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Nur 333 fundamentals 2 > WK 1: oxygenation and trachs > Flashcards

WK 1: oxygenation and trachs Flashcards

1
Q

Factors that affect oxygenation
(and examples of each)

A

-decreased oxygen-carrying capacity
(Hemoglobin level, carbon monoxide)
-hypovolemia
-decreased inspired O2 concentration
(Increased altitude)
-chest wall movement
(pregnancy, obesity, trauma)

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2
Q

thorough respiratory assessment consists of what

A

-RR
-pattern, depth and rhythm

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3
Q

Hypoventilation
-def
-S/Sx

A

not enough oxygenation
inadequate alveolar ventilation
causes: medications, lung Dz
S/Sx: AMS, dysrhythmias, somnolent
can lead to: cardiac arrest, Sz, LOC, death

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4
Q

atelectasis
-def

A

collapsed alveoli which prevents nml gas exchange
VERY preventable by nurse
Conditions associated: immobility, obesity, sleep apnea, chronic Lung Dz
Can lead to: lung collapse, PNA, Resp failure

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5
Q

Chronic hypoxia

A

Chronic: assoc. with chronic lung Dz
common assessment findings: cyanotic nail beds, slow cap refill, clubbing, barrel chest

We do not treat for chronic hypoxia, while acute hypoxia is requires immediate intervention

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6
Q

hypoxia
-def
-S/Sx (rat/bed)

A

inadequate tissue oxygenation at cellular level, can be related to hypovolemia
Causes: low hemoglobin, low O2 concentration, pH imbalance, decreased diffusion, poor perfusion, impaired ventilation from traumas
S/Sx:
Early: RAT (restlessness, anxiety, tachycardia/tachypnea)
Late: BED (bradycardia, extreme restlessness, dyspnea)

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7
Q

Why do we encourage coughing?

A

helps maintain airway patency
most effective way to move secretions through airway

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8
Q

components of dyspnea

A

-associated with hypoxia
-SUBJECTIVE, difficult breathing, related to SOB
-S/Sx: accessory muscles, nasal flaring, increased RR and depth

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9
Q

Nursing interventions to improve oxygenation
(Include long/shirt term measures)

A

Long-term: vaccinations, healthy lifestyle, environmental and occupational exposures

Short-term: coughing, deep breathing, supplemental O2 (has to be ordered)

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10
Q

Ventilation
-what is it
-the goal of it

A

movement of gas in and out of lungs
Goal: nml arterial CO2 and O2 tension
ventilation = respirations

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11
Q

Diffusion

A

oxygen and CO2 exchange in alveoli and red blood cells

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12
Q

perfusion

A

distribution of newly oxygenated red blood cells to tissues in the body

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13
Q

When CO2 increases (hypercarbia) the body knows to increase __1__ and ___2__ of breathing

A

rate
depth

Why? to remove CO2 quicker

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14
Q

Tidal volume
What is it? What is it impacted by?

A

amount of air exhaled following normal inspiration

Tidal volume impacted by: health status, activity, pregnancy, exercise, obesity, lung Dz

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15
Q

What is the function of alveoli?

A

to promote gas exchange

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16
Q

What are three expected and normal breath sounds? where are they heard?
what do they sound like?

A
  1. bronchial: heard over tracheal area
    -high pitched/loud
  2. Bronchovesicular: heard over mainstream bronchi
    -medium pitch
  3. vesicular: heard laterally
    -soft/low pitch/sounds like snoring
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17
Q

Crackles/rales

A

COARSE bubbly sounds, low pitched

associated with air passing through fluids
Course vs. fine?

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18
Q

Wheezing

A

high pitched whistling
narrow airways
asthma/inflammatory response

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19
Q

Rhonchi

A

low pitched rumbling
fluid/mucus in airway
can resolve with coughing

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20
Q

stridor

A

choking/ gasping sound
something is obstructing upper airway

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21
Q

pleural friction rub

A

inflamed pleural space
low pitched, harsh/grating sound with I/E

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22
Q

Bradypnea

A

abnormally slow respirations (< 12 breathes/min)

23
Q

Tachypnea

A

abnormally rapid respirations ( > 20 breathes/min)

24
Q

Apnea

A

respirations stop for several seconds
-if this happens persistently then respiratory arrest could occur

