Unit 5: Oxygenation Flashcards
What diagnostic study measures the arterial blood level of oxygen, carbon dioxide, and pH?
Aterial Blood Levels
The nurse explains to the patient that ABG labs are obtained from a(n) _______ because_________________.
Artery -because- arterial blood is oxygenated.
What arteries are used to obtain ABG’s?
Radial, Brachial, Femoral
How long is pressure applied to the puncture site after obtaining the ABG’s?
Radial/Brachial- 5 minutes.
Femoral- 10 minutes.
What is the function of HCO3?
Maintain normal acid-base balance of the blood.
Where is HCO3 produced? Stored?
Produced & Stored in the Kidneys.
What diagnostic study measures the oxygen saturation of arterial blood non-invasively?
Pulse Oximetry
What does pulse oximetry measure?
Percentage of hemoglobin that combines with oxygen.
What can affect sensor accuracy when performing pulse oximetry?
Patient motion, cigarette smoking, fingernail polish, cold extremities.
What diagnostic study measures lung volume, lung capacities, volume/time relationships, and diffusion/perfusion measurements?
Pulmonary function studies.
What is the best time of day for a sputum specimen?
Morning, before eating.
How are sputum specimens obtained?
1) Having the patient couching up the specimen,
2) Suctioning,
3) Bronchoscopy.
What is defined as the inadequate oxygen at the cellular level?
Hypoxia
What are the S/S of hypoxia?
Tachycardia, hypertension, peripheral vasoconstriction, dizziness, mental confusion.
Severe hypoxia can be identified by what S/S?
Irregular Respirations (Apnea, Cheyne-Stokes, Respiratory Failure)
Define: Atelactasis
Collapse of alveoli, preventing the normal respiratory exchange of oxygen and carbon dioxide.
Alternating periods of apnea and deep rapid breathing is termed:
Cheyne-Stokes
Respirations in which the abdomen moves out while the diaphragm descends on inspiration is termed:
Diaphragmatic Breathing
The presence of free air or gas in the subcutaneous tissues, may produce a crackling or popping sound as air moves under the skin is termed:
Subcutaneous Emphysema
What level should chest tube systems be placed and kept?
Below the chest level.
The nurse assessing the chest tube system notes tidaling of fluid in the water seal chamber. She identifies this as (NORMAL -or- ABNORMAL)
Normal.
The nurse assessing the chest tube system notes bubbling of fluid in the water seal chamber. She identifies this as (NORMAL -or- ABNORMAL)
Abnormal.
What does bubbling in the water seal chamber suggest?
Suggests a leak in the drainage system.
The nurse assessing the chest tube system notes an absence of tidaling in the water seal chamber. What does this suggest?
System is not patent, or lung may have re-expanded.
What should the nurse assess for a patient with a chest tube?
Color, amount, and consistency of drainage in the drainage tube.
Vital Signs, Breath Sounds, SpO2,
Insertion site for drainage and subcutaneous emphysema.
What should the nurse encourage the patient who has a chest tube to do?
Perform deep breathing, coughing, incentive spirometry.
What should be done immediately following the removal of a chest tube?
Apply a sterile occlusive petroleum gauze dressing over the site to prevent air from entering the pleural space.
What is the single most effective method of controlling respiratory secretions?
Coughing
Post operative patients without lung disease should be encourage to do what? Why?
Cough deeply to help mobilize secretions and to open collapsed alveoli.
What are the 5 uses of an incentive spirometer?
1) Improve pulmonary ventilation
2) Counteract the effects of anesthesia
3) Loosen respiratory secretions
4) Facilitate respiratory gas exchange
5) Expand collapsed alveoli.
What position should the patient be placed when using the incentive spirometer? Why?
Sitting up right, Facilitates maximum ventilation.
How does the nurse instruct a post-operative patient without lung disease to use the incentive spirometer?
Place lips over mouthpiece. Inhale slowly and steadily. When maximum inhalation has occured, instruct patient to hold breath for 2-3 seconds, then slowly exhale.
When is oxygen therapy used?
Difficulty breathing, impaired gas exchange, heart failure.
What is needed to administer oxygen therapy?
Doctors order
What does the doctor order in regard to oxygen therapy?
Concentration, method of delivery, and liter flow per minute.
What should be checked before transferring the patient to a portable oxygen tank?
The amount of oxygen within the tank.
When is an oxygen tank considered empty?
Gauge reads less than 500 psi.
