week 7 - breathing Flashcards
oxygenation
need for more oxygen
ventilation
helping (assisting) them to breathe
3 lobes of the right lung
- upper
- middle
- lower
2 lobes of the left lung
- upper
- lower
5 chest osculation techniques
- quiet environment
- remove excess clothing
- apply stethoscope to landmarks
- have the patient inhale and exhale deeply
- listen to 1 full breath
if you hear adventitious sounds during chest osculation what are the 3 things to ask yourself
- are they during the inspiratory or expiratory or both
- where on the chest wall are they
- do they clear with deep breathing or cough
hypoxia
a lack of oxygen to the body cells and tissues
anoxia
absence of oxygen
example of Fio2
the gas mixture at room air has a fraction of inspired O2 at 21% meaning that the fraction of O2 at room air is 21%
Fio2
the fraction of inspired oxygen is the concentration of oxygen in the gas mixture (% of oxygen in the space being measured)
dyspnea
any difficulty in respiratory rate, regularity or effort
bradypnea
is a respiratory rate this is lower than normal for age
tidal volume
normal volume of air displaced between normal inhalation and exhalation
tachypnea
is a respiratory rate that is greater than normal for age
apnea
stopping of breathing
effects of hypoxia
has effects on every body system and every cell but first most rapid effects are seen in the brain
difference between a failed respiratory system and a failed circulatory system
failed respiratory system = O2 can’t get in
failed circulatory system = O2 can’t be distributed
5 neurological effects of hypoxia
- decreased LOC
- confusion
- disorientation
- agitation
- uncoordinated movements
when does hypoxia occur
when the bodies requirements for O2 aren’t met
inspiratory reserve volume
maximal amount of air that can be drawn into the lungs after normal inspiration
residual volume
the volume of air remaining in the lungs after the most forcible expiration
expiratory reserve volume
the additional amount of air that can be expired after normal breath
5 physical signs of respiratory distress
- accessory muscle use
- cyanosis (fingertips = peripheral, central = lips)
- pallor
- diaphoresis
- tripod position
where does cyanosis show first
in the fingertips, if seen near the lips that indicated it is way more severe
general impression
the hands off, from a distance assessment of how distressed a patient is
order of respiratory assessment
- general impression
- physical exam
- vital signs
4 things to look for when giving a general impression
- position
- LOC
- fatigue
- appearance of difficulty
6 things to assess when performing a physical exam
- head
- neck
- chest
- abdomen
- extremities
- speech
what to look for when assessing the extremities
- cyanosis
- radial pulse
- muscle tone
** cyanosis = hypoxia present for awhile
** radial pulse = quicker pulse means quicker respiratory rate
what to look for when assessing the head
- cyanosis
- fatigue
- airway sounds
what to look for when assessing the neck
- accessory muscle use
what to look for when assessing the abdomen
- accessory muscle use in the intercostal muscles
what to look for when assessing the chest
- lung sounds
- accessory muscle use
crackling adventitious sounds
- bubbling or crackle sounds are like when you have a straw in milk and are blowing bubbles
- indicates fluid in the lungs
- best heard on inspiration
- pathology = CHF, pneumonia, bronchitis, fibrosis
what to look for when assessing the speech
how well a person can speak is a useful indicator of how much respiratory distress they are in
- the sound of their voice
- use yes or no (close-ended questions) for someone who can’t breathe well
consolidation adventitious sounds
- low pitch, snoring quality to the absence of breath sounds
- best heard on expiration
- trachea and mainstream bronchi
- pathology = pneumonia, bronchitis, aspiration
aspiration
if the patient’s airway is not clear they will start breathing in whatever is blocking the airway for example vomit, blood etc
wheezing adventitious sounds
- high pitched sound
- air is being forced through a small space
- best heard on expiration but might be present on inspiration
- all lung fields
- pathology = asthma, COPD, bronchitis
pleural rub adventitious sounds
- rubbing or grating
- inflammation of the pleural surfaces (lining of the lungs)
- best heard during inspiration and expiration
- peripheral lung fields
3 things to asses respiratory rates for
- number of breaths per minute
