Oxygenation/Circulatory Support - Nursing Foundations 2

The function of this system is gas exchange

the respiratory system

Term for the movement of air into and out of the lungs through act of breathing

Ventilation

Term for the exchange of the gases of oxygen and CO2 in the lungs

Respiration

Term for when air flows into the lungs

Inspiration

What 4 things are involved to help with inspiration?

1. Diaphragm

2. Intercostal muscles

3. Pleural membranes

4. Expansion

Term for when air flows out of the lungs

Exhalation

Does exhalation require energy?

No energy or effort is required

Oxygenation of the blood, and ultimately of the organs and tissues depends on adequate ______________

ventilation

Term for how fast someone breathes

The rate

Term for how much lung expansion

Depth

refers to the ease with which the lungs expand during inhalation, determined by the elasticity of lung tissue and the surface tension in the alveoli.

Lung compliance

What 3 things decrease lung compliance?

1. Edema

2. Loss of surfactant

3. Scar tissue

refers to the ability of the lungs to stretch (expand) and recoil (contract) effectively during inhalation and exhalation, enabling proper airflow and gas exchange.

Lung elasticity

a chronic lung condition characterized by damage to the alveoli (air sacs), leading to reduced elasticity, air trapping, and difficulty in exhaling, commonly caused by smoking or environmental factors.

Emphysema

The diameter of the trachea affects this. Even small changes in the diameter, secretions, and bronchospasm.

Airway resistance

Term for the exchange of gases between the blood and the body's tissues, where oxygen moves from the blood into cells and carbon dioxide moves from cells into the blood.

Internal respiration

Term for the exchange of oxygen and carbon dioxide between the air in the alveoli of the lungs and the blood in the surrounding capillaries.

External respiration

State of ventilation in which lungs remove CO2 faster than it is produced

Hyperventilation

Some causes of this abnormal breathing pattern:

- Anxiety

- Body's mechanism to compensate (fever, metabolic acidosis, etc.)

Hyperventilation

Increased respiratory rate and/or depth (sighing respirations) could be a symptom of what type of abnormal breathing pattern?

Hyperventilation

Dizzy/Lightheaded (even loss of consciousness) could be a symptom of what type of abnormal breathing pattern?

Hyperventilation

Numbness/tingling in fingers, hands, feet or around mouth could be a symptom of what type of abnormal breathing pattern?

Hyperventilation

Type of abnormal breathing pattern where alveolar ventilation is inadequate to meet the body's oxygen demand or to eliminate sufficient CO2

Hypoventilation

Some causes of this abnormal breathing pattern:

- Atelectasis (a partial or full collapse of the lung that occurs when the air sacs (alveoli) in the lungs are blocked)

- Excessive oxygen administration to pt. with COPD

- Respiratory depression related to meds

Hypoventilation

Decreased respiratory rate and/or depth could be a symptom of what type of abnormal breathing pattern?

Hypoventilation

Mental status change as CO2 builds could be a symptom of what type of abnormal breathing pattern?

Hypoventilation

Dysrhythmias an irregular or abnormal heartbeat) could be a symptom of what type of abnormal breathing pattern?

Hypoventilation

Term for inadequate tissue oxygenation at the cellular level

Hypoxia

Some causes of this condition:

- Decreased hemoglobin

- Pneumonia

- Shock

Hypoxia

Signs/symptoms of this condition:

- Restlessness

- Apprehension

- Inability to concentrate

- Dizzy/lightheadedness

- Fatigued

- Declining level of conscious

Hypoxia

Signs/symptoms of this condition:

- Dyspnea (shortness of breath)

- Nasal flaring

- Substernal/Intercostal retractions

- Can't lie flat

- Cyanosis

Hypoxia

With someone who has hypoxia would you expect an increase or decrease in their pulse/HR?

Increased pulse/HR

With someone who has hypoxia would you expect an increase or decrease in their rate and/or depth of respirations?

