Oxygenation (Exam 1) (Sub with JD's FCs) Flashcards by Isaiah Smith

Breathing is what kind of process?

Passive. It is regulated by O2 CO2 and pH of the blood.

-When CO2 increases the body knows to increase rate and depth of breaking to help remove CO2

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Lung Volumes depend on

Age, Gender, Height

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Tidal Volume

-Amount of air exhaled following normal inspiration

-Tidal volume can vary based on health status, activity, pregnancy, exercise, obesity, and etc

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Alveoli Function

Promote gas exchange

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Respiration assessment

-Is measuring ventilations. Normal 12-20.

-Watch the depth and rhythm of breathing

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Who’s respiration is higher?

Kids and Males. They are abdominal breathers where as females are thoracic breathers

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Crackles

Fine to coarse bubbly sounds associated with air passing through fluid or collapsed small airways

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Wheezes

High pitched whistling, narrow obstructed airways. Musical

Asthma or allergic reaction

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Rhonchi

-Loud low pitch rumbling, rattling, can resolve with coughing

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Stridor

Chocking and in children

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Pleural friction rub

Inflamed pleural friction rub

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Oxygen Saturation Assess

Diffusion and perfusion

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Work of Breathing

-Determine by rate and depth. Evaluate accessory muscle use.

-Effort to expand and contract lungs

-COPD (Effort to breath)

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Compliance

Ability of lungs to distend or expand in response to pressure changes

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Decreased compliance, increased airway resistance, and/or increased accessory muscle use ____________ work of breathing

increases

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Factors Affecting Oxygenations: 4 main factors

Physiological
Developmental
Lifestyle
Environmental

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Factors Affecting Oxygenation: Chest wall movement

-Pregnancy, obesity, musculoskeletal diseases, trauma, neuromuscular disease, CNS alterations

-Damage to the Medulla Oblongata

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Goal of Ventilations

Normal Arterial carbon dioxide tension and normal arterial oxygenations tension

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Labs:

PaO2 = 80-100

PaCO2 = 34-45

EtCO2 = 35-45

O2 sat (SpO2) = > 95%

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Hypoventilation Causes and S/S

Medications and Atelectasis

Mental status changes and heart dysrthythmias

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Hypoventilation

Inadequate alveolar ventilation to meet demand

Not enough O2 or too much CO2

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Hyperventilation

-Removing CO2 faster than it is produced by cellular metabolism

-Anxiety attacks (severe), infection, drugs, pH imbalance, aspirin poisoning, amphetamine use

Numbness/tingling, hands feet, light-headedness, loc

INCREASE WOB

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Hypoxia

In adequate tissue oxygenation at the cellular level

Can lead to cardiac problems because the heart needs O2 to function

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Hypoxia Causes

-Decreased hemoglobin levels/low O2 carrying capability (Decrease Hemo)

-Diminished O2 concentration of inspired O2 (Altitude)

-Inability of tissues to get O2 from the blood (Cyanide poison)

-Decreased diffusion of O2 from alveoli to blood-infections/pneumonia

-Poor perfusion with oxygenated blood (shock)

-Impaired ventilations from trauma (rib fracture)

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Which Cyanosis do we worry about hypoxia

Central Cyanosis.

Chronic Hypoxia

-Chronic Lung conditions (COPD) -Cyanotic nail beds -Clubbed nail -Sluggish Cap refill -Barrel chest

Important when it comes to coughing

Control the patients pain

Sputum collection

-Collect early morning -Collect 1-2 hours after patient eats -Sterile procedure -Teach patient to cough into the container and get as much expectorate sputum as possible -May require suctioning if they cant cough anything up

Negative sputum collections means

It was normal and they did not have anything

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 cancer -Differentiate type of cancer cells

Pulmonary Function Test

-Basic ventilation studies. How well you are breathing -Determines ability of the lungs to efficiently exchange O2 and CO2. -Used to differentiate pulmonary obstructive from restrictive disease

Peak Expiratory Flow Rate (PEFR)

-Airway resistance. Asthma and progression of asthma

Bronchoscopy

Checking for normal airways without massess, pus, or foreign bodies

Lung scan

-Nuclear scanning test used to identify abnormal masses by size and location. Used to find blood clots preventing normal perfusion or ventilation

Thick secretions : Nursing Diagnoses

-Ineffective airway clearance

Weak cough : Nursing Diagnosis

Risk for Aspiration

Atelectasis and Chronic lung disease and Infections: Nursing diagnoses

Impaired Gas Exchange

Head position airway maintenance

head title and chin lift Jaw Thrust (Spinal Cord injury)

Long Term Preventative Measures

-Vaccinations -Healthy Lifestyle -Environmental and Occupational exposures

CPR order

Compression Airway Breathing C_A_B

Managing Pulmonary Secretions

-Mobilize -Hydrate -Humidification -Medicaitons

Chest Physiotherapy Contraindications

-pregnant -Rib/chest -Increased intracranial pressure -Recent abdominal surgery -Bleeding disorders -Osteropororsis

When is suctioning indicated

-When patients cannot clear secretions on their own through coughing or CPT -Orotracheal and Nasotracheal NT

Which type of suctioning is most common

-Nasotracheal (NT)

Incentive Spirometer

-Promotes lung expansion through deep breathing

Nasal Cannule

FiO2: 1-6L/min: 24-44% Use humidification if greater than 4L of flow or more than 24 hours

Simple face mask

FiO2: 6-12 L/min: 35-50% Short Transportation Can worsen CO2

Non-Rebreather Mask

Highest non evasive O2 Critical patients Use before intubation

Pharyngeal airways

Through the mouth or nose and for people still breathing on their own. They may have a decrease in breathing which calls for it loss of muscle or need suctioning

Tracheal Airways

Unable to breathing effectively on their own

Endotracheal Tube

Ventilator. Tube goes all the way down

Percutaneous

The normal trach

Accidental Decannulation

-Keep orburator at bedside -Insert orburator into outer cannula -Extend neck and open tissue. Insert cannula -Remover obturator -Check breath sounds -Secure trach

Signs and symptoms indicating need for suctioning

1. Increase restlessness 2. Increase WOB 3. Noisy congestion when encouraged to cough 4. Noisy breath sounds upon ausculation

What is at bedside at all times

Spare inner cannula, spare trach, ambu bag, and obturator

Hyper-oxygentation

With 100% O2 set at 10/15 L/min with 100% humidity for at least 30 seconds. Deep breathe 3/4 times to facilitate hyper-oxygenation

Only suction the patient on the way out

Sucitoning

Allow 1 min between suctioning passes. Limit suctioning pass to no more than 2-3x in one setting.

Inner cannula goes into what solution

1/2 NS 1/2 peroxide

Clean faceplate with

Only NS

Fenestrated vs Non-fenestrated trach

Non-fenestrated patient are very ill and need all the air forced into lungs Fenestrated is patient we are trying to wean off incubator