Oxygentation- Exam 1 Flashcards
Lung volumes
Dependent on age, gender, and height.
Tidal volume
Amount of air exhaled following normal inspiration.
Can be affected by: health status, pergnancy, obesity, exercise, COPD, other lung diseases.
Function of aveoli
Promote gas exchange. Swap CO2 for O2.
Normal respiration rate/ what affects RR
12-20
- age
- meds
- exercise
- fear
- anxiety
- pain!
Normal breath sounds/ pitch/ location
Bronchial: high pitch/ heard over trachea
Broncovesicular: medium pitch/ mainstream bronchi
Vesicular: low pitch/ most of normal lung
Crackles/rales
Fine to coarse bubbly sounds, associated with air passing through fluid or collapsed small airways.
Wheeze
High pitched whistling (musical)
Associated with narrow obstructed airways. (Think inflammation/ allergies)
Rhonchi
“Junk in the lungs”
Loud, low pitched rumbling, fluid or mucous in airways. Can usually be resolved with coughing.
Stridor
Very high pitched. Associated with chocking and primarily observed in children.
Bradypnea
rate of breathing regular but abnormally slow (less than 12 breaths/min)
Tachypnea
Rate of breathing regular but abnormally rapid (greater than 20 breaths/min)
Apnea
Respirations cease for several seconds. Persistent cessation results in respiratory arrest. RR=0
Hyperventilation
Rate and depth of respirations increase. Hypocarbia can occur. (Low CO2)
Hypoventilation
Repiratory rate is abnormally low and depth of ventilation is depressed. Hypercarbia can occur (high CO2)
Best way to assess perfusion and diffusion
Oxygen saturation
SpO2 vs SaO2
Normal values
Peripheral oxygen saturation
Arterial oxygen saturation
Normal: 95-100%
What factors can affect an accurate oxygen saturation measurement
- 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
Work of breathing
Effort to expand and contract lungs
-in a normal person, WOB should be quiet with minimal effort.
Involves inspiration (active) and expiration (passive)
What determines WOB?
Rate and depth of breathing.
Use of accessory muscles.
-males: abdominal muscles
-females: thoracic muscles
Compliance
Ability to distend and expand the lungs. Dependent on interthoracic pressure changes.
What increases WOB?
- decreased compliance
- increased airway resistance
- increased accessory muscle use
Factors affecting oxygenation
- 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)
Goal of ventilation=
Establish normal arterial carbon dioxide tension and normal arterial oxygentation tension.
Hypoventilation concept/causes/ SS
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
Atelectasis concept/ conditions associated with
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
Hyperventilation concept/ causes/ ss
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.
Hypoxia
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)
Hypoxia causes
- 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)
Hypoxia s/s
- 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)
Cyanosis (peripheral vs central)
Central: tongue, soft palate, conjuctiva of eye= hypoxia
Peripheral: extremities, nail beds, earlobes= vasoconstriction/circulation not oxygentation problem
RAT BED
Early signs:
R- restless
A- anxiety
T- tachycardia/ tachypnea
Late:
B- bradycardia
E- extreme restlessness
D- dyspnea
Chronic Hypoxia
Associated with chronic lung conditions (COPD)
Common assessment findings:
- cyanotic nailbeds
- clubbing
- barrel chest (AP diameter 1:1 not 2:1)
Dyspnea
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
Dyspnea questions
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)
Cough
Protective reflex to clear trachea, bronch, and lungs of irritants and secretions. Chronic cough often disease related, whereas acute cough often associated with URI.
Cough Questions
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?
Cough/expectorate
- 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
Specimen Collection
- 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.
Sputum culture and sensitivity
Obtained to identify specific microorganism growing in sputum.
Identifies drug resistance and sensitivities to determine appropriate antibiotic therapy.
Sputum for acid-fast bacillus (AFB)
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
Sputum for cytology
Obtained to identify lung cancer and differentiates type of cancer cells.
Pulmonary function tests
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
PEFR- peak expiratory flow rate
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.
Bronchoscopy
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.
Lung scan
Expected findings: normal lung structure without masses.
-used to identify abnormal masses by size and locations. Can be used to find blot clots.
Oxygenation interventions: long-term, preventative measures
- vaccines (flu, pneumonia)
- healthy lifestyle (nutrition exercise)
- STOP SMOKING
- environmental and occupational exposures (miners, factory workers)
Dyspnea management
- difficult to treat
- treat UNDERLYING CONDITION (asthma, pneumonia, heart failure, etc)
- oxygen therapy
- drugs (bronchodilators, inhaled steroids, mucolytic, anti-anxiety)
Managing pulmonary secretions
- Mobilize (promote gas exchange and shorter hospitalstays)
- Hydrate (thin secretions)
- Humidification (keep airway moist and thin secretions/ nebulizations)
- Medications (mucolytics etc)
Positioning
Position patient for maximum respiratory function.
- change frequently
- upright, unsupported is best
- helps prevent atelectasis
- helps mobilize secretions
- bedridden= Q2H
Cough and Deep breath
