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Therapeutic Skills > Week 8 - Respiratory Care > Flashcards

Week 8 - Respiratory Care Flashcards

1
Q

Hypoventilation

A

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

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2
Q

Hyperventilation

A

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
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3
Q

Properties of respiration control (3)

A
  1. Normally involuntary (controlled by ANS)
  2. Mediated by the respiratory center in the brain stem
  3. Breathing patterns change in response to varying levels of CO2 AND O2 in the blood
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4
Q

Stimulus to Breathe

A
  1. Normal stimulus to breathe in most people is an increase in CO2 or hypercapnia
  2. A decrease in O2 (hypoxemia) also increases respirations, but less effective than hypercapnia
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5
Q

Hypercapnia

A

increase in CO2 in bloodstream

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6
Q

Hypoxia and signs (8)

A

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)
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7
Q

Hemoptysis

A

Blood in cough

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8
Q

Considerations for Infants and Children (3)

A
  • Surfactant not present until 32w gestation
  • Smaller size of the respiratory system
  • Immune system immaturity
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9
Q

Considerations for Pregnancy (3)

A
  • Decreased space for lung expansion
  • Increased circumference of thoracic cage
  • Increased O2 demand
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10
Q

Considerations for Aging Adults (4)

A
  • Costal cartilage calcification (stiff)
  • Decreased respiratory muscle strength
  • Decreased elasticity within the lungs (more rigid, harder to inflate)
  • Increase in small airway closure
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11
Q

Four Major Functions of the Respiratory System

A
  1. Supply oxygen to the body
  2. Remove carbon dioxide
  3. Maintain homeostasis (acid-base balance)
  4. Maintain heat exchange
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12
Q

Hypovolemia

A

Caused by shock and severe dehydration and decreased circulating blood volume

= increased HR and vasoconstriction

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13
Q

Anemia

A

Low hemoglobin levels, resulting in decreased oxygen-carrying capacity

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14
Q

Ventilation

A

Process of moving air in and out of the lungs (muscular/physical)

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15
Q

Diffusion

A

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)

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16
Q

Perfusion

A

The ability of the CV system to pump oxygenated blood to the tissues and return deoxygenated blood to the lungs.

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17
Q

The RIGHT ventricle pumps blood through the _______.

A

pulmonary circulation

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18
Q

The LEFT ventricle pumps blood to the _________.

A

systemic circulation

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19
Q

The four chambers of the heart FILL with blood during _______.

A

diastole

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20
Q

The four chambers of the heart EMPTY with blood during _______.

A

systole

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21
Q

Four types of factors influencing oxygenation

A

physiological
developmental
lifestyle
environmental

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22
Q

Physiological factors influencing oxygenation (7)

A

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

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23
Q

Lifestyle factors influencing oxygenation (5)

A
  • smoking
  • exercise
  • nutrition
  • substance use
  • stress
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24
Q

Environmental factors influencing oxygenation

A
  • air quality/smog/pollutants

- altitude

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25
Q

Oropharyngeal and nasopharyngeal suctioning

A

Used when pt is able to cough effectively but unable to clear secretions by swallowing or expectorating

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26
Q

Tracheal suctioning

A

Suctioning of the artificial airway.

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27
Q

Oral airway

A

The simplest type of artificial airway, intubated through the mouth into the trachea

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28
Q

Tracheal airway

A

Used in patients with decreased LOC or airway obstruction

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29
Q

Developmental factors influencing oxygenation

A

Age-related changes resulting in decreased ability for the lungs to expand.

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30
Q

Inspiration

A

Active process, stimultated by chemical receptors in aorta.

Requires diaphragmatic contraction and lung expansion/intercostal muscle expansion

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31
Q

Expiration

A

Passive process depending on elastic-recoi in the lungs. and relaxation of diaphragm and intercostal muscles

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32
Q

Alterations in Respiratory Function (3)

A

Hyperventilation (alveolar)
Hypoventilation (alveolar)
Hypoxia (cellular)

33
Q

Causes of Hyperventilation (6)

A 
Anxiety
Infections
Fever
Shock
Acid-base imbalance
Meds (e.g., ASA, amphetamines)
34
Q

Causes of Hypoventilation (5)

A 
Atelectasis
Brain stem injury
Neuromuscular impairment
Opioid overdose
COPD*
35
Q

Atelectasis

A

collapse of alveoli

36
Q

Causes if Hypoxia (6)

A
  • 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)
37
Q

Pulmonary Function Test (PFT)

A

measures lung volume and capacity

38
Q

Arterial Blood Gases (ABG) test

A

measures the adequacy
of tissue oxygenation

Involves blood sample, assessment of adequacy of ventilation, oxygen deivery, and acid-base balance

39
Q

Pulse Oximetry (SPO2)

A

indirect measure of oxygen

saturation

40
Q

Imaging

A

x-rays and CT scans provide visualization of lung fields

41
Q

Methods for Mobilization of Airway Secretions (4)

A
  • Humidification
  • Nebulization
  • Chest Physiotherapy (CPT)
  • Postural Drainage
42
Q

