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NUR 333 Fund Adult Nursing Care 2 > Week 1 Oxygenation > Flashcards

Week 1 Oxygenation Flashcards

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1
Q

Alveoli

A

Diffusion (exchange of respiratory gasses) occur in alveoli.

They’re at the terminal end of the lower airway.

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2
Q

Tidal volume

A

amount of air exhaled following normal inspiration

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3
Q

Adventitious breath sounds

A

Abnormal breath sounds

• Crackles/rales- fine to coarse bubbly sounds, associated with air passing
through fluid or collapsed small airways

• Wheezes- high pitched whistling, narrow obstructed airways

• Rhonchi- loud low pitched rumbling, fluid or mucus in airways, can resolve
with coughing

  • Stridor- choking, children
  • Pleural friction rub
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4
Q

Bradypnea

A

Rate of breathing is regular but abnormally slow (less than 12 breaths/min).

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5
Q

Tachypnea

A

Rate of breathing is regular but abnormally rapid (greater than 20 breaths/min).

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6
Q

Apnea

A

Respirations cease for several seconds. Persistent cessation results in respiratory arrest.

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7
Q

Hyperventilation vs Hypoventilation

A

HYPER: Rate and depth of respirations increase. Hypocarbia sometimes occurs. Increased WOB.
Causes:
• Anxiety attacks (severe), infection/fever, drugs, acid-base imbalance (pH), aspirin poisoning, amphetamine use

Signs/Symptoms:
• Rapid respirations, sighing breaths, numbness/tingling of hands feet, light-
headedness, loss of consciousness

HYPO: Respiratory rate is abnormally low, and depth of ventilation is depressed. Hypercarbia sometimes occurs.

Causes:
• Medications, alveolar collapse=atelectasis (lung diseases)

S/S:
• Mental status changes, dysrhythmias
• Can lead to cardiac arrest, convulsions

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8
Q

Compliance

A

ability to extend or expand, relies on pressure change

decreased compliance, increased airway resistance, and/or increased accessory muscle use increases WOB

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9
Q

Work of breathing

A
  • Effort to expand and contract lungs
    • Healthy person= quiet, minimal effort
  • Determine by rate and depth
    • Evaluate accessory muscle use
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10
Q

Hypercarbia vs. Hypocarbia

A

HYPER: Increased CO2

HYPO: Decreased CO2

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11
Q

Atelectasis

A

Collapse of alveoli in the lung

Prevents normal respiratory gas exchange

Conditions associated:
    • IMMOBILITY 
    • Obesity 
    • Sleep apnea
    • Chronic lung conditions
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12
Q

Hypoxia

A

Inadequate TISSUE OXYGENATION
• At the cellular level, not enough oxygen to meet needs
• Can be related to a delivery problem

Untreated can lead to cardiac dysrhythmias, why?
• Cardiac cells need oxygen

Causes:
• Decreased hemoglobin levels/low oxygen-carrying capability
• Diminished oxygen concentration of inspired oxygen (think altitude)
• Inability of tissues to get oxygen from blood (cyanide poisoning)
• Decreased diffusion of oxygen from alveoli to blood- infections/pneumonia
• Poor perfusion with oxygenated blood– shock
• Impaired ventilation from traumas– rib fractures

Signs/symptoms:
• Apprehension, restless, inability to concentrate, decreased level of
consciousness, dizziness, behavioral changes

 * Difficulty staying still, lying flat
 * Fatigued, yet agitated
 * Causes increased pulse, increased respirations (rate and depth) 
 * Initially increased blood pressure, then leads to shock/low BP
 * Cyanosis: blue discoloration skin/mucous membranes, late sign of hypoxia 
 * Not a reliable measure of oxygen status
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13
Q

Cyanosis (central and peripheral)

A

• Central cyanosis –> tongue, soft palate, conjunctiva of the eye = hypoxemia

• Peripheral cyanosis –> extremities, nail beds, earlobes = vasoconstriction not
oxygenation problem

