Unit 2 - Oxygenation Flashcards
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
differences in a child and their anatomy in regards to breathing
diaphragm and gag reflex changes
nervous system changes (less efficient)
gastroesophageal reflux
kyphosis (can’t expand lungs as well)
oxygenation in older adults
air moving into lungs and oxygenation of blood should nearly match.
- this is considered normal
near match
ventilatory or oxygenation failure. patient will be hypoxic matter what.
mismatch
inadequate gas exchange
acute respiratory failure
oxygen level in the blood
hypoxemia (emia: blood)
oxygen level in the tissue
hypoxic
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.
ventilatory failure
- neuromuscular disorders
- central nervous system dysfunction
- chemical depression
extrapulmonary failure
- airway obstruction
- ventilation perfusion (V/Q mismatch)
intrapulmonary failure
- 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%
oxygenation (gas exchange) failure
- 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
combined ventilatory/oxygenation failure
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%
combination ventilatory and oxygenation failure
hallmark of respiratory failure
dyspnea
s/sx: restlessness, irritability, agitation, CONFUSION, TACHYCARDIA (heart is compensating), anxious
hypoxia
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
hypercapnia
s/sx: decreased LOC, drowsiness (not excessive), confusion, HYPOTENSION, BRADYCARDIA, weak peripheral pulses, weakness
acidosis
client exhibits:
- dyspnea
- nasal flaring
- use of accessory muscles to breathe
- pursed lip or diaphragmatic breathing
- decreased endurance
- skin, mucous membrane changes (pallor, cyanosis)
there is a need for oxygen
what is the goal of oxygen therapy?
use lowest fraction of inspired oxygen (FiO2) for acceptable blood O2 level without causing harmful side effects
how is acute respiratory failure treated?
- drug therapy: nebulizer
- comfort
- relaxation : this decreases anxiety
- energy conserving measures
- deep breathing exercises
- ) nasal cannula (based on O2 sat) after 4L needs to be humidified
2) non rebreather mask: starts at 10-15 L
oxygen techniques
a pH level < 7.35
acidosis
a pH level between 7.35 - 7.45
normal pH level or compensated
a pH level > 7.45
alkalosis
pH level is decreased, PaCo2 level is increased and HCO3 is normal
respiratory acidosis
pH level is increased, PaCO2 is decreased and HCO3 is normal
respiratory alkalosis
pH level is decreased, PaCO2 is normal and HCO3 is decreased
metabolic acidosis
pH level is increased, PaCO2 is normal and HCO3 is increased
metabolic alkalosis
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)
breathing patterns and ABG’s within patient’s baseline
what do you do when the patient’s goal is an effective cough with ability to clear secretions.
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
what is the number one cause of ARDS?
sepsis
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)
Acute Respiratory distress syndrome (ARDS)
A = atelectasis (surfactant being decreased or not being reproduced) R = refractory hypoxemia D = decreased lung compliance S = surfactant cell damage
Acute Respiratory distress syndrome (ARDS)
what is considered a direct insult to ARDS?
- 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
what is considered a indirect insult to ARDS?
- body (not lung) sepsis
- trauma
- GI infections (pancreatitis)
- drug overdoes (depressed O2)
- blood transfusion (multiple)
- cardiopulmonary bypass
- burns
beginning of ARDS that is characterized by edema.
exudative
the only way to treat an ARDS patient is with?
ventilation
The stage of ARDS that is characterized by the body attempting to repair
fibroproliferative phase
the stage of ARDS where death occurs or the body can take care of the cause.
resolution phase
a “white-out” CXR is indicative of what ?
end-stage
what diagnostic test would be done in regards to ARDS?
- 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
what type of position is best for a patient with ARDS?
a prone position. helps move secretions and relieves pressure off the back of the lungs
what are the initial clinical manifestations of someone with ARDs?
dyspnea
tachypnea
initially the breath sounds are clear
what clinical manifestations are there when ARDS progresses?
- increase RR, intercostal retraction, use of accessory muscles
- rales, rhonchi will develop
- cyanosis develops
- refractory hypoxemia
- changes in mental status
what kind of diet will someone with ARDS be on ?
decreased carb and fat. Told to avoid saturated fats
what kind of medication would someone with ARDs be prescribed?
- bronchodilators
- corticosterioids (used later in ARDS)
- neuromuscular blockers
- 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
criteria for systemic inflammatory response syndrome (SIRS)
- 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
assessment of someone with ARDS
- 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)
what should be monitored when a patient is on mechanical ventilation
- 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.
care needed for endotracheal tube
- 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
nursing management of artificial airways
level goes up with inspiration and down with expiration
tidaling
review pg. 590 in Iggy
Chest Tube information
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)
another method to prioritize
