Oxygen Therapy & Respiratory Disorders (Med Surge II Exam 3)

What is ventilation?

The process of moving air in and out of the lungs, allowing gas exchange with the alveoli.

What is perfusion?

The flow of blood through the pulmonary capillaries to the alveoli, enabling gas exchange.

Define hypoxia.

A condition in which there is insufficient oxygen available to tissues, regardless of blood oxygen levels.

Define hypoxemia.

Low oxygen levels in the blood, specifically measured by PaO₂ or SpO₂.

Define hypercapnia.

Elevated levels of carbon dioxide (CO₂) in the blood, usually due to hypoventilation.

What is dyspnea?

Difficulty or labored breathing; a subjective sensation of shortness of breath.

What is oxygen saturation (SpO₂)?

The percentage of hemoglobin binding sites in the bloodstream occupied by oxygen; normal is typically 95-100%.

What is the purpose of an incentive spirometer?

To encourage deep breathing, prevent atelectasis, and improve lung expansion.

How should a patient use an incentive spirometer?

1. Sit upright, 2. Exhale normally, 3. Place mouthpiece in mouth, 4. Inhale slowly and deeply to raise the piston/ball, 5. Hold breath 3-5 seconds, 6. Exhale and repeat 10 times per hour while awake.

What teaching points are important for incentive spirometer use?

Use every hour while awake, maintain good posture, avoid using for short, shallow breaths, and clean the device per instructions.

What are common indications for supplemental oxygen?

Hypoxemia (SpO₂ < 90%), respiratory distress, chronic lung disease exacerbation, post-surgery, or shock.

What are potential complications of oxygen therapy?

Oxygen toxicity, dry or irritated mucous membranes, CO₂ retention in COPD patients, fire hazard, infection risk from contaminated equipment.

How should patients on supplemental oxygen be monitored?

Check SpO₂ regularly, observe respiratory rate and effort, monitor for signs of oxygen toxicity, ensure correct device use, and assess for skin irritation from masks/cannulas.

What is FIO₂?

Fraction of inspired oxygen; the percentage of oxygen in the air delivered to the patient.

Examples of noninvasive oxygen delivery methods and FIO₂:

Nasal cannula: 24-44% FIO₂ (1-6 L/min), Simple face mask: 40-60% FIO₂ (5-10 L/min), Venturi mask: precise FIO₂ 24-50%, Nonrebreather mask: 60-100% FIO₂ (10-15 L/min).

Complications of noninvasive oxygen delivery:

Skin breakdown, dry mucous membranes, aspiration risk, CO₂ retention (especially in COPD).

Examples of invasive oxygen delivery and FIO₂:

Endotracheal tube or tracheostomy with mechanical ventilation: FIO₂ 21-100%, High-flow nasal cannula: up to 100% FIO₂.

Complications of invasive oxygen delivery:

Infection (ventilator-associated pneumonia), barotrauma, airway injury, oxygen toxicity, decreased patient comfort.

Risk factors for laryngeal cancer

Smoking/tobacco use, heavy alcohol consumption, exposure to asbestos or industrial chemicals, chronic laryngitis, HPV infection, male gender, age > 55 years.

Earliest symptom of laryngeal cancer

Persistent hoarseness or voice changes lasting more than 2 weeks.

Common clinical manifestations of laryngeal cancer

Difficulty swallowing (dysphagia), persistent cough, sore throat, ear pain (referred otalgia), a lump in the neck, breathing difficulty if tumor obstructs airway, unexplained weight loss.

Symptoms indicating advanced laryngeal cancer

Stridor, dyspnea, severe pain, hemoptysis, airway obstruction, visible neck mass.

Treatment options for laryngeal cancer

Surgery (partial or total laryngectomy), Radiation therapy, Chemotherapy, Targeted therapy or immunotherapy in select cases.

Nursing priorities post-laryngectomy

Airway management, maintaining adequate oxygenation, wound care, suctioning, monitoring for bleeding or infection, pain management.

Communication management after laryngectomy

Use of esophageal speech, electrolarynx, communication boards, or tracheoesophageal puncture (TEP) with voice prosthesis.

Essential patient teaching for laryngeal cancer care

Smoking and alcohol cessation, stoma care, infection prevention, proper nutrition, use of assistive communication devices, adherence to follow-up care and therapy.

Psychosocial support for laryngeal cancer patients

Counseling for body image changes, support groups, coping strategies for altered communication, assistance with lifestyle adjustments.

Risk factor for cystic fibrosis

Inheriting two defective CFTR genes (autosomal recessive), one from each parent.

Populations most commonly affected by CF

Caucasians of Northern European descent have the highest incidence.

Other risk factors for CF

Family history of CF and genetic carrier status.

Common respiratory manifestations of CF

Chronic cough, thick sticky mucus, recurrent respiratory infections (e.g., Pseudomonas, Staph aureus), wheezing, bronchiectasis.

