Week 8 Oxygenation Part 1 Flashcards
explain lung compliance
ease of lung inflation
ability of the chest wall to be able to move
Explain external and internal respirations
External:
- alveolar-capillary gas exchange
- conditions that slow diffusion include: pleural effusion, pneumothorax, asthma
- hypoxemia
Internal:
- capillary-tissue gas exchange
- requires adequate external respirations and adequate peripheral circulation
- hypoxia (problem with tissues)
- transition from lungs to organs
Explain the factors that influence pulmonary function
- life span and development (respiratory distress syndrome, upper respiratory infection, adolescent smoking, cardiac insufficiency)
- environment (stress, allergies)
- lifestyle (nutrition, exercise, substance abuse
- smoking
- medications (diuretics which pull fluid off to help with breathing)
What are the factors to consider when thinking about pulmonary function in the older adult
- reduced lung expansion and less alveolar inflation (costal cartilage calcify, lungs have less recoil ability, alveoli lose elasticity)
- difficulty expelling mucous or foreign materials
- diminished ability ventilate with increased demand (diaphragm strength decrease, vital capacity reduced)
- declining immune response
- gastroesophageal reflux more common
- chemoreceptors response slows
- they lose their ability to take deep breaths so they begin air trapping the CO2
What are the upper respiratory infections that influence pulmonary function
- cold (no fever, no body aches)
- rhinosinusitis (adults)
- pharyngitis (sore throat)
- influenza (fever, body aches)
what are the lower respiratory infections that influence pulmonary function
- respiratory syncytial virus (RSV)
- acute bronchitis
- tuberculosis
- bronchiolitis (children)
What are the other pulmonary conditions that influence pulmonary function
- pulmonary system abnormalities (pneumos)
- pulmonary circulation abnormalities (p.e.)
- central nervous system abnormalities (stroke pt w/ head trauma)
- neuromuscular abnormalities (MS, Lou Gehrig’s)
Name and explain the different breathing patterns
- eupnea: normal breathing
- tachypnea: over 24 breaths
- bradypnea: slower than 12 breaths
- Kussmaul’s: rapid; causes acidosis; diabetic ketoacidosis
- Biot’s: rapid breathing
- Cheyne-stokes: rapid with periods of apnea
- Apnea: no breaths over a 20 second period
Name and explain the different sputum color
- white or clear: viral infections (normal cold)
- yellow or green: neutrophil response (inflammatory response but not indicative of being infectious)
- black: coal dust, smoke or soot inhalation
- rust colored: pneumococcal pneumonia, tuberculosis
- hemoptysis: blood or bloody sputum (frank blood, not old blood)
- pink and frothy: pulmonary edema
- foul smelling sputum: bacterial infection
What are the ways to assess oxygenation status
- diagnostic testing (sputum samples, skin testing)
- pulse ox
- capnography (CO2)
- spirometry (component of pulmonary function testing, computer analyzes how well they are able to move air with forced expiration
- ABG
- peak flow monitoring
What are the factors that impact oximetry accuracy
- client movement (ear probe, nasal sensor)
- acrylic nails/nail polish
- dirt and skin oils
- poor perfusion (position, cool extremities and disease process)
- lighting (cover the probe with blanket to help)
- anemia, carbon dioxide (they don’t have hemoglobin to carry the oxygen)
- equipment function (bring in another machine)
- rely on clinical judgement/assessment (most important)
What are the non-invasive interventions for optimal oxygenation
- positioning: maximum lung excursion
- mobilizing secretions: deep breathing and coughing, hydration, chest physiotherapy
- therapeutic self
- incentive spirometry
- intermittent positive pressure breathing
- acapella vibratory PEP therapy device
What are the therapeutic responses to hypoxemia
- use a calm and confident approach
- provide emotional support and comfort
- sit down and make eye contact
- keep the patient informed of what you are doing
- hold the person’s hand
- practice therapeutic touch
What are the artificial airways used for optimal oxygenation
- oropharyngeal
- nasopharyngeal
- endotracheal tubes
- tracheostomy tubes
- artificial airway patency (pharyngeal suctioning and deep tracheal suctioning)
Explain the supplemental oxygen used for optimal oxygenation
- oxygen therapy (cannula, mask, transtracheal catheter)
- use of high flow oxygen
- use of a mechanical ventilator
- use of chest tube drainage systems
What are the 3 key things to remember with oxygen therapy
- provides oxygen concentrations greater than room air (21%)
- oxygen is a medication
- prescription of dosage and route
What are the complications related to oxygen therapy. How can you prevent complications?
