Week 8 - Respiratory Care Flashcards
Hypoventilation
increases CO2 in the blood
Lower RR than required to eliminate “normal” venous CO2
Signs:
- Dysrhythmias
- Mental status/LOC changes
- Potential for cardiac arrest
- Convulsions, loss of consciousness, death
*can be relieved with use of oral artificial airway
Hyperventilation
decreases CO2 in the blood
Greater RR than required to eliminate “normal” venous CO2
Signs:
- Increased RR and depth
- Respiratory alkalosis
- Agitation
- Loss of consciousness
Properties of respiration control (3)
- Normally involuntary (controlled by ANS)
- Mediated by the respiratory center in the brain stem
- Breathing patterns change in response to varying levels of CO2 AND O2 in the blood
Stimulus to Breathe
- Normal stimulus to breathe in most people is an increase in CO2 or hypercapnia
- A decrease in O2 (hypoxemia) also increases respirations, but less effective than hypercapnia
Hypercapnia
increase in CO2 in bloodstream
Hypoxia and signs (8)
decrease in O2 in tissues (cellular level)
Signs:
- Anxiety (early sign)
- Confusion (early sign)
- Restlessness (early sign)
- Hypotension, tachypnea, dyspnea
- Decreased activity tolerance/fatigue
- Flaring nostrils/pursed lips
- Cyanosis-circumoral, central (late sign)
- Decreased LOC (late sign)
Hemoptysis
Blood in cough
Considerations for Infants and Children (3)
- Surfactant not present until 32w gestation
- Smaller size of the respiratory system
- Immune system immaturity
Considerations for Pregnancy (3)
- Decreased space for lung expansion
- Increased circumference of thoracic cage
- Increased O2 demand
Considerations for Aging Adults (4)
- Costal cartilage calcification (stiff)
- Decreased respiratory muscle strength
- Decreased elasticity within the lungs (more rigid, harder to inflate)
- Increase in small airway closure
Four Major Functions of the Respiratory System
- Supply oxygen to the body
- Remove carbon dioxide
- Maintain homeostasis (acid-base balance)
- Maintain heat exchange
Hypovolemia
Caused by shock and severe dehydration and decreased circulating blood volume
= increased HR and vasoconstriction
Anemia
Low hemoglobin levels, resulting in decreased oxygen-carrying capacity
Ventilation
Process of moving air in and out of the lungs (muscular/physical)
Diffusion
Exchange of O2 and CO2 molecules from areas of high concentration to low concentration throughout the body (organs, nerves, muscles, tissues, etc.)
Happens in alveoli and depending on alveolar membrane thickness
(molecular level)
Perfusion
The ability of the CV system to pump oxygenated blood to the tissues and return deoxygenated blood to the lungs.
The RIGHT ventricle pumps blood through the _______.
pulmonary circulation
The LEFT ventricle pumps blood to the _________.
systemic circulation
The four chambers of the heart FILL with blood during _______.
diastole
The four chambers of the heart EMPTY with blood during _______.
systole
Four types of factors influencing oxygenation
physiological
developmental
lifestyle
environmental
Physiological factors influencing oxygenation (7)
Cardiac disorders, anemia, pregnancy, fever, infection, CNS or chest wall conditions.
I.e.,
- decreased oxygen-carrying capacity
- low [O2] on inspiration
- hypovolemia
- increased metabolic rate
All result in increased O2 needs by the body, increased HR and WOB
Lifestyle factors influencing oxygenation (5)
- smoking
- exercise
- nutrition
- substance use
- stress
Environmental factors influencing oxygenation
- air quality/smog/pollutants
- altitude
Oropharyngeal and nasopharyngeal suctioning
Used when pt is able to cough effectively but unable to clear secretions by swallowing or expectorating
Tracheal suctioning
Suctioning of the artificial airway.
Oral airway
The simplest type of artificial airway, intubated through the mouth into the trachea
Tracheal airway
Used in patients with decreased LOC or airway obstruction
Developmental factors influencing oxygenation
Age-related changes resulting in decreased ability for the lungs to expand.
Inspiration
Active process, stimultated by chemical receptors in aorta.
