NUR 118 - Lecture 7/8 - Oxygenation Flashcards
LECTURE OBJECTIVE
Identify structures of the upper and lower airway
Upper:
Nasal air passage
Nasopharynx
Mouth
Oropharynx
Pharynx
Epiglottis
Lower:
Trachea, bronchi, bronchioles, alveoli,
-Above the Larynx is Upper Airway, below is lower airway
LECTURE OBJECTIVE
Distinguish Between External and Internal Respirations
External: Exchange is in lungs at alveoli
Internal: Exchange is at body organs & tissues
LECTURE OBJECTIVES
Respiratory Assessment: Inspection
- Color of skin & mucus membranes: (Clubbing and Cyanosis)
- Cough & Sputum - COCAF
- Respiratory Rate
- Rhythm, depth, pattern, effort
- Symmetry of chest movement
- Inspect shape of chest: normal vs barrel chest
- Spinal deformities: (AP Diameter)
- Edema
LECTURE OBJECTIVES
Respiratory Assessment:
Inspection - What are the 9 breathing patterns?
-Eupnea: normal respirations
-Tachypnea: Fast, shallow respirations
-Bradypnea: Slow respirations
-Dyspnea: Difficulty breathing
-Orthopnea: Difficulty breathing when supine
-Apnea : No breathing
-Kussmaul’s Respirations: Fast & abnormally deep; metabolic acidosis
-Cheyne-Stokes Respirations: Fast, deep respirations, then decreased depth to apnea
-Biot’s Respirations: Irregular fast and shallow
-Stridor = EMERGENCY
LECTURE OBJECTIVES
Respiratory Assessment:
Inspection - 8 observations that indicate respiratory effort
- Nasal Flaring
- Retractions
- Use of accessory muscles
- Grunting
- Body position (to help respirations(
- Conversational Dyspnea
- Stridor
- Wheezing
LECTURE OBJECTIVES
Respiratory Assessment: Palpation
What to check when palpating?
check anterior, posterior and lateral
1.Pain/Tenderness
2.Masses
3.Normal Chest Excursion: Symmetric thoracic expansion when breathing
- (Place thumbs adjacent, have patient breath in and out
LECTURE OBJECTIVES
Respiratory Assessment: Auscultation
What is the technique? (JUST Technique)
Technique:
- Start above clavicle-below xiphoid process-nipple area-ribcage-abdomen
- Left to right, right to left, down
LECTURE OBJECTIVES
Respiratory Assessment: Auscultation
What are normal lung sounds?
Normal lung Sounds:
Bronchial: over trachea
Broncho-vesicular: Over sternum in front, between clavicles posteriorly
Vesicular: Heard over lower lung fields
LECTURE OBJECTIVES
Respiratory Assessment: Auscultation
What are abnormal lung sounds?
Abnormal lung Sounds:
Rales (crackles) - Air bubbling through fluid in alveoli
- Rales in the tails (Alveoli
Grunting: Grunting noise; trapped air that is forced out on expiration
Rhonchi - Rumbling snoring sound; air through mucus in large airways = bronchi
- Rhonchi in Bronchi
Wheezes - Musical, whistling sound; Narrow/constricted small airways from partial obstruction
- Think: Whistling through narrow airway
Pleural friction rub: Like leather rubbing together; pleural layers rubbing together
Stridor: Loud whistle/gasping; Upper airway partial obstruction; EMERGENCY
LECTURE OBJECTIVE
List labs and diagnostics related to gaseous transfer
May need to add more detail later on
CBC:
- WBC: Infection
- Hemoglobin + Hematocrit: O2 carrying capacity of blood
Allergy Testing
Sputum: for infection
>TB
>Culture
PPD (Tuberculin Skin Test): Detect antibody form of tubercle bacillus
ABG’s: Acid/Base balance in blood,
Peak Flow Meter:
Chest X-Ray:
Pulse Oximetry:
Sleep Studies:
- For sleep apnea
Bronchoscopy: Visualization of tracheobronchial tree
CAT Scan: Inspect tissue densities, shows lesion
Thoracentesis: Sampling of pleural fluid; analysis of the fluid for cellular composition and chemical constituents like glucose, protein and LDH.
Pulmonary Function Tests (PFTs): Measure ability of resp. system to do gas exchange; assesses ventilation, diffusion
LECTURE OBJECTIVE
Gaseous Transfer Nursing Interventions
Position for maximum ventilation
>HIGH FOWLER’S - ORTHOPNEIC
Mobilize Secretions
>Coughing, deep breathing, chest PT
>Maintain hydration - Increase fluids to thin secretions
Assist with incentive spirometry
Respiratory Medications: ex; bronchodilators, corticosteroids, cough suppressants
Support Smoking Cessation
Teaching - Health promotion - diet & exercise
Provide Oxygen Therapy if needed
Suction if needed
LECTURE OBJECTIVE
Hypoxia S/S — Describe Early and Late signs of hypoxia
(aka: inadequate oxygenation of tissue/organ)
Early S/S: (R-A-T)
- Restlessness
- Anxiety
- Tachycardia/Tachypnea
- Confusion
Late S/S: (B-E-D)
-Bradycardia
-Extreme Restlessness
-Dyspnea
LECTURE OBJECTIVE
What is COPD?
