W4 oxygen Flashcards
(98 cards)
1
Q
how are infants/toddlers at risk for upper respiratory tract infections?
A
- frequent exposure to other children
- exposure to second-hand smoke
- during teething, some infants develop nasal congestion which encourages bacterial growth=increases the risk of respiratory tract infection
2
Q
how are school-aged children and adolescents at risk for respiratory infection?
A
- exposure to second hand smoking and cigarette smoking
- a person who starts smoking in adolescence and continues to smoking into middle age =increase risk of cardiopulmonary disease and lung cancer
3
Q
how are young and middle-age adults at risk for respiratory infection?
A
- unhealthy diet
- lack of exercise
- stress
- over-the-counter
- prescription drugs not used as intended
- illegall drugs
- smoking
4
Q
how are elders at risk for respiratory infection?
A
- cardiac and respiratory system undergo changes throughout the aging process
- these changes include calcification of the heart vales, SA node, and costal cartilages
- arterial system develop atherosclerotic plaques
- osteoporosis leads to changes in the size and shape of the thorax
- trachea and large bronchi become enlarged from calcification of airways
- alveoli enlarge decreases the surface area viable for gas exchange
- number of functional cilia is reduced =decrease the effectiveness of cough mechanisms
- ventilation and transfer of respiratory gases decline w/ age b/c lung are unable to expand fully= leading to lower o2 levels
5
Q
how to reduce the risk of respiratory infections?
A
- smoking cessation
- weight reduction
- low-cholesterol and low-sodium diet
- management of HTN and moderate exercise
6
Q
what happens to a pt lung when they are obese?
A
- obesity decreases lung expansion and the increased body weight increase oxygen demands to meet metabolic needs
- also at risk of anemia
7
Q
what happens to a pt lungs when malnourished?
A
- may experience respiratory muscle wasting, resulting in decrease muscle strength and respiratory excursion
- cough efficiency is reduced secondary to respiratory muscle weakness, putting the pt at risk for retention of pulmonary secretions
- at risk for anemia
8
Q
smoking as a risk
A
- associated with heart disease, stroke, COPD, and lung cancer
- inhaled nicotine causes vasoconstriction of peripheral and coronary blood vessels, increasing B/P and decreasing blood flow to peripheral vessels
- women who smoke and take birth control are at increase risk for cardiovascular problem (thrombophlebitis and pulmonary emboli)
9
Q
substance abuse as a risk
A
- pt tend to have poor nutritional intake
- excessive use can depress the respiratory centre, reducing the rate and depth of respiration and the amount of inhaled oxygen
- substance abuse by smoking or inhaling can cause direct injury to lung tissue causing permanent lung damage and impaired oxygen
10
Q
stress as a risk factor
A
a continuous state of stress or severe anxiety increases the body’s metabolic rate and the oxygen demand
11
Q
what are the nursing assessment for lungs
A
-in-depth hx of pts normal and present cardiopulmonary function
-past impairments in circulatory or respiratory functioning
-measures that pt uses to optimize oxygenation
-hx should include review of drugs food, and other allergies, such as pet dander, mould, and environmental triggers
-any pain, dyspnea, fatigue, peripheral circulation, cardiac risk factors, and presence of past or concurrent cardiac conditions
-cough, SOB, wheezing, pain, environmental exposure
-hx of respiratory tract infections
-hx of smoking
-alleriges
-family hx
-
12
Q
what is dyspnea
A
- a clinical sign of hypoxia and manifests as breathlessness/SOB
- subjective
- SOB associated w/ excerise or excitement
- can also be present w/out any relation to activity or expertise
13
Q
what are the clinical signs w/ dyspnea
A
- exaggerated respiratory effort
- use of accessory muscle of respiration
- nasal flaring
- increase rate and depth of reparations
- impairs pts ability to lie flat
14
Q
what is the vital analogue scale? (VAS)
A
- the vas is 100-mm vertical line w/ end points of 0-10
- zero= no dyspnea and 10 is=the worst breathlessness the pt has experienced
15
Q
what is orthopnea?
A
an abnormal condition in which the person must use multiple pillows when lying down or must sit w/ the arms elevated and leaning forward to breath
16
Q
what is a cough?
