Normal Values for
Oxygen saturation (SpO2 ) is
95-100%
Normal Values for
Partial pressure of arterial oxygenation: (Pa02) is
60-100mm Hg
Normal Values for
Arterial carbon dioxide tension (PaCO2) is
35-45 mm Hg
4 Physiological factors affecting oxygen
Decreased oxygen-carrying capacity (anemia then subsequent hypoxemia)
Decreased inspired oxygen concentration (High Altitude)
Hypovolemia (trauma, surgery)
Increased metabolic rate (sepsis, illness)
6 Conditions Affecting Chest Wall Movement:
Pregnancy
Obesity
Musculoskeletal abnormalities
Trauma
Neuromuscular disease
CNS alterations
During early stages of hypoxia the blood pressure is _______ unless the condition is caused by shock. As the hypoxia worsens, the respiratory rate _____ as a result of respiratory muscle fatigue.
elevated
declines
3 early Central Nervous System Signs and Symptoms of Hypoxia
apprehension
restlessness or irritability
confusion, poor concentration and lethargy
3 late Central Nervous System Signs and Symptoms of Hypoxia
- Combativeness
- Coma
- confusion
2 early Respiratory Signs and Symptoms of Hypoxia
Tachypnea
Dyspnea on exertion (DOE)
4 late Respiratory Signs and Symptoms of Hypoxia
Dyspnea at rest
Use of accessory muscles
Retractions on inspiration
Pause for breath between sentences, words
3 early Cardiovascular Signs and Symptoms of Hypoxia
Tachycardia
Mild elevated BP
Dysrhythmias
3 late Cardiovascular Signs and Symptoms of Hypoxia
Dysrhythmias
Cyanosis
Cool, clammy skin
- Determines ability of the lungs to efficiently exchange oxygen and carbon dioxide. differentiate pulmonary obstructive from restrictive disease
Pulmonary function studies (PFT)
- Specimen of plural fluid obtained for cytological examination
- Results may indicate an infection or neoplastic disease
Thoracentesis
- Visual examination of the tracheobronchial tree through a narrow, flexible fiberoptic bronchoscope
- Performed to obtain fluid, sputum, or biopsy samples; remove mucus plugs or foreign bodie
Bronchoscopy
- Nuclear scanning test used to identify abnormal masses by size and location
lung scan
can be performed nasally, orally, or via artificial airways such as endotracheal tubes and tracheostomies
Suctioning
Oral suctioning is performed with a ____ device.
Yankauer
Goal is to achieve and maintain a maximal inspiration to improve pulmonary ventilation, loosen secretions, facilitates gas exchange and prevent alveolar collapse.
Incentive Spirometry
Incentive Spirometry Correct use:
exhale normally then slowly and deeply inhale as much as possible, hold 3 seconds and exhale, repeat 10X every hour while awake
Humidification is necessary for clients receiving O2 therapy >__L/min
4
Keep O2 delivery systems ___ feet from open flames
10
Oxygen Capability at 1-6L/min
Nasal Cannula
Best option for patients with COPD as it delivers very low flow oxygen
Nasal Cannula
Provide concentrations of O2 at 4-8L/m
Face Tent
Provides 5-10L of O2
Simple Face Mask
Minimum of 5L/min O2 required to prevent client from re-breathing exhaled carbon dioxide
Simple Face Mask
Provides 6-10 L of O2 per minute
Partial Non-rebreather with a reservoir bag
rebreathe first third of exhaled air in conjunction with O2.
Patient is still taking in room air.
Partial Non-rebreather with a reservoir bag
Provides 10L/min of O2
Non-rebreather Face Mask with reservoir bag
prevent room air and client’s exhaled air from entering the bag so only O2 in bag is inspired
Non-rebreather Face Mask with reservoir bag
4L=24-28%
8L=35-40%
12L=50-60%
Venturi Mask
Hydration ________ml/day
Cough and deep breathe every___ hours while awake
1500-2000
1-2
6 (+1) Rights of Medication Administration
Right Patient Right Medication Right Amount (dose & volume) Right Route Right Time Right Documentation Right Reason Remember: PMART DR
7 things that must be on a medication order
patients full name date and time order is written medication name dosage route time and frequency of administration signature of health care provider
the expected or predicted physiological response of the medication
Therapeutic effect:
: predictable and often unavoidable secondary effect of the medication
Side Effect
: unintended, undesirable and unpredictable severe responses
Adverse effect
: a severe and potentially life threatening allergy requiring immediate medical attention
Anaphylactic reaction
: developed after prolonged intake or when a medication accumulates due to impaired metabolism or excretion
Toxic Effect
- Solid, liquid, sustained release
- Sublingual (under tongue), buccal (side of cheek)
- Inhalation (Aerosolized)
are all considered what kind of medication form
oral
- Skin
- Body Cavity
- Irrigation
are all considered what form of medicaion
topical
- Intravenous
- IV, IO
- Injections
- IM, SubQ, ID
are all considered what form of medication
Parenteral
with oral medication Food may _______ therapeutic effect.
decrease
are enteric-coated or extended release tabs or caps crushable
no
when Giving a medication through a feeding tube Never add directly to a ______
tube feeding
when Giving a medication through a feeding tube
Flush tube with _____ before medication, in between medications, and when done
water
. If GRV is ___ mL or less, return aspirated contents to stomach. If GRV is greater than ____ mL, hold medication
250
Nasal: For access to frontal and ______, tilt head back over edge of bed or pillow with head turned toward side to be treated
maxillary sinus
Eye: Avoid instilling any form of eye medications directly onto the _____
cornea
Ear: instill eardrops at ______ to prevent vertigo, dizziness, or nausea.