Increased rate and/or depth of respirations (eventually RR declines)

What age range does not make enough surfactant (reduces surface tension, which helps prevent alveolar collapse for better expiration)

Premature infants

True or false infants and toddlers have a narrow trachea

True

This environmental factor can suppress the immune system and inflammatory response. A chronically suppressed immune and inflammatory response increases the risk for all infections, including respiratory.

Stress

Pulmonary allergens include such things as dust, dust mites, cockroach particles, pollen, molds, newsprint, tobacco smoke, animal dander, and sometimes foods which can lead to _______________

Allergic reactions

Low oxygen levels at high altitudes can cause hypoxemia and _____________

hypoxia

____________________ constricts bronchioles, increases fluid secretion into the airways, causes inflammation and swelling of the bronchial lining, and paralyzes cilia.

Tobacco smoke

What can lead to a reduced airflow and increased production of secretions that are not easily removed from the airways?

Smoke

The use of __________________ has been linked to chronic lung disease and asthma

E cigarettes

The combined use of _____________ and ___________________ is associated with cardiovascular disease

E-cigarettes and traditional cigarettes

These medications generally act by depressing central nervous system control of breathing or by weakening the muscles of breathing.

Respiratory depressants

What can be given to improve respiratory function?

Medications such as bronchodilators, anti-inflammatory agents such as corticosteroids, cough suppressants, expectorants, and decongestants.

Over-the-counter cough and cold medicines should not be given to children younger than the age of ______________ because there is a risk of serious and even life-threatening side effects.

4 years

A machine that assists a patient to breathe.

A mechanical ventilator. Usually the patient is intubated before they are placed on the ventilator.

What two types of tubes can be connected by oxygen tubing to the ventilator?

An endotracheal tube and tracheostomy tube.

Before initiating ________________, be certain that the healthcare team is aware of advance directives and consults with family members.

Ventilation

The purpose of a _________________ is to remove air or fluid from the pleural space without allowing it to re-enter

Chest-drainage system

Flow of air and fluid must be in _________________: from the patient to the collection system

one direction

____________________ is pneumonia that is contracted by a patient in a hospital or inpatient facility. It is often caused by bacteria other than Streptococcus pneumoniae, which is the organism involved in most cases of pneumonia. It tends to be more complicated and to have a higher mortality rate than community-acquired pneumonia.

Healthcare-associated pneumonia (HCAP)

_______________ infections (URIs) may be viral or bacterial

Upper respiratory

Viral infections usually last about ________ to ________ days and are self-limiting.

10 to 21

These infections can lead to other respiratory diseases and seriously compromised oxygenation in children, older adults, and people who have other illnesses

Upper respiratory infections

Stoping this is important in preventing and treating all respiratory problems, including URIs, influenza, and pneumonia

Smoking cessation

This position pulls abdominal organs down, allowing maximum diaphragm excursion and lung expansion

An upright or elevated position

This device is designed to encourage patients to take deep breaths by reaching a goal-directed volume of air

Incentive spirometer

This device is usually reserved for patients at risk for developing atelectasis or pneumonia; for example, patients who have had abdominal, chest, or pelvic surgery; patients on prolonged bedrest; or patients with a history of respiratory problems

Incentive spirometry

Patients with a decreased level of consciousness, diminished gag or cough reflex, or difficulty with swallowing are at an increased risk for this

Aspiration. You should keep a suction setup available for routine and emergency use.

_________________ promotes deep inhalation and forceful expulsion of secretions

Coughing

All of these Interventions help mobilize _______________:

- Deep breathing

- Coughing exercises

- Hydration

Secretions

a technique that uses mechanical methods to help clear mucus from the lungs. It moves secretions to the large, central airways for expectoration (coughing) or suctioning. Examples include postural drainage, chest percussion, and chest vibration.

Chest physiotherapy

a technique that uses gravity and different body positions to help drain mucus from specific areas of the lungs

Postural drainage

a technique where a therapist uses a cupped hand to rhythmically hit the back to loosen mucus

Percussion

A technique where a therapist uses an open hand to gently move back and forth against the back to loosen mucus

Vibration

What type of devices are these?