A
- a sudden, audible explosion of air from the lungs
- person breaths in, glottis is partially closed and the accessory muscles of expiration contract to expel the air forcibly
- coughing is a protective reflex to clear the trachea, bronchi and lungs of irritants and secretions
17
Q
what is sputum contain?
A
mucus, cellular debris, and microorganisms, and may contain pus or blood
18
Q
what is hemoptysis?
A
bloody sputum
- determine if it is associated w/ coughing and bleeding from the upper respiratory tract, from sinus drainage or from the gastrointestinal tract (hematemesis)
- tests: examination of sputum specimens, chest x-ray, and bronchoscopy should be performed
19
Q
what is wheezing?
A
characterized by a high-pitched musical sound caused by high-velocity movement of air through a narrowed airways
- may be associated w/ asthma, acute bronchitis, or pneumonia
- can occur during inspiration, expiration or both
20
Q
what should the nurse inspect for?
A
- observe any nails for clubbing
- any chest wall movement for retraction, sinking in of soft tissues of the chest between the intercostal spaces
- paradoxical breathing (chest wall contracts during inspiration and expands during exhalation)
- asynchronous breathing
- note the anteroposterior diameter of the chest wall
- cough
21
Q
what should the nurse palpate for?
A
the presence and quality of peripheral pulses, skin temperature, colour, cap refill
-feet/legs should be palpated for presence/absence of peripheral edema (grade from 1+-4+)
22
Q
percussion and respiratory assessment
A
- used to detect the presence of abnormal fluid or air in the lungs
- also aids in determining diaphragmatic excursion
23
Q
what is auscultation used for in respiratory assessment?
A
- involves listening for movement of air throughout all lung fields-anterior, posterior, and lateral
- identify normal and abnormal heart and lung sounds
- includes s1, s2, s3, and s4 sounds
- is there a bruit over the carotid arteries?
- any fluid?
- adventitious breath sounds occur with collapse of a lung segment, fluid in a lung segment, or narrowing or obstruction of an airway.
24
Q
what are some airway maintenance strategies?
A
- adequate hydration to prevent thick tenacious secretions
- proper coughing to remove secretions and keep airway open
- suctioning
- CPT (chest physiotherapy)
- nebulizer therapy
25
what are 4 managements for dyspnea?
- pharmacological measures (bronchodilators steroids, mucolytics, low-dose anti-anxiety meds)
- oxygen therapy (can reduce dyspnea associated w/ exercise
- physical techniques (coughing, pursed lips)
- psychosocial techniques
26
humidification and oxygen therapy
humidification is the process of adding water to gas
-air or oxygen w/ a high relative humidity keeps the airway moist and help loosen and mobilize pulmonary secretions
-humidification is necessary for pts receiving oxygen therapy at >4L/minute
-bubbling oxygen through water can add humidity to the oxygen delivered to the upper airways, as w/ a nasal cannula or face mask
-
27
what is a nebulizer?
nebulization is the process of adding moisture or medication to inspired air by mixing particles of varying sizes w/ the air
- a nebulizer uses the aerosol principle to suspend a maximum number of water drops or particles of the desired size in inspired air.
- the moisture added to the respiratory system through nebulization improves clearance of pulmonary secretions
- humidification through nebulization enhances mucociliary clearance, the body’s natural mechanism for removing mucus and cellular debris from the respiratory tract
28
what is chest physiotherapy (CPT)
- a group of therapies used in combination to mobilize pulmonary secretions
- include postural drainage, chest percussion, vibration!!
- CPT should be followed by productive cough, and suctioning of pt who has a decreased ability to cough
- CPT is recommended for pts who produce greater than 30 mL of sputum per/day or has atelectasis
- safe for infants/young children
29
how is chest percussion performed?
- involves striking the chest wall over the area being drained
- percussion on the surface sends waves of varying amplitude and frequency through the chest, changing the consistency and location of the sputum
- it is performed by striking the chest wall alternately w/ cupped hands
- performed over a single layer of clothing (smooth) -prevent slapping pts skin
30
when is chest percussion contraindicated?
in pts w/ bleeding disorders, osteoporosis or fractured ribs
31
how is vibration done?
it is a fine, shaking pressure applied to the chest wall only during exhalation
- increases the velocity and turbulence of exhaled air
- facilitates secretion removal
- increases the exhalation of trapped air and may shake mucus loose and induce a cough
32
how is postural drainage done?
