Respiratory Panopto Part 2 Flashcards
Reduced oxygen levels in the blood =
Hypoxemia
Poor diffusion at the alveolar-capillary level (like Pulmonary Edema, Atelectasis) =
Hypoxemia
Not enough tissue oxygen ANYWHERE in the body, especially at the cellular level =
Hypoxia
Hypoxia for how long can lead to permanent brain damage?
3-5 Minutes
Causes of Hypoxia:
Hypoventilation (Not enough air, poor ventilation)
Hypoxemia (Low O2 levels from poor diffusion)
Low RBC (Decreased O2 carrying capacity)
Alterations in your respiratory function can be things like-
Hypoxia
Altered Breathing Pattern (Khusmal’s, Cheyne-Strokes)
The level of the O2 in the blood is measured as the-
pO2
A low pO2 can be labeled as-
Hypoxemia
Will lab values vary from place to place?
Yes
A normal lab value range for pO2 =
80 - 100 mm Hg
A normal lab value range for SaO2 =
95% - 98%
A normal lab value range for pCO2 =
35-45 mm Hg
A normal lab value range for RBC =
Men = 4.6 - 6.0 mm3 (Average is 5 Million)
Women = 4.0 - 5.0 mm3 (Average is 4.5 Million)
A normal lab value range for HgB =
Men = 13.5 - 18 g/dl
Women = 12 - 15 g/dl
A normal lab value range for HcT =
Men = 40% - 54%
Women = 36% - 46%
% of RBC’s in plasma, usually about 3x the HgB =
HcT
HcT is increased in -
HcT is lower in-
FVD (Fluid Volume Deficit)
Over-Hydration
What are your best indicators of tissue oxygenation?
pO2 and HgB
A low HgB and RBC value can be caused by-
Anemia
Hemorrhage
Blood Cancers (like Leukemia)
A low HgB value is gonna mean less oxygen can be carried by the blood. This results in-
Difficult Respirations
HcT can be used as an indicator for-
Hydration Status (Remember, High = Dry)
Amount of oxygen that is dissolved in the blood =
PaO2
Your Oxygen Saturation, the amount of oxygen that is bound to your hemoglobin =
SaO2
If your SaO2 is 90%, then what does that mean?
90% of your hemoglobin has O2 bound to it
Your Pulse Oximetry, this is an indirect measurement of O2 Saturation =
SpO2
What is the normal lab value for your SpO2?
94 - 99 %
What is the normal lab value for your Pa02?
80-100 mm Hg
What is the normal lab value for your SaO2?
Greater than 95%
Which indicates the need for continuous O2 therapy?
A.) SpO2 92%, PaO2 65 mm Hg
B.) SpO2 95%, PaO2 70 mm Hg
C.) SpO2 90%, PaO2 60 mm Hg
D.) SpO2 88%, PaO2 55 mm Hg
D
Early Clinical Manifestations of Hypoxia:
Respiratory Changes:
Tachypnea
LOC Changes:
Restless, Irritable, Anxious
Skin Changes:
Pallor
Abnormal Labs:
Low pO2
Low SaO2 (O2 Saturation)
High pCO2 (this is called Hypercapnia)
Late Clinical Manifestations of Hypoxia:
Respiratory Changes:
Dyspnea at rest + Use of Accessory Muscles
LOC Changes:
Confusion
Skin Changes:
Cyanosis
Abnormal Labs:
Low pO2
Low SaO2 (O2 Saturation)
High pCO2 (this is called Hypercapnia)
Is Nasal Flaring a good thing?
Nope
What late respiratory changes concerning hypoxia might you witness in children?
Substernal or Intercostal Retractions
Nasal Flaring
Why do LOC changes happen because of hypoxia?
Lack of oxygen to the brain
Hypercapnia is also referred to as-
Hypercarbia
Elevated level of CO2 in the blood =
Hypercapnia
What is Hypercapnia caused by?
