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Fundamentals II > Oxygenation > Flashcards

Oxygenation Flashcards

1
Q

Patients from what countries have a higher likelihood of contracting TB in the United States?

A

Mexico, Philippines, China, India, and Vietnam.

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2
Q

What ethnic background and education background have the highest rates of smoking?

A

American Indian / Alaskan natives.
Less than a high school education.

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3
Q

How can immunization clinics concentrate on urban communities?

A

By targeting at risk populations.

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4
Q

What is a nursing intervention for a patient with impaired gas exchange?

A

Administering O2 at 1L / minute (to maintain O2 sat > 92%) [you need an order for this].
Elevate head of bed to 30-45 degree angle.

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5
Q

What are some nursing interventions for a patient with activity intolerance?

A

Ambulate progressively at least 2 times per day.
Cluster care to allow for periods of rest.
Encourage pursed-lip breathing during activity.

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6
Q

What are some nursing interventions for a patient with impaired airway clearance?

A

Elevate head of bed 30-45 degrees.
Encourage patient to huff cough.
Encourage fluid intake to at least 2 L / day.
Frequently reposition.
Ambulate as tolerated.

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7
Q

What does the arterial blood gas diagnostic test show?

A

Information about patient’s metabolic acid/base (pH) and adequacy of oxygenation.

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8
Q

What do pulmonary function tests determine?

A

Ability of the lungs to efficiently exchange oxygen and carbon dioxide.
Also used to differentiate obstructive from restrictive pulmonary diseases.

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9
Q

What is peak expiratory flow rate?

A

The point of highest flow during maximal expiration.

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10
Q

Why would a HCP order a bronchoscopy?

A

To get a visual examination of the tracheobronchial tree, obtain sputum/biopsy sample, to remove mucus or foreign bodes.

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11
Q

What does a lung scan do?

A

Identify abnormal masses by size and location or to find a blood clot.

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12
Q

What is thoracentesis?

A

Surgical perforation of chest wall and pleural space with a needle to aspirate fluid for diagnostic/therapeutic purposes.

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13
Q

What 4 things must the nurse be aware of before a patient receives chest physiotherapy?

A

Medications, medical history, cognitive level of patient, and exercise tolerace.

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14
Q

What 3 types of medications are especially important to know prior to a patient beginning CPT? Why?

A

Diuretics and antihypertensives because they can cause fluid and hemodynamic changes that decrease a person’s tolerance to positional changes and postural drainage.
(long term) Steroids because they increase patient risk of rib fractures and contraindicates vibration.

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15
Q

Thoracic trauma and surgery contraindicates what 2 things.

A

Percussion and vibration.

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16
Q

Function of the epicardium.

A

Secretes serous fluid that prevents friction as the heart beats.

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17
Q

What does the myocardium of the heart do?

A

Contracts to propel blood into the next chamber or to pump out of the heart.

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18
Q

What is the endocardium?

A

Inner most layer of the heart that acts as a protective lining of the chambers and valves.

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19
Q

How does deoxygenated blood flow?

A

Returns to the blood, goes into the right atrium, pushed into right ventricle, then is pumped to the respiratory system.

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20
Q

How does oxygenated blood flow?

A

Leaves the lungs, flows to left atrium, pushed into left ventricle, and then is pumped to all of the body.

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21
Q

What is diastole?

A

Heart muscle relaxation.

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22
Q

What is systole?

A

Heart muscle contraction.

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23
Q

Define cardiac output.

A

Amount of blood pumped out of the heart in 1 minute.

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24
Q

What is the equation to find cardiac output?