-use of positioning techniques that draw secretions from specific segment of the lungs and bronchi into the trachea
33
suctioning technique
-important when pt cannot clear their respiratory tract secretions w/ coughing
-includes oropharyngeal and nasopharyngeal
-sterile technique is used b/c the trachea is considered sterile
but the mouth is considered clean
-so suction the oral secretion after suctioning of the oropharynx and trachea
34
risk of too-frequent suctioning?
-can put the pt at risk for development of hypoxemia, hypotension, arrhythmias, and possible trauma to the mucosa of the lungs
35
when do we use oropharygenal and nasopharyngeal suctioning?
- oropharyngeal and nasopharyngeal suctioning is used when the pt is able to cough but unable to clear secretions by expectorating or swallowing
- the more we reduce the pulmonary secretions pt becomes less fatigued and pt may be able to expectorate or swallow the mucus, making it no longer required to suction
36
when do we use orothacheal and nasotracheal suctioning (I made 2 of the same cards basically)
when the pt w/ pulmonary secretions is unable to manage secretions by coughing and does not have an artificial airway
- -catheter is passed through the mouth or nose into the trachea.
- the nose is the preferred route b/c stimulation of the gag reflex is minimal
- entire procedure should be done quickly, no longer than 10 seconds
- pt should be allowed to rest during passes of the catheter unless in respiratory distress
- if they are using supplemental oxygen the oxygen should be place during rest periods
37
how to perform tracheal suctioning?
- accomplished through artificial airway (endotracheal tube or tracheostomy tube)
- to avoid trauma to the mucosa of the lungs, never apply suction pressure less than 150 mm Hg in adults
- u can rotate the Cather to enhance removal of secretions
- don't use normal saline installation to try and improve secretions- it is harmful and not recommended
- open vs closed suctioning
38
what is open suctioning?
involves a sterile catheter that is opened at the time of suctioning
-must wear sterile gloves
39
what is closed suctioning?
involves a multiple-use suction catheter encased in a plastic sheath
- used on pt who require mechanical ventilation to support their respiratory efforts b/c it permits continuous delivery of oxygen while suction is being performed =reducing the risk of oxygen desaturation
- wear disposable gloves can be sterile or non sterile
40
what is an artificial airway
- indicated for pt w/ a decrease LOC or they have an airway obstruction and to aid in the removal of tracheobronchial secretions
- types: oral airway, endotracheal and tracheal airway
41
what is the oral airway?
- simplest type of artificial airway
- prevents obstruction of the trachea by displacement of the tongue into the oropharynx
- always the tongue to remain in it's normal position
- must use the correct size to avoid complications
- used on unconscious pts
42
what to measure to insert the oral airway?
by measuring the distance from the corner of the mouth to the angel of the jaw just below the ear
- if it is too small, the tongue is not held in the anterior portion of the mouth
- if it is too large, it may force the tongue towards the epiglottis and obstruct the airway
43
complications of having an artificial airway?
- place the pt at high risk for infection and airway injury
- must be maintained in the correct position to prevent airway damage
- use sterile technique to avoid heath care associated infections
44
what is an endotracheal (ET) tube?
are used in short-term artificial airways to administer mechanical ventilation
- it relieves upper airway obstruction
- protect against aspiration
- clear secretions
- only for specialized health care providers can insert this
- ET are usually removed w/in 14 days (can be used for longer period of time if the pt is showing progress towards weaning off from the vent)
- if pt needs long-term assistance, tracheostomy is used
45
what is a tracheostomy tube?
a surgical incision made into the trachea, and a short artificial airway (a tracheotomy tube) is inserted
-for long term use
46
what are the maintenance and promotion of lung expansion?