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14
Q

Barrel chest

A

AP diameter 1:1

Associated with chronic lung conditions

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15
Q

Clubbing

A

Associated with chronic hypoxia

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16
Q

Dyspnea

A

Abnormal or difficulty breathing

Associated with hypoxia

R/t SOB with exercise or diseases

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17
Q

Sputum

A

Nasal aspirate/swabs for respiratory syncytial virus, influenza

Sputum collection:
• To analyze for pathogens (usually pneumonia, cytology)

  • Best to collect in early morning
  • Wait 1-2 hours after patient eats

• Sterile specimen container– teach patient not to touch the inside of container
or lid

• Tell patients to cough into the container and get as much expectorate sputum
as possible

• If patient too weak or cannot get expectorate into container, may require
suctioning

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18
Q

Cascade cough

A

When using a cascade cough, the patient takes a slow deep breath, holds it for 1 to 2 seconds, then opens the mouth and performs a series of coughs throughout exhalation. This technique is often used in patients with large amounts of sputum, such as those with cystic fibrosis.

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19
Q

huff cough

A

The huff cough stimulates a natural cough reflex and is generally used to help move secretions to the larger airways. The patient inhales deeply and then holds his or her breath for 2 to 3 seconds. While forcefully exhaling, the patient opens the glottis by saying the word huff.

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20
Q

quad cough

A

The quad cough, or manually assisted cough technique, is for patients without abdominal muscle control, such as those with spinal cord injuries. While the patient breathes out with a maximal expiratory effort, the patient or nurse pushes inward and upward on the abdominal muscles toward the diaphragm, causing the cough.

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21
Q

Chest physiotherapy

A

(percussion and postural drainage) is another method still used by respiratory therapists with the goal of keeping the airways clear. It helps the patient drain secretions from specific segments of the bronchi and lungs into the trachea so that he or she is able to cough and expel them.

  • Indications: patients with thick secretions
  • Contraindications: pregnant, rib/chest injuries, increased intracranial pressure, recent abdominal/thoracic surgery, bleeding disorders, osteoporosis
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22
Q

Postural drainage

A

it consists of drainage, positioning, and turning and is sometimes accompanied by chest percussion and vibration. It aids in improving secretion clearance and oxygenation. Positioning involves draining affected lung segments and helps to drain secretions from those segments of the lungs and bronchi into the trachea. Some patients do not require postural drainage of all lung segments, and clinical assessment is crucial in identifying specific lung segments requiring it.

For example, patients with left lower lobe atelectasis require postural drainage of only the affected region, whereas a child with CF often requires postural drainage of all lung segments.

Lecture example:
Lay on unaffected side to promote drainage of one particular lobe
–> Infiltration seen on RIGHT lower lobe. Lay on left side, in Trendelenburg.

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23
Q

FiO2

A

• % of O² in inspired air is referred to as fraction of inspired O² or “FiO²”; Room
air = FiO² of 21%

• Gives oxygen at higher concentration than our ambient air (21%)

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24
Q

Bubbler/ bubble humidifier

A

• Prevents drying out of mucous membranes
• ALWAYS when greater than 4L/M or greater than 24 hours of
supplemental oxygen
• Use with any supplemental oxygen
• Sterile water is used

24
Q

Venturi Mask

A

High Flow Mask

FiO2: 4-12L/min; 24%-50%

Provides the ability to deliver PRECISE oxygen concentration with humidity

Not preferable for long periods of time

Used for pts who need highly regulated O2 concentrations (chronic lung dz)

25
Q

Face tent (aerosol mask)

A

Fits loosely around face and neck, 24%-100% of oxygen

Provides relatively high humidity

See a lot in post-operative

High-flow nasal cannula

Nasal cannula with ETCO2 monitor

26
Q

Non Rebreather vs Partial Rebreather

A

Non Rebreather

  • Flap covers exhalation ports so that patient does not rebreathe exhaled air
  • FiO2: 10-15L/min; 80%-95%
  • Best for a patient in critical need of oxygen, steps before intubation
  • Low flow

