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NUR 213 > Unit 2 - Oxygenation > Flashcards

Unit 2 - Oxygenation Flashcards

1
Q

4 mm diameter airway
abdominal breathers (ribcage is more flexible)
trachea is more narrow (higher risk for choking)
airway is the size of a straw
about 50 million alveoli for children
small nares (easily occluded)
tilting a child’s head during CPR can occlude it

A

differences in a child and their anatomy in regards to breathing

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2
Q

diaphragm and gag reflex changes
nervous system changes (less efficient)
gastroesophageal reflux
kyphosis (can’t expand lungs as well)

A

oxygenation in older adults

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3
Q

air moving into lungs and oxygenation of blood should nearly match.
- this is considered normal

A

near match

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4
Q

ventilatory or oxygenation failure. patient will be hypoxic matter what.

A

mismatch

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5
Q

inadequate gas exchange

A

acute respiratory failure

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6
Q

oxygen level in the blood

A

hypoxemia (emia: blood)

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7
Q

oxygen level in the tissue

A

hypoxic

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8
Q

problem with the lungs or the respiratory trigger in the brain.
- defined by partial pressure of arterial carbon dioxide (paCO2), level above 45 mmHg (hypercapnia), plus academia (pH < 7.35), and an arterial oxygen saturation (SaO2) less than 90.

A

ventilatory failure

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9
Q
  • neuromuscular disorders
  • central nervous system dysfunction
  • chemical depression
A

extrapulmonary failure

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10
Q
  • airway obstruction

- ventilation perfusion (V/Q mismatch)

A

intrapulmonary failure

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11
Q
  • V/Q mismatch
  • insufficient oxygenation of pulmonary blood at the alveolar level
  • right to left shunting of blood (sign that blood isn’t oxygenating)
  • lung perfusion inadequate
  • defined as a partial pressure of arterial oxygen (PaO2) less than 60 mmHg AND arterial oxygenation saturation (SaO2) less than 90%
A

oxygenation (gas exchange) failure

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12
Q
  • often occurs in patients with abnormal lungs. (chronic bronchitis, emphysema, cystic fibrosis, asthma attack)
  • diseased bronchioles and alveoli causing oxygenation failure
  • work of breathing increases until respiratory muscles unable to function effectively causing ventilatory failure
A

combined ventilatory/oxygenation failure

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13
Q

defined by paO2 less than 60 mmHg (oxygenation failure), PaCO2 greater than 45 mmHg (hypercapnia), and a pH < 7.35 (academia), and SaO2 less than 90%

A

combination ventilatory and oxygenation failure

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14
Q

hallmark of respiratory failure

A

dyspnea

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15
Q

s/sx: restlessness, irritability, agitation, CONFUSION, TACHYCARDIA (heart is compensating), anxious

A

hypoxia

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16
Q

s/sx: decreased LOC (somnolence: hard time waking them up), HEADACHE (too much CO2), drowsiness.
- if left untreated this can lead to seizures and unconcious

A

hypercapnia

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17
Q

s/sx: decreased LOC, drowsiness (not excessive), confusion, HYPOTENSION, BRADYCARDIA, weak peripheral pulses, weakness

A

acidosis

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18
Q

client exhibits:

  • dyspnea
  • nasal flaring
  • use of accessory muscles to breathe
  • pursed lip or diaphragmatic breathing
  • decreased endurance
  • skin, mucous membrane changes (pallor, cyanosis)
A

there is a need for oxygen

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19
Q

what is the goal of oxygen therapy?

A

use lowest fraction of inspired oxygen (FiO2) for acceptable blood O2 level without causing harmful side effects

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20
Q

how is acute respiratory failure treated?

A
  • drug therapy: nebulizer
  • comfort
  • relaxation : this decreases anxiety
  • energy conserving measures
  • deep breathing exercises
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21
Q
  1. ) nasal cannula (based on O2 sat) after 4L needs to be humidified
    2) non rebreather mask: starts at 10-15 L
A

oxygen techniques

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22
Q

a pH level < 7.35

A

acidosis

23
Q

a pH level between 7.35 - 7.45

A

normal pH level or compensated

24
Q

a pH level > 7.45

A

alkalosis

25
Q

pH level is decreased, PaCo2 level is increased and HCO3 is normal

A

respiratory acidosis

26
Q

pH level is increased, PaCO2 is decreased and HCO3 is normal

A

respiratory alkalosis

27
Q

pH level is decreased, PaCO2 is normal and HCO3 is decreased

A

metabolic acidosis

28
Q

pH level is increased, PaCO2 is normal and HCO3 is increased

A

metabolic alkalosis

29
Q

what is the patient goal in regards to oxygenation?

  • maintain PaO2 > 60 mmHG
  • SaO2 > 90% at the lowest O2 concentration
  • position upright
  • energy conserving (cluster care)
A

breathing patterns and ABG’s within patient’s baseline

30
Q

what do you do when the patient’s goal is an effective cough with ability to clear secretions.

A

Interventions:
- mobilization and liquidation of secretions through:
hydration and humidification
deep breathing exercises
chest physical therapy
airway suctioning: you can hear when it’s needed and you auscultate afterwards to gauge if it was successful

31
Q

what is the number one cause of ARDS?

