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N5 471 > Week 3: Oxygenation > Flashcards

Week 3: Oxygenation Flashcards

1
Q

Assessment of the respiratory system includes:

A

ABGs

Breath sounds

Meds

PFTs

Structure & function

Common symptoms

Normal changes of aging

Respiratory risk factors

Physical exam

Diagnostic tests

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2
Q

Prednisone (Deltasone)

A

Action: synthetic corticosteroid that is effective as an immunosuppressant; decreases inflammation

Used to treat inflammatory diseases

Route: PO or IV

Side effects: weight gain, N/V, restlessness, insomnia, headache, thinning skin, GI ulcer formation, hyperglycemia, HTN, cushingoid appearance, opportunistic infection

Contraindications: pts with HIV, concomitant immune system disease because it suppresses the immune system

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3
Q

Proair, Ventolin, proventil (albuterol)

A

Action: synthetic sympathimimetic agent, beta 2 adrenergic agonist (relax bronchial smooth muscle), inhibits histamine release, produces bronchodilatation

Relief of bronchospasm

Route: PO/inhalation

Contradictions: pregnancy 🤰 category C (risk/benefit), lactation, children younger than 2 years

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4
Q

Albuterol continues

A

Precautions: CV disease, HTN, hyperthyroidism, DM

Side effects: tremor, anxiety, nervousness, restlessness, convulsions, headache, increased HR, palpitations, HTN, hypotension

Drug interactions: epinephrine, additive effect with other bronchodilators

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5
Q

Atrovent (ipratropium bromide)

A

Action: inhaled anticholinergics; produce a little bronchodilation by preventing bronchoconstriction

Route: inhaled

Side effects: memory impairment, confusion, hallucinations, dry mouth, blurry vision, urinary retention, constipation, tachycardia, increased intraocular pressure, acute angle glaucoma

Duoneb is a respiratory inhalant combo of 2 bronchodilators: albuterol sulfate and ipratropium bromide to open the airways usually in COPD

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6
Q

AsthmaNefrin (Epinephrine)

A

Action: nonselective adrenergic agonist. Increased activation of the sympathetic system; increased peripheral resistance via alpha 1 receptor-dependent vasoconstriction and increased cardiac output via binding to beta 1 receptors

Epinephrine/adrenaline is the drug of choice to treat anaphylaxis. Increased HR and facilitates bronchial dilation

Route: IV, SQ, IM, inhalation

Dose: variable depending on situation

Adverse reactions: palpitations, tachycardia, arrhythmia, anxiety, panic attack, headache, tremor, HTN, and acute pulmonary edema

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7
Q

Pulmicort (Budesonide)

A

Actions: bronchodilator

Inhaled corticosteroid for 6yo+

Route: sterile suspension for inhalation via jet nebulizer

Contraindications: should NOT be used to treat an acute asthma attack

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8
Q

Montelukast (Singulair)

A

Actions: Leukotriene receptor antagonist/ anti-inflammatory: leukotrienes released in response to inhaling an allergen; decreases asthma and allergy symptoms: reduces swelling and inflammation

Route: PO

Used for prevention and long-term Tx of asthma attacks in adults and children as young as 12

Side effects: headache, drowsiness, rash

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9
Q

Fluticasone (Flovent)

A

Action: corticosteroid with potent anti-inflammatory activity

Used for asthma

Dose: starting doses above 100mcg BID for adults and adolescents; 50mcg BID for children 4-11 yo; may be considered for pts with poor asthma control

Side effects: may mask signs of infection

Max benefit may not be achieved for 1-2 weeks or longer after starting Tx

Contraindications: in the primary Tx of status asthmaticus or other acute episodes of asthma where intensive measures are required

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10
Q

Organs/tissues needed for oxygenation

A

Lungs for oxygen intake

Heart for oxygen delivery

Blood vessels and RBCs for oxygen delivery

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11
Q

Respiratory defense mechanism

A

Nose and sinuses

Warm, humidify and filter: insensible loss = 250 ml/d

Larynx: closure of glottis ➡️ intrathoracic pressure (cough)

Lower airway: carina (landmark= angle of Louis); Right main stem bronchus, smooth muscles in bronchioles; terminal respiratory unit (resp, bronchioles➡️ alveoli): surfactant