Partial Rebreather

  • Partially filled reservoir bag
  • FiO2: 6-11 L/min; 60-75%
  • Used for short periods of dyspnea or other increased oxygen needs
  • Patients’ rebreathe up to 1/3 of exhaled air, helps with humidification
  • Low flow
27
Q

Simple Face Mask

A
  • 6-12 L/MIN: 33-55%
  • Best for short periods, transportation
  • Not great for claustrophobic patients, skin breakdown, higher risk of
    aspiration
  • Low low mask
28
Q

Nasal Cannula

A
  • FiO2: 1-6L/min: 22-44%
  • Safe and well tolerated
  • FiO2 can vary, can lead to skin breakdown, tubing dislodges easily
  • Use humidification if greater than 4L of flow
  • Low flow
29
Q

INCENTIVE SPIROMETER

A
  • Promotes lung expansion through deep breathing
  • Prevents or treats atelectasis
  • Most often used in the post-operative patient
30
Q

SUCTIONING

A

• Indicated when patients cannot clear secretions on their own through
coughing or CPT

  • Sterile procedure in hospital
  • Orotracheal and Nasotracheal (NT) common
  • Sterile catheter passed through nose (NT most common) into pharynx
  • Extremely uncomfortable, often stimulate patient into extreme coughing
  • Should be less than 10 seconds total
31
Q

TCDB

A

Turn cough deep breathe

32
Q

Best positioning for breathing

A

Upright, supported

Semi-Fowlers, High Fowlers

33
Q

How can you manage pulmonary secretions?

A

mobilize, hydrate, humidification, medications

34
Q

CAB

A

Circulation/compressions, airway, breathing

35
Q

Dyspnea Management

A

Difficult to treat, treat underlying condition, O2 therapy, medications

36
Q

Nursing Diagnoses related to oxygenation

A

ineffective airway clearance, risk for aspiration, impaired gas exchange, activity intolerance

37
Q

Symptoms of Hypoxia

A 
Early 
RAT
R - Restlessness 
A - Anxiety 
T - Tachycardia/pnea
Late 
BED 
B - Bradycardia
E - Extreme restlessness
D - Dyspnea
38
Q

Normal SpO2 range

A

95-100%; best is 98%

chronic lung disease – 88%

39
Q

Hyperpnea

A

Not common term used

Respirations are labored, increased in depth, and increased in rate (greater than 20 breaths/min) (occurs normally during exercise)

40
Q

Expected lung sounds

A
  • Bronchial: high pitch, heard over trachea
  • Bronchovesicular: medium pitch, heard over mainstream bronchi
  • Vesicular: low pitch, heard over most of normal lung
41
Q

RR normal range

A

12-20

42
Q

Ventilation

A

movement of gas in and out of lungs

43
Q

Diffusion

A

O2 and CO2 exchange between alveoli and RBC

44
Q

Perfusion

A

Distribution of oxygenated RBC to all tissues in the body

45
Q

The nurse is caring for a patient who came in with respiratory distress. When the nurse enters the room the patient is lying with the head of bed at 10%, has the nasal cannula laying beside them, is complaining they cannot catch their breath, and the O2 sat is reading 84%. What is the first thing the nurse should do?

A

Elevate the head of bed to greater than 45%

46
Q

What instructions given by the nurse are appropriate for a patient who has intermittent episodes of cough accompanied by thick, yellow sputum, and coarse crackles in the lungs? Select all that apply.

A. Drink plenty of water
B. Walk around as much as you can
C. Place a warm compress on the chest
D. Try to spend time in the prone position
E. Perform deep breathing exercises every hour you are awake

A

A, B, E

47
Q

A nurse tells you that her patient has chronic hypoxia. What cues would you recognize as consistent with this condition? Select all that apply.

