiety
T- tachycardia/ tachypnea

Late:
B- bradycardia
E- extreme restlessness
D- dyspnea

32
Q

Chronic Hypoxia

A

Associated with chronic lung conditions (COPD)

Common assessment findings:

  • cyanotic nailbeds
  • clubbing
  • barrel chest (AP diameter 1:1 not 2:1)
33
Q

Dyspnea

A

Associated with hypoxia. (Subjective) difficulty breathing that can be related to shortness of breath (often disease related and not exercise or excitement induced).

S/s: use of accessory muscles, nasal flaring, increased RR/depth

34
Q

Dyspnea questions

A

When does it occur?
What improves it?
Worsened by something? Lying down?

Can ask patient to reate difficulty on an analog scale (think pain scale)

35
Q

Cough

A

Protective reflex to clear trachea, bronch, and lungs of irritants and secretions. Chronic cough often disease related, whereas acute cough often associated with URI.

36
Q

Cough Questions

A

How often is the cough? (frequency)
Is it productive or nonproductive?
What does the sputum look like? (if productive) -mucus, blood (hemoptysis) thick, thin, odorous?

37
Q

Cough/expectorate

A
  • Adequate hydration can thin secretions and help maintain airway patency.
  • encourage coughing- most effective way to move secretions through airway (more efficient than artificial suctioning.
  • Pain can affect the effectiveness of cough. (Especially important in patients with recent surgery who need to cough but it hurts to cough00
38
Q

Specimen Collection

A
  • used to analyze for pathogens (pneumonia/cytology)
  • best to collect in early morning
  • wait 1-2 hours after patient eats (prevent contaminations)
  • use a sterile specimen container (tell pt not to touch inner sides of containers or lid)
  • tell pt to cough into the container and get as much sputum as possible
  • can suction pt to acquire a sputum sample.
39
Q

Sputum culture and sensitivity

A

Obtained to identify specific microorganism growing in sputum.
Identifies drug resistance and sensitivities to determine appropriate antibiotic therapy.

40
Q

Sputum for acid-fast bacillus (AFB)

A

Screens for presence of AFB to detect tuberculosis by early morning specimens three days in a row.

WHAT ARE INFECTION CONTROL PRACTICES BEFORE TB IS RULED OUT?
N95 MASK

41
Q

Sputum for cytology

A

Obtained to identify lung cancer and differentiates type of cancer cells.

42
Q

Pulmonary function tests

A

Basic ventilation studies that determines the ability of the lungs to efficiently exchange oxygen and carbon dioxide.

Used to differentiate pulmonary obstructive from resistrictive disease

43
Q

PEFR- peak expiratory flow rate

A

PEFR: point of highest flow during maximal expiration (based on body weight and age)

Reflects changes in large airway sizes. Excellent predictor of overall airway resistance in a patient with asthma. Daily measurement for early detection of asthma exacerabations.

44
Q

Bronchoscopy

A

Expected findings: normal airways without masses, pus, or foreign bodies.
-Visual examination of tracheobronchial tree. Performed to obtain fluid, sputum, or biopsy samples; remove mucus plugs or foreign bodies.

45
Q

Lung scan

A

Expected findings: normal lung structure without masses.

-used to identify abnormal masses by size and locations. Can be used to find blot clots.

46
Q

Oxygenation interventions: long-term, preventative measures

A
  • vaccines (flu, pneumonia)
  • healthy lifestyle (nutrition exercise)
  • STOP SMOKING
  • environmental and occupational exposures (miners, factory workers)
47
Q

Dyspnea management

A
  • difficult to treat
  • treat UNDERLYING CONDITION (asthma, pneumonia, heart failure, etc)
  • oxygen therapy
  • drugs (bronchodilators, inhaled steroids, mucolytic, anti-anxiety)
48
Q

Managing pulmonary secretions

A
  1. Mobilize (promote gas exchange and shorter hospitalstays)
  2. Hydrate (thin secretions)
  3. Humidification (keep airway moist and thin secretions/ nebulizations)
  4. Medications (mucolytics etc)
49
Q

Positioning

A

Position patient for maximum respiratory function.

  • change frequently
  • upright, unsupported is best
  • helps prevent atelectasis
  • helps mobilize secretions
  • bedridden= Q2H
50
Q

Cough and Deep breath

A

NUR 333 Exam Preps (2 decks)

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