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NUR544 Complex > Oxygen > Flashcards

Oxygen Flashcards

(71 cards)

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1
Q

Define ventilation

A

Gas distribution in and out of the pulmonary airways

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2
Q

What does ventilation assess the status of?

A

CO2

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3
Q

Define pulmonary perfusion

A

Blood flow from the right side of the heart, through the pulmonary circulation & into the left side of the heart

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4
Q

Define diffusion

A

Gas movement from an area of greater to lesser concentration through semipermeable membrane

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5
Q

Explain the receiving end & supplying end of blood in the alveoli & capillaries

A

Alveoli receive O2 at ~ 4L/min & capillaries supply blood at ~ 5L/min

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6
Q

What is the average VQ ratio?

A

4:5 or 0.8

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7
Q

What does VQ ratio look at?

A

Ventilation to perfusion ratio

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8
Q

What does VQ ratio depend on?

A

Body position & regions of the lung

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9
Q

Explain the difference of intrapleural pressure btwn the apex & base of the lung

A

Apex → more negative pressure
Base → less negative pressure

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10
Q

Explain the difference of transmural pressure gradient btwn apex & base of the lungs

A

Apex → greater
Base → smaller

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11
Q

Explain the difference btwn alveoli in the apex & base of the lungs

A

Apex → larger & less compliant
Base → smaller & more compliant

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12
Q

Explain the difference in ventilation btwn the apex & base of the lungs

A

Apex → less ventilation
Base → more ventilation

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13
Q

What does less compliant alveoli mean?

A

Means we just don’t get as good of ventilation at the top of our lungs

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14
Q

How can sitting up in bed affect ventilation?

A

Gets ventilation down to the base of the lungs

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15
Q

V/Q mismatch:

What is shunting? Hint: 3

A

1) Problem with decreased ventilation
2) Alveoli perfused but are not ventilated
3) Allows deoxygenated blood to go into left side of the heart & into the body

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16
Q

V/Q mismatch:

List 6 disorders associated with shunting

A

1) congenital
2) airway obstruction
3) ARDS
4) pneumonia
5) atelectasis
6) pulmonary edema

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17
Q

V/Q mismatch:

Describe dead space

A

When there is decreased perfusion (not enough) or a problem w blood in the lungs becoming oxygenated

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18
Q

V/Q mismatch:

List 2 disorders associated with dead space

A

1) Pulmonary embolism
2) Pulmonary infarction

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19
Q

V/Q mismatch:

Describe silent unit Hint: 2

A

1) Problem with ventilation & perfusion
2) There is shunting & dead space

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20
Q

V/Q mismatch:

List 2 disorders associated with silent unit

A

1) ARDS
2) Pneumothorax

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21
Q

Define hypoxemia

A

Low arterial oxygen tension in the blood
Adversely affects every tissue in the body

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22
Q

Explain the supply & demand mismatch of hypoxemia Hint: 2

A

1) Poor perfusion such as ischemia
2) Decreased arterial O2 such as anemia

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23
Q

What must be provided until cause of hypoxemia can be reversed?

A

Must provide oxygen

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24
Q

List 5 causes of hypoxemia

A

1) Depletion of ATP
2) Acidosis
3) Damage to cells from noxious stimuli (i.e. poison)
4) Abnormal Ca inside the cell
5) Inflammatory response