What are the two types of oxygen delivery systems?
Nasal Cannula and Face Mask
What are the advantages of the nasal cannula?
Pt is able to eat and talk without interrupted oxygen therapy. More comfortable than face mask.
What are the disadvantages of the face mask?
Improper fitting, poor tolerance by some patients who complain of a smothering feeling.
What are the normal flow rates for the nasal cannula?
2-6 lpm.
What does the nurse assess to determine the need for suctioning?
Respiratory status: dyspnea, adventitious breath sounds, hypoxia, pallor/cyanosis.
What types of suctioning require sterile technique? Clean technique?
Sterile: Nasopharyngeal and Tracheostomy
Clean: Oral
What are the indications for a tracheostomy?
Sever/recurrent upper airway obstruction. Regular aspiration of food/stomach contents. Secretion control (ready access for suction) Long-Term mechanical ventilation.
What tool is used to ease the insertion of a tracheostomy tube?
Obturator
What is the purpose of a chest tube?
Drain fluid, air, or blood from the pleural space.
What type of pressure exists within the thoracic cavity?
Negative pressure.
Pleural space filled with air is termed:
pneumothorax
Pleural space filled with blood is termed:
hemothorax
Pleaural space filled with fluid is termed:
pleural effusion
Air leaking into the pleural space from an opening within the lung is termed:
Closed Pneumothorax
Air leaking into the pleural space from an opening outside of the lung is termed:
Open pneumothorax.
What site is a chest tube inserted for a pneumothorax?
2nd ICS, MCL
What site is a chest tube inserted for a hemothorax or pleural effusion?
5th ICS mid-axillary
Give the 5 reasons for chest tube insertion.
1) Pneumothorax
2) Tension pneumothorax
3) Hemothorax
4) Empyema
5) Following Open Heart Surgery
Define Empyema
Purulent Material/pus in the pleural space
Why is a tension pneumothorax a life-threatening situation?
Deviate the trachea.
Increases pressure on the heart.
Respiratory/Cardiac Failure.
Where is the proximal end of the chest tube inserted?
Pleural space of the lungs.
What three chambers make up the chest tube drainage system?
1) Collection
2) Water Seal
3) Suction
How is collection tracked in a chest tube?
Collection is marked on the drainage system every shift by the nurse.
What type of valve is used to control the water seal camber?
One-way valve.
What should the nurse look for in a water seal chamber?
Tidaling and Bubbling.
Define tidaling.
Fluctuation of water in the water seal chamber. Even with respirations.
What control the amount of suction in the suction control chamber?
The level of water.
Who determines the amount or water to be placed in the water seal chamber?
Dr. writes order.
Suction set too high will be evidenced by what in the suction chamber?
Rapid Bubbling and evaporation of water.
What type of bubbling is normal, and what does it indicate?
Gentle bubbling, indicates settings are correct.
When is water added to the control chamber?
If it is evaporates.
If the suction control chamber is not connected to wall suction, how is the drainage unit operating?
By gravity.
What solution is added in the second chamber to produce a water seal?
Sterile water or NS.
What level is solution added in he 2nd chamber to produce a water seal?
2cm
Where should the chest tube drainage system be placed? Why?
Below the chest, to prevent backflow.
What type of dressing is placed directly over the insertion site and why?
Occlusive petroleum dressing- prevents air from entering pleural space.
How is chest tube placement verified?
CXR
What should chest tube insertion site be monitored for?
Subcutaenous Emphysema
Infection
Drainage
What are 6 complications that may occur with the chest drainage unit?
1) Air Leak
2) Blockage in tubing
3) Inadvertent removal of the chest tube.
4) Disconnection of the chest tube from the drainage system.
5) Chest drainage unit tips over
6) Unit becomes full.
The nurse observes a chest tube is dislodged from the chest. What should the nurse do?
Place an occlusive petroleum gauze dressing over the insertion site.
The nurse observes the chest tube has disconnected from the drainage unit. What should the nurse do?
Place the chest tube in sterile water/NS
The nurse observes the chest tube drainage unit to be tipped over on the floor. What should the nurse do?
Change the drainage system.
What does continuous bubbling in the water seal chamber indicate?
Airleak
How will the nurse prevent air from entering the pleural space when changing the drainage unit?
Clamping the chest tube.
What would the nurse expect to see when the lung has re-expanded?
CXR: Lungs expanded.
Respiratory rate normal
Drainage < 100ml/24hr.