Common gastrointestinal manifestations of CF

Malabsorption, steatorrhea (fatty stools), poor weight gain, meconium ileus in newborns, pancreatic insufficiency, constipation.

Other clinical signs of CF

Salty-tasting skin, clubbing of fingers and toes, nasal polyps, infertility in males (due to absence of vas deferens).

Main treatment goals for CF

Manage respiratory symptoms, prevent infections, improve nutrition, and maintain quality of life.

Respiratory treatments used in CF

Chest physiotherapy (percussion), postural drainage, inhaled bronchodilators, mucolytics (e.g., dornase alfa), antibiotics for infections, supplemental oxygen as needed.

Nutritional therapies important for CF

High-calorie, high-protein diet, pancreatic enzyme replacement, fat-soluble vitamin supplementation (A, D, E, K).

Medications used in CF

CFTR modulators (e.g., ivacaftor), antibiotics for infections, anti-inflammatories, bronchodilators, mucolytics.

Key nursing management strategies for CF

Monitor respiratory status, administer medications and chest physiotherapy, teach proper pancreatic enzyme use, support nutrition, provide psychosocial support, educate on infection prevention.

Essential patient teaching for CF

Adherence to therapies, importance of infection control, airway clearance techniques, diet management, early recognition of respiratory infections.

Risk factors for pulmonary embolism

Virchow's Triad: Hypercoagulability, Venous stasis, Endothelial injury.

Hypercoagulability

Inherited clotting disorders, cancer, pregnancy, oral contraceptives, hormone therapy.

Venous stasis

Prolonged immobility, long flights, obesity, heart failure.

Endothelial injury

Surgery, trauma, central venous catheters, smoking.

DVT related to PE

Deep vein thrombosis (DVT) in the legs can dislodge and travel to the lungs, causing a pulmonary embolism.

Symptoms of PE

Sudden dyspnea, pleuritic chest pain, tachypnea, tachycardia, anxiety, cough, hemoptysis.

Signs of severe or massive PE

Hypotension, syncope, cyanosis, shock, cardiac arrest, jugular venous distention.

Primary treatment for PE

Anticoagulation therapy (heparin, low molecular weight heparin, warfarin, or DOACs) to prevent further clot formation.

Other treatments for PE

Thrombolytic therapy for massive PE, surgical embolectomy, or catheter-directed thrombectomy in select cases.

Nursing management strategies for PE

Monitor vital signs and oxygenation, administer anticoagulants as prescribed, assess for bleeding, provide oxygen therapy, encourage ambulation when safe, patient education on medication adherence and lifestyle modifications.

Complications of anticoagulant therapy

Bleeding (internal or external), bruising, heparin-induced thrombocytopenia (HIT), gastrointestinal upset, interactions with other medications.

Prevention of recurrence of PE

Long-term anticoagulation as prescribed, early ambulation after surgery or hospitalization, compression stockings, maintaining hydration, avoiding prolonged immobility, managing underlying risk factors (obesity, smoking).

Patient education for PE prevention

Recognize DVT/PE symptoms (leg swelling, pain, sudden shortness of breath), adhere to anticoagulant therapy, lifestyle modifications (exercise, hydration, smoking cessation), and follow-up care.

Risk factors for lung cancer

Smoking/tobacco use (primary), secondhand smoke, exposure to asbestos, radon, air pollution, genetic predisposition, history of chronic lung disease, age > 50.

Common early symptoms of lung cancer

Persistent cough, hemoptysis (coughing up blood), hoarseness, recurrent respiratory infections, shortness of breath.

Advanced or systemic symptoms of lung cancer

Weight loss, fatigue, chest pain, pleural effusion, clubbing of fingers, bone pain if metastasis, neurological symptoms if brain metastasis.

Treatment options for lung cancer

Surgery (lobectomy, pneumonectomy), radiation therapy, chemotherapy, targeted therapy, immunotherapy, or combination therapy depending on stage and type (NSCLC vs SCLC).

Nursing priorities during treatment

Monitor respiratory status, manage side effects of chemo/radiation (nausea, fatigue, immunosuppression), provide pain management, assess for complications, and offer psychosocial support.

Important patient teaching during lung cancer treatment

Smoking cessation, infection prevention, recognizing signs of treatment complications, adherence to medications and appointments, and symptom reporting.

Goals of hospice care for lung cancer patients

Provide comfort, manage pain and symptoms, support emotional, social, and spiritual needs, and improve quality of life rather than pursuing curative treatment.

Symptoms managed in end-of-life care for lung cancer

Dyspnea, pain, cough, anxiety, fatigue, nutritional issues, and decreased mobility.

Nursing interventions in hospice care for lung cancer

Administer pain and symptom medications, provide oxygen therapy for comfort, support family education and coping, assist with positioning and mobility, provide emotional and spiritual support.

Teaching/support important for family caregivers

How to manage medications, recognize signs of distress, provide comfort measures, and utilize hospice resources for emotional and practical support.