Hypoventilation or whenever the Alveoli are ventilated but not perfused
The accumulation of carbon dioxide in the blood causes the pH of the blood to-
Drop, leading to a state of Respiratory Acidosis
Hypoxia & Hypercapnia, Intervention =
Hypoxia & Hypercapnia = These are Medical Emergencies, should be treated promptly.
Failure to initiate oxygen therapy when needed can cause serious harm or death to the pt.
Oxygen therapy can be started without a provider’s order in emergency situations.
Other Interventions:
Elevate HOB + Tripod Positioning + Breathing & Coughing Techniques + O2 Therapy & Equipment + Respiratory Meds + Suctioning + Pain Relief + Chest Physiotherapy + Flutter Valve + Plan Rest Periods + Assess Anxiety Level + Assess for Sleep Apnea + Assess if the Hypoxia or Hypercapnia is an adverse effect from a medication (like Opioids) + Attempt to treat the cause of the Dyspnea (CPAP or BIPAP may be needed)
Enhanced Coughing & Breathing Techniques =
Pursed-Lip Breathing, Incentive Spirometer, Cough & Deep Breathing Exercises, Huff Coughing, Vibratory Positive Expiratory Pressure (PEP) Therapy
Huff Coughing is a technique that helps-
Remove mucous from lungs
What is it called when you begin breathing with a slightly active expiration against an expiratory resistance?
PEP Therapy
Helps people to take slow, deep breaths =
Incentive Spirometer
For an incentive spirometer, are you supposed to inhale into the device, exhale into the device, or both?
You are supposed to inhale into the device
What are the steps for the Huff Coughing Technique?
Sit up straight with chin tilted slightly up and mouth open.
Take a slow deep breath to fill lungs about three quarters full.
Hold breath for two or three seconds.
Exhale forcefully, but slowly, in a continuous exhalation to move mucus from the smaller to the larger airways.
Repeat this maneuver two more times and then follow with one strong cough to clear mucus from the larger airways.
Do a cycle of four to five huff coughs as part of your airway clearance.
After each round of 20 exhales using the PEP, you should-
When should you stop using the PEP?
Give 3 deep coughs
Whenever you feel light-headed
What is the difference between ABG’s and Pulse Oximetry?
ABG’s are an invasive and direct method that can give you your pO2 and SaO2 values.
These can either be done by an Arterial Puncture (Intermittent Analysis with Many Sticks)
Or via a Arterial Catheter (Intermittent Analysis with No Sticks)
Oximetry is a non-invasive, indirect, and continuous method.
Measures SpO2 with a Pulse Oximeter.
Can probe the finger, toe, ear, or bridge of the nose.
What are the pro’s and con’s of Oximetry?
Useful in decreased LOC. Part of routine Vital Signs.
Low accuracy, SpO2 is less than 70% with motion, thick nails, or anemia.
Useful in the ICU or in a Pre-Op situation where the pt is sedated
When in doubt about your oximetry levels, what should you do?
Verify with an ABG
If a patient is unconscious or sedated, can this mask hypoxia?
Yes, so Oximetry can be helpful in finding out if a patient has hypoxia
Oximetry can be used to adjust-
O2 Flow Rates
What maintains the rate, rhythm, and depth of respirations?
The Respiratory Center
Chemoreceptors react to changes in-
Hydrogen, Oxygen, and Carbon Dioxide
In a healthy person, what is the strongest stimulus to increase respiratory rate and depth?
An increase in pCO2
COPD client adapts to chronic, high levels of -
It is because of this that COPD pt’s are insensitive to high-
pCO2
pCO2 Levels
Does a low level of O2 stimulate respiration in some COPD clients?
Yes
High levels of O2 may do what to a person’s stimulus to breathe?
Reduce It
Low flow O2 = How Many Liters?
This amount is not always enough for many people with-
1-3 L
COPD
The patient diagnosed with COPD has been discharged to home.
Which action indicates that the patient understands the plan of care?
A.) Promises to do pursed-lip breathing.
B.) States actions to reduce pain.
C.) Uses O2 via nasal cannula at 8L/min.