- include noninvasive and invasive techniques
- noninvasive include: ambulation, positioning, and incentive spirometry
- invasive include- management of chest tube
47
maintenance and promotion of lung expansion- ambulation
- immobility=at risk for atelectasis and ventilator-associated pneumonia
- early ambulation= increased general strength and lung expansion
- usually done by RT or PT
48
maintenance and promotion of lung expansion-positioning
-frequent changes of position are effective in reducing the risk of stasis of pulmonary secretions and decreased chest wall expansion
49
what is the most effective position for pts w/ cardiopulmonary disease?
- 45-degree semi-Flower's position, using gravity to assist in lung expansion and reduce pressure from the abdomen on the diaphragm
- ensure pt does not slide down
50
what is the best position for pt w/ unilateral lung disease? (pneumothorax, atelectasis, pneumonia, thoracotomy, or multiple trauma affecting one lung
- should be positioned with the unaffected lung down (good lung down)
- promotes better perfusion of the healthy lung, improving oxygenation
- BUT- IF PT HAS PULMONARY ABSCESS OR HEMORRHAGE PT SHOULD BE PLACED W/ THE AFFECTED LUNG DOWN TO PREVENT DRAINAGE TOWARD THE UNAFFECTED (HEALTHY) LUNG
51
maintenance and promotion of lung expansion-incentive spirometry
- a method to encourage voluntary deep breathing by providing visual feedback to pt about inspiratory volume
- promotes deep breathing to prevent/treat atelectasis in post-op pts
- purpose is to promote lung expansion =preventing post-op pulmonary complication following abdominal surgery
- and encourages pt to breathe to their normal inspiratory capacities
52
what is an acceptable post-op inspiratory capacity reading?
one-half to three-fourths is acceptable b/c of post-op pain
- can give pain meds before doing this to help pt
- recommended to do 5-10 breaths per session every hour as the pt is awake
53
what is a chest tube?
a catheter that is inserted through the thorax to remove fluid or air
54
what is the purpose of a chest tube?
- it is inserted to remove air and fluids from the pleural space, prevent air or fluid from re-entering the pleural space, and re-establish normal intrapleural and intraalumonic pressures
- commonly used after chest surgery and chest trauma and for pneumothorax or hemothorax to promote lung re-expansion
55
what is a mobile system chest tube?
- relies on gravity, not suction for drainage
- it reduces length of time needed for the chest tube, improves ambulation, and decreases the length of time spent in the hospital
- they are lighter and smaller, so the pt can move more easily= reducing risk of DVT and pulmonary embolism
56
what is pneumothorax?
- a collection of air in the pleural space
- theres a loss of negative intrapleural pressure causing the lung to collapse
- can be caused by: chest trauma (stabbing, car accident), rupture of an emphysematous bleb on the surface of lung, or from an invasive procedure such as an insertion of subclavian IV line
- dyspnea is common and worsens as the size of pneumothorax increases
57
what is a hemothorax?
accumulation of blood and fluid in the pleural cavity between the parietal and visceral pleurae usually as a result of trauma
-produces counterpressure and prevents lungs from full expansion
-can also be caused by the rupture of small blood vessels fro inflammatory processes such as pneumonia or TB
s/s pain, dyspnea, and shock if blood loss is severe
58
what is a single drainage system?
a single-chamber system allows air from a pneumothorax to bubble out of the water seal and escape through the air outlet. preventing air from re-entering the intrapleural space
59
what is a two or three chamber system?
a system that drains both a hemothorax and a pneumothorax
the two-chamber system allows fluid to flow into a collection chamber and air to flow into the water seal chamber
a three-chamber system permits the drainage of fluid and air through controlled suction
both have two compartments-one for fluid or blood and the second for water seal or a one-way valve
the three-chamber system has a third compartment for suction control if needed
60
what are the two types of commercial drainage devices?
water-seal and waterless systems
- waterless system does not require fluid for setup and the water seal is replaced by a one-way valve
- suction chamber should be set between -10cm h20 and -40cm h20
61
what happens if pts chest drainage tubing disconnects from the drainage unit?
the pt should be instructed to exhale as much as possible and cough
- this manoeuvre rids the pleural space of as much air as possible
- nurse should cleanse the tips of the tubing and reconnect them quickly
- if the drainage unit is broken, the end of he chest tube can be quickly submerged in a container of sterile water to re-establish the seal
62
why might we not want to clamp a chest tube?