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12
Q

A&P alterations in disease: inspiratory and expiratory muscles

A

Inhalation- active process

Includes:
Diaphragm (phrenic nerve)
External intercostals
Scalene muscles

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13
Q

A&P alterations in disease: intrathoracic pressure changes

A

Chest tubes and ventilators alter oxygen

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14
Q

Muscles of respiration

A

Sternomastoid muscles

Scalenes

Inspiratory intercostals

Expiratory intercostals

Diaphragm

External obliques

Expiratory abdominals

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15
Q

A&P alterations in disease: factors ➡️⬇️oxygen diffusion

A

⬇️ Atmospheric O2 (high altitude)

⬇️ Alveolar vent (obstruction/restrictive)

⬇️ Alveolar-capillary membrane surface area (emphysema, asthma, lung cancer, PE, thiracotomy)

⬆️ Alveolar-capillary membrane thickness (inflammation, pulmonary fibrosis, sarcoidosis)

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16
Q

A&P alterations in disease: control of respiration

A

Central and peripheral chemoreceptors:

Changes in PaCO2 affect CSF pH: ⬆️ PaCO2 ➡️⬆️rate and depth of ventilation

Changes in PaCO2 (60 mmHg) affect peripheral; hypoxic drive in COPD

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17
Q

Bronchoscopy

A

Flexible or rigid

Used to diagnose/manage pulmonary diseases

Insertion of tube into airways as far as secondary bronchi to view airway structures and obtain tissue samples for testing

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18
Q

The mallampati score

A

Class I: complete visualization of the soft palate

Class II: complete visualization of the uvula

Class III: visualization of only the base of the uvula

Class IV: soft palate is not visible at all

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19
Q

Upper airway anatomy

A

Air with oxygen enters the mouth/nose

Moves through airway: trachea, bronchi, bronchioles And into alveoli (air sacs)

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20
Q

Gas exchange

A

Interaction between neuro, cardio, and respiratory systems

Chemoreceptors in medulla sense increase in CO2

Impulse to diaphragm & intercostal muscles

Diaphragm contracts, pressure pulls in O2

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21
Q

Bronchial system

A

Carries blood needed to oxygenate lungs

DOES NOT participate in gas exchange

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22
Q

Pulmonary system

A

Highly vascular

RV into pulmonary artery (PA)

PA branches into arterioles

Forms capillary networks (that are meshed around and through alveoli)

Alveoli site of gas exchange

Capillaries to pulmonary veins to LA to LV to systemic circulation

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23
Q

Surface Area

A

Alveoli significantly increase the surface area of the lungs

Due to the many surface walls of the alveoli, the lungs have a surface area that is approximately the size of a tennis court

This large surface area allows for rapid gas exchange

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24
Q

Respiratory processes and partial pressure

A

Exchange of gases between alveoli and blood occurs to simple diffusion

O2 diffusing from alveoli into blood

CO2 from the blood into the alveoli

Diffusion requires a concentration gradient

The concentration (or partial pressure) of O2 in the alveoli must be kept at a higher level than in the blood

The concentration (or partial pressure) of CO2 in the alveoli must be kept at a lower level than in the blood

Continuously breathe in fresh air (with lots of O2 and little CO2) into the lungs and the alveoli

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25
Q

Surfactant

A

Decreases surface tension which:

Increase pulmonary compliance

Reduces tendency for alveoli to collapse

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26
Q

Variations in gas exchange

A

Ventilation: inadequate function(bone, muscle, nerve); lack of O2, poor gas exchange (PE, ARDS, pneumonia); narrow airways: bronchoconstriction (asthma), obstruction (bronchitis, cystic fibrosis)

Transport: availability of Hgb and ability to carry O2 (anemia)

Perfusion: ability of blood to transport Hgb (decreased CO, thrombi, emboli, narrow vessels, vasoconstriction)

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27
Q

Changes with Aging

A

Thoracic cage gets rigid from cartilage calcification, rib osteoporosis, kyphosis or arthritic changes in spine, increased A-P diameter

⬇️chest wall compliance -> loss of elastic recoil of lungs -> ⬆️work of breathing