Types of Suctioning (3)

A
  • Oropharyngeal & nasopharyngeal
  • Orotracheal & nasotracheal
  • Tracheal
43
Q

Types of artificial airways

A

Oral, nasal and endotracheal

44
Q

Humidification (what, why, for who)

A
  • Process of adding water to gas
  • Keeps airways moist and helps to loosen secretions
  • Needed for clients receiving O2 > 4Lpm
45
Q

Nebulization (what, why, for who)

A
  • Process of adding moisture or medications to inspired air
  • Improves clearance of pulmonary secretions
  • Often used for bronchodilators and mucolytic agents
46
Q

Chest Physiotherapy (CPT)

what, why, for who, contraindications

A
  • 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)
47
Q

Postural Drainage positions

A

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
48
Q

Oropharyngeal and nasopharyngeal suctioning (use, considerations, contraindications)

A

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
49
Q

Orotracheal and nasotracheal suctioning

A

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.

50
Q

Tracheal Suctioning

A

suction via an artificial airway (endotracheal or tracheal tube)

Choose a suction catheter no bigger than 50% of airway diameter.

51
Q

Yankauer Suction

A

Used for oropharyngeal suctioning of saliva and respiratory secretions

52
Q

Open suction tubing

A
  • 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
53
Q

Closed suction tubing

A
  • Used for clients requiring mechanical ventilation

- Can receive continuous oxygenation while being suctioned

54
Q

Principles of Suctioning (10)

A
  • 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)

55
Q

Hazards of over-suctioning (6)

A
  • trauma to airway
  • drying of airway
  • lower O2 levels (hypoxia)
  • bronchospasms
  • cardiac arrhythmia
  • nosocomial infection
56
Q

Suctioning Technique: Nasopharyngeal and Nasotracheal

A
  • 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
57
Q

Suctioning Technique: Tracheal Suction

A
  • 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
58
Q

Types of artificial airways and when to use them (3)

A 
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
59
Q

Bag Masks (ambu bags)

A

Used in emergency situations when O2 and ventilaition are needed.

Can be used with or without ETT

60
Q

Non-invasive methods for lung expansion (4)

A
  • Ambulation
  • Positioning
  • Cough techniques and deep breathing exercises
  • Incentive spirometer (IS)
61
Q

Invasive methods for lung expansion

A

Chest tubes

Inserted to remove air and fluids form pleural space in the lung

62
Q

Incentive Spirometer (IS)

A

Little breathing device used to practice and measure breathing exerises.

5-10 breaths every hour while awake. Gamifies deep breathing exercises.

63
Q

Types of oxygen delivery devices (2)

A

Wall-mounted

Portable O2 tank

64
Q

Low-flow oxygen devices (purpose and 4 examples)

A

Oxygen concentration varies depending on breathing pattern

Examples

  • Nasal cannula
  • Simple face mask
  • Non-rebreathing mask (aka reservoir mask)
  • Face tent
65
Q

FiO2

A

mixture of room air and O2 delivered to patient (ex: 28%)

66
Q

High-flow devices

purpose and 1 example

A

Provide a fixed FiO2 regardless of breathing pattern

Example:
Venturi mask

67
Q

Oximizer

A

Special type of nasal cannula that gives higher FiO2 while using less O2 - concentrates O2 in pendant.

Downside: do not humidify

68
Q

Nasal Cannula

A

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
69
Q

Simple face mask

A

Low-flow device; short-term use

Used to deliver [O2] of 40-60%
Can be uncomfortable

70
Q

Non-rebreathing mask (aka reservoir mask

A

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%

71
Q

Venturi Mask

A

High-flow device

  • More precise delivery of [O2] through use of adapter.
  • For clients with COPD or very unstable clients
72
Q

Oxygen Safety Precautions (5)

A
  • 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
73
Q

Risks of O2 Administration (5)

A
  • Nosocomial infection from equipment
  • Skin breakdown around the mask, ears, and nares
  • Hypoventilation in patients with COPD
  • Absorption atelectasis
  • Oxygen toxicity
74
Q

Absorption atelectasis

A

Reduction in alveolar volume and ultimate collapse of alveoli

75
Q

Oxygen Toxicity
(Risk factors; Manifestation;
Prevention)

A

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

76
Q

Cardiopulmonary physiology involves the delivery of ________ to the right side of the heart and to the pulmonary circulation

A

deoxygenated blood

77
Q

Cardiopulmonary physiology involves the delivery of __________ from the lungs to the left side of the heart and the tissues.

A

oxygenated blood

78
Q

Process of blood flow through the heart

A

*Blood flow through the heart is unidirectional, with help of valves

  1. Deoxygenated blood enters RA through the superior venae cavae
  2. Flows through tricuspid valve into RV.
  3. From RV out through pulmonic valve into PA into lungs. 4. Oxygenated blood from pulmonary vein into LA
  4. Through mitral valve into LV
  5. Contraction of the heart increases pressure in atria, blood leaves ventricles through aortic valve and aorta into the system

Therapeutic Skills (11 decks)

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