may result in a tension pneumothorax
| -air pressure builds in the pleural space, collapsing the lungs and creating a life threatening event
63
what is the purpose of oxygen therapy?
to relieve or prevent tissue hypoxia
- it can cause atelectasis or oxygen toxicity
- it is a highly combustible gas
64
safety precautions with oxygen
- no smoking permitted in areas where oxygen is in use
- ensure all electrical equipment in the room is functioning correctly and is properly grounded. an electrical spark in the presence of oxygen can result in a serious fire
- locate the closet fire extinguisher
- know the fire procedures and the evacuation route
- always ensure there is enough oxygen in tanks before transporting pt
65
what is a low-flow device?
ex. nasal cannula, simple face mask, and reservoir masks provide oxygen in concentration that vary with the pt's respiratory pattern
66
what is a high-flow device?
delivers oxygen rates above the normal inspiratory flow rate and thus provide a fixed FiO2 (fraction of inspired oxygen) regardless of the pts inspiratory flow and breathing pattern
-ex., venturi mask
67
what is a nasal cannula?
a low-flow device used for oxygen delivery
- oxygen is delivered via the cannulas w/ a flow rate of up to 6L/minute
- anything great than 4L/minute needs humidification
- be alert for skin breakdown over eats/nares
68
what is the purpose of an oxygen mask?
-administer oxygen, humidity, or heated humidity
69
what is the purpose of a simple face mask?
- short-term oxygen therapy
- fights loosely and delivers oxygen concentration from 40-60%
- it is CONTRAINDICATED FOR PTS W/ CARBON DIOXIDE RETENTION BC RETENTION CAN BE WORSEN (ex. COPD)
70
partial rebreather mask oxygen concentration
-has an oxygen concentration of 40-70% w/ a minimum flow rate of 10/L min
71
non-rebreather oxygen concentration
-provides a high concentration of oxygen at 60-80% w/ a minimum flow rate of 10/Lmin
72
how does the partial rebreathing mask or non-rebreathing mask work?
oxygen flows into the reservoir bag and mask during inhalation; one-way values on the non-rebreather mask prevent expired air from flowing back into the bag
- bag should always be inflated
- if it is deflated the pt may be breathing large amounts of exhaled carbon dioxide
73
what is the indication for home oxygen therapy?
includes PaO2 of 55m Hg or less or an SaO2 of 88% or less on room air at rest, on exertion or with exercise
74
what is a cardiac arrest?
a sudden cessation of cardiac output and circulation
- oxygen is not delivered to the tissue, and carbon dioxide is not transported from tissues, tissue metabolism becomes anaerobic, and metabolic and respiratory acidosis occur.
- permanent damage to the heart, brain and other tissues can occur w/in 4-6 minutes
- lack of pulse and respirations
75
what is cardiopulmonary rehabilitation?
-involves activity helping the pt to achieve and maintain an optimal level of health through controlled physical exercise, nutrition counselling, relaxation and stress management techniques, prescribed medications and oxygen
76
why is hydration important?
maintains adequate systemic hydration
- keeps mucociliary clearance normal
- pulmonary secretions are thin, white, watery, and easily removable
- 1500 to 2000 ml/day of h20
77
what are the three types of oxygen?
compressed oxygen, liquid oxygen, and oxygen concentrators
78
what is compressed gas cylinders?
- stationary and portable intermittent therapy
- used for exercise or sleep only
- no las of gas during storage
- portable
- delivers up to 15L/min
- 100%
- disadvantage: bulky, frequent refilling w/ continuous use
79
what is compressed gas?
small cylinder w/ compressed gas for easy portability
- allows from 1-5 hours of portable oxygen
- but only last a few hours
- E-cylinders not appropriate as sole source of oxygen
80
what is liquid oxygen systems?