D.) Agrees to call the provider if dyspnea on exertion increases.
D is correct
Pain is not a symptom with chronic lung problems, Pleurisy is though.
It is not A because promises from the client are not measurable.
Patient’s with COPD should use low flow oxygen, not an 8L/min nasal cannula.
An inflammation of the pleura causes the membranes to rub and grate against each other =
Pleurisy
Low flow rate oxygen is not always enough for many people with COPD.
What should you assess to ensure that you are making the right choice when giving a patient low flow rate oxygen?
Tiltrate O2 should be based on SpO2, ABG’s, and their LOC
What are two things that you must ask your patient?
What their priorities are, often times their priorities do not line up with nursing priorities.
What their expectations are from their visit.
What are some respiratory related health history things to figure out about if your patient has?
Health Risks
Pain
Fatigue
Dyspnea
Cough
Environmental & Occupational Exposures
Smoking
Respiratory Infections
Allergies
Medications
What are the steps of your physical examination again?
Inspect, Palpate, Percuss, & Auscultate
Clubbing means that there is a-
Chronic lack of oxygen (COPD)
You are assessing your patient for clubbing, their nails are at a 160 degree angle. What does this mean?
Normal
You are assessing your patient for clubbing, their nails are at a 180 degree angle. What does this mean?
How should the end of the nail feel?
Early Clubbing
Springy, and Floating
You are assessing your patient for clubbing, their nails are at degree angle higher than 180. What does this mean?
How should the end of the nail feel?
Clubbing
Swollen, Springy, and Floating
Vesicular breathing noises are-
Normal
Normally heard anteriorly over 1st and 2nd intercostal spaces and between shoulders posteriorly. This breathing sound has intermediate intensity and pitch with the duration of the expirations and inspirations being equal =
Bronchovesicular
Loud, harsh breathing sounds with a midrange pitch =
Bronchial
Soft, low-pitched breathing sounds =
Vesicular Breathing
Should you auscultate all the lobes of the lungs when checking respiratory?
Yup
Continuous gurgling or bubbling sounds typically heard during both inhalation and exhalation. Produced by constricted larger airways, including the tracheobronchial passages =
Rhonchi breathing sound
An abnormal, high-pitched respiratory sound produced by irregular airflow in a narrowed airway =
Stridor breathing sound
When fluid is in the lungs, you will hear this breathing sound =
Crackles
A high-pitched whistling sound made while breathing. Caused by inflammation and narrowing of the airway in any location, from your throat out into your lungs =
Wheezing
What should you palpate for whenever it comes to the respiratory system?
Palpate the chest wall for Fremitus
What are you typically percussin for whenever it comes to the respiratory system?
Fluid in the alveolar or bronchial passages
A sensation felt by a hand placed on a part of the body (such as the chest) that vibrates during speech =
Fremitus
Is Diaphragmatic Breathing Useful?
Ye
Incentive Spirometry is used specifically to-
Expand the lungs
What are your primary levels of prevention for respiratory illnesses?
Hydration
Vaccinations
A Healthy Lifestyle
What are your secondary levels of prevention for respiratory illnesses?
Airway Maintenance & Proper Breathing
Deep Breathing & Coughing Exercises
Diaphragmatic & Pursed Lip Breathing
Chest physiotherapy
Incentive Spirometry to expand lungs
Percussion, vibration, and postural drainage to mobilize secretions. These are all examples of-
Chest Physiotherapy
The pt is bradypneic. What is the role of the UAP (Unlicensed Assistive Personnel)
Take vitals + respirations and report those
The pt is bradypneic. What is the role of the LPN?
They can administer oxygen + reposition the pt
The pt is bradypneic. What is the role of the RN?
Anything that requires critical thinking
1.) Initiate O2 administration by nasal cannula
2.) Reapply nasal cannula that fell off pt’s nose
3.) Position for postural drainage
4.) Suction airway
5.) Report to RN a change in respirations & skin color
1= RN
2= UAP
3= LPN
4=
If oral = UAP
If Oropharyngeal or Nasopharyngeal = RN or Respiratory Therapist
5= UAP
A client comes to the ED and reports lightheadedness and shortness of breath. This client has a history of asthma. Which nursing actions are emergent or non-emergent?