A

CO = HR x SV

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25
What is the valve between the right atrium and right ventricle?
Tricuspid valve.
26
What is the valve between the right ventricle and the lungs?
Pulmonary valve.
27
What takes blood from the lungs to the left atrium?
Pulmonary veins.
28
What valve is in between the left atrium and the left ventricle?
Mitral valve.
29
What is included in the upper and lower respiratory tract?
Upper: nose, nasal cavity, pharynx. Lower: larynx, trachea, branches of the respiratory tree.
30
Define ventilation?
Movement of air in and out of the lungs.
31
Define oxygenation.
Intake of air and the gas exchange in the lungs.
32
What is the order of inspiration and expiration?
1. The respiratory center in the pain sends impulses to nerves. 2. The phrenic nerve stimulates the diaphragm to move downward and the intercostal nerve causes the intercostal muscles to contract. 3. Chest cavity expands, causing decreased intra-alveolar pressure. 4. Atmospheric pressure is now greater than intra-alveolar pressure, causing air to move into the respiratory tract to fill the lungs. 5. The diaphragm relaxes and the intra-alveolar pressure increases. 6. Air is forced out.
33
Define alveoli:
Where gas exchange happens, where the O2 is exchanged for CO2.
34
Define tidal volume:
The amount of air exhaled during a normal exhalation.
35
Bradypnea vs. tachypnea:
Bradypnea: Breathing rate regular but slow (less than 12). Tachypnea: Breathing rate is regular but rapid (more than 20).
36
Define apnea.
Respirations cease for several seconds.
37
Hyperventilation vs. hypoventilation.
Hyperventilation: Rate AND depth increase. Hypoventilation: Rate AND depth decrease.
38
Define compliance.
The expandability of the lungs and chest wall.
39
Define work of breathing.
Effort required to expand and contract the lungs.
40
Define hypercarbia and hypocarbia.
Hyper- Increase in carbon dioxide in the bloodstream. Hypo- Decrease in alveolar and blood carbon dioxide below 35 mmHg.
41
Define hypoxia.
Inadequate tissue oxygenation at the cellular level.
42
Central cyanosis vs. peripheral cyanosis.
Central - Blue discoloration of the tongue, soft palate, and conjunctiva of the eye. Peripheral - Blue discoloration of the nail beds, earlobes, and other extremities.
43
When does clubbing of the fingers occur?
With chronic hypoxia.
44
What is chest physiotherapy?
External chest wall manipulation using percussion, vibration, and high-frequency chest wall compression.
45
What does postural drainage aid in?
Improving secretion clearance and oxygenation.
46
What is FiO2? What does it mean?
Fraction of inspired oxygen - concentration of oxygen in a gas mixture
47
What is a bubbler?
Adds moisture to oxygen delivery.
48
What are 3 examples of things that can change ventilation?
Medications, pain, and anxiety.
49
What is normal oxygen saturation?
95-100%
50
SaO2 vs SpO2
Sa = arterial oxygenation Sp = peripheral oxygenation
51
Describe in words what bronchial breath sounds sound like and where to find them.
High pitch, found over the trachea.
52
Describe in words what bronchovesicular breath sounds sound like and where to find them.
Medium pitch, found over mainstream bronchi.
53
Describe in words what vesicular breath sounds sound like and where to find them.
Low pitch, found over most of lung.
54
Describe in words what crackles / rales sound like.
Fine to coarse bubbly sounds.
55
What is happening in the lungs when crackles / rales are present?
Air is passing through fluid or collapsed airways. (pneumonia)
56
Describe in words what wheezing sound like.
High pitch/whistling, musical.
57
What are examples of when you would hear wheezing in the lungs?
Allergic reaction, asthma.
58
Describe in words what rhonchi sound like.
Low pitched rumbling.
59
What is happening in the lungs when rhonchi are present?
Fluid or mucus in airway.
60
What happens if you don't have enough or don't make surfactant?
Increased surface tension can cause the alveoli to stick together.
61
What happens if there is decreased lung compliance?
Increased airway resistance, increased use of accessory muscles, and overall increase of work of breathing.
62
How does carbon monoxide affect hemoglobin?
Lowers oxygen carrying ability.
63
What is the goal of ventilation?
Normal ARTERIAL carbon dioxide and oxygenation tension. [arterial because in venous systems the blood is deoxygenated]
64
Two potential causes for hypoventilation?
Medications (pain medications can lower drive to breathe) and alveolar collapse.
