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Flashcards in Oxygentation Deck (46):
1

physiological factors affecting oxygenation

-carrying capacity of patient (anemia)
-decreased inspired oxygen (resp obstruction, wrong rate of oxygen)
-hypovolemia (shock w loss of fluid)
-high metabolic rate (fever, exercise, pregnancy)

2

conditions affecting pt oxygenation

-preg
-obesity
-trauma
-neuromuscular disease
-spinal cord injury

3

developmental factors affecting oxygenation

infants and toddlers - teething, nasal congestion, upper airway problems
school-age and adolescents - second-hand smoke, smoking, asthma
young and middle age adults - occupational hazards, poor diet, stress, cardiac and resp probs
older adults: reduced mobility, lung structural problems

4

5 behavioral risk factors

1. smoking --> vasoconstriction
2. diet --> obesity, airway probs
3. exercise
4. substance abuse
5. stress -->increase metabolic rate = increased O2 demand

5

environmental factors

not using right PPE
pollution
natural decay of uranium causes lung cancer
organic dusk disease seen in farmers

6

hyperventilation

over-breathing, common with anxiety, fear, infection.
SS - lightheaded, numbness, tingling fingers

7

hypoventilation

inadequate breathing, causes - COPD, resp depression

8

Hypoxia

inadequate tissue oxygenation.
SS - cyanosis, increase HR, resp rate increases, confusion, restlessness, skin color change (palor)

9

cyanosis

blue color around lips, fingers

10

dyspnea

SOB

11

Eupnea

normal, 12-20

12

tachypnea

>35 bpm

13

Cheyne-stokes

very deep to very shallow breathing with temporary apnea

14

bradypea

<10 bpm

15

kussmaul's respirations

hyperventilation that accompanies metabolic acidosis

16

orhopnea

trouble breathing except in up-right position

17

blood tests you can do

hemoglobin (m - 135-180, f 125)
WBC - 5-10
serum electrolytes - K and Na in relation to diet

18

ventilation and perfusion scans (v/q)

looking for pulmonary embolism

19

pulmonary function test (PFT)

looking at lung capacity

20

sputum samples (culture sensitivity and cytology

C&S - Looking for an organism growing
Cytology - Cells within the sputum

21

When is the best time to collect a sputum sample?

the morning before breakfast .. Get the patient to do oral hygiene before you get the sample … think about PPE

22

Arterial Blood Gases
• Ph –
• PaCO2–
• PaO2–
• SaO2–
• HCO3–

• Ph – 7.35-7.45
• PaCO2–35-45mmHg
• PaO2–80-100mmHg
• SaO2–95-100%
• HCO3–26-26mmol/L

23

Infectious + Inflammatory Disorders

• Exemplar - pneumonia
• Inflammation of the respiratory bronchioles and alveoli
• Community-acquired or healthcare acquired
• Infectious or non-infectious - could be bacterial or virus or fungal etc.

24

SS pneumonia

decreased gas exchange, increased exudate, cough, fever, chills, tachypnea, decreased breath sounds

25

Monitoring Airway Clearance

• Resp status + vs + O2 sat, breath sounds, cough closely
• Positioning
• DB&C + Incentive Spirometer
• 2.5-3 L/day
• Meds + O2
• Pulmonary Hygiene – percussion, vibration and postural drainage

26

monitoring Breathing Pattern

• Positioning
• Rest
• Assess and document CP
• Reassurance - trouble breathing can be anxiety provoking
• Breathing + relaxation techniques
• Distracting individual s

27

percussion and vibrations of chest

Percussion
• Rhythmically clapping the chest wall with cupped hands.
• Causes vibrations to loosen secretions

Vibration
• Helps loosen and move secretions into larger airways

28

postural drainage

gravity to remove secretions from a lung segment
• Certain positions may be contraindication of the patient

29

activity tolerance

Assess for changes in HR, RR, dyspnea, diaphoresisor cyanosis with activity
• Assist with ADL’s
• Rest
• Assistive devices - turning into better position
• Emotional support/support persons

30

medications of pneumonia

Immunization
• Pneumoccocal (recommended for the elderly, children those with chronic health challenges)
• Annual influenza (recommended for elderly, children those with chronic health challenges and health care providers)
ABX - antibiotics
Bronchodilators - can expand or open the airway
Expectorants - can help breath up the mucus