- used w/ active patients
- 100% oxygen
- conveniently portable
- can be refilled eat home
- delivery up to 6L/min
- but need weekly delivery necessary for refill
- evaporates if not used
- potential risk for frostbite at connections and if liquid is spilled
81
what is oxygen concentrators
- stationary systems for patients requiring low-flow continuous oxygen and limited mobility
- provides large source of oxygen
- inexpensive
- delivers 1-5L/min, delivery up to 10L/min w/ certain models
- but oxygen concentration decreases as litre flow increases, power supply needed, electric bill increase, second system needed for portability
82
benefit of coughing technique
- enable to pt to remove secretions from the upper & lower airways
- cough mechanism- deep inhalation, closure of the glottis, active contraction of the expiratory muscles, and glottis opening
- deep inhalation increases the lung volume and airway diameter allowing air to pass through partially obstructing mucous plugs or other foreign matter
- when the glottis opens a large flow of air is expelled at a high speed providing momentum for mucus to move to the upper airway=expectorated or swallowed
83
how often should pts cough?
at least every 2 hrs while awake
-pts w/ large amount of sputum should be encouraged to cough every hour while awake and every 2-3 hours while asleep until acute phase of mucus production has ended
84
what is a cascade cough?
- pt takes a slow, deep breath and holds it for 2 seconds while contracting expiratory muscles
- the pt opens the mouth and performs a series of coughs throughout exhalation, coughing at progressively lowered lung volumes
- promotes airway clearance and a patent airway in pts w/ large volumes of sputum
85
what is the huff cough?
- stimulates a natural cough reflex and is generally effective only for clearing central airways
- while exhaling the pt opens the glottis by saying the "huff"
- w/ practice, pt inhales more air and may be able to progress the cascade cough
86
what is the quad cough?
- technique is used for pts w/out abdominal muscle control, such as those w/ spinal cord injuries
- while the pt breaths out w/ a maximal expiratory effort, the pt or nurse pushes inwards and upwards on the abdominal muscle towards the diaphragm causing the cause
87
respiratory muscle training
- improves muscle strength and endurance, resulting in improved activity tolerance
- can prevent respiratory failure in pts w/ COPD
- can use the incentive spirometer resistive breathing device (ISRBD)
- must be used on a schedule routine (twice a day for 15 mins for example)
88
what are the four breathing exercises?
- deep breathing (routine for post-op pts)
- cough exercises (routine for post-op pts)
- pursed-lip breathing
- diaphragmatic breathing
89
what is pursed lip breathing?
- involves deep inspiration and prolonged expiration through pursed lips to prevent alveolar collapse
- pt sits up and take deep breath while sitting up and exhales slowly through pursed lips as if they are blowing through a straw
- monitor using pulse oximetry
90
what is diaphragmatic breathing?
more difficult and require the pt to relax intercostal and accessory respiratory muscles while taking deep inspirations
- can measures results objectively with pulmonary function tests, VS, ECG tracings, and physical assessments
- teach pt to place one hand flat below the breastbone and above the waist, and the other hand 2-3 cm below the first hand
- ask pt to inhale w/ the lower hand moves outwards during inspiration
- taught in supine position, then practised while sits/stands
- often used w/ pursed-lip breathing
- useful for pts w/ pulmonary disease, for post-op pts & for women in labour to promote relaxation and provide pain control
- it works by improving efficiency of breathing by decreasing air trapping and reducing the work of breathing
91
what is the primary function of the heart?
to deliver deoxygenated blood to the lungs for oxygenation and to deliver oxygen and nutrients to the tissues
92
what is the primary function of the lungs?
transfer oxygen from the atmosphere into the alveoli and to transfer carbon dioxide out of the body as a waste product
93
how is respiration controlled?
by the central nervous system and by chemicals w/in the blood
94
if pt has decrease hemoglobin levels it means _
alters the pts ability to transport oxygen
95
what is hyperventilation
-a respiratory rate greater than that is required to maintain normal levels of carbon dioxide
96
hypoventilation
-causes carbon dioxide retention
97
where can u attach a pulse oximeter?
-pts finger, toe, nose, earlobe or forehead
98
what is a CPAP? continuous positive airway pressure mask
Purpose: To deliver continuous air to assist keeping alveoli open during sleep
-Nasal CPAP delivered through a full or partial face mask or nasal
pillows
-Most commonly used for obstructive sleep apnea