Requires diaphragmatic contraction and lung expansion/intercostal muscle expansion
Expiration
Passive process depending on elastic-recoi in the lungs. and relaxation of diaphragm and intercostal muscles
Alterations in Respiratory Function (3)
Hyperventilation (alveolar)
Hypoventilation (alveolar)
Hypoxia (cellular)
Causes of Hyperventilation (6)
Anxiety Infections Fever Shock Acid-base imbalance Meds (e.g., ASA, amphetamines)
Causes of Hypoventilation (5)
Atelectasis Brain stem injury Neuromuscular impairment Opioid overdose COPD*
Atelectasis
collapse of alveoli
Causes if Hypoxia (6)
- Anemia
- Decreased concentration of inhaled O2 (high altitude)
- Inability of tissues to extract O2 from blood (cyanide poisning)
- Decreased diffusion of O2 from alveoli to blood (pneumonia)
- Poor tissue perfusion (shock)
- Impaired ventilation (trauma)
Pulmonary Function Test (PFT)
measures lung volume and capacity
Arterial Blood Gases (ABG) test
measures the adequacy
of tissue oxygenation
Involves blood sample, assessment of adequacy of ventilation, oxygen deivery, and acid-base balance
Pulse Oximetry (SPO2)
indirect measure of oxygen
saturation
Imaging
x-rays and CT scans provide visualization of lung fields
Methods for Mobilization of Airway Secretions (4)
- Humidification
- Nebulization
- Chest Physiotherapy (CPT)
- Postural Drainage
Types of Suctioning (3)
- Oropharyngeal & nasopharyngeal
- Orotracheal & nasotracheal
- Tracheal
Types of artificial airways
Oral, nasal and endotracheal
Humidification (what, why, for who)
- Process of adding water to gas
- Keeps airways moist and helps to loosen secretions
- Needed for clients receiving O2 > 4Lpm
Nebulization (what, why, for who)
- Process of adding moisture or medications to inspired air
- Improves clearance of pulmonary secretions
- Often used for bronchodilators and mucolytic agents
Chest Physiotherapy (CPT)
what, why, for who, contraindications
- percussion (cupping) and vibration of the chest
- Used to loosen secretions in the chest
- Used in pts producing large amounts of sputum or who have atelectasis
Contraindications:
- bleeding disorders
- fractured ribs
- steroid med use (increases risk of fractures)
Postural Drainage positions
Used to draw out secretions from specific areas of the lungs, and pt can cough or spit them out as they flow into trachea.
Contraindications:
- clients with increased intracranial pressure
- head injuries
- abdominal aortic aneurisms
- cognitive status needs to be assessed so that they can follow instructions
Oropharyngeal and nasopharyngeal suctioning (use, considerations, contraindications)
Used when pt is able to cough effectively but unable to clear secretions by swallowing or expectorating
Considerations:
Nasal route is preferred to prevent gag reflex stimulation
Contraindications:
- nasal occlusions
- nose bleed
- epiglottitis
- croup
- some head/face/neck sx,
- irritable airway/bronchospasm
- MI
Orotracheal and nasotracheal suctioning
Used when pt is unable to manage secretions by coughing and does not have an artificial airway.
A catheter is passed through mouth or nose into trachea.
Tracheal Suctioning
suction via an artificial airway (endotracheal or tracheal tube)
Choose a suction catheter no bigger than 50% of airway diameter.
Yankauer Suction
Used for oropharyngeal suctioning of saliva and respiratory secretions
Open suction tubing
- Flexible, soft suction catheter
- Used for orotracheal suctioning
- Many sizes
- Measured in “french” (smaller the french the smaller the diameter), determined based on the thickness of secretions
Closed suction tubing
- Used for clients requiring mechanical ventilation
- Can receive continuous oxygenation while being suctioned
Principles of Suctioning (10)
- Assess pt (including SpO2)
- Semi-Fowler’s position
- No suction during insertion of catheter
- Rotate catheter and apply intermittent suction during WITHDRAWAL
- Suction pressure should be maintained between 100-150 mmHg (Adult) but check unit/agency policy
- Suctioning should not exceed 10 seconds per pass
- Administer oxygen between passes
- Wait 1-2 minutes between each pass
- Encourage patient to cough
- Don’t forget the mouth care!
Monitor HR and SPO2 througout
(SPo2 should not drop more than 5% or HR drop of more than 20 bpm or increase of more than 40bpm)
Hazards of over-suctioning (6)
- trauma to airway
- drying of airway
- lower O2 levels (hypoxia)
- bronchospasms
- cardiac arrhythmia
- nosocomial infection
Suctioning Technique: Nasopharyngeal and Nasotracheal
- Use water-soluble lubricant
- Insert during inhalation
Nasopharyngeal:
Approx. 16 cms (length of tip of nose to angle of mandible)
Nasotracheal:
- Approx. 15-20cms. If you hit resistance, pull back by 1-2 cm.
