week 7 - breathing Flashcards
1
Q
oxygenation
A
need for more oxygen
2
Q
ventilation
A
helping (assisting) them to breathe
2
Q
3 lobes of the right lung
A
- upper
- middle
- lower
3
Q
2 lobes of the left lung
A
- upper
- lower
4
Q
5 chest osculation techniques
A
- quiet environment
- remove excess clothing
- apply stethoscope to landmarks
- have the patient inhale and exhale deeply
- listen to 1 full breath
5
Q
if you hear adventitious sounds during chest osculation what are the 3 things to ask yourself
A
- are they during the inspiratory or expiratory or both
- where on the chest wall are they
- do they clear with deep breathing or cough
6
Q
hypoxia
A
a lack of oxygen to the body cells and tissues
7
Q
anoxia
A
absence of oxygen
8
Q
example of Fio2
A
the gas mixture at room air has a fraction of inspired O2 at 21% meaning that the fraction of O2 at room air is 21%
8
Q
Fio2
A
the fraction of inspired oxygen is the concentration of oxygen in the gas mixture (% of oxygen in the space being measured)
9
Q
dyspnea
A
any difficulty in respiratory rate, regularity or effort
10
Q
bradypnea
A
is a respiratory rate this is lower than normal for age
11
Q
tidal volume
A
normal volume of air displaced between normal inhalation and exhalation
11
Q
tachypnea
A
is a respiratory rate that is greater than normal for age
12
Q
apnea
A
stopping of breathing
13
Q
effects of hypoxia
A
has effects on every body system and every cell but first most rapid effects are seen in the brain
14
Q
difference between a failed respiratory system and a failed circulatory system
A
failed respiratory system = O2 can’t get in
failed circulatory system = O2 can’t be distributed
15
Q
5 neurological effects of hypoxia
A
- decreased LOC
- confusion
- disorientation
- agitation
- uncoordinated movements
16
Q
when does hypoxia occur
A
when the bodies requirements for O2 aren’t met
17
Q
inspiratory reserve volume
A
maximal amount of air that can be drawn into the lungs after normal inspiration
18
Q
residual volume
A
the volume of air remaining in the lungs after the most forcible expiration
18
Q
expiratory reserve volume
A
the additional amount of air that can be expired after normal breath
19
Q
5 physical signs of respiratory distress
A
- accessory muscle use
- cyanosis (fingertips = peripheral, central = lips)
- pallor
- diaphoresis
- tripod position
20
Q
where does cyanosis show first
A
in the fingertips, if seen near the lips that indicated it is way more severe
20
general impression
the hands off, from a distance assessment of how distressed a patient is
20
order of respiratory assessment
1. general impression
2. physical exam
3. vital signs
21
4 things to look for when giving a general impression
1. position
2. LOC
3. fatigue
4. appearance of difficulty
22
6 things to assess when performing a physical exam
1. head
2. neck
3. chest
4. abdomen
5. extremities
6. speech
23
what to look for when assessing the extremities
1. cyanosis
2. radial pulse
3. muscle tone
** cyanosis = hypoxia present for awhile
** radial pulse = quicker pulse means quicker respiratory rate
23
what to look for when assessing the head
1. cyanosis
2. fatigue
3. airway sounds
24
what to look for when assessing the neck
1. accessory muscle use
25
what to look for when assessing the abdomen
1. accessory muscle use in the intercostal muscles
25
what to look for when assessing the chest
1. lung sounds
2. accessory muscle use
26
crackling adventitious sounds
1. bubbling or crackle sounds are like when you have a straw in milk and are blowing bubbles
2. indicates fluid in the lungs
3. best heard on inspiration
4. pathology = CHF, pneumonia, bronchitis, fibrosis
26
what to look for when assessing the speech
how well a person can speak is a useful indicator of how much respiratory distress they are in
- the sound of their voice
- use yes or no (close-ended questions) for someone who can't breathe well
27
consolidation adventitious sounds
1. low pitch, snoring quality to the absence of breath sounds
2. best heard on expiration
3. trachea and mainstream bronchi
4. pathology = pneumonia, bronchitis, aspiration
28
aspiration
if the patient's airway is not clear they will start breathing in whatever is blocking the airway for example vomit, blood etc
28
wheezing adventitious sounds
1. high pitched sound
2. air is being forced through a small space
3. best heard on expiration but might be present on inspiration
4. all lung fields
5. pathology = asthma, COPD, bronchitis
29
pleural rub adventitious sounds
1. rubbing or grating
2. inflammation of the pleural surfaces (lining of the lungs)
3. best heard during inspiration and expiration
4. peripheral lung fields
30
3 things to asses respiratory rates for
