Oxygenation

Question 1

What 3 things influence the capacity of the blood to carry O2?

Answer 1

Amount of dissolved O2 in the plasma

Amount of hemoglobin

Ability of the Hb to bind with O2

Question 2

What regulates ventilation?

Answer 2

Central Nervous System

Question 3

Define:
Hypoventilation

Hyperventilation

Hypoxia

Answer 3

Hypoventilation: alveolar ventilation is inadequate to meet the O2 demand of the body or eliminate sufficient CO2

Hyperventilation: lungs remove CO2 faster than it is produced by cellular metabolism

Hypoxia: inadequate tissue oxygenation at the cellular level

Question 4

What would it mean if the patient gained 5lb in one day?

Answer 4

Hypervolemia- a fluid imbalance- increases risk of heart failure

Question 5

Explain the differences between early and late hypoxia

Answer 5

Early: apprehension, restlessness, elevated BP (unless shock), unable to lie flat, fatigued, agitated

Late: cyanosis, decreased HR/BP/RR

Question 6

What vaccinations influence oxygenation?

Answer 6

Influenza
Pneumococcal

Question 7

What are some environmental pollutants

Answer 7

Secondhand smoke
Work chemicals/pollutants

Question 8

List 3 ways Dyspnea can be managed?

Answer 8

Medications

Oxygen

Relaxation

Question 9

What are some methods of airway maintenance?

Answer 9

Hydration to manage secretions

suctioning

Chest physiotherapy (CPT)

Nebulizers

Question 10

How are pulmonary secretions mobilized?

Answer 10

Suction, repositioning

Question 11

Explain 2 breathing exercises

Answer 11

Pursed-lip breathing
-deep inspiration and prolonged expiration through pursed lips to prevent alveolar collapse

Diaphragmatic breathing
-Increased tidal volume, decreases respiratory rate, leads to overall improved breathing pattern/quality of life

Question 12

What is the goal of oxygen therapy?

Answer 12

To prevent or relieve hypoxemia by delivering the lowest amount of oxygen possible to achieve adequate tissue oxygenation

Question 13

Explain 3 forms of low flow oxygen therapy

Answer 13

Nasal Cannula 1-6L (24-44%)
-simple, easily tolerated, can eat/drink/talk

Simple Face Mask 6-12L (35-50%)
-Short term, transport

Partial & Non-rebreather 10-15L
(60-90%)
-Short term, increased FiO2

Question 14

Explain 2 forms of high flow oxygen therapy

Answer 14

Venturi mask (24-50%)
-Very specific amount of O2
-similar to simple mask

High flow nasal cannula

Question 15

Explain 2 forms of non-invasive ventilation to avoid artificial airway in acute situations

Answer 15

Continuous positive pressure airway (CPAP) 21-100%
-pushes air in and out- sleep apnea

Bilevel positive airway pressure (BiPAP) 21-200%

Question 16

What is FiO2?

Answer 16

Fraction of inspired oxygen concentration

Question 17

How often should incentive spirometry be used?

Answer 17

5-10 breaths per session every hour when awake

Question 18

Who is an oral airway used for?

Answer 18

Prevents obstruction of trachea by displacement of the tongue into oropharynx

Only used on non-alert/awake patients- causes puking if they’re awake

Question 19

What is a management/safety consideration of an ET tube?

Answer 19

Ventilator-associated pneumonia

Question 20

What are chest tubes used for?

Answer 20

Pneumothorax
Hemothorax

Question 21

List the key safety guidelines

Answer 21

Know the baseline vital sign range

Limit introduction of catheter to 2 times with each suctioning procedure

Do tracheal suctioning before pharyngeal suctioning whenever possible

Caution when suctioning patients w/ head injury

NS instillation into airway before suctioning is not recommended

Review institutional policy before stripping or milking chest tubes

Most serious tracheostomy complication is airway obstruction

Patients with COPD who are breathing spontaneously should cautiously receive high levels of O2 therapy

Question 22

A patient with a tracheostomy has thick tenacious secretions. To maintain the airway, the most appropriate action for the nurse includes:

Answer 22

Tracheal suctioning

Question 23

Which skills can the nurse delegate to AP? Select any:

Initiate O2 therapy via nasal cannula

Perform nasotracheal suctioning on a patient

Educate patient about incentive spirometer use

Assist w/ care of established tracheostomy tube

Reposition a patient w/ a chest tube

Answer 23

Assist w/ care of established tracheostomy tube

Reposition a patient w/ a chest tube

Question 24

The nurse is caring for a patient w/ pneumonia. On entering the room, the nurse finds the patient lying in bed, coughing, and unable to clear secretions. What should the nurse do first?:

Start O2 at 2L/min via nasal cannula

Elevate head of bed to 45degrees

Encourage patient to use incentive spirometer

Notify the healthcare provider

Answer 24

Elevate head of bed to 45 degrees

Question 25

Which assessment findings indicate that the patient is experiencing an acute disturbance in oxygenation and requires immediate intervention? Select any: SpO2 value of 95% Chest retractions RR of 28 breaths/min Nasal flaring Clubbing of fingers

Answer 25

Chest retractions RR of 28 breaths/min (tachypnea) Nasal flaring Clubbing is a sign of chronic O2 desatt, not acute

Question 26

Define: Orthopnea Tachypnea

Answer 26

Orthopnea: patient must use pillows to prop themselves up to breathe at night Tachypnea: >20 breaths/min

Question 27

Define: Hemoptysis Expectorate

Answer 27

Hemoptysis: blood sputum Expectorate: to cough/spit out something

Question 28

Is SpO2 of 95% acceptable in older adults?

Answer 28

Yes

Question 29

Explain CPT

Answer 29

Chest Physiotherapy: firm pats on anterior thorax to break up lung secretions

Question 30

Is a provider order necessary for O2 therapy?

Answer 30

No- but they should be informed right after

Question 31

What kind of O2 therapy care can be delegated to an AP?

Answer 31

AP can apply the nasal cannula or O2 mask after the method of delivery and % of O2 is determined.

Question 32

What can immobility lead to?

Answer 32

Atelectasis

Question 33

What kind of technique is used for oropharyngeal and nasotracheal suctioning? What about tracheal?

Answer 33

Clean Sterile

Question 34

How long can orotracheal and nasotracheal suctioning last? What about tracheal?

Answer 34

10-15 seconds 10 seconds

Question 35

What is the pressure range for tracheal suctioning?

Answer 35

80-120 mm Hg

Question 36

Is saline/lubricant used for tracheal suctioning?

Answer 36

NO

Question 37

What kind of suctioning tasks can be delegated to AP?

Answer 37

oropharyngeal and well-established tracheal suctioning can be delegated if the patient is assessed and stable

Question 38

When is an Endotracheal tube established?

Answer 38

When the patient cannot breathe for themselves Short-term artificial airway to administer invasive mechanical ventilation

Question 39

How should chest tubes be maintained?

Answer 39

Keep sealed Clean drainage cannister

Question 40

When are chest tubes used?

Answer 40

Removes air from pneumothroax Removes blood/fluids from hemothorax