- Nasal cannula

- Simple face masks

- Rebreather masks

Low-flow devices

What type of devices are these

- Venturi masks

- Aerosol face masks

- Face tents

- Tracheostomy collars

High-flow devices. Are all capable of reaching up to 100% oxygen concentration.

Type of catheter that is placed into the tracheostomy to deliver O2 directly into the trachea. It is rarely used because oxygen cannot be humidified through this device.

A transtracheal catheter

Type of artificial airway used in unconscious patients because they are likely to trigger gagging, vomiting, or laryngospasm in responsive patients with intact airway reflexes

Oropharyngeal

Type of artificial airway where the length should extend from the front of the teeth to the end of the jawline

Oropharyngeal

These type of artificial airways are tolerated in patients who are semiconscious because they do not stimulate the gag reflex

Nasopharyngeal

Type of artificial airway that where flexible rubber tubes are inserted through a nostril into the pharynx

Nasopharyngeal

Type of pliable tube that is inserted into the trachea through the following routes:

- Orotracheal tube: The mouth

- Nasotracheal tube: The nose

- Tracheostomy tube: An opening directly into the trachea

Endotracheal tubes

Type of tracheostomy tube that has an inflatable balloon around the tube's shaft that helps stabilize the tube and create an airtight seal in the airway.

A cuffed tracheostomy tube

Type of tracheostomy tube that doesn't have a cuff that can be inflated inside the trachea.

An uncuffed tracheostomy tube

a type of endotracheal tube that has provides independent ventilation for each lung

A double lumen tracheostomy tube

Type of tracheostomy tube that only contains the outer cannula, and no inner cannula.

Single lumen tracheostomy tube

Type of procedure performed to prevent oral and nasal secretions from entering the lower airway when the patient is too weak to cough up secretions

Pharyngeal suctioning

Suctioning the _____________ triggers a cough, which helps loosen and mobilize secretions.

pharynx

In tracheal suctioning, a catheter is passed beyond the pharynx into the ______________ to remove secretions from the lower airways.

trachea

a non-invasive way to measure and display the amount of carbon dioxide (CO2) in exhaled breath

Capnography

What noninvasive device estimates arterial blood oxygen saturation (SpO2)?

Pulse Oximetry

What device detects hypoxemia before clinical signs and symptoms?

Pulse Oximetry

All of these factors affect the accuracy of this device:

- External light

- Activity/movement

- Jaundice

- Artificial nails, nail polish

- Circulation (diseases like PVD, hypothermia, vasoconstrictive meds)

- Carbon monoxide poisoning

- Hemoglobin level

Pulse Oximetry

What is a normal ETCO2?

35-45 mmHg

A high or low ETCO2 equals hypoventilation?

High ETCO2

A high or low ETCO2 equals hyperventilation?

Low ETCO2

COPD patients, opioid patients, and those who have went under anesthesia all retain ___________

Retain CO2

What method detects changes in breathing quicker than a pulse ox?

Capnography

a breathing technique that involves inhaling through your nose and exhaling slowly through pursed lips:

Pursed lip breathing

After deep breathing or the use of an incentive spirometry how many times should you cough?

2-3 times

How often should deep breathing exercises or the use of an incentive spirometry be used?

Every 1-2 hours while awake

a technique that involves supporting the chest and abdomen to reduce discomfort and protect the incision while coughing, sneezing, or breathing deeply

Splinting abdominal or chest incisions

When performing IS what position should be patient be in?

Seated or semi-fowler's position

When performing IS how long should you hold your breath after inhaling?

3-5 seconds

How many times should you repeat IS in an hour?

10 times

What is the best position that looks for maximum expansion of the lungs?

Tri pod position

What helps keep secretions mobile and thin?

Hydration/ Humidification

If a patient is unable to take in enough fluids orally what other route can fluids be administered?

IV

Type of device that can be used to help humidify the lungs

Nebulizer