L1+2 Oxygen And Suction Flashcards by Chun Wing Wong

Process of gas exchange

Pulmonary ventilation
Alveolar gas exchange
Transport of oxygen and carbon dioxide
Systematic diffusion

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Transportation of oxygen and carbon dioxide
Flow of co2 and o2
Where o2 goes?
What affect rate of oxygen transport

O2 from lung goes into tissue
Co2 goes from tissue to lung (exhale)

o2 combined lossely with hemoglobin in rbs into tissue as oxyhemoglobin

Exercise, cardiac output

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Factors that affect respiratory function

Age
Environment
lifestyle
Health status
Stress
Medication

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Affecting respiratory function-age

Neonate
Lung filled with amniotic fluid
Fully expand by 2wks old

Older adult
More rigid chest wall and less elastic
Less cough reflex

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Environment

Higher altitude=lower po2cold or too hot, cold-) must expend more energy to maintain temperature

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How lifestyle affect respiratory function?
Have exercise vs didnt

Lifestyle with physical exercise will increase rate and depth of respiration
Sit-) lack of alveolar expansion and deep breath pattern

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Health status& medication affecting respiratory function

Respiratory system disease affect oxygenation of blood

Medication can reduce rate and depth of breathing such as diazepam and opioid
RR has to be monitored with nurse when administering these drugs

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Stress affecting respiratory function

Pow increase and pco2 decrease as hyperventilation
Light head, numbness of finger and tows and mouth
Short term symptoms

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Other a alteration in respiratory function
Airway patency

Upper airway obstruction
Due to foreign object obstruction e.g. fall tongue

Lower respiratory obstrution
Due to accumulate of mucus or inflammatory exudates
Client may have restlessness, dyspnea

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Tachypnea
Bradypnea

Tachypnea: fever, pain, hypoxemia
Brady: drug affected, brain injury

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Heath history taking related to respiratory disease

History of respiratory disease
Presence of risk factors
Lifestyle related to respiratory problems
Current respiratory problems
Presence of cough and sputum
Present of chest pain
Environmental history
Medical history

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Inspection to sputum

White/ clear: viral infection
Yellow or green: bacteria infection
Black: coal dust
Rusty (blood): pneumococcal pneumonia, TB
Hemoptysis: small to large amount of frank blood
Pink& frothy (泡）
Foul smelling (臭

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Other assesment for physical examination

Palpation
Pulse
Skin tempt
Tenderness

Percussion敲
Area of consolidation/ air pocket

Auscultation
Breathing sound
Heart sound

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Assesment- pulse oximeter

SpO2=95-100

remove acrylics nails
Remove dirt and skin oil
Minimize patient movement

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Assesment- arterial blood gases (ABG)

Sample taken from radial, bradial, femoral pulse

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Assesment-sputum samples
-chest x ray
- allergy test

Microscope evaluation of sputum

Xray: provide anterior-posterior view of heart& lung

Allergy test: indentify antigen that may cause hypersensitivity

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Assesment- spirometry- peak flow monitoring

Measure the amount of air can be exhale with forcible effort

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Diagnosis
-have what problem?

Impaired gas exchange
Activity intolerance

Planning

To expectorate secretion clearly
Maintain patent airway
Improve comfort
Improve on ability to physical activity

Implementation to facilitate pulmonary ventilation

Chest tubes
Artificial airway
Oxygen therapy
Suctioning
Hydration
Incentive spirometry

Promote oxygenation

Raise the bed to semi fowlers or fowlers position

Encourage frauent change if position

Encourage taking deep breath

Deep breathing
Aims*2

Aims
1. Remove secretion
2. Avoid dyspnea

Inhale slowly& evenly thru nose until greatest chest expansion
Hold the breath for 2-3 sec

Cough:
Take deep breath and hold for 2-3 sec, then cough 1-2

Deep breathing for dypsnea client

Ask client to take deep breath as usual using nose
Exhale thru pursed lips
Ask client to tighten abdominal muscles

Incentive spirometry

Sit in upright position
Hold the meter in upright position
Exhale normally
Lips cover the mouthpiece and inhale slowly and deeply
Hold the breath for 2-6 sec
May have cough—) deep breath may loosen mucus
Cough can facilitate removal.
Repeat 4-5 times hourly

Hydration

Nebulizers （面罩）deliver humidity Humidifier

Artificial airway Aims? Types of artificial airway?

Maintain patent airway to client whose airway is obstructed Oropharyngeal airway Can hold falling tongue No gag reflex Nasopharyngeal airway Flexible tube insert into nose Reinsert every 8hrs avoid mucosa necrosis Endotracheal tube Thru mouth or nose into trachea Tracheostomy Opening into trachea to form a new airway

Concentration of oxygen given? xx% Why client have hypoxemia?

21% Loss of lung tissue Decreased ability to diffuse O2 Anemia leads to not enough rbc to carry O2

Oxygen supply system have what?

Portable system Wall outlet Connect humidifier bottle filled with distilled water to the wall outlet 4L/min

Type of flow system

Nasal cannula Face mask Oxygen tent Transtracheal catheter

Introduce oxygen delivery systems- nasal cannula

Nasal cannula Most common Inexpensive Relatively comfy Flow rate 2-6L

Introduce oxygen delivery system- face mask

Difficult in fit and tolerance to some client 5-8L

Introduce oxygen supply system-transtracheal catheter

Surgically created tract Clean 2-4 times a day >15L per minute

Introduction to oxygen supply system (high flow) Venturi mask, non-rebreathing mask

Venturi mask 4-10L Non-rebreathing mask Highest concentration 95-100% >10L/min

Safety precautions of oxygen therapy

No smoking Stay up- secretion will drain down to airway

Percussion, vibration, postural drainage

Percussion: rhythmic clapping of chest wall with cupped hand

Suctioning type

Oropharyngeal suctioning Nasopharyngeal suctioning Endotracheal suctioning Tracheostomy suctioning

Indication to suctioning

Dyspnea Unable to cough up secretion Tachycardia

Suctioning precauction

Dont apply too frequently cuz: Will increase intracranial pressure Cause bronchospasm Cause o2 saturation decrease

Nasopharyngeal suctioning IMPORTANT STUFF

use sterile water Use sterile gloves Do not apply suction when insertion 10-15cm

Medication for oxygenation

Bronchodilators Cough depressant Expectorant Anti-inflammatory drugs

Bronchodilators

Inhalator Reduce bronchospasm Open tight airway Avoid increase of hr/ bp Increased BP—) do ECG

Medication for oxygenation—) anti-inflammatory drugs

E.g. glucocorticoid Decrease edema and inflammation MOUTH WASH AFTER ADMINISTRATION First broncodilator then anti-inflammatory

Medication- expectorant

Expectorant helps in break up mucus Cough suppressant given when chronic cough affect sleeping e.g. codeine

Diagnosis of oxygenation problem

Ineffective airway clearance Inability to clear secretions/ obstruction in respiratory tract to maintain a clear airway Ineffective breathing pattern Inhale or exhale do not have adequate ventilation Impaired gas exchange Excess of deficit of carbon dioxide elimination at alveolar -capillary membrane