25
Hyperventilation
Rate and depth of respirations increases. Hypocarbia sometimes occurs
26
Hypoventilation
RR abnormally low and depth of ventilation is depressed. hypocarbia sometimes occurs
27
Oxygen Saturation
-measures diffusion and perfusion -Peripheral oxygenation -normal: 95-100% -goal is: 95-98% -Chronic lung Dz: 88% is nml, why wouldn't you apply O2? -SPO2 is measured with light transmission, impaired with: jaundice, nail polish, intravascular dyes, PVD, hypothermia, excessive edema
28
Compliance of lungs
ability of lungs to distend and expand, relies on inter-thoracic pressure changes -lungs loose compliance -> unable to open/ close effectively
29
Work of breathing
effort to expand and contract lungs determined by rate and depth
30
What is the purpose of an ABG? (arterial blood gas)
arterial blood is taken instead of peripheral blood b/c it will tell us how oxygenated the blood is
31
End tidal CO2
how much CO2 is present is at the end of exhalation
32
Hyperventilation
removing CO2 faster than it is produced by cellular metabolism Causes: anxiety attack, fever, drugs, pH imbalance, asprin poisoning S/Sx: high RR, sighing breathing (panting), numb/tinging, LH, LOC Increased WOB
33
Primary problems/ nursing diagnoses related to oxygenation
ineffective airway clearance risk for aspiration impaired gas exchange activity intolerance
34
Coughing techniques (need to know three)
1. Huff cough: deep inhale, hold 2-3 seconds, forceful exhale, open glottis by saying "huff" 2. Cascade cough: slow deep breath, hold 1-2 sec, then open mouth and perform series of coughs while exhaling 3. Quad cough: manually assisted, for pt w/o abd muscle control, nurse pushes in/up on abd while pt exhales
35
Chest physiotherapy
includes: postural drainage, chest percussion, chest vibration dependent nursing intervention for Pt with thick secretions w/ goal to mobilize secretions
36
Postural Drainage EX: there is an infiltration seen in the Rt lower lobe, what position do you use?
laying on unaffected side to promote drainage of one particular lobe lay on Lt side in trendelenburg
37
How to use an Incentive spirometer
sit up deep breath lips over mouthpiece breathe in slowly, keeping range indicator at target zone hold breath 3 seconds repeat as Rx, usually 10 breathes every hour cough and deep breathes after
38
Can a nurse delegate applying supplemental O2 to a CNA?
Yes BUT the nurse must do a respiratory assessment along with assessment of pt response, setup, and adjustment responses
39
NC (nasal cannula)
1-6 liters 22-44% use humidification if >4 liters or used over 24 Hrs usually safe and well tolerated
40
Simple Face Mask
6-12 Liters 33-55% best for short periods/ transportation assess for fit, watch for aspiration risk/ claustrophobia
41
Partial Rebreather Mask
6-11 Liters 60-75% used for short periods of dyspnea keep reservoir partially inflated HOURLY assessment
42
Non-Rebreather Mask
10-15 Liters 80-95% best for critical needs, prior to intubation HOURLY assessment Pt is not rebreathing exhaled air d/t flaps covering ports on side of mask
43
Venturi Mask
High flow O2 4-12 Liters 24-50% delivers PRECISE O2 concentration w/ humidity NOT for long periods of time
44
Complications of O2 therapy
drying of mucus membranes oxygen toxicity skin breakdown
45
Pharyngeal airways
short term use NPA & OPA's Pt still has respiratory drive used for Pt with decreased LOC or who need frequent suctioning
46
Tracheal airways
longterm patency issues for people who need mechanical ventilation
47
Endotracheal airways Vs. Percutaneous airways
ETT is always on a vent Percutaneous trach is through the skin, bypasses upper airway structure, Pt can breathe independently or through vent
48
Indications for a tracheostomy
acute airway obstruction airway protection facilitate removal or secretions prolonged intubation ( > 1 wk) less damage to airway more comfortable allowed to eat improved mobility
49
Shiley Vs. Jackson Trachs
Shiley: disposable inner cannula, plastic, cuff, obturator Jackson: Reusable inner cannula, no cuff, obturator, metal *with jackson you ALWAYS use a trach care kit for cleaning, but it should be used for shiley too
50
What is an obturator
device used to insert a trach, like a guidewire
51
1. what is the purpose of a cuff on a trachea? 2. dangers of prolonged inflation
1. To help create a snug fit for the trachea, precent aspiration, and help ventilator give strong breaths 2. increased mucosal pressure, causing ischemia, softening cartilage, mucosal erosion -inflation of cuff has to be ordered by the physician
52
Passy-Muir
-speaking valve -cuff deflated while being used -cant use if Pt has respiratory distress
53
Nursing problems for a patient with a trach
-ineffective airway clearance -impaired verbal communication -risk for infection -impaired swelling -body image disturbance -anxiety
54
how often is trach care done?
every 12 hours usually patient dependent

Nur 333 fundamentals 2 (7 decks)

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