Oxygenation # 2

Question 1

Objective data physical examination: Palpation

Answer 1

• Palpation: Skin temperature, moisture, tenderness, lumps, masses, thrills, heaves

Notes: symmetrical expansion ( thoracic excursion) & tactile fremitus (vibrations in lungs), crepitus (coarse crackling sensation -air escaping from trachea

Question 2

Physical examination: Auscultation

Answer 2

• sitting with arms on lap; breathe through mouth, slightly deeper
• Breath sounds
  1. Bronchial ( trachea&larynx) inspiration < expiration; high pitched, loud, hollow
  2. Bronchi vesicular ( R and L bronchi; scapulae) Inspiration = expiration; moderate pitch
  3. Vesicular (lung periphery) Inspiration > expiration-low soft pitched sounds

Question 3

Voice Sounds

Answer 3

• Bronchophony
• Egophony
• Whispered pectoriloquy

Question 4

Respiratory Activity in the Infant

Answer 4

• Lungs are transformed from fluid - filled structures to air filled organs
• The infant’s chest is small, airways are short, and aspiration is potential problem
• Respiratory rate is rapid and respiratory activity is primarily abdominal
• Synthetic surfactant can be given to the infant to reopen alveoli
• Crackles heard at the end of deep respiration are normal

Question 5

Respiratory Activity in the child

Answer 5

• Some subcutaneous fat is deposited on the chest wall, making landmarks less prominent
• Estachian tubes, bronchi, and bronchiole are enlongated and less angular
• The average number of routine colds and infections decreases until children enter daycare or school
• Good hygiene and tissue etiquette are encouraged
• By the end of late childhood, the immune system protects from most infections

Question 6

Respiratory Functioning in the Older Adults

Answer 6

• Body landmarks are more prominent due to loss of subcutaneous fat
• Kyphosis contributes to appearance of learning forward
• Barrel chest deformity may result in increased anteroposterior diameter
• Tissues and airways become more rigid; diaphragm moves less efficiently
• Older adults have an increased risk for disease, especially pneumonia

Question 7

Lab and diagnostic tests

Answer 7

• Arterial Blood Gas Analysis
• Pulse oximetry
• Chest X - Ray
• Pulmonary Function Test

Question 8

Potential Nursing Diagnoses

Answer 8

• Ineffective Airway Clearance
• Ineffective Breathing Pattern
• Impaired Gas Exchange
• Activity Intolerance related to imbalance between oxygen supply and demand
• Anxiety related to …..
• Fatigue related to impaired oxygen transport system

Question 9

Planning : Goal and outcomes

Answer 9

. Overall goals
- restore optimum function related to oxygenation
-Alleviate symptoms or side effects of disease or treatment
- Prevent complicates
. What are the specific patient outcomes and goals?

Question 10

Interventions

Answer 10

• Liquidfication
• Mobilization
• Percussion/ chest physiotherapy
• Deep breathing and coughing techniques
• Postural drainage and positioning
• Incentive Spirometer
• Positioning
• Clearing the airways : suctioning, coughing
• Reducing breathing effort
• Medications - bronchodilators, corticosteroids..
• Lifestyle Management

Question 11

Oxygen Administration and humidification Devices

Answer 11

• Caution : No smoking; Fire Safety
• Nasal Cannula: Low flow 1-6 liters ( care of nostrils
• pts. With COPD, low levels of or minimum needed for O2 sat of 88-92% Usuallg 1-3l/min
• Face masks
• rebreathing mask
• Other devices

Question 12

Additional Oxygen Delivery systems and devices

Answer 12

• Endotracheal tubes
• Tracheotomy tubes
• Tracheostomy collars
• Oropharyngeal and Nasopharyngeal airways
• Ventilators

Question 13

Administering Cardiopulmonary Resuscitation

Answer 13

• Chest Compression: Check the pulse. If the victim has no pulse, initiate chest compressions to provide artificial circulation.
• Airway: Tilt the head and lift the chin; check for breathing. The respiratory tract must be opened so that air can enter
• Breathing: If the victim does not start to breathe spontaneously after the way is opened , give two breaths lasting 1 second each.
• Defibrillation: Apply the AED as soon as it is available

Question 14

Summary

Answer 14

• oxygenation is vital for survival
  -priorities are given to the ABC’s ( Airway, Breathing and Circulation
  _ Nurses must assess, plan, implement and evaluate patient outcomes
• Application of the nurisng process