⬇️muscle strength (intercostals/diaphragm) which alters lung volumes, inspiratory/expiratory force leading to weaker cough; can be reversed with exercise; ⬆️ residual volume, ⬇️forced viral capacity (VC), ⬇️FEV, ⬇️max voluntary ventilation, ⬇️peak expiratory flow

Alveoli less elastic and more fibrous (dyspnea)

⬇️alveolar-capillary membrane surface area leading to ⬇️diffusion capacity

Elastic recoil capacity ⬇️

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28
Q

Consequences of impaired gas exchange

A

Fatigue, ⬆️HR, RR, T
⬇️SpO2

CO2 transport from the cells to the alveoli lead to buildup of acid

Ventilation problem= respiratory acidosis

Transport/perfusion problem= Met Acidosis

Cellular ischemia, necrosis, death

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29
Q

Respiratory health history: Dyspnea

A

Breathlessness

Environmental irritants

Orthopnea

Post nasal drip (PND)

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30
Q

Respiratory health history: Cough

A

Productive/nonproductive

Pattern

Duration (>2-3 weeks?)

Associated with fatigue, SOB, fever?

Interfere with sleep?

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31
Q

Respiratory health history: sputum

A

Production changes:

Color

Consistency

Amount (normal is 100ml/day)

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32
Q

Respiratory health history: hemoptysis

A

Frothy

Alkaline pH & bright red

Not hematemesis- acidic pH

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33
Q

Respiratory health history: wheezing

A

Phases of respiratory cycle

Indicates obstruction

34
Q

Respiratory health history: Chest Pain

A

COLDSPA

35
Q

Respiratory health history: others and risk factors

A

Night sweats

Occupational and leisure activities

Risk factors: smoking, respiratory disorders, family history, environmental irritants, psychosocial history

36
Q

Smoking history

A

Joint commission requires screening documentation and a Tx program be offered

Pack-years (cigarette smoking): # of packs smoked a day x years smoked

Note attempts to quit smoking

Exposure to second hand smoke

Other forms: cigars, pipes, smokeless tobacco, vapes, illegal substances

37
Q

Normal respiratory pattern

A

Eupnea

12-20 breaths per minute

38
Q

Fast respiratory pattern

A

Tachypnea

> 20 breaths per minute

39
Q

Slow respiratory pattern

A

Bradypnea

<12 breaths per minute

40
Q

Abnormal respiratory patterns

A

Apnea: absence of breathing

Hyperventilation (hyperpnea): increased depth

Cheyne-Stokes: crescendo/decrescendo respirations/apnea

Ataxic- periods of apnea

Kussmaul’s: rapid, deep, labored (air hunger)

Apneustic: gasping

41
Q

Inspection

A

Shape and symmetry of thorax

A-P diameter

S/S of respiratory distress

Normal= 1:1.5
COPD= 1:1

Position of trachea, symmetry of chest expansion

42
Q

Palpitation

A

Fremitus (vibration)

Crepitus (sq emphysema)

43
Q

Percussion

A

Resonance- normal lung tissue

Dull- atelectasis, pneumonia, pleural effusion

Tympany- pneumothorax

44
Q

Auscultation

A

“Normal” when heard in proper location

Abnormal:

Adventitious

Crackles

Rhonchi

Wheezes

Pleural friction rub

45
Q

Respiratory Dx tests

A

CBC, ABG, D-dimer

Sputum analysis (organisms or abnormal cells). Best time is upon awakening after rinsing mouth

CXR:
Verify ett or catheter placement
Assess lung pathology: pneumonia, atelectasis, pneumothorax, tumor, pleural fluid

CT Scan/MRI: assess soft tissues, identify lesion or clot

46
Q

Respiratory Dx Tests: VQ Scan

A

Ventilation and Perfusion (VQ) scan is a 2-part test:

  1. Ventilation scan
  2. Perfusion scan

No special post-procedure care

47
Q

Respiratory Dx Tests: pulmonary angiography

A

Pre- & Post-procedure care

NPO, labs, allergy to contrast

48
Q

Respiratory Dx Tests: Horowitz Index for lung function (P/F Ratio)