A. Restlessness
B. Nasal flaring
C. Clubbed finger tips
D. O2 sat 89% on 2L NC 
E. AP chest diameter 2:1 
F. Cap refill >3 seconds 
G. Patient complains of dyspnea 
H. Cyanotic lips
A

C, D, F

Restlessness - acute
dyspnea - acute
AP 1:1

47
Q

A nurse tells you that her patient has chronic hypoxia. What cues would you recognize as consistent with this condition? Select all that apply.

A. Restlessness
B. Nasal flaring
C. Clubbed finger tips
D. O2 sat 89% on 2L NC 
E. AP chest diameter 2:1 
F. Cap refill >3 seconds 
G. Patient complains of dyspnea 
H. Cyanotic lips
A

C, D, F

Restlessness - acute
dyspnea - acute
AP 1:1

48
Q

A patient has been prescribed CPT twice daily. What is the PRIMARY purpose of this intervention?

A

Promote airway clearance

49
Q

The nurse is assessing a patient and find the following:

A: Patient is restless
B: Patient has O2 sat of 93%
C: Patient is on 4L NC
D: Patient refuses to walk

What is the most concerning finding?

A

Patient is restless (hypoxia)

50
Q

Box 41.2 Questions to Ask Associated With Breathing

A

• Describe the breathing problems you are having.
• How has your breathing pattern changed?
• Do you have a cough? Is the coughing increasing? Is it worse at a certain time
of day?
• Describe your cough. Is it dry or moist? Do you have sputum with coughing? Is
this different in color, volume, or thickness?
• On a scale of 0 to 10, with 10 being the most severe, rate your shortness of
breath. What helps your shortness of breath?

51
Q

Box 41.3 Cultural Aspects of CareCultural Impact on Pulmonary Diseases

A

The cigarette smoking rate in the United States is highest in American Indian/Alaskan Natives (24.6%), Caucasians (15.3%), African-Americans (15.1%), Hispanics (9.9%), and Asians (7.0%).

Smoking rates are also highest in those who have less than a high school education (22%) than in those who have a baccalaureate degree or higher (5.8%).

Smoking increases the risk for a number of cancer types, chronic obstructive pulmonary disease (COPD), and heart disease

52
Q

Box 41.5 Impaired gas exchange r/t decreased lung expansion

A

Ask patient or family about patient’s mood, attentiveness, memory, and activity level.

Observe patient’s respirations for rate, rhythm, depth.

Inspect skin and mucous membranes.

Auscultate chest.

53
Q

Figure 41.6 Concept Map

A

Look at image on ipad

54
Q

Table 41.5 Ventilation and Oxygenation Studies

A

Know terminology for different labs, tests.

Not tested on lab values

55
Q

Box 41.7 Guidelines for Chest Physiotherapy

A

Nursing and respiratory therapy collaborate with the health care provider to determine whether chest physiotherapy (CPT) is best for a patient. The following guidelines help in physical assessment and subsequent decision making:

  • Conduct a complete respiratory assessment to confirm need for CPT, including sputum production, effectiveness of cough, history of pulmonary problems successfully relieved with CPT, abnormal lung sounds, and documented conditions such as atelectasis, complicated pneumonia, vital signs, or changes in oxygenation status.
  • Know the patient’s medications. Certain medications, particularly diuretics and antihypertensives, cause fluid and hemodynamic changes. These decrease a patient’s tolerance to positional changes and postural drainage. Long-term steroid use increases a patient’s risk of pathological rib fractures and often contraindicates vibration.
  • Know the patient’s medical history. Certain conditions such as increased intracranial pressure, spinal cord injuries, and abdominal aneurysm resection contraindicate the positional changes of postural drainage. Thoracic trauma or surgery contraindicates percussion and vibration.
  • Know the patient’s level of cognitive function. Participation in controlled coughing techniques requires him or her to follow instructions. Congenital or acquired cognitive limitations alter a patient’s ability to learn and participate in these techniques.
  • Be aware of the patient’s exercise tolerance. CPT maneuvers are fatiguing.
56
Q

Table 41.6 Positions for Postural Drainage

A

Ipad

NUR 333 Fund Adult Nursing Care 2 (4 decks)

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