Oxygenation Flashcards
(28 cards)
Three Main Elements of Respiration?
- Ventilation
- Transport
- Perfusion
Age Related factors: For Babies
( Born before 36 weeks )
- Insufficient surfactant to keep alveoli from collapsing
Age Related factors: For Babies
( Newborn - 3 mon )
- Breath through nose, sneeze a lot, irregular respiratory patterns
Age Related factors: For Older Adults
- Diminished muscle strength
- Reduced inspiratory / expiratory effort
- Less RBC’s
- Less alveolar elasticity
Oxygenation Impairment
Mild Impairment: Compensation; fatigue, increased HR, RR
Moderate Impairment: Less O2 to cells- Cellular injury, More CO2 in cells: Resp Acidosis
Consequences of Impairment of Oxygen
Hypoxemia –> Hypoxia —> Anoxia —> Cell death
Risk factors for impaired oxygen
- Age
- Smoking
- COPD, CF presence
- Anemia
- Brain injury
- Prolonged immobility
Ventilation
The process of inhaling oxygen into the lungs
Impaired –>
High altitude
Disorders
Rib fractures
Narrowed airways ( COPD, CF )
Poor gas diffusion ( PE, pneumonia )
Transport
Refers to the availability and ability of hemoglobin to carry oxygen from the alveoli into the cells
Impaired –>
Not enough erythrocytes or hemoglobin = anemia
Perfusion
Refers to the ability of the blood to transport oxygen containing hemoglobin to the cells
Impaired —>
Decreased CO, thrombi, emboli, vessel narrowing
Unexpected finding Assessment for Breathing:
- Use of accessory muscles, asymmetrical, barrel chested
- HR over 100 bPM
- Wheezing, stridor, rhonchi, dull
Diagnostic Tests
ABG, complete blood count, sputum, biopsy
Chest X ray
Endoscopy: Stent to see blockage
Pulm function ( FVC ) : Max air you can blow out in 1 min
What is a pneumothorax?
Presence of air or gas in the pleural space which causes lung collapse
Air vs Liquid
Pneumothorax: Air in pleural cavity
Hemothorax: Blood
Pleural Effusion: Fluid
Pneumothorax traumatic vs spontaneous
Traumatic:
- Air enters space due to trauma
- Blunt force ( broken rib )
- Penetrating trauma ( stabbing, shooting )
Spontaneous:
- Small sac of air called bleb in lung tissue ruptures
- Weak lung tissue
- High pressure pushing into lungs
- No trauma
- COPD, old age –> Fragile lung tissue , lung infection
Risk factors for pneumothorax
- Blunt chest trauma
- Penetrating chest wound
- COPD
- Older adults: decreased lung elasticity = more fragile lung tissue
Tension Pneumothorax
- Air enters during inspiration but not able to leave
- Hypotension
- *** Mediastinal shift; r/t pressure rise
- JVD
- More likely after trauma
- ** Emergent Situation
S/S of pneumothorax
- Anxiety, pain, inability to take breath
- Sudden onset
- Sharp, severe chest pain felt on same side as the pneumothrorax ( ipsilateral )
- Usually unilateral
Pneumothorax physical assessment
- Resp distress
- *** Tracheal Deviation
-Reduced breath sounds on affected side - Asymmetrical chest wall movement ( 1 side functioning normal )
- Hyperrsonance ( Drum ) = trapped air
- Hemothorax ( Dull )
- Subq emphysema ( air )
Diagnostic tests for pneumothorax
- ABG’s: PaO2 less than 80 mmHg
- Chest X ray: Confirmation of pneumothorax or hemo
- Thoracentesis: Temp fix, large bore needle into chest wall and pleural space, if tension = emergent!
Oxygenation Nursing Care
- Admin oxygen, meds
- Listen to heart and lungs
- Vital signs
- Position to high fowlers
- Monitor for; chest tube drainage, s/s of infection
Patient Centered Care: Meds
- Benzodiazepines ( Lorezepam )
- Decrease anxiety = sedatives
- Decreases anxiety
- Vital signs: watch for hypotension, amnesiac effects, monitor for euphoria/ rage, drowsiness, memory loss
Patient Centered Care: Meds
Opiod agonists
- For severe pain
- Morphine, sulfate, fentanyl
- Monitor for respiratory depression
- Pain Q4hrs
- Hypotension, N/V, constipation
Therapeutic Procedures
- Chest tube insertion
: Drain blood, fluid, air - Re establish negative pressure
- Facilitate lung expansion
- Restore normal intrapleural pressure