A

“P” represents PaO2 from ABG

“F” represents FIO2 expressed as a decimal (40% oxygen= FIO2 of 0.40)

P divided by F= P/F ratio

Rooms air is 20% (0.20) and each L/min of oxygen= +4% (0.04)

49
Q

Respiratory Dx Tests: PFTs

A

Pulmonary function tests (PFTs) assess lung function and breathing problems; measure lung volumes, capacities, flow rates, diffusion capacity, gas exchange, airway resistance, distribution of ventilation

Restrictive vs obstructive disease

Tidal volume (Vt)- minute ventilation

Patient prep: no smoking 6-8 hours; no bronchodilators 4-6 hours

50
Q

Forced viral capacity (FVC)

A

Volume of air forcibly exhaled from the point of max inspirations

Indicates muscle strength and ventilators reserve

51
Q

Forced expiratory volume in one second (FEV1)

A

Records the max amount of air that can be exhaled in first second of expiration

Normal or increased with restrictive lung disease

Reduced with obstructive disease or age

FVC/FEV1= ratio that indicates obstruction to airflow

52
Q

Thoracentesis

A

Needle aspiration of pleural fluid or air from the pleural space

Can be done at bedside or IR with assist of CT or U/S

Complications: SQ emphysema, infection, pneumothorax

53
Q

Phlebotomy: arterial blood sample

A

ABG analysis assess:

Gas exchange 
Perfusion (PaO2)
Alveolar ventilation (PaCO2)
54
Q

Allen’s test (remember 5-15 seconds!)

A

Normal (positive): hand quickly becomes warm and returns to normal color after in-occluding the radial and ulnar arteries. This means one artery alone will be enough to supply blood to your hands and fingers

Abnormal (negative): hand remains cold and pale after in-occluding the arteries. This means that one artery is not enough to supply blood to your hand and fingers. Blood will not be collected from an artery in this hand

55
Q

Respiratory Nursing Interventions: airway management

A

Positioning to improve ventilation and relieve dyspnea

Chest PT

DB&C (instruct and encourage)

Auscultation

Administer bronchodilators

Suctioning

Fluid intake

56
Q

Respiratory Nursing Interventions: cough Enhancement

A

Assist pt to sitting position with head slightly flexed, shoulders relaxed, & knees flexed

Encourage pt to take several deep breaths

Encourage pt to take a deep breath, hold in for 2 seconds, & cough 2-3x in succession

Instruct pt to inhale deeply, bend forward slightly & perform 3-4 huffs (against an open glottis)

Instruct pt to inhale deeply several times, to exhale slowly, & to cough at the end of exhalation

57
Q

Respiratory Nursing Interventions: Oxygen Therapy

A

Restrict smoking

Maintain airway patency

Administer O2 via humidified system

Monitor liter flow

Monitor effectiveness

Monitor skin breakdown

Educate

58
Q

Upper airway problems

A

Rhinitis

Sinusitis

Acute pharyngitis

Acute follicular tonsillitis

Acute laryngitis

Laryngeal paralysis

Laryngeal edema

59
Q

Pertussis

A

Bacterial infection

Bordetella pertussis

Highly contagious

Most dangerous for infants <1 year: 1 in 4 will get pneumonia; 1 in 2 will have a febrile seizure; 2 in 3 will have apnea

60
Q

Pertussis disease progression

A

Stage 1: Catarrheal Stage (1-2 weeks): runny nose, low-grade fever, mild occasional cough; highly contagious

Stage 2: paroxysmal stage (1-6 weeks; may extend to 10): fits of numerous rapid coughs followed by “whoop” sound; vomiting and exhaustion after coughing fits (called paroxymsms)

Stage 3: convalescent stage (lasts 2-3 weeks; susceptible to many other respiratory infections): recovery is gradual; cough lessens but fits of coughing may return

61
Q

Lower airway problems

A

Acute bronchitis

Pneumonia

COPD

62
Q

Acute bronchitis

A

Inflammation of the bronchi and usually trachea (tracheobronchitis)

Occurs most often with persons with CLD

Extension of URI

Typically viral but can be bacterial or irritant

Treat symptomatically

63
Q

Pneumonia patho

A

Colonization- growth of organisms other than normal flora without signs of infection