- rhythm
- volume and depth
2 types of rhythm
- irregular
- regular
4 types of volumes
- shallow
- deep
- gasping
- “agonal”
normal respiratory rates
adults = 12-20 breaths per min
children = 15-30 breaths per min
infants = 25-30 breaths per min
pulse oximetry
measures the percentage of hemoglobin bound to a gas (usually O2)
normal pulse oximetry range
92-96 % (based on reading)
**anything below 92% = hypoxic
** values in 70 & 80% = critical
6 caution notes when measuring pulse oximetry
- ambient light
- hypothermia
- carbon monoxide
- poor perfusion
- manicures
- incorrectly position or placed
levels of patient distress
- mild
- moderate
- severe
- respiratory failure
oxygen
stored in pressurized aluminum cylinders
2 sizes of oxygen tanks by letter
- D tank
- M tank
supplemental oxygen
increases the alveolar content of inspired oxygen and decreases the work of breathing
M tank
- bigger
- in ambulance
- is used when a patient has been put into the ambulance and you are moving elsewhere
D tank
- smaller
- used in the field to take to the patient
- in bags on the ambulance
cylinder size for D oxygen tank
0.16
cylinder size for M oxygen tank
1.56
what is the safe residual pressure of a oxygen tank
200 psi
how to calculate a tank life (in minutes)
tank pressure (psi) - are residual pressure x cylinder constant (divided by) flow rate (L/min) = duration of flow in minutes
TRUE or FALSE
it is a routine procedure at the end of shift to check oxygen
FALSE - it is routine procedure at the START of the shift to check the oxygen
what is the tank pressure in psi
- look at the gage
- full tank = 2000 psi
- value on tank indicated pressure
what is the safe residual pressure
- never under 200
- change tank once it reaches just over 200 or else it won’t run smoothly
what are the cylinder constants
D = 0.16
M = 1.56
** will be either constant depending on what tank is being used at the time of calculation
what is the flow rate (L/min)
how much oxygen you are giving the patient
what must be present in order to have oxygen delivery
spontaneous breathing
spontaneous breathing
the movement of gas in and out of the lungs that is produced in response to an individual’s respiratory muscles = natural breathing
5 steps to oxygen administration
- turn on the oxygen source
- select oxygen delivery device
- connect the O2 delivery device to the regulator and select the appropriate flow rate
- apply oxygen delivery deice to patient
- reassess patient
6 ways of oxygen delivery for spontaneously breathing patients
- nasal cannula
- simple face mask
- non rebreather mask
- filtered mask
- controlled concentration mask
- pocket mask
specifications of a nasal cannula
1-6 LPM
24-44 % Fio2
VERY SLOW
specifications of simple face mask
6-10 LPM
35-60% Fio2
specifications of non rebreather mask
10-15 LPM
> 95% Fio2
filtered mask
- the patient is breathing out
- air is being filtered before coming out to help eliminate germs/particles that the patient is breathing out so some is filtered
apneic or ineffective breathing
not breathing or ineffective breathing
what is used to help a patient that has apneic breathing
BVM
BVM
bag valve mask
specifications of BVM
- 15-25 LPM
- 90-100% Fio2 (closer to 100% SPO2)
- 2000mL capacity
- when you see the patients chest start rising = stop squeezing
decreased LOC + respiratory distress =
positive pressure ventilations
establishing an airway in a less responsive patient - 4 techniques in order
- sniffing position
- E2SN (if practical)
- airway adjunct (as needed)
- suction
establishing an airway in an unresponsive/VSA patient - 4 techniques in order
- head tilt chin lift
- sniffing position
- E2SN (if practical)
- oral airway
considerations for ventilating a patient
- tidal volume (vT)
- respiratory rate
- resistance
- compliance
- gastric insufflation (pushing air into stomach, expands stomach, and causes patient to vomit)
2 types of mask placements
- one handed
- two handed
technique for ventilating the patient
- deliver slow - 1 to 2 seconds for each ventilation
- allow for exhalation
- monitor chest rise
- ventilate gently
mnemonic for good BVM seal
JAWS
what does JAWS stand for
J = jaw thrust
A = airways (OPA/NPA)
W = work together
S = slow and small squeezes
6 steps to ventilation
- position patient
- establish airway
- connect BVM to O2
- apply BVM
- ventilate patient
- assess
predictors of a difficult airway
O = obesity
B = beards
E = edentulous (lacking teeth)
S = sleep apnea
E = elderly