1. number of breaths per minute
2. rhythm
3. volume and depth
31
2 types of rhythm
1. irregular
2. regular
32
4 types of volumes
1. shallow
2. deep
3. gasping
4. "agonal"
33
normal respiratory rates
adults = 12-20 breaths per min
children = 15-30 breaths per min
infants = 25-30 breaths per min
34
pulse oximetry
measures the percentage of hemoglobin bound to a gas (usually O2)
35
normal pulse oximetry range
92-96 % (based on reading)
**anything below 92% = hypoxic
** values in 70 & 80% = critical
36
6 caution notes when measuring pulse oximetry
1. ambient light
2. hypothermia
3. carbon monoxide
4. poor perfusion
5. manicures
6. incorrectly position or placed
37
levels of patient distress
1. mild
2. moderate
3. severe
4. respiratory failure
38
oxygen
stored in pressurized aluminum cylinders
38
2 sizes of oxygen tanks by letter
1. D tank
2. M tank
39
supplemental oxygen
increases the alveolar content of inspired oxygen and decreases the work of breathing
40
M tank
- bigger
- in ambulance
- is used when a patient has been put into the ambulance and you are moving elsewhere
41
D tank
- smaller
- used in the field to take to the patient
- in bags on the ambulance
42
cylinder size for D oxygen tank
0.16
43
cylinder size for M oxygen tank
1.56
44
what is the safe residual pressure of a oxygen tank
200 psi
45
how to calculate a tank life (in minutes)
tank pressure (psi) - are residual pressure x cylinder constant (divided by) flow rate (L/min) = duration of flow in minutes
46
TRUE or FALSE
it is a routine procedure at the end of shift to check oxygen
FALSE - it is routine procedure at the START of the shift to check the oxygen
47
what is the tank pressure in psi
- look at the gage
- full tank = 2000 psi
- value on tank indicated pressure
48
what is the safe residual pressure
- never under 200
- change tank once it reaches just over 200 or else it won't run smoothly
49
what are the cylinder constants
D = 0.16
M = 1.56
** will be either constant depending on what tank is being used at the time of calculation
50
what is the flow rate (L/min)
how much oxygen you are giving the patient
51
what must be present in order to have oxygen delivery
spontaneous breathing
52
spontaneous breathing
the movement of gas in and out of the lungs that is produced in response to an individual's respiratory muscles = natural breathing
53
5 steps to oxygen administration
1. turn on the oxygen source
2. select oxygen delivery device
3. connect the O2 delivery device to the regulator and select the appropriate flow rate
4. apply oxygen delivery deice to patient
5. reassess patient
54
6 ways of oxygen delivery for spontaneously breathing patients
1. nasal cannula
2. simple face mask
3. non rebreather mask
4. filtered mask
5. controlled concentration mask
6. pocket mask
55
specifications of a nasal cannula
1-6 LPM
24-44 % Fio2
VERY SLOW
56
specifications of simple face mask
6-10 LPM
35-60% Fio2
57
specifications of non rebreather mask
10-15 LPM
> 95% Fio2
58
filtered mask
- the patient is breathing out
- air is being filtered before coming out to help eliminate germs/particles that the patient is breathing out so some is filtered
59
apneic or ineffective breathing
not breathing or ineffective breathing
60
what is used to help a patient that has apneic breathing
BVM
61
BVM
bag valve mask
62
specifications of BVM
1. 15-25 LPM
2. 90-100% Fio2 (closer to 100% SPO2)
3. 2000mL capacity
4. when you see the patients chest start rising = stop squeezing
63
decreased LOC + respiratory distress =
positive pressure ventilations
64
establishing an airway in a less responsive patient - 4 techniques in order
1. sniffing position
2. E2SN (if practical)
3. airway adjunct (as needed)
4. suction
64
establishing an airway in an unresponsive/VSA patient - 4 techniques in order
1. head tilt chin lift
2. sniffing position
3. E2SN (if practical)
4. oral airway
65
considerations for ventilating a patient
1. tidal volume (vT)
2. respiratory rate
3. resistance
4. compliance
5. gastric insufflation (pushing air into stomach, expands stomach, and causes patient to vomit)
65
2 types of mask placements
1. one handed
2. two handed
66
technique for ventilating the patient
1. deliver slow - 1 to 2 seconds for each ventilation
2. allow for exhalation
3. monitor chest rise
4. ventilate gently
67
mnemonic for good BVM seal
JAWS
68
what does JAWS stand for
J = jaw thrust
A = airways (OPA/NPA)
W = work together
S = slow and small squeezes
69
6 steps to ventilation
1. position patient
2. establish airway
3. connect BVM to O2
4. apply BVM
5. ventilate patient
6. assess
70
predictors of a difficult airway
O = obesity
B = beards
E = edentulous (lacking teeth)
S = sleep apnea
E = elderly