Oropharyngeal colonization:
Normal- gram(+) and anaerobic 
Abnormal- gram (-)
Available for aspiration 
Higher in hospitalized

Importance of oral care

64
Q

Pneumonia continued

A

Acute inflammation of the lung tissue

Caused: infection, atelectasis, noxious inhalation, radiation

Patho: normal pulmonary defense mechanisms are impaired or overwhelmed, allowing microorganisms to multiply rapidly

Entry routes: aspiration (primary route), inhalation, hematogenous spread (proximity of pulmonary blood supply)

65
Q

Pneumonia patho continued

A 
Gastric colonization:
Normally sterile
⬆️pH= ⬆️colonization 
⬆️risk for oropharyngeal colonization
Risk factors: enteral feedings, H2 blockers, antacids, aged

Contaminated Aerosols:
Respiratory & anesthesia equipment
⬇️ frequency of changing vent circuits

66
Q

Lobar pneumonia

A

Consolidation in a segment or entire lobe of the lung

67
Q

Bronchopneumonia

A

Diffusely scattered patches around the bronchi

68
Q

Community Acquired Pneumonia (CAP)

A

Organisms: streptococcus pneumoniae; hemophilus influenza

Risk factors:
Older adult
No pneumococcal vaccination
Exposure to respiratory viral or influenza infection
Tobacco or alcohol use
69
Q

Healthcare Acquired Pneumonia

A

Organisms: staph aureus, pseudomonas

Risk factors: 
Older adult
CLD
Gram (-) colonization of mouth, throat, stomach
Altered LOC
Aspiration 
Presence of ett, teach, or OG/NG
Mechanical ventilator
Poor nutritional status
Reduced immunity
Medications that increase gastric pH or alkaline TF
70
Q

Pneumonia diagnosis

A

Symptoms

Assessment

Tests: CXR, ABG, pulse ox, CBC, blood culture

Fever, rigors, sweats, new cough with or without sputum, change sputum color, chest discomfort, onset of dyspnea

71
Q

Pneumonia interventions

A

Preventative: hand hygiene, annual flu vaccine, pneumococcal vaccination (at 65 yo or chronic illness), no smoking, healthy diet, adequate hydration (3L water), avoid crowds, increase mobility, DB&C exercises, clean any respiratory equipment, avoid pollutants, adequate rest/sleep

Acute

72
Q

Pneumonia prognosis

A

Prediction model

Demographic factors: age, gender, nursing home

Comorbid illnesses: neoplasm, liver, CHF, cerebral, renal disease

Physical finds: LOC, RR, ⬇️BP, high or low temp, ⬆️pulse

Lab finds: ⬇️pH, ⬆️BUN, ⬇️HGB, ⬆️glucose

73
Q

Pneumonia complications

A

Respiratory failure

Lung damage

Sepsis

74
Q

Pneumonia nursing care: ineffective airway clearance

A

NICs: airway management, cough enhancement (hydration, nebulizer, bronchi-active meds), positioning, respiratory monitoring

75
Q

Pneumonia nursing care: impaired gas exchange

A

NICs: airway management, oxygen therapy, respiratory monitoring

76
Q

Pneumonia nursing care: activity intolerance

A

NICs: energy management, self-care assistance

77
Q

Pneumonia nursing care: imbalanced nutrition

A
78
Q

Pneumonia Nursing Care NOCs

A

Activity tolerance

Nutrition status: energy, food and fluid intake

Respiratory status: gas exchange, ventilation, vital signs

79
Q

Preventing hospital acquired pneumonia

A

DB&C, spirometer, ⬆️activity

Prevention of ventilator associated pneumonia (VAP)= “vent bundle”:
HOB ⬆️30 degrees
Oral hygiene 
Glucose control
Gastric ulcer prophylaxis (thoughtful)
Sub-glottic suctioning
DVT prophylaxis 
Early mobilization 
Delirium assessment and prevention
80
Q

Chest tube chambers

A

Chamber I: collects fluid draining from pt

Chamber II: water seal prevents air re-entry

Chamber III: suction control of system

N5 471 (5 decks)

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