PCC EXAM 3(minus documenting and med admin):

Oxygenation refers to:

how well the cells, tissues, and organs of the body are supplied with oxygen.

Ventilation (Mechanical):

• Inhalation(inahle) vs. Exhalation(exhale) - diaphragm is important for these

Respiration (Chemical) - process of gas exchange

• Internal(Co2 and O2 are diffused over cell wall)vs. External(O2 is diffused into alveoli)

• Exchange of oxygen and carbon dioxide in the alveoli and capillary membrane.

Factors Impacting Oxygenation

Low hemoglobin—→low oxygen

Age(Babies(premature-lungs are immature and they do not have sufficient surfactant) Infants(choking/obstruction of airway, apnea is common(20sec periods is normal)), Preschooler: exchange of germs, upper resp. infections, small airways and inflammation of airways—→lots of issues). School aged: asthma, allergies. Adolescents: smoking, vaping. Young/middle ages adults: occupation(exposure to chemicals, sedentary job. Older adults: lose muscle strength and ability to breathe; thorax is not able to expand fully, GERD and reflux, alveoli do not inflate as well, immune system function decrease

Lifestyle

• obesity—→sleep apnea

• pregnancy: fetus pushes up on diaphragm so they are unable to take deep breathes—>tachypnea

Environment

Medications: albuterol - bronchodilator , opioids, sedatives, benzos - decrease resp. rate

• steroids and antibiotics

Comorbidities: pneumonia, PE, pneumothorax, fibrosis

Trauma: thoracic region

Assessment of Oxygenation Status

Physical Exam: head bobbing, retractions, accessory muscles, pale or blue skin, decreased LOC, nasal flaring, decreased capillary refill, barrel chest + nail clubbing(chronic), tracheal deviation, collapse of lung—>assymetry

Medical History: smoking, meds, resp. conditions(asthma, COPD, pneumothorax, FX, vaccines, premature birth or childhood trauma/asthma

Breathing Pattern: coughing, congestion, chest tightness, wheezing, dyspnea

Respiratory Effort: SOB, nasal flaring, retractions, grunting, tripod positioning

Pulse Oximetry

Diagnostic Testing

• Arterial Blood Gas (ABG’s) - monitor pH *go over

• Peak Flow Monitoring - read textbook

• Imaging

Breathing Patterns

Eupnea - regular breathing; 12-20

Bradypnea - slow breathing due to overdose, opioids, sedatives, athletes naturally have slower breaths

Tachypnea - rapid breathing due to anxiety, stress, compensatory mechanism

Kussmauls Respirations - increased rate and abnormally deep respirations

Biots Respirations - irregular with variable depth, associated with damage to brain(medulla) and increased ICP

Cheyne-Stokes Respirations - fast/shallow breathing with periods of apnea(also with brain injury)

Apnea - no breathing

• agonal breathing: gasping for air

Indications for Oxygen Therapy

normal 95-100

Hypoxemia: low levels of oxygen (<90%) in arterial blood. start to get worried

Hypoxia: low levels of oxygen in the tissues

Pulse ox: affected by cold hands, moving, nail polish/acrylics, decreased blood flow

• Early signs in adults: trying to compensate—→tachypnea, tachycardia, restlessness, anxiety, confusion, pale skin and mucous membranes, elevated blood pressure, use of accessory muscles, nasal flaring, adventitious(abnormal) lung sounds

Late Signs in Adults: no longer able to compensate—→stupor(look dead), cyanotic skin and mucous membranes, bradypnea, bradycardia, hypotension, cardiac dysrhythmias

Nursing interventions: hypoxia

• Confirm probe placement.

• Confirm that the oxygen delivery system is working and the patient is receiving the prescribed amount (check all tubing and equipment).

• Raise the head of the bed and encourage pursed lip breathing(kiss shaped lips).

• Stay with the patient, provide support, and decrease anxiety.

Nasal Cannula

(1-6 L/min, 24-44%) (room air is 21%; increase 1L —→25%)

ADVANTAGES

• Safe and easy-to-apply.

• Comfortable and well-tolerated.

• Patient can eat, talk, and ambulate.

DISADVANTAGES

• FiO2 varies with the flow rate, and rate/depth of breathing.

• Skin breakdown and dry mucous membranes long term(within the nares).

NURSING ACTIONS

• Assess patency & tubing.

• Ensure proper fit.

• Use water-soluble gel to prevent dry nares.

• Humidification for flow rates of 4 L/min and greater.

• no smoking, acetone, alcohol; flammable

  • no where the closest fire extinguisher is