Oxygenation Flashcards

Question

Hyperventilation

Answer 1

Removing CO2 faster than it is produced by cellular metabolism Causes: Anxiety attacks (severe), infection/fever, drugs, acid-base imbalance (pH), aspirin poisoning, amphetamine use Signs/Symptoms: Rapid respirations, sighing breaths, numbness/tingling of hands feet, light-headedness, loss of consciousness Think increased WOB Increased body temperature (fever) increases the metabolic rate, thereby increasing carbon dioxide production. The increased carbon dioxide level stimulates increase in the patient's rate and depth of respiration, causing hyperventilation.

Answer 2

Collapsed alveoli Prevents normal respiratory gas exchange Conditions associated: IMMOBILITY Obesity Sleep apnea Chronic lung conditions Can lead to lung collapse respiratory distress syndromes/pneumonias/respiratory failure It occurs when the tiny air sacs (alveoli) within the lung become deflated or possibly filled with alveolar fluid. Risk factors: Older age Any condition that makes it difficult to swallow Confinement to bed with infrequent changes of position Lung disease, such as asthma, COPD, bronchiectasis or cystic fibrosis Recent abdominal or chest surgery Recent general anesthesia Weak breathing (respiratory) muscles due to muscular dystrophy, spinal cord injury or another neuromuscular condition Medications that may cause shallow breathing Pain or injury that may make it painful to cough or cause shallow breathing, including stomach pain or rib fracture Smoking

Answer 3

Inadequate TISSUE OXYGENATION At the cellular level, not enough oxygen to meet needs Can be related to a delivery problem Untreated can lead to cardiac dysrhythmias, why? Cardiac cells need oxygen to work Causes: Decreased hemoglobin levels/low oxygen-carrying capability Diminished oxygen concentration of inspired oxygen (think altitude) Inability of tissues to get oxygen from blood (cyanide poisoning) Decreased diffusion of oxygen from alveoli to blood- infections/pneumonia Poor perfusion with oxygenated blood– shock Impaired ventilation from traumas– rib fractures Signs/symptoms: Apprehension, restless, inability to concentrate, decreased level of consciousness, dizziness, behavioral changes Difficulty staying still, lying flat Fatigued, yet agitated Causes increased pulse, increased respirations (rate and depth) Initially increased blood pressure, then leads to shock/low BP Cyanosis: blue discoloration skin/mucous membranes, late sign of hypoxia Not a reliable measure of oxygen status Central cyanosis tongue, soft palate, conjunctiva of the eye = hypoxemia Peripheral cyanosis extremities, nail beds, earlobes = vasoconstriction not oxygenation problem

Answer 4

Associated with chronic lung conditions COPD most common Common assessment findings: Cyanotic nailbeds Sluggish capillary refill Clubbing Barrel chest AP diameter 1:1 (normal 2:1) Young- middle aged adults: focus is on avoidance of oxygenation problem risk factors Smoking, unhealthy lifestyle, environmental considerations Older-adults: Mental status changes typically first sign of any issue More susceptible to respiratory infections and compromise Low reserve once compromised can deteriorate quickly

Answer 5

Smoking Secondhand exposure Obesity Air pollution/quality Malnourished Muscle weakness, weak cough Exercise protective increases metabolic activity, helps promote increased oxygen consumption Substance Use Occupational exposure Kids second hand exposure– asthma, pneumonia, ear infections Babies- higher risk of SIDS Substances– inhaled substances permanent lung damage Environmental: Occupational pollutants include asbestos, talcum powder, dust, and airborne fibers. Asbestos. Firefighters increased risk of lung damage Radon

Answer 6

Protective reflex to clear trachea, bronchi and lungs of irritants and secretions How often is cough? (frequency) Productive/nonproductive? Sputum- what is coughed up What does it look like? Bloody, mucus? Thin/thick? Odorous? Bloody= hemoptysis Chronic versus acute Adequate hydration and coughing helps patient maintain airway patency Encourage coughing– most effective way to move secretions through the airways More efficient than artificial suctioning Pain

Answer 7

Sputum collection: To analyze for pathogens (usually pneumonia, cytology) Best to collect in early morning Wait 1-2 hours after patient eats Sterile specimen container– teach patient not to touch the inside of container or lid Tell patients to cough into the container and get as much expectorate sputum as possible If patient too weak or cannot get expectorate into container, may require suctioning

