Oxygenation

Question 1

What is pulmonary ventilation

Answer 1

(Breathing) - movement of air into and out of the lungs. It has two phases: inspiration and expiration.

Question 2

What are the two phases of ventilation

Answer 2

• Respiration
• Diffusion

Question 3

Explain respirations

Answer 3

involves gas exchange between the atmospheric air in the alveoli and blood in the capillaries through the process of diffusion

Co2 and 02 exchange. Alveoli is rich in o2

Question 4

Explain diffusion

Answer 4

movement of gas or particles from areas of high pressure or concentration to areas of lower pressure or concentration

Question 5

In order for diffusion to occur, there must be what?

Answer 5

adequate “surfactant” to prevent the collapse of the alveoli (atelectasis)

Question 6

Explain perfusion

Answer 6

process by which oxygenated capillary blood passes through body tissues

Question 7

What controls breathing

Answer 7

Respiratory center in the medulla

Question 7

Explain internal respiration

Answer 7

exchange of oxygen and carbon dioxide between the circulating blood and tissue cells

Question 8

What triggers the respiratory center

Answer 8

high CO₂ levels → Increases breathing rate to remove CO₂ & boost O₂.

Question 9

What maintains balance

Answer 9

Negative feedback loop

Question 10

What are some COPD considerations

Answer 10

• COPD patients:
  o Used to high CO₂ → Their drive to breathe is low oxygen (hypoxemia).
  o Hypoxia (low O₂) → Main symptom: Dyspnea (difficulty breathing).
• Breathing alterations:
  o Hypoventilation – Slow, shallow breathing.
  o Hyperventilation – Rapid, deep breathing

Question 11

What are some Oxygenation-related heart conditions:

Answer 11

o Dysrhythmia (Arrhythmia) – Irregular heart rhythm. “A-fib” no P wave.
o Myocardial ischemia – Angina (chest pain) or Infarction (heart attack).
o Heart failure (HF) – Heart’s inability to pump effectively. ( right and left sided failure)

Question 12

What are some oxygenation changes related to older adults

Answer 12

• Less elastic respiratory tissues & alveoli → Reduced lung expansion.
• Weaker respiratory & abdominal muscles → Less breathing power.
• Chest stiffness → Decreased maximum inspiration & expiration.
• Easier airway collapse → Increased breathing difficulty.
• Reduced cardiac response to physical/emotional stress.
• Decreased physical activity & conditioning.
• Less elastic blood vessels & stiff heart valves → Affects circulation & oxygenation.

Question 13

What are some physical assessment techniques for oxygenation

Answer 13

Inspection, level of consciousness, ABC’s, palpate, auscultate, labs, other diagnostic testing

Question 14

How would you assess using inspection for oxygenation

Answer 14

level of consciousness, any respiratory or cardiac distress (restlessness / anxiousness), skin color, chest diameter (COPD - barrel shape chest) and spine curvature, breathing pattern (tachypnea/bradypnea)

Question 15

How would you assess using palpation for oxygenation

Answer 15

skin temperature, chest symmetry, note any masses, edema and tenderness, note PMI (Point of Maximal Impulse/apical pulse) and any vibrations, pulses and capillary refill

Question 16

How would you assess using auscultation for oxygenation

Answer 16

breath sounds (normal / adventitious), heart sounds (normal / abnormal)

Question 17

What labs would you monitor for oxygenation

Answer 17

• Arterial Blood Gas (ABG)
• Cardiac Biomarkers - CK; Troponin (more specific after injury to the heart)
• Complete Blood Count (CBC)
  - Hemoglobin (Hgb): Reflects amount of RBCs in blood (g/dL)
  
  • Hematocrit (Hct) [Equals Hgb x3]: measures percent of RBCs in blood, reflects viscosity/thickness of blood
• Cytologic Study (detect malignancy)

Question 18

How would you assess using other diagnostic testing/ other forms of testing for oxygenation

Answer 18

• Electrocardiography (EKG)
• Pulse Oximetry: uses laser to measure the amount of oxygen in your blood (in capillaries) also known as oxygen saturation
• Capnography: uses sensor to measure the amount of carbon dioxide (CO2) in a patient’s exhaled breath
• Thoracentesis (removal of fluid from pleural space)
• Others: Pulmonary Function Studies (done mostly by respiratory therapists)

Question 19

What are the low flow oxygenation delivery systems

Answer 19

nasal canula, oxymizer cannula, face mask, and non-rebreather reservoir mask

Question 20

What are the high flow oxygenation delivery systems

Answer 20

nasal cannula and venturi mask

Question 21

What is the flow rate for low flow nasal cannula

Answer 21

flow rate:
1 – 6 L/min
24% - 44%

patients: with chronic lung disease, limit rate to the minimum needed to raise arterial oxygen saturation to maintain a level of 88–92%

Question 22

What is the flow rate for oxymizer cannula

Answer 22

flow rate:
3 to 4x more compare to regular nasal cannula with the same flow rate
*Don’t use humidifier.

Question 23

What is the flow rate for face mask

Answer 23

flow rate:
5 – 8 L/min
40% – 60%

Question 24

What is the flow rate for non-rebreather reservoir mask

Answer 24

flow rate: 10 – 15 L/min 80% – 95% *Don’t use humidifier.

Question 25

What is the flow rate for high flow nasal cannula

Answer 25

flow rate: Maximum Flow 60L/min 10 L/min – 65% 15 L/min – 90% better tolerated by children

Question 26

What is the flow rate for venturi mask

Answer 26

flow rate: Deliver precise, high-flow rates of oxygen; masks are available for delivery of 24%, 28%, 31%, 35%, 40% and 60% *Don’t use humidifier.

Question 27

Explain Left sided heart failure

Answer 27

Most common. No o2 to the body. Blood goes back into the lungs. This causes fatigue, decrease in urine out out, weight gain, irregular heart beat, pulmonary edema and difficulty breathing.

Question 28

Explain right sided heart failure

Answer 28

Back flow of blood causing JVD, pitting edema ( legs), hypoventilation, enlarged liver, irregular heart beat, weight gain.