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Foundations of Nursing > Week 8 Oxygenation Part 1 > Flashcards

Week 8 Oxygenation Part 1 Flashcards

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1
Q

explain lung compliance

A

ease of lung inflation

ability of the chest wall to be able to move

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2
Q

Explain external and internal respirations

A

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
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3
Q

Explain the factors that influence pulmonary function

A
  • 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)
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4
Q

What are the factors to consider when thinking about pulmonary function in the older adult

A
  • 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
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5
Q

What are the upper respiratory infections that influence pulmonary function

A
  • cold (no fever, no body aches)
  • rhinosinusitis (adults)
  • pharyngitis (sore throat)
  • influenza (fever, body aches)
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6
Q

what are the lower respiratory infections that influence pulmonary function

A
  • respiratory syncytial virus (RSV)
  • acute bronchitis
  • tuberculosis
  • bronchiolitis (children)
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7
Q

What are the other pulmonary conditions that influence pulmonary function

A
  • pulmonary system abnormalities (pneumos)
  • pulmonary circulation abnormalities (p.e.)
  • central nervous system abnormalities (stroke pt w/ head trauma)
  • neuromuscular abnormalities (MS, Lou Gehrig’s)
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8
Q

Name and explain the different breathing patterns

A
  • 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
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9
Q

Name and explain the different sputum color

A
  • 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
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10
Q

What are the ways to assess oxygenation status

A
  • 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
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11
Q

What are the factors that impact oximetry accuracy

A
  • 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)
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12
Q

What are the non-invasive interventions for optimal oxygenation

A
  • 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
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13
Q

What are the therapeutic responses to hypoxemia

A
  • 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
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14
Q

What are the artificial airways used for optimal oxygenation

A
  • oropharyngeal
  • nasopharyngeal
  • endotracheal tubes
  • tracheostomy tubes
  • artificial airway patency (pharyngeal suctioning and deep tracheal suctioning)
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15
Q

Explain the supplemental oxygen used for optimal oxygenation

A
  • oxygen therapy (cannula, mask, transtracheal catheter)
  • use of high flow oxygen
  • use of a mechanical ventilator
  • use of chest tube drainage systems
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16
Q

What are the 3 key things to remember with oxygen therapy

A
  • provides oxygen concentrations greater than room air (21%)
  • oxygen is a medication
  • prescription of dosage and route
17
Q

What are the complications related to oxygen therapy. How can you prevent complications?

A
  • 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
18
Q

Explain a nasal cannula (low flow)

A
  • 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 >)
19
Q

Explain the partial rebreather mask

A
  • 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
20
Q

Explain the nonrebreather mask

A
  • 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
21
Q

Explain high flow delivery devices: venturi mask

A
  • high flow device
  • humidified
  • use different adapters
  • 24% to 60%
  • O2 flow 2 to 15 L/min
22
Q

Explain high flow nasal cannula

A
  • 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
23
Q

Explain a transtracheal oxygen therapy

A
  • delivers directly into the trachea
  • small plastic catheter
  • cannot humidify, rarely used
24
Q

Explain mechanical ventilation

A
  • provides support until underlying pathophysiology process corrected
  • improves ventilation and respiration
  • decreases work of breathing
25
Q

What are the three components of a chest tube drainage device

A
  • suction component
  • water seal component
  • where the drainage collects
26
Q

Explain the key things to keep in mind with a chest tube and the rescue actions to take if something is wrong

A
  • 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
27
Q

What are the health promotion/prevention tools to use to optimize oxygenation in out patient and in patient settings

A

Out-patient:

  • influenza vaccination
  • pneumococcal vaccine
  • smoking cessation

In patient:

  • positioning
  • incentive spirometer
  • mobilizing secretions
  • aspiration precautions
  • prevent healthcare associated pneumonia
  • smoking cessation
28
Q

Explain the 5 A’s to treating tobacco dependence

A
  1. Ask: about tobacco use and document tobacco use status
  2. advise: to quit, use a clear, strong, personalized approach
  3. Assess: willingness to make a quit attempt at this time
  4. Assist: in quit attempt: if client willing refer for counseling and medication, if not willing provide interventions to increase future quit attempts
  5. Arrange: begin follow up beginning first week
29
Q

What are the conditions affecting gas exchange

A
  • 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)
30
Q

What are the different types of pneumonia

What are the characteristics/symptoms

A
  • 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
31
Q

What are the assessments for pneumonia

A
  • auscultate lungs
  • observe sputum color, consistency, and amount
  • observe for cough
  • obtain temp
  • observe for increased RR and breathing difficulty
32
Q

What are the diagnostic tests for pneumonia

A
  • blood tests (CBC for WBCs)
  • chest x-ray (#1 for identifying pneumonia)
  • +/- sputum culture (not standard)
  • pulse ox
33
Q

What are the short term nursing interventions for pneumonia

A
  • hydration, to thin secretions
  • rest, to conserve energy
  • perform deep breathing and coughing exercises
  • position for ease of breathing
  • assist with frequent position changes
34
Q

What are the long term nursing interventions for pneumonia

A
  • 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
35
Q

What are the provider interventions for pneumonia

A
  • 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)

Foundations of Nursing (12 decks)

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