Answer 8

Sputum Specimens - Nasal aspirate/swabs for respiratory syncytial virus, influenza Sputum culture and sensitivity - Obtained to identify a specific microorganism or organism growing in sputumIdentifies drug resistance and sensitivities to determine appropriate antibiotic therapy Sputum for acid-fast bacillus (AFB) - Screens for presence of AFB for detection of tuberculosis by early-morning specimens on 3 consecutive days Sputum for cytology - Obtained to identify lung cancerDifferentiates type of cancer cells (small cell, oat cell, large cell)

Answer 9

Basic ventilation studies

Answer 10

The point of highest flow during maximal expiration (Normal in adults is based on age and body weight.)

Answer 11

Vaccinations Flu vaccine, pneumonia vaccine (over 65, immunocompromised) Healthy lifestyle Nutrition, exercise Environmental and occupational exposures STOP SMOKING May need to change jobs if reaction to exposure

Answer 12

Difficult to treat Treat underlying condition (Asthma, pneumonia, heart failure, etc.) Oxygen therapy Pharmacologic treatment Bronchodilators, inhaled steroids, mucolytic, anti-anxiety medication

Answer 13

Coughing helps keep airways clear and expectorate (get rid of) sputum, mucous Nursing intervention can be to ENCOURAGE COUGHING Typically encourage patients to initiate coughing every 2 hours when experiencing lung conditions/upper respiratory problems Deep breathing– increases air to the lower lobes of the lungs Opens small pores between alveoli which help promote gas exchange What are some considerations nurses make take into account when teaching about these techniques? With the cascade cough the patient takes a slow, deep breath and holds it for 2 seconds while contracting expiratory muscles. Then he or she opens the mouth and performs a series of coughs throughout exhalation, thereby coughing at progressively lowered lung volumes. This technique promotes airway clearance and a patent airway in patients with large volumes of sputum. The huff cough stimulates a natural cough reflex and is generally effective only for clearing central airways. While exhaling, the patient opens the glottis by saying the word huff. With practice he or she inhales more air and is able to progress to the cascade cough. The quad cough technique is for patients without abdominal muscle control such as those with spinal cord injuries. While the patient breathes out with a maximal expiratory effort, the patient or nurse pushes inward and upward on the abdominal muscles toward the diaphragm, causing the cough. Cover mouth, wash hands, if a patient is too compromised or in an anxious state, coughing would not be appropriate, deep breathing may be appropriate

Answer 14

Goal: mobilize pulmonary secretions Include multiple activities Postural drainage Chest percussion Chest vibration Follow these activities with coughing and deep breathing Indications: patients with thick secretions Contraindications: pregnant, rib/chest injuries, increased intracranial pressure, recent abdominal/thoracic surgery, bleeding disorders, osteoporosis Percussion- cupped hands to clap rhythmically on chest to break up secretions Vibrations0 use of shaking movements during exhalation to help remove secretion Postural drainage- use of various positions to allow secretions to drain by gravity -- Lay on unaffected side to promote drainage of one particular lobe Example: Infiltration seen on RIGHT lower lobe Lay on left side, in Trendelenburg Other considerations: 1 hour before eating, 2 hours after eating, doing before bedtime helps (but can cause coughing so not RIGHT before) Bronchodilators, and nebulizers 30 minutes before postural drainiage Spend 10-15 minutes in each position If client reports dizziness, faint stop Older clients decreased res muscle strength, and chest wall compliance risk for aspiration

Answer 15

Indicated when patients cannot clear secretions on their own through coughing or CPT Sterile procedure in hospital Orotracheal and Nasotracheal (NT) common Sterile catheter passed through nose (NT most common) into pharynx Extremely uncomfortable, often stimulate patient into extreme coughing Should be less than 10 seconds total Will be discussed more in lab

Answer 16

Promotes lung expansion through deep breathing Prevents or treats atelectasis Most often used in the post-operative patient

Answer 17

Despite other interventions, such as coughing and deep breathing, many patients require oxygen therapy Goal: prevent or relieve hypoxia % of O² in inspired air is referred to as fraction of inspired O² or “FiO²”; Room air = FiO² of 21% Gives oxygen at higher concentration than our ambient air (21%) MUST HAVE A HEALTHCARE ORDER TO ADMINISTER OXYGEN THERAPY Outside of an emergency situation Must follow the six rights of medication administration