Chronic Obstructive Pulmonary Disease (COPD):
A preventable and treatable disease state of airflow limitations involving the airways, lung tissue or both
- Chronic inflammatory lung disease that causes obstructed airflow
- It includes emphysema & chronic bronchitis
LECTURE OBJECTIVES
COPD - Chronic Bronchitis
Definition, etiology, s/s, diagnosis tests
Definition: Inflammation and hypersecretion of mucus in bronchi & bronchioles, d/t chronic exposure to irritants, results in airway obstruction
- Excess mucus in bronchi bc of irritants = obstruction
Etiology: Smoking (90% of cases), occupational, air pollution, asthma, cystic fibrosis
Signs and Symptoms: Chronic cough, thick sputum, rhonchi in the bronchi, Hypoxemia & hypoxia, tachycardia & tachypnea, dyspnea & SOB
Diagnosis: PFT, Chest X-Ray, ABG
LECTURE OBJECTIVES
COPD - Chronic Bronchitis
Treatment
Bronchodilators, Corticosteroids, expectorants
Antiinfectives if r/t infection
Controlled Oxygen delivery or BiPAP
Pulmonary Rehab
Stop smoking
LECTURE OBJECTIVES
COPD - Emphysema
Definition, etiology, s/s, diagnosis tests
Emphysema: Destruction of alveoli, narrowing of bronchioles and trapping of air resulting in loss of lung elasticity
Etiology: Smoking (90% of cases), occupational exposures, air pollution
S/S: Difficulty exhaling, pursed lip breathing, barrel chest, weight loss, tripod position, clubbing d/t chronic hypoxia
Diagnosis tests: PFT, Chest X-Ray, ABG
LECTURE OBJECTIVES
COPD - Emphysema
Treatment
Bronchodilators, corticosteroids, expectorant
Anti-Infectives if r/t infection
Controlled oxygen delivery / BiPAP
Pulmonary Rehab
Stop Smoking
LECTURE OBJECTIVES
Sleep Apnea
Definition, risk factors, s/s, diagnostic tests
A periodic interruption in breathing during sleep–an absence of air flow through the nose or mouth during sleep
- Pauses last 10-30 seconds
Risk factors: Small upper airway, overweight, large neck, Age > 40, smoking, alcohol
s/s: snoring, period of apnea of 10-120 seconds, morning headache, daytime sleepiness, dry mouth in am
Diagnostics: Sleep studies overnight
LECTURE OBJECTIVES
Sleep Apnea
Treatments
Continuous positive airway pressure (CPAP) - Delivers forced air to keep airways open
BiPAP (Bi-level positive airway pressure) - Similar to CPAP, but airflow changes primarily with breathing in but also breathing out
- Side lying positioning for sleep, avoid blockage of airway
- No smoking, no alcohol
LECTURE OBJECTIVES
Differentiate between normal stimulus to breathe and the “hypoxic drive”
Normal Stimulus:
- Increase levels of CO2 stimulate breathing to eliminate excess CO2
- Respiratory centers in brainstem control breathing
- Chemoreceptors detect changes in blood pH
COPD = Chronic Bronchitis:
- Decreased levels of O2
LECTURE OBJECTIVES
What independent nursing interventions can be used for patients with respiratory distress?
- HOB up, high fowlers
- Pull up in bed
- Orthopneic position
LECTURE OBJECTIVES
In which situations do we apply supplemental O2?
-Patient is dyspneic
- <90% O2 SAT / Impaired gas exchange
-Restless
-Cyanotic
-Gray
-Difficulty ventilating all areas of their lungs
-Heart Failure
-MI (Myocardial infarction)
We will usually start with nasal cannula
LECTURE OBJECTIVES
When is suctioning done; is it independent or dependent?
When to suction using yankauer and suction catheter?
Describe the suction catheter procedure.
Suctioning is done as needed (prn), independent nursing intervention
Yankauer:
-Upper airway
-Secretions in mouth or back of throat, that CANNOT be expectorated
Suction Catheter:
-Lower airway
-STERILE procedure
-Pre-oxygenate with 100% O2
-Duration of each suction should be limited to 10 seconds
-# of passes: 3 or less
LECTURE OBJECTIVES
Medications Guaifenesin
Class: Expectorant
- Reduces viscosity of tenacious secretions by increasing respiratory tract fluid
(Remember suctioning is used if expectorants aren’t enough)
Implications: FINISH THIS
