Chapter 39: Oxygenation and Perfusion Flashcards
(152 cards)
1
Q
Respiratory and cardiovascular system
A
cardiopulmonary system
2
Q
cardiovascular system
A
heart and BV
3
Q
oxygentation
A
process of providing life sustaining oxygen to body cells
4
Q
Importance of data nurse collects about cardiopulmonary system
A
decide if data lead to problem statement, indicate another problem or possible cause of problem
5
Q
upper airway
A
nose, pharynx, larynx, and epiglottis
6
Q
function of Upper airway
A
warm, humidify and filter inspired air
7
Q
lower airway
A
trachea, right and left main bronchi, segmental bronchi and terminal bronchioles
8
Q
lower airway function
A
air conduction, muco-ciliary clearance and make pulmonary surfactant
9
Q
mucus
A
traps cells, particles and infectious debris
protect underlying tissues from irritation and infection
10
Q
Cilia
A
microscopic hairlike projects
propel trapped material and accompanying mucus toward upper airway for coughing removal
11
Q
role of fluid intake for cilia
A
makes mucus watery and allows easier removal from LRS
12
Q
geography of lungs
A
from diaphragm to apex, above the first rib
13
Q
lung composition
A
elastic tissue
14
Q
alveoli
A
small air sacs; gas exchange bc thin layer of cells in wall
15
Q
surfactant
A
phospholipid; reduces surface tension between moist membranes of alveoli; preventing collapse
16
Q
pleural fluid
A
in pleural space btw visceral and parietal pleura; lubricant and adhesive agent that holds lungs in expanded position
17
Q
pressure in pleural space (intrapleural pressure)
A
negative pressure (less than Atm)
18
Q
pulmonary ventilation
A
movement of air in and out of lungs
19
Q
respiration
A
gas exchange between atmosphere air in the alveoli and blood in capillaries
20
Q
perfusion
A
process by which oxygenated capillary blood passes through tissues
21
Q
ventilation
A
inspiration (inhale)
expiration (exhale)
22
Q
events of inspiration
A
- diaphragm contracts and descends
- lengthening of thoracic cavity
- external intercostal muscles contract; lift ribs upward and outward
- sternum pushes forward
- volume increases and pressure decrease => air from atm moves into lungs
23
Q
events of expiration
A
- diaphragm relaxes
- ribs move down
- sternum drops back down
- decreased volume and increased pressure => air moves out
24
Q
factors contributing to airflow in and out of lungs
A
condition of musculature
compliance of lung tissue
airway resistance
25
effects of weakened musculature
- may use accessory muscles of abdomen, neck, back
| called RETRACTION
26
conditions causing harder time inflating lungs (less lung compliance)
- emphysema
| - changes associated with aging
27
airway resistance
any process that changes bronchial diameter or width
28
example airway obstructions
```
food
coin
toy
liquids (drowning)
thickened secretions
tissues (tumor)
decrease in size of airway passages
```
29
Diffusion
movement of gas from high to low concentration
30
Things that affect diffusion of gas in the lungs
- changes in surface area available
- thickening of the alveolar-capillary membrane
- partial pressure
31
Atelectasis
incomplete lung expansion or the collapse of the alveoli
| prevents pressure changes and the exchange of gas by diffusion
32
predisposal to Atelectasis
- obstructions of air by foreign bodies or mucus
- airway constriction
- external compression by tumors or enlarged BVs
- immobility
33
What causes thickening of alveolar-capillary membrane
pneumonia, pulmonary edema
34
Effect of exercise on perfusion
- greater need for O2
- increase in cardiac output
- increased blood return to lungs
35
What affects amount of blood in any given area of lung
position of body
36
What affects perfusion to body's tissues
- adequate blood supply and proper cardiac functioning
37
Where is respiratory system in brain
- medulla, above spinal cord
38
What stimulates medulla of brain
- increased CO2 and H+ ions
| - to a lesser degree: decreased oxygen in arterial blood
39
What stimulates medulla
- chemoreceptors aortic arch and carotid bodies = sensitive to same arterial blood gas levels and blood
- --CAN BECOME DESENSITIZED WITH CHRONIC CONDITIONS
- blood pressure
40
What increases ventilation during body movements
Proprioceptors in muscles and joints
41
Stimulation of medulla
increase rate and depth of breathing
42
Impulse from medulla
goes to spinal cord then to respiratory muscles stimulating contraction
43
Hypoxia
inadequate amount of oxygen available to cells
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symptoms of hypoxia
dyspnea (difficulty breathing), elevated BP with small pulse pressure, increased respiratory and pulse rates, pallor, cyanosis, anxiety, restlessness, confusion, drowsiness
45
Cause of hypoxia
- hypoventilation
| - chronic
46
effects of hypoxia
- altered thought processes
- headaches
- chest pain
- enlarged heart
- clubbing of fingers and toes
- anorexia
- constipation
- decreased urine output
- decreased libido