A

sepsis

32
Q

characterized by:

  • refractory hyoxemia (hallmark s/sx) when max of supplementaal O2 is used and the O2 stats are still not coming up.
  • decreased pulmonary compliance
  • dyspnea
  • noncardiac pulmonary edema
  • dense pulmonary infiltrates on CXR
  • occurs after an acute lung injury (ALI)
A

Acute Respiratory distress syndrome (ARDS)

33
Q 
A = atelectasis (surfactant being decreased or not being reproduced)
R = refractory hypoxemia 
D = decreased lung compliance
S = surfactant cell damage
A

Acute Respiratory distress syndrome (ARDS)

34
Q

what is considered a direct insult to ARDS?

A
  • pulmonary infections
  • aspiration of gastric contents
  • inhalation injuries
  • near drowning (w/ fresh HO the patient will be hypotonic. fluid out of lungs into bloodstream. w/ ocean H20 it would be hypertonic. the fluid would be pulled in)
  • embolism
35
Q

what is considered a indirect insult to ARDS?

A
  • body (not lung) sepsis
  • trauma
  • GI infections (pancreatitis)
  • drug overdoes (depressed O2)
  • blood transfusion (multiple)
  • cardiopulmonary bypass
  • burns
36
Q

beginning of ARDS that is characterized by edema.

A

exudative

37
Q

the only way to treat an ARDS patient is with?

A

ventilation

38
Q

The stage of ARDS that is characterized by the body attempting to repair

A

fibroproliferative phase

39
Q

the stage of ARDS where death occurs or the body can take care of the cause.

A

resolution phase

40
Q

a “white-out” CXR is indicative of what ?

A

end-stage

41
Q

what diagnostic test would be done in regards to ARDS?

A
  • ABG analysis
  • Blood test (CBC, WBC, BNP, electrolytes)
  • sputum culture
  • pulmonary function test (tells how well the lungs are able to expand)
  • BNP (normal is < 100) this is done to tell you whether or not it is cardiac related
42
Q

what type of position is best for a patient with ARDS?

A

a prone position. helps move secretions and relieves pressure off the back of the lungs

43
Q

what are the initial clinical manifestations of someone with ARDs?

A

dyspnea
tachypnea
initially the breath sounds are clear

44
Q

what clinical manifestations are there when ARDS progresses?

A
  • increase RR, intercostal retraction, use of accessory muscles
  • rales, rhonchi will develop
  • cyanosis develops
  • refractory hypoxemia
  • changes in mental status
45
Q

what kind of diet will someone with ARDS be on ?

A

decreased carb and fat. Told to avoid saturated fats

46
Q

what kind of medication would someone with ARDs be prescribed?

A
  • bronchodilators
  • corticosterioids (used later in ARDS)
  • neuromuscular blockers
47
Q
  • a fever over 100.4 or less than 96.8
  • tachycardia greater than 90
  • tachypnea greater than 20
  • WBC greater than 12,000 or less than 4,000
A

criteria for systemic inflammatory response syndrome (SIRS)

48
Q
  • identify at risk clients
  • client interview (>70 y.o.)
  • respiratory assessment (use of accessory muscles? intercoastal retractions? dyspnea? dyspnea on exertion?)
  • altered body temp (really high or really low)
  • mental status (build up of CO2 then LOC)
  • cardiac assessment (tachy b/c O2 blood not in blood, decreased CO)
  • immunocompromised
  • smoking
  • liver/pancreas issues
  • asthma/emphysema
  • COP or resp infection in 3/4 days
A

assessment of someone with ARDS

49
Q
  • fluid and electrolytes (retention of H2O and Na)
  • renal perfusion and function
  • perfusion assessment (skin, cap refill)
  • neurological assessment
  • pulmonary wedge pressure
  • intake and output (retaining fluid? perfusion to kidneys)
  • daily weights
  • enteral or parenteral nutrition (TPN or JP tube least to most invasive)
  • administer neuromuscular blocking agents as needed (pancuronium)
A

what should be monitored when a patient is on mechanical ventilation

50
Q
  • establish alternate methods for communications
  • provide good oral hygiene
  • reposition the tube from side to side (prevent skin breakdown)
  • suction when needed** (can hear the need the most in the tracheal area)
  • note markings on the tube to ensure proper position is maintained.
A

care needed for endotracheal tube

51
Q
  • check placement
  • suction airway clearance
  • auscultate lung sounds q4H minimally
  • humidity
  • maintain cuff inflation
  • establish alternate method for communications
  • assess for adequate gas exchange and oxygenation
A

nursing management of artificial airways

52
Q

level goes up with inspiration and down with expiration

A

tidaling

53
Q

review pg. 590 in Iggy

A

Chest Tube information

54
Q 
C = criticial (ex. chest pain, respiratory distress, and sudden changes in LOC)
U = urget (PRN analgesic, responding to bed alarm, and clarifying MD med order before admin)
R = standard daily nursing activities 
E = extras (promote comfort)
A

another method to prioritize

NUR 213 (20 decks)

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