1.) Place client NPO
2.) Titrate oxygen to keep the saturations above 92%
3.) Position in semi-high fowlers
4.) Administer albuterol
5.) Provide humidification for the oxygen
6.) Teach purse lip breathing
1 = Non-Emergent
2 = Emergent
3 = Emergent
4 = Emergent
5 = Non-Emergent
6 = Emergent
The nurse is admitting a 70-year-old male to PMC . The client reports shortness of air.
Their Lab Results are as follows:
• 2/22/02 1000 Chest x-ray: Right
lower lobe infiltrate, consistent with
pneumonia.
• 2/22/02 ABG:
Ph: 7.20
pCO2: 25
HCO3: 18
1.) The nurse notes that the pt is experiencing -
2.) To compensate for this imbalance, the patient is experiencing -
1 = Metabolic Acidosis
2 = Kussmaul’s Respirations
A nurse is caring for a client who is wheezing and gasping
for breath just after receiving a dose of amoxicillin. Which
action is the nurse’s priority?
A.) Administer epinephrine parentally
B.) Provide reassurance to the client
C.) Initiate an infusion of 0.9% sodium chloride
D.) Place client on a cardiac monitor
A, because this counter-acts Bronchoconstriction
Which should you worry about first?
Acute problems or chronic problems?
Chronic
A nurse is receiving a hand-off report at the beginning of the shift for four clients. Which client should the nurse assess first?
A.) A client who has macular degeneration and does not want to take his medication.
B.) A client who is taking insulin and has an HbA1c of 7%.
C.) A client who has Graves’ disease and has exophthalmos.
D.) A client who is taking digoxin and is experiencing anorexia.
D, because anorexia is a possible indication of Digoxin Toxicity
What is Graves’ Disease?
What is Exopthalmos?
An immune disorder that results in an overproduction of Thyroid Hormones.
Exophthalmos is whenever you have protruding eyeballs.
1000: Client was brought to the ED by her
daughter due to increased shortness of breath
this morning. The daughter reports that the
client has been running a fever for the past
few days and has started to cough up
greenish-colored mucous and to complain of
“soreness” throughout her body. The client
was recently hospitalized for issues with atrial
fibrillation 6 days ago. The client has a history
of hypertension. Vital signs: T 101.1°F (38.4°C),
P 92, RR 22, BP 152/86, pulse oximetry reading
94% on oxygen at 2 L/min via nasal cannula.
Upon assessment, the client’s breathing
appears slightly labored, and course crackles
are noted in bilateral lung bases. Skin slightly
cool to touch and pale pink in tone; pulse +3
and irregular. Capillary refill is 3 seconds. Client
is alert and oriented to person, place, and
time. The client’s daughter states, “Sometimes
it seems like my mother is confused.”
Select the 4 things below that require a follow up:
vital signs
lung sounds
capillary refill
client orientation
radial pulse characteristics
characteristics of the cough
The nurse is evaluating a client’s plan of care prior to discharge. For each assessment finding below, check to indicate whether findings from this client’s assessment provide evidence of adequate airway clearance, ineffective airway clearance, or evidence is unrelated to airway clearance.
1.) Bilateral Wheezing
2.) Oliguria
3.) Dyspnea
4.) Ineffective Cough
5.) Converses well
6.) Nails pink with rapid capillary refill
7.) Active bowel sounds
1 = This is Evidence of an Ineffective Airway Clearance
2 = This is Evidence Unrelated to Airway Clearance
3 = This is Evidence of an Ineffective Airway Clearance
4 = This is Evidence of an Ineffective Airway Clearance
5 = This is Evidence of Adequate Airway Clearance
6 = This is Evidence of Adequate Airway Clearance
7 = This is Evidence Unrelated to Airway Clearance