- weakness of extremity muscles
- muscle pain
47
Circulation
continuous one-way circuit of blood through BV
48
Atria
upper chambers of heart
49
Ventricles
lower chambers of heart
50
Stroke volume
how much blood the left ventricle pumps out with each beat
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Cardiac output
hod much blood the left ventricle pumps out in a min
52
Internal repsiration
exchange of O2 and CO2 between BV and tissues
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SA node
top of right atrium
pacemaker
initiates transmission of electrical impulses
54
AV node
mass of tissue at bottom of right atrium
| delay to let atria contract
55
AV bundle
where impulse is sent after Av node
| divides into right and left bundle branches
56
Purkinje fibers
smaller conduction branches in each ventricle wall
57
Dysrhythmia
disturbance of the rhythm of the heart
58
ischemia
decreased oxygen blood supply to the heart caused by insufficient blood supply
59
Angina
temporary imbalance between amount of O2 needed by the heart and amount delivered to heart muscles
causes chest pain
60
heart failure
heart unable to pump sufficient blood supply, inadequate perfusion and oxygenation of tissues
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Arterial blood gas supply and pH analysis
- determine pressure exerted by oxygen in arterial blood and pH
- measures adequacy of oxygenation, ventilation, and perfusion
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Normal results of Arterial blood gas supply and pH analysis
```
pH: 7.35-7.45
pCO2: 35-45 mm Hg
PO2: 80-100 mmHg
HCO3: 22-26 mEq/L
base excess or deficit: -2-+2 mmol/L
```
63
Prep for Arterial blood gas supply and pH analysis
- inform test involves arterial puncture
- use radial, brachial, or femoral artery
- perform Allen test to ensure adequate ulnar flow if using radial artery
64
Aftercare for Arterial blood gas supply and pH analysis
- record supplemental O2 or respirator settings on specimen info
- specimen on ice and to lab
- apply 5-10 min of pressure
- watch for bleeding
- apply more pressure if taking anticoagulants
65
Cardiac Biomarkers
- Creatine kinases and isoenzymes are enzymes released bc of injury to tissues, including heart muscle
- Troponin found in skeletal and cardiac muscle fibers and released after injury to heart
- used to monitor cardiac injury and myocardial infarction
- help determine extent and timing of damage
66
Perp for Cardiac Biomarkers
- review procedures, inform this test can assist in assessing for heart damage
- series of samples will be taken, sample could be taken 3-4 times in 3-4 hour intervals
- inform that specimen collection is about 5-10 min
- address concerns about pain and explain there may be some pain during venipuncture
- no food, fluid, or med restrictions unless noted by HCP
67
Aftercare for Cardiac Biomarkers
- recognize anxiety
- provide teaching and info regarding test results
- reinforce info given by HCP regarding further testing, treatment, or referral to another HCP
- depending on results, additional testing may be needed to eval or monitor the progression of illness
- eval test results in relation to patient's symptoms, HC problems and other tests performed
68
Complete blood count (CBC) preparation
- review proced w pat
- inform this test eval body's response to illness
- inform the collection = 5-10 min
- address pain concerns and explain some discomfort during venipuncture
- no food, fluid or med restrictions unless HCP says so
69
Complete blood count (CBC) aftercare
- reinforce info given by HCP regarding further testing, treatment, or referral to another HCP
- depending on results, additional testing may be needed to eval or monitor the progression of illness
- eval test results in relation to patient's symptoms, HC problems and other tests performed
70
Cytologic study
microscopic examination of sputum and cells it contains
| detect cells that may be malignant, determine organisms causing infection and identify blood or pus in sputum
71
Cytologic study prep
- collect spcimen (morning b4 breakfast)
- 3 successive days of sputum collection
- 1 teaspoon needed for specimen
- pt deep breath and cough
- sterile container with possible preservative
- close with tight lid
72
Cytologic aftercare
- label and pack then send to lab
73
thoracentesis definition
puncturing chest wall and aspirating pleural fluid
| used for either diagnostic purposes or to remove build up of fluid
74
thoracentesis pat position
sitting on chair or edge of bed with legs supported and arms folded, resting on pillow on bedside table
75
thoracentesis nursing responsobilities
- collecting baseline data
- preparation physically and emotionally
- instruct pt not to cough or breath deeply
- monitor color, pulse, RR, deviation from baseline
- fainting, nausea, vomiting
- send specimen to lab
76
outcomes wanted for improvement in oxygenation
- restore optimum function related to oxygenation