- Turn head to L for R bronchus and R for L bronchus
Suctioning Technique: Tracheal Suction
- Choose a suction catheter no bigger than 50% of airway diameter
- Hyperoxygenate before starting
- Insert catheter until resistance is met and pull back 1-2cm and suction
Types of artificial airways and when to use them (3)
Types: - oral airway - nasal airway - tracheal airways (endotracheal ETT [emergencies, unconscious pts] and tracheal tubes [inserted through surgical inscision])
Indication:
- decreased level of consciousness
- airway obstruction
- help with removal of secretions
Bag Masks (ambu bags)
Used in emergency situations when O2 and ventilaition are needed.
Can be used with or without ETT
Non-invasive methods for lung expansion (4)
- Ambulation
- Positioning
- Cough techniques and deep breathing exercises
- Incentive spirometer (IS)
Invasive methods for lung expansion
Chest tubes
Inserted to remove air and fluids form pleural space in the lung
Incentive Spirometer (IS)
Little breathing device used to practice and measure breathing exerises.
5-10 breaths every hour while awake. Gamifies deep breathing exercises.
Types of oxygen delivery devices (2)
Wall-mounted
Portable O2 tank
Low-flow oxygen devices (purpose and 4 examples)
Oxygen concentration varies depending on breathing pattern
Examples
- Nasal cannula
- Simple face mask
- Non-rebreathing mask (aka reservoir mask)
- Face tent
FiO2
mixture of room air and O2 delivered to patient (ex: 28%)
High-flow devices
purpose and 1 example
Provide a fixed FiO2 regardless of breathing pattern
Example:
Venturi mask
Oximizer
Special type of nasal cannula that gives higher FiO2 while using less O2 - concentrates O2 in pendant.
Downside: do not humidify
Nasal Cannula
Most common low-flow device, allows for more pt freedom
Consideratios:
- Give up to 6L/min O2
- Must humidify (4L/min or – higher)
- Make sure skin around nose and ears are intact during use
Contraindications:
- mouth breathers
- pts prone to nosebleeds
Simple face mask
Low-flow device; short-term use
Used to deliver [O2] of 40-60%
Can be uncomfortable
Non-rebreathing mask (aka reservoir mask
Low-flow device
- Prevents the client from breathing in own CO2 (one-way valve)
- Can be partial or full
Partial: delivers [O2] of 40-70%
Full: delivers [O2] of 60-80%
Venturi Mask
High-flow device
- More precise delivery of [O2] through use of adapter.
- For clients with COPD or very unstable clients
Oxygen Safety Precautions (5)
- Highly combustible
- “No smoking” enforced
- Ensure all electrical equipment is working properly
- Be familiar with fire procedures and the location of the closest fire extinguisher
- Check level of portable tanks prior to transporting patient
Risks of O2 Administration (5)
- Nosocomial infection from equipment
- Skin breakdown around the mask, ears, and nares
- Hypoventilation in patients with COPD
- Absorption atelectasis
- Oxygen toxicity
Absorption atelectasis
Reduction in alveolar volume and ultimate collapse of alveoli
Oxygen Toxicity
(Risk factors; Manifestation;
Prevention)
Risk factors: Receiving oxygen at concentration >50% for >24hours
Damage to the lung and respiratory distress
Manifestations: dyspnea, nasal congestion, cough, sore throat, chest pain with deep breathing
Prevention: Limit use of 100% O2, use lowest concentration possible
Cardiopulmonary physiology involves the delivery of ________ to the right side of the heart and to the pulmonary circulation
deoxygenated blood
Cardiopulmonary physiology involves the delivery of __________ from the lungs to the left side of the heart and the tissues.
oxygenated blood
Process of blood flow through the heart
*Blood flow through the heart is unidirectional, with help of valves
- Deoxygenated blood enters RA through the superior venae cavae
- Flows through tricuspid valve into RV.
- From RV out through pulmonic valve into PA into lungs. 4. Oxygenated blood from pulmonary vein into LA
- Through mitral valve into LV
- Contraction of the heart increases pressure in atria, blood leaves ventricles through aortic valve and aorta into the system
