Unit 5 & 6 Review (Exam 4) Flashcards
What is Inspiration?
Breathing in (diaphragm contracts).
What is expiration?
Breathing out (diaphragm relaxes).
What is Ventilation?
The movement of air in and out of the lungs.
Where does External Respiration occur?
At the most distal point in the airway between the alveolar and capillary membranes.
Where does Internal Respiration occur?
At the cellular level by means of hemoglobin and body cells.
What must we assess for Oxygenation?
- Physical Assessment
- Arterial Blood Gases
- Pulse Oximetry
- Hypoxemia
- Hypoxia
What are ABG’s?
Arterial Blood Gases
What is Hypoxemia?
Insufficient oxygen within arterial blood.
What is Hypoxia?
Inadequate oxygen at the cellular level.
Normal pH
7.35-7.45
PaO2
Partial pressure of oxygen dissolved in plasma; 80-100 mmHg.
PaCO2
Partial pressure of carbon dioxide dissolved in plasma; 35-45 mmHg.
SaO2
Percentage of hemoglobin saturated with oxygen; 95%-100%.
HCO
Bicarbonate level; 22-26 mEq
What is Acidosis?
Low acidity level of 7.35
What is Alkalosis?
High acidity level of 7.45
What does R.O.M.E. represent?
Acid Base Mnemonic
R - Respiratory
O - Opposite
M - Metabolic
E - Equal
What is Pulse Oximetry?
Noninvasive, transcutaneous method of measuring oxygen saturation of blood.
What are ways to promote oxygenation in terms of positioning?
- High Fowler’s
- Tripod
- Orthopneic
What are ways to promote oxygenation in terms of Breathing Techniques?
- Deep Breathing
- Pursed-Lip Breathing
- Diaphragmatic Breathing
- Nasal Strips
What is Oxygen Therapy?
Administering more oxygen than is present in the atmosphere.
What does Oxygen Therapy require?
- Oxygen
- Flowmeter
- Humidifier
- Delivery devices
Types of Oxygen Sources
- Wall Outlet
- Portable Tanks
- Liquid Oxygen Unit
- Oxygen Concentrator
What is the purpose of a Flowmeter?
To regulate the amount of oxygen delivered through a gauge.
How is Oxygen Delivery measured?
Liters per minute (L/min)
FIO2
Fraction of Inspired Oxygen
What are some Oxygen Delivery Devices?
- Nasal Cannula
- Masks
- Face Tent
- Tracheostomy Collar
- T-Piece
What are the signs and symptoms of Oxygen Toxicity?
- Nonproductive Cough
- Substernal Chest Pain
- Nasal Stiffness
- Nausea and Vomiting
- Fatigue
- Headache
- Sore Throat
- Hypoventilation
What are some Oxygen Hazards?
- Fire
- Oxygen Toxicity
Positive Airway Pressure
- Relieve impaired oxygen levels caused by sleep apnea
- Relaxed muscles in the soft palate and tongue cause mild airway obstruction resulting in dyspnea or apnea.
What does OSA represent?
Obstructive Sleep Apnea
What does the Three Chamber System consist of?
One Chamber - Collects blood/acts as a exit route for pleural air
Two Chamber -
What is Intubation?
Placement of a tube into a body.
What is Orogastric Intubation?
Insertion of a tube through the mouth into the stomach.
What is Nasogastric Intubation?
Insertion of a tube through the nose into the stomach.
What is an Ostomy?
A surgically created opening.
Why are gastric/intestinal tubes necessary?
- Gavage; provide nourishment
- Administration of medications
- Diagnostic sampling of secretion
- Lavage; removal of substances from stomach
- Decompression; removing gas and liquid from stomach or bowel
- Temponade (pressure); controlling gastric bleeding
True/False: When choosing the type of tube that is needed, it is a must to remember that the larger the number, the larger the diameter.
TRUE.
What is the purpose of Orogastric Tubes?
- Used emergently to pump stomach contents.
- Tubes such as Ewald is large enough to remove pill fragments and stomach debris.
What is the purpose of Nasointestinal Tubes?
- Used for nutrition; Feeding tubes
What is the purpose of Transabdominal Tubes?
- Used when tube feeding will be necessary for longer than 1 month.
What are the types of of Transabdominal Tubes?
- Used when tube feeding will be necessary for longer than 1 month.
What does the preparation of Nasogastric Tubes consist of ?
- Preparing the client; explain procedure, give instructions on how to assist, provide them with some means of control (waving hand to indicate a pause during insertion)
Nasogastric Tube Preintubation Assessment
- LOC
- Weight
- Bowel Sounds
- Abdominal Distention
- Integrity of nasal and oral mucosa
- Ability to swallow, cough, and gag
- Nausea and vomiting
- Pulse oximetry reading
Nasogastric Tube Management
- Nasal Inspection
- Tube measurement (NEX)
- Tube Placement
- Checking Placement (aspirating stomach fluid, pH of aspirate
- Chest x-ray
- Monitoring external tube length (after x-ray)
True/False: You have to have x-ray placement for feeding.
TRUE.
Gastric Decompression
Suction - continuous/intermittent; prescribed by the physician
Patency - Promoting patency, restoring patency, enternal nutrition (must have doctor’s order)
Indications for removal of Nasogastric Tube
- Client’s condition improves
- Tube is hopelessly obstructed
- Facility standards for maintaining nasal mucosa
- Trial period for oral intake may occure, if asymptomatic tube is removed.
True/False: Transabdominal Tubes are inserted by Physicians.
TRUE.
Tube-Feeding Schedules
- Bolus feeding
- Intermittent feedings
- Cyclic feedings
- Continuous feedings
What is Gastric Residual?
It is done to determine whether the client is receiving too much feeding.
What are the causes of overfilling the stomach?
- Gastric Reflux
- Regurgitation
- Vomiting
- Aspiration
- Pneumonia
Rule of Thumb
The gastric residual should be no more than 100 cc or no more than 20% of the previous hour’s tube-feeding volume.
Maintaining Tube Patency
- Flush tubes with 30-60 ml of water immediately before and after administering a feeding or medications; flush every 4 hours if continously fed.
How to clear an Obstruction
- Use warm water; back/forth motion;
- May have to remove tube
True/False: Adults require 30ml of water per kilogram of weight. Always check for dehydration and fluid overload.
TRUE.
Pharmacologic Consideration
- Liquid medications are preferred for central administration.
- Tablets crushed and mixed with water may reduce GI distress from liquid medications.
Gerontological Considerations
- Elderly clients usually have diminished efficency of gag reflex
- They have ethical considerations for refusal to eat; some older adults tend to tolerate small, continuous feedings.
- Increased risk for fluid and electrolyte disturbances
- Check blood glucose levels with tube feedings.
- Monitor for confusion or agitation