- alleviate symptoms or side effects of disease or treatment
- prevent complications
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Example outcomes for oxygenation
pg. 1500
78
nursing interventions related to oxygenation
- promote optimal functioning of cardiopul. systems
- promote comfort
- promote and control coughing
79
Hoe nurses can intervene to help oxygenation
- suctioning the airway
- meeting resp needs with medications
- providing supplemental oxygen
- managing chest tubes
- using artificial airways
- cleaning obstructed airway
- CPR
80
How to promote optimal health in those with altered oxygenation
- encourage vaccination
- teach them importance of living in pollution-free environ
- minimize anxiety
- promote good nutrition
-
81
How to promote healthy lifestyle for better cardiopulmonary function
- healthy diet
- healthy weight
- exercise (150 min a week)
- monitor cholesterol, triglyceride, lipoprotein (HDL), and LDL. BP
- limit alcohol intake and stop smoking
82
Who is at risk for influenza
young children, pregnant women, people with chronic health conditions like asthma or heart and lung disease, 65+ yrs old
83
age limit for influenza vaccine
6 months of age and older
84
Pneumococcal disease
caused by pneumococcus bacteria
types:
- Pneumococcal pneumonia, meningitis, otitis media
85
long of Pneumococcal disease
- brain damage
- hearing loss
- limb loss
GET VACCINE
86
how to prevent exposure to environmental triggers
- job change
- use of PPE
- requesting enforcements of anti-pollution laws by governing facilities
- subcontracting jobs
- dust and vacuum
87
Effects of smoke inhalation
- increases airway resistance
- reduces ciliary action
- increases mucus production
- causes thickening of alveolar-capillary membrane
- causes thickening of bronchial walls to thicken and lose elasticity
88
Most common cause of COPD
Smoking
89
Cancer and smoking
increases risk for cancers of:
- oral cavity
- esophagus
- lung
- urinary bladder
- kidneys
90
smoking and BVs
- narrows BV
| - causes coronary heart disease
91
increase risks for smoking
- stroke
- peripheral vascular disease
- abdominal aortic aneurysm
92
Good eating habits for good cardiopulm health, and decreased obesity
```
fruits
veggies
low-fat dairy products
whole grains
variety of protein foods
reduced sat fats, trans fats, added sugars, sodium
```
93
how to promote comfort
- proper positioning
- adequate fluid intake
- humidification of inspired air
- appropriate breathing techniques
94
Comfortable position for people with dyspnea
-high- Fowler's
| eases use of accessory muscles
95
Comfortable position for people with acute respiratory distress syndrome
prone position
| posterior dependent sections of lungs better ventilated and perfused
96
daily fluid intake
1.9-2.9 L/ day
97
When increased fluids are needed
- elevated temp
- people breathing through mouth
- people coughing
- people losing excessive body fluids
98
When to LIMIT fluid intake
- heart failure
| - low sodium levels (1.5L)
99
Benefits of humidified air
- reduces irritation and infection due to dry air
100
Use of breathing exercises
patients achieve more efficient and controlled ventilations
decrease work of breathing
correct respiratory deficits
101
Deep breathing
-overcome hypoventilation
- deep breath to bottom of ribs
- start with deep breaths nasally then expire slowly through mouth
(hourly while awake or four times daily)
102
Using incentive spirometry
- assists patient to breathe slowly and deeply to sustain max inspiration
- can measure own progress
- optimal gas exchange
- secretions cleared and expectorated
103
Pursed-lip breathing
- for patients who experience dyspnea and feelings of panic
- slows and prolongs expiration
- good for COPD
- pat sits upright and inhales through nose
- counts to three
- exhales slowly against pursed lips
- tighten ab muscles
- exhales and counts to 7
- walking: 2 steps inhale; 4 steps exhale
104
Diaphragmatic Breathing positives
- reduces RR
- increase alveolar ventilation
- helps expel as much air as possible during exhalation
105
breathing of people with COPD
shallow, rapid, exhausting pattern
106
Steps of Diaphragmatic Breathing
- one hand is one stomach and other on chest
- patient breathes slowly through nose
- breathes out through lips
- allow contraction of ab muscles
- one hand inward and upward on abdomen
- repeat for 1 min
- 2 min rest
107
coughing
cleansing mechanism
108
Nonproductive cough
dry cough
109
Productive cough
produces secretions
110
respiratory secretion expelled by coughing or clearing throat
sputum
111
congetion
excessive fluid or secretions in organ or body tissue
112
thick resp secretions
phlegm
113
series of events producing cough
- initial irritation
- deep inspiration
- quick, tight closure of glottis together
- forceful contraction of expiratory intercostal muscles
- upward thrust of diaphragm
- air moves from lower to upper Rt
- most effective when pat it sitting upraight with feet flat on floor