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25
Define FiO2
Fraction of inspired oxygen (%); what is inhaled
26
Define PaCO2
Partial pressure of Co2 in arterial blood; used to assess the adequacy of ventilation
27
Define PaO2
Partial pressure of O2 in arterial blood; used to assess the adequacy of oxygenation
28
Define SaO2
Arterial O2 sat measured from blood specimen (the ABG)
29
Define SpO2
Arterial O2 sat measured via pulse ox
30
Define hypercapnia
Increased amounts of CO2 in the blood
31
Define hypoxia
Low O2 level at the tissues
32
Define tidal volume
The amount of gas that moves in & out of the lungs w each breath, measured in mL (6-10 mL/kg)
33
Define minute ventilation
Total amount of gas moving in & out of the lungs per min **multiply tidal volume by RR, measured in L/min**
34
Define peak inspiratory flow rate (PIFR)
The fastest flow rate of air during inspiration, measured in L/sec
35
What does PIFR give us an idea of?
Muscle function
36
List 4 artificial airways
1) Oropharyngeal airway 2) Nasopharyngeal airway 3) Endotracheal tube 4) Tracheostomy
37
List 2 examples of airway adjuncts
1) Oral airway 2) Nasal airway
38
When are airway adjuncts used?
To open up the airway; when you are NOT ready to intubate yet
39
Why would we use an oral airway adjunct?
To keep the tongue from closing off the airway; or for patients with thicker necks
40
Oxygen therapy: When does a person need MORE oxygen
When client has decreased perfusion
41
Oxygen therapy: When does a person need MORE flow
When client has decreased ventilation **More pressure to get the CO2 out**
42
What is the usual amount of room air O2 that we breathe in?
21%
43
What is FiO2 % if O2 flow is 2 L/min
28%
44
What is FiO2 % if O2 flow is 6 L/min
44%
45
What are low flow O2 delivery?
These systems are specific devices that do NOT provide the patient's entire ventilatory requirements
46
What type of patients may be put on low flow O2 delivery systems?
Stable patients b/c they are not reliable in the delivery of O2
47
Approx what % of FiO2 do face masks provide?
~ 40-50%
48
When are face masks used?
For temporary use → b/c there is not ventilation control
49
What are high flow oxygen delivery systems?
Systems are specific devices that deliver the patient's entire ventilatory demand, meeting, & exceeding the pt's PIFR, thereby providing an accurate FiO2
50
How do high flow O2 delivery systems differ from low flow systems?
High flow CAN control ventilatory components
51
What is a BiPAP and how does it work?
**Bilevel positive pressure O2 delivery system** "Pushes" air into the lungs
52
What complication can occur from a BiPAP machine?
Eye irritation → looks like pink eye but not contagious
53
List 3 other potential complications of BiPAP machines
1) Can be uncomfortable 2) Drying 3) Bloating
54
List 4 important functions of high flow nasal cannulas
1) Decreases airway inflammation 2) Maintains mucociliary function 3) Improves mucous clearance 4) Reduces caloric expenditure in acute respiratory failure
55
What type of pressure do high flow NC provide?
Positive pressure
56
High flow NC decreases ___ ___ & lowers ____
Decreases wash out & lowers CO2
57
List 3 things high flow NC is associated with
1) Decreased RR 2) Decreased work of breathing 3) Better oxygenation than O2 delivery by face mask
58
What type of O2 delivery system can deliver up to 95% FiO2?
Non-rebreather mask
59
When using a non-rebreather mask what must we always assess for?
Bag deflation → bag should NEVER be completely deflated
60
What should the flow meter be set to when using a non-rebreather mask?
15 L
61
Pulse oximetry ONLY measures ____
Perfusion!! → not ventilation
62
Explain the correlation btwn SpO2 & PaO2 on a oxyhemoglobin dissociation curve
Not a linear curve → pulse ox reading may still look okay but client's PaO2 will drop more
63
What are the two types of blades used on a laryngoscope?
Macintosh or Miller blade
64
What are ETT & Stylets used for during intubation?
Stylet provides stability & then is removed when the tube is inserted
65
List 8 nursing roles during intubation
1) Explain to patient what is happening 2) Admin sedation → assess after given 3) Listen for B/L breath sounds 4) Be certain chest X ray is done 5) Maintain cuff volume 6) Maintain tube patency 7) Proper oral care 8) Aspiration precautions
66
What is ETCO2 monitoring (Capnography)? **Hint: 2**
1) End tidal CO2 monitoring 2) Provides valuable information on CO2 clearance (typically 2-5 mm lower than CO2)
67
What is the gold standard to ensure correct ETT placement?
Chest x-ray
68
When can ventilator acquired pneumonia be considered?
After the client has been intubated for 48-72 hrs
69
List 9 nursing interventions for VAP
1) **Hand hygiene** 2) HOB elevated 30-45 degrees 3) Suctioning secretions in oral cavity 4) Drain water collecting in tubing 5) Mouth/ oral care regularly 6) Sedation vacation 7) Daily assessment of readiness for extubation 8) Peptic ulcer prophylaxis 9) DVT prophylaxis
70
What is the % of mortality in one year for client's requiring prolonged ventilatory care (i.e. trachs)
50-60%
71
Who benefits best from a tracheostomy? **Hint: 2**
**Evidence is NOT clear who benefits best** 1) High likelihood of survival 2) Neurologic injury seems to do better with trach

NUR544 Complex (12 decks)

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