31

obstructive lung disorders

1. Secretions • Increase work of breathing + air trapping in lungs
2. Walls edematous
3. Smooth airway muscle constricts
4. Lungs lose elasticity
5. Supportive tissue lost
• Increase work of breathing + air trapping in lungs
• Inhaled air mixes with trapped air – less oxygen for gas exchange.
• Exemplars – COPD and Asthma
• Give them SOB, cough, dyspnea
• Got to work harder to breath

32

What is COPD? what is the biggest cause

• COPD is the most rapidly growing health problem.
• Inflammatory respiratory disease–chronic and progressive obstruction of airflow
• Mostly with over lapping signs and symptoms of 2 distinct disease processes:
Emphysema
Chronic Bronchitis
• #1 cause SMOKING
• Asthma separate disorder but can coexist with COPD.
•Biggest cause: SMOKING
•COPD changes structure and function

33

meds for COPD

manage and slow progression
• Immunization
• Inhaled bronchodilators–MDI, DPI or nebulized
• Corticosteroids–decrease inflammation and edema
• Cough suppressants and sedatives avoided
• Antimicrobials(as appropriate)
• Drugs for smoking cessation

34

cascade and huff coughing

Cascade
• Deep breath and multiple coughs

Huff
• Inhale deep sharply say huff

35

restorative and continuing care coughing

Diaphragmatic breathing
• Belly breathing
• Breathing from the abdomen

Pursed lip breathing
• Blow out slowly through pursed lips

Deep breathing and coughing
• In through the nose out through the mouth

36

copd and oxygen therapy

• Care needs to be exercised in patients with chronic obstructive pulmonary disease, such as emphysema, especially in those known to retain carbon dioxide.
• These patients may further accumulate carbon dioxide and decreased their body pH.
• In the worst case, administration of high levels of oxygenin patients with severe emphysema and high blood carbon dioxide may reduce respiratory drive to the point of respiratory failure (ie: drive to breath may be knocked out).
• However, the risk of the loss of respiratory drive are far outweighed by the risks of withholding emergency oxygen, and therefore emergency administration of oxygen is never contraindicated.
• Need to be careful with COPD when administering O2 - they usually have a standard order
• Discontinue oxygen when the patient no longer requires it

37

smoking cessation

• Ask
• Advise
• Assist
• Arrange protocol

38

children pulm

• Smaller nasopharynx – easily occluded
• Long, floppy epiglottis, vulnerable to swelling--> obstruction
• Larynx and glottis are higher in neck, increase risk of aspiration
• Fewer muscles mature in airway --> less able to compensate for edema/trauma/spasm
• Physically increase of infection

39

what breathing technique do u use under 6

Under 6 use the diaphragm breathe b/c intercostal muscles immature

40

children in canada w asthma

1 out o 5

41

what is asthma

Chronic inflammatory disorder of the airways characterized by recurrent episodes of:
• Wheezing
• Breathlessness
• Chest tightness
• Coughing

42

types of inhalers

MDI
• Meter dose inhaler
• Prime it first by shaking it or rolling it in your hands - make sure it works
• Exhale before you use the medication
• Spacer or air chamber - breaks the medication down so it goes deep in your lungs - better cordination
• Once you inhale - hold for around 10 secs then exhale slowly through pursed lips
DPI
• Dry powder inhaler
• Spray directly into mouth
• Rinse mouth after!!

Peak Flow Meter
• • Device that you blow into to get a reading of how rapidly you can exhale the air from your lungs. This is known as your "peak flow rate".
• • A peak flow meter can be useful for getting an objective measure of the condition of your asthma - that is, you can assign a number to it.
• • Using a peak flow meter can sometimes help you see that your asthma is starting to get out of control before you might even notice symptoms.

43

sleep apnea

1. Sleep quietly and breathe normally.
2. Begin to snore loudly (airway is partly blocked).
3. Next, airway closes off. No air reaches lungs. Brain is telling to breathe as usual, but can’t take in a breath b/c airway has closed off (apnea). After a pause of 10-30 seconds or more, brain realizes not breathing, jolts awake to take a breath. Big gasp of air and start breathing again.

44

when do you need artificial airways

An abnormal condition characterized by the collapse of alveoli, preventing the respiratory exchange of CO2 and O2 in parts of the lung is called atelectasis
• Spiramonitor

45

chest tubes

A catheter placed through the thorax to:
• remove air and fluids from the pleural space
• prevent air from re-entering
• re-establish intrapleural and intrapulmonic pressures

46

thoracentetis

Relieves a pleural effusion by inserting a needle into the pleural space to remove fluid