65
What are some signs and symptoms of hypoventilation?
Mental status changes, dysrhythmias.
66
What are some causes of hyperventilation?
Anxiety attacks, infection/fever, drugs, pH imbalance, aspirin poisoning, amphetamine use.
67
What are some signs and symptoms of hyperventilation?
Rapid respirations, sighing breaths, numbness/tingling in hand and feet, light headedness, loss of consciousness.
68
Does hyperventilation increase or decrease the work of breathing?
Increases.
69
What is the main problem with atelectasis?
Prevents normal gas exchange in the alveolar sacs because they are collapsed.
70
What are some causes of hypoxia?
Decreased hemoglobin level, low oxygen concentration of inspired oxygen (like at high altitudes), inability to get oxygen from blood (like in cyanide poisoning), decreased diffusion of oxygen from alveoli to blood (like in pneumonia), poor perfusion with oxygenated blood (like in shock), and impaired ventilation due to trauma (like a rib fracture).
71
Initially hypoxia causes a ______ blood pressure followed by shock and ______ blood pressure.
High Low.
72
What are key early signs of hypoxia?
Restlessness, anxiety, tachy(cardia and pnea).
73
What are key late signs of hypoxia?
Bradycardia, extreme restlessness, and dyspnea.
74
What are common assessment finding with someone who is chronically hypoxic?
Cyanotic nail beds, clubbing, sluggish capillary refills, barrel chested.
75
In older adults what is typically the first indication that something is wrong with oxygenation?
Mental status changes.
76
What are some signs and symptoms of dyspnea?
Subjective accounts of shortness of breath, use of accessory muscles, nasal flaring, increased rate and depth of breathing.
77
What two instances would a patient be more at risk for aspiration?
When they have weak throat muscles or have been intubated for a long time.
78
What are 3 long term preventative measures that could help oxygenation?
Vaccinations (flu, pneumonia for older adults), healthy lifestyle, and managing environmental/occupational exposures.
79
What is the best way to treat dyspnea?
To treat the underlying condition (asthma, HF, COPD, etc)
80
How does mobilizing patients help manage secretions?
Makes cough more effective, promotes lung expansion, and improves gas exchange.
81
How does hydration help patients manage secretions?
Helps reduce viscosity of secretions.
82
How does humidification help patients manage secretions?
Helps keep airway moist and loosen secretions.
83
What is the first intervention for a patient that has low O2 saturation?
Reposition, try to get them to take deep breaths to bring saturation up.
84
What are contraindications for CPT?
Pregnant, rib/chest injuries, increased intracranial pressure, abdominal/chest surgery, osteoporosis, and those at an increased bleeding risk.
85
One pass for tracheostomy suctioning should last no longer than:
10 seconds.
86
FiO2 of room air is what?
21%
87
What is the FiO2 of nasal cannula delivery? What is the range in L/min?
22-44%, 1-6 L/min.
88
What is the FiO2 of simple face mask oxygen delivery? What is the range in L/min?
33-55%, 6-12 L/min.
89
What is the FiO2 of partial rebreather oxygen delivery? What is the range in L/min?
60-75%, 6-11 L/min.
90
What is the FiO2 of non-rebreather oxygen delivery? What is the range in L/min?
80-95%, 10-15 L/min.
91
What is the FiO2 of venturi mask oxygen delivery? What is the range in L/min?
24-50%, 4-12 L/min.
92
What should the inflation of the reservoir bag be for a partial rebreather?
Partially inflated.
93
When should the patient have humidification for oxygen delivery?
When it is 4 L/min or for more than 24 hours.
94
What type of tracheostomy tube have a disposable inner cannula and a cuff?
Shiley.
95
What is the purpose of the huff cough?
To move secretions to the larger airways.
96
When is the quad cough (other wise known as the manually assisted cough) used?
When patients don't have abdominal muscle control, like those with spinal cord injuries.
97
How does a patient complete a quad cough?
They breathe in deep and exhales with maximum effort while the nurse pushes in and up on the abdominal muscles towards the diaphragm, causing the cough.
98
When is a cascade cough normally used?
When patients have a large amount of sputum, like in those with cystic fibrosis.
99
Can pain influence breathing?
Yes, it can influence airway clearance and oxygenation.

Fundamentals II (4 decks)

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