room temperature
: Injection into the dermis just under the epidermis
Intradermal (ID)
- typically are used for skin testing
- injection is 5 to 15 degrees
Intradermal (ID)
Injection into tissues just below the dermis of the skin
Subcutaneous:
Syringe (1 to 3 mL) and needle (25- to 27-gauge, 3/8- to 5/8-inch)
when injecting, If you can grasp 2 inches insert at a 90-degree angle; (1 inch) of tissue, 45-degree
Subcutaneous:
: Injection into a muscle
Intramuscular (IM)
_______ are only given intramuscularly.
Immunizations
Syringe 2 to 3 mL
90-degree angle
Intramuscular (IM)
Injection into a vein 25 degree angle
Intravenous (IV):
Injection locations
recommended for volumes greater than 2 mL
Ventrogluteal
Injection locations
recommended for 2ml or less
Deltoid
Injection locations
up to 3 ml
Vastus lateralis
- calibrated in sixteenths of a minim and hundredths of a milliliter and has a capacity of 1 mL
The tuberculin syringe
- Each milliliter of U-100 insulin contains 100 units of insulin.
Insulin syringes
Prevents medication from leaking back into the tissues
Reduces pain and discomfort
Good for elderly patients who have decreased muscle mass
Z-track Technique
Use abdomen, avoiding the 2” area around umbilicus
Never massage
Heparin
Pre-filled syringe
Do not expel air bubble prior to administration
lovenox
Insulin is classified by __________
rate of action
5 Environmental factors affecting nutrition
- Lack of access to full-service grocery stores
- high cost of healthy food
- widespread availability of less healthy foods in fast-food restaurants
- widespread advertising of less healthy food
- lack of access to safe places to play and exercise
to avoid aspirations
- Have patient remain sitting upright for at least ____-_____ minutes after meal.
30 to 60
4 reasons for NG tube
1) Decompression 2) Enteral feeding 3) Compression 4) Lavage
nutrition
Used with patients who have functional GI tract
Enteral
nutrition
Used with patients who have un functional GI tract
Parenteral
4 types of delivery systems for enteral feeding
- Nasogastric tube
- Gastrostomy tube
- PEG tube
- Jejunostomy tube
with enteral feeding If residue volume is >____ml HOLD TUBE FEEDING
200
steps of diet progression
- clear liquid
- full liquid
- thickened/ pureed liquids (dysphagia)
- mechanical soft
- soft/low residue
- high fiber
- low sodium
- low cholesterol
- diabetic
- gluten free
- regular
4 Metabolic complications of parenteral nutrition
- Electrolyte imbalance
- Hypercapnia
- Hypoglycemia-Diaphoresis, shakiness, confusion, loss of consciousness
- Hyperglycemia-
10 Complications of enteral feedings:
- Pulmonary aspiration:
- Regurgitation of formula, Feeding tube displaced, Deficient gag reflex, Delayed gastric emptying - Diarrhea:
- Hyperosmolar formula or medications, antibiotic therapy, bacteria contamination, malabsorption - Constipation:
- lack of fiber, lack of free water, inactivity - Tube occlusion:
- pulverized medications given per tube, sedimentation of formula, reaction of incompatible medications or formula - Tube displacement:
- coughing, vomiting, not taped securely - Cramping:
- high osmolality of formula, rapid increase in rate/volume, lactose intolerance, intestinal obstruction, high fat formula used - Delayed gastric emptying:
- diabetic gastroparesis, serious illness, inactivity - Serum electrolyte intolerance:
- excess GI losses, dehydration, presence of disease - Fluid overload:
- refeeding syndrome in malnutrition - Hyperosmolar dehydration:
- hypertonic formula with insufficient free water
Clear fat-free broth, bouillon, coffee, tea, carbonated beverages, clear fruit juices, gelatin, fruit ices, popsicles
Clear Liquid
As for clear liquid, with addition of smooth-textured dairy products (e.g., ice cream), strained or blended cream soups, custards, refined cooked cereals, vegetable juice, pureed vegetables, all fruit juices, sherbets, puddings, frozen yogurt
Full Liquid
As for clear and full liquid, with addition of scrambled eggs; pureed meats, vegetables, and fruits; mashed potatoes and gravy
Dysphagia Stages, Thickened Liquids, Pureed
As for clear and full liquid and pureed, with addition of all cream soups, ground or finely diced meats, flaked fish, cottage cheese, cheese, rice, potatoes, pancakes, light breads, cooked vegetables, cooked or canned fruits, bananas, soups, peanut butter, eggs (not fried)
Mechanical Soft
Addition of low-fiber, easily digested foods such as pastas, casseroles, moist tender meats, and canned cooked fruits and vegetables; desserts, cakes, and cookies without nuts or coconut
Soft/Low Residue
Addition of fresh uncooked fruits, steamed vegetables, bran, oatmeal, and dried fruits
High Fiber
4-g (no added salt), 2-g, 1-g, or 500-mg sodium diets; vary from no-added-salt to severe sodium restriction (500-mg sodium diet), which requires selective food purchases
low sodium
300 mg/day l, in keeping with American Heart Association guidelines for serum lipid reduction
Low Cholesterol
Nutrition recommendations by the American Diabetes Association: focus on total energy, nutrient and food distribution; include a balanced intake of carbohydrates, fats, and proteins; varied caloric recommendations to accommodate patient’s metabolic demands
Diabetic
Eliminates wheat, oats, rye, barley and their derivatives
Gluten Free
Oxygen Capability 24-48%
Nasal cannula
Provide 30-50% concentrations of O2
face tent
Provide 40-60% concentrations of O2
simple face mask
Provide 40-70% concentrations of O2
Partial Non-rebreather with a reservoir bag
Provide 60-80% concentrations of O2
Non-rebreather Face Mask with reservoir bag
Provides 24%-60% oxygen
Venturi Mask