114
Effective coughing
Coughing + deep breathing
115
Early morning cough
removes secretions from night
116
Coughing before meals
improves taste of food and oxygenation
117
coughing at bedtime
improves sleep
| removes buildup of secretions
118
assisted cough
- firm pressure on abdomen below diaphragm in rhythm with exhalation
-
119
Involuntary cough
- respiratory tract infections and irritations
- triggered by secretions
- must examine cough to determine best kind of medication
120
Expectorants
- reduce viscosity of secretions
- can make nonproductive cough productive
- ex Guaifenesin
- fluid intake and air humidfication
121
Cough supressants
- Codeine (BUT addictive)
- Non-addictive= dextromethorphan
- only for sleep
122
Lozenges
- relieve mild nonprod cough without congestion
- in mouth until it dissolves
- usually control coughs bc of local anesthetic effects of benzocaine (acts on sensory and motor nerves)
123
Bad effects of cough meds with high sugar or alcohol
- disturb metabolic balance of pt with diabetes mellitus
| - tigger relapse of alcoholics
124
Bad effects of cough meds with antihistamines
- anticholinergic action
| - problems with people with glaucoma or urinary retention in men with enlarged prostate
125
Bad effects of cough meds
- some bad for hypertension or thyroid/cardiac diseases
| - some suppress other bad health effects
126
Chest physiotherapy
- loosen and mobilize secretions
- percussion, vibrations, postural drainage
- NOT for children with pneumonia, adults with COPD and postoperative care adults
127
Reason for suctioning of airway
- suctioning pharynx
- maintain patent airway
- remove saliva, blood, pulmonary secretions, vomitus, foreign material
128
Negative of suctioning airways
- may induce hypoxemia (insuff ox in blood)
- -- PREOXYGENATE PATIENT
- irritates mucosa
129
Prep for suctioning airway
- individualized pain management
- oxygen
-
130
Complications of suctioning airway
- infection
- cardiac arrhythmias
- hypoxia
- mucosal trauma
- death
131
PPE for suctioning airways
- gloves
goggles
mask
gown
132
What to monitor for during suctioning
- color
- HR
- blood
- cyanosis
133
What to avoid when taking meds used to dilate bronchial airways
caffeine
134
Inhaled meds given to open narrowed airways
bronchodilators
135
Inhaled meds given to loosen thick secretions
mucolytic agents
136
Inhaled meds given to reduce inflammation
corticosteroids
137
how inhaled meds are given
- dry powder inhaler (DPI)
- nebulizer
- metered-dose inhaler (MDI)
138
Nebulizer
- disperse fine particles of liquid med into deep passages of resp tract
139
MDI
```
deliver controlled dose of med with each compression of canister
common mistakes (1506)
```
140
DPIs
breath activated
no coordination to activate it and inhale like with MDIs
Med clump if exposed to humidity
141
Important things to teach about inhaled meds
- overuse= serious side effects and ineffectiveness
- know how to clean nebulizer effectively
- must keep track of dosing with MDI
- must use deep inspirations
- spacer is using corticosteroid inhaler to prevent oral fungal infection
142
Oxygen prescription
must be prescribed EXCEPT if it is an emergency situation or decreasing O2 saturation or tachypnea
143
Therapeutic oxygen
- wall outlet or portable cylinder tank
- flow meter attached to wall outlet
- valve regulates O2 flow in meters per minute
- regulator releases O2 safely and at desired rate
- ---two gauges
- --one nearest to tank shows pressure or amount of O2 in tank
- ---other indicates number number of liters per minute of O2 being released
144
oxygen concentrators
- concentrate room air to provide the appropriate amount of O2
- can be used with portable tank
145
oxygen conserving device
- pulse of O2 at beginning of inspiration
146
Oxygen flow rate
- liters per minute
- determine amount of O2 delivered when using wall outlet or portable cylinders
- depends on pt condition and route of O2
- can analyze air pt is breathing to monitor O2 percentage
147
What to monitor with supplemental Oxygen
- RR
- pule oximetry
- ABG results
148
Humidification with suppl oxygen
only at rate higher than 4L/min
149
safety with O2
1509
150
Nasal cannula
most common
| connect to O2 with flow meter and humidifier
151
Face masks
- Simple
- ---O2 tubing, humidifier, flow meter, vents on both sides
- --used for increased oxygen for less than 24 hrs
- ---possible skins breakdown bc pressure and moisture
- ---hard to eat and talk
- --NEVER apply with flow rate < 5l/min
- Partial rebreather
- ---reservoir bag
- ---should only deflate slightly with inspiration
- Nonbreather
- --- delivers highest concentration of O2 via mask to spontan. breathing patient
- --- cannot rebreathe exhaled air
- ---can be used for heliox admin
- Venturi
- --allows mask to deliver most precise amount of O2
- --side ports pull O2 in as tube narrows and pressure drops
- --1511
152
Liquid O2
-kept in small container refilled with large tank in home
| -