- oxygen toxicity
- support combustion
- oxygen tanks high pressure
- skin break down
complication prevention:
- assess face, ear and neck skin q 4-8 hours
- mouth care
- pad elastic band/tubing
- cleanse equipment
- cleanse and moisturize skin
Explain a nasal cannula (low flow)
- most commonly used
- two soft nasal prongs
- low levels of oxygen
- 24% (1L/min) to 44% (6L/min)
- can be humidified (must humidify 4L/min or >)
Explain the partial rebreather mask
- simple mask plus attached reservoir bag
- keep reservoir bad 1/3 to 1/2 full on inspiration
- flow rate 8 to 10 L/min
- provides 50% to 75% O2
- advantage: can deliver high levels of O2
Explain the nonrebreather mask
- similar partial rebreather
- one way valve: prevents exhale air from entering bag
- one way valve: sides of mask
- inflate at one third to one half
- minima flow rate 10L/min
- provides 90% O2
Explain high flow delivery devices: venturi mask
- high flow device
- humidified
- use different adapters
- 24% to 60%
- O2 flow 2 to 15 L/min
Explain high flow nasal cannula
- air oxygen blender
- active humidifier
- deliver heated and humidified gas up to 60L/min
- reduces anatomical dead space
- positive end expiratory pressure
- constant FIO2 and humidification
- soft flexible prongs
Explain a transtracheal oxygen therapy
- delivers directly into the trachea
- small plastic catheter
- cannot humidify, rarely used
Explain mechanical ventilation
- provides support until underlying pathophysiology process corrected
- improves ventilation and respiration
- decreases work of breathing
What are the three components of a chest tube drainage device
- suction component
- water seal component
- where the drainage collects
Explain the key things to keep in mind with a chest tube and the rescue actions to take if something is wrong
- assess resp system, mental status, VS, pain
- monitor chest drainage, dressing, tissue around dressing, possible air leaks
- actions: reposition O2, encourage use of arm on affected side; promote pulmonary toileting (positioning is vital)
- do not clamp chest tube, milk or strip tubing
Rescue:
- tube pulled out: cover with dry, sterile dressing
- tube disconnects from drainage system: immerse end in at least 2 cm H2O to reestablish water seal
What are the health promotion/prevention tools to use to optimize oxygenation in out patient and in patient settings
Out-patient:
- influenza vaccination
- pneumococcal vaccine
- smoking cessation
In patient:
- positioning
- incentive spirometer
- mobilizing secretions
- aspiration precautions
- prevent healthcare associated pneumonia
- smoking cessation
Explain the 5 A’s to treating tobacco dependence
- Ask: about tobacco use and document tobacco use status
- advise: to quit, use a clear, strong, personalized approach
- Assess: willingness to make a quit attempt at this time
- Assist: in quit attempt: if client willing refer for counseling and medication, if not willing provide interventions to increase future quit attempts
- Arrange: begin follow up beginning first week
What are the conditions affecting gas exchange
- upper respiratory infections
- lower respiratory infections (RSV, acute bronchitis, pneumonia, TB)
- structural abnormalities (fractures ribs, kyphosis, pneumothorax, fluid in pleural space)
- airway inflammation/obstruction (asthma, COPD, foreign object, laryngospasm, swollen structures)
- atelectasis
- alveolar capillary membrane disorders (pulmonary edema, acute respiratory distress syndrome, pulmonary fibrosis)
- pulmonary circulations abnormalities (PE, pulmonary hypertension)
- CNS abnormalities (trauma, stroke, spinal cord injuries, immature breathing patterns)
What are the different types of pneumonia
What are the characteristics/symptoms
- inflammation of lung parenchyma
- community acquired pneumonia
- health care associated pneumonia
- ventilator associated pneumonia
Characteristics/symptoms
- cough
- malaise
- pleural pain from coughing
- discolored sputum
- fever and chills
- dyspnea
- elevated WBC
What are the assessments for pneumonia
- auscultate lungs
- observe sputum color, consistency, and amount
- observe for cough
- obtain temp
- observe for increased RR and breathing difficulty
What are the diagnostic tests for pneumonia
- blood tests (CBC for WBCs)
- chest x-ray (#1 for identifying pneumonia)
- +/- sputum culture (not standard)
- pulse ox
What are the short term nursing interventions for pneumonia
- hydration, to thin secretions
- rest, to conserve energy
- perform deep breathing and coughing exercises
- position for ease of breathing
- assist with frequent position changes
What are the long term nursing interventions for pneumonia
- eat well balanced meals
- get adequate rest
- exercise
- avoid smoking
- avoid others with URIs
- drink large amounts of fluids
- void spread by washing hands
- prompt treatment: contact provider if fever increases and fatigue is not subsiding
What are the provider interventions for pneumonia
- antipyretics (decrease temp)
- expectorants (to help get secretions out but not trying to suppress cough)
- anti-infective agents (oral and IV)
- chest physiotherapy
- oxygen therapy
- respirator inhalations (nebulizers, Ventalin or flovent)
