oxygenation

oxygen

inspired air

percentage of o2 in room air

21%

what co2 is too high what happens?

you stop breathing

what is pulse ox the measure of

how much o2 is getting into the body when taking a breath in

why is o2 so important

so make brain and organs function properly

co2

pulmonary circulation, very little in room air (all contained in exhaled air)

upper respiratory tract

mouth, nose, pharynx, larynx

lower respiratory tract

trachea, bronchi, bronchioles, alveoli, pulmonary capillaries

what do the alveolis work for

exchange between o2 and co2

how do alveolis open

get enough o2 and pressure

ventilation

breathing= inhalation & exhalation

inhalation

active process

what is inhalation

air into lungs, diapragm contracts (goes down to increase chest wall), decrease in pulmonary pressure

what is exhalation

air out of lungs, diaphragm relaxes, increase in pulmonary pressure

exhalation

passive process

when does gas exchange occur

post alveolar ventilation

what happens to o2 during diffusion

o2 from alveoli to pulmonary capillaries

what happens to co2 during diffusion

co2 from pulmonary capillaries into the alveoli

respiratory process

alveolar ventilation, diffusion of o2 and co2, transport of o2 and co2

alveolar ventilation

increase to decrease in concentration

diffusion of o2 and co2

partial pressure of o2 (alveolar vs pulmonary arterial)

partial pressure of co2 (pulmonary arterial vs alveolar)

transport of o2 and co2

o2 transport (lungs TO tissues)

co2 transport (tissues TO lungs)

comprehensive assessment

factors influencing respiratory physiology (age continuum, env, lifestyle, comorbidities, meds, stress)

impaired respiratory status

work of breathing

hypoxemia

low o2 lvls in BLOOD (poor lung uptake)—> lungs not breathing it in= low levels

hypoxemia s&s

hypoxia less severe AND SPO2 below 90 (but depends on pt baseline)

how to measure hypoxemia

measure w arterial blood gas test

treatment for hypoxemia

PRBCs, mechanical ventilation

hypoxia

low o2 levels in TISSUES (poor flow/hypoxemia)—→ bringing it in but not getting into the tissues

s&s of hypoxia

SOB, headaches, cyanosis, confusion, tachycardia, restlessness

why should you find out what the cause is of restlessness

because if u give a sedative and are already not getting enough o2, then o2 lvls will go even lower

what is hypoxia a sequela of

hypoxemia

what is the treatment for hypoxia

rest, breathing exercise

what does it mean if a patient cant complete a sentence and stops to breathe

they have a problem with breathing

nursing interventions to promote respiratory functions

positioning, breathing exercises, cough techniques, hydration

positioning for promoting respiratory function

prone

breathing exercises for promoting resp function

diaphragmatic, pursed lip

diaphragmatic

2 hands, one on chest and one on abdomen (for calming) in and out slowly

pursed lip

ppl w copd usually do this, allows for smaller thinner stream but better stream

cough techniques

huff, cascade, quad

huff

inhale,exhale,huff (deeper each time)→ like fogging a mirror

cascade 

huff 3 times, deeper breathing as you go

quad

abdominal thrust inward and upward

make sure people are well hydrated during the cough techniques

especially the huff

hydration

med administration and teaching

promoting respiratory function

multi-disciplinary therapeutic interventions, meds, resp therapies

meds for respiratory function

bronchodilators, anti-infl meds, cough supressants, expectorants

why does wheezing occur

breathing tunnels are getting narrower

respiratory therapies

incentive spirometry, percussion, vibration, postural drainage

co2 retaining pts

chronic high levels of co2, they lose their drive to breathe if o2 is high, minimize o2 therapy, purse lip breathing

what is different w co2 levels in pts that are co2 retainers

normally high co2 levels, need to give them more co2 than o2 to make them feel better

what should you find out if a patient has copd

if theyre co2 retainers

fine o2 levels for co2 retainers

87-88

what level should co2 retainers not be on in terms of oxygen

94% or above

what is a good amount of o2 to give a co2 retainer

0.5 L

o2 therapies

MD ordered

FlO2

inspired O2 percentage

opti-flow

nasal increase flow of o2 (21-100% o2, humid/warm)

what is a complaint of nasal cannula

long-term skin breakdown of the ears

nasal cannula

24-44% o2

what happens if you don’t give someone humidified o2

mucus will fry and plug and block o2 from getting in

CPAP

enhances inhalation of o2 past larger throat structures, seal is important for the machine

what condition are CPAPs used for

sleep apnea

BIPAP

enhances ventilation to avoid mechanical ventilation, not long term

what is mechanical ventilation

a medical treatment that uses a machine called a ventilator to help a person breathe when they cannot do so effectively on their own

what are BIPAPs treatments for

exacerbations of CHF, COPD, short term inability to manage oxygenation AND ventilation

what is the only exception for when BIPAP would be a long-term solution

for palliation, when comfort is the goal and not curing

pts w copd and end stage HF

don’t get off ventilators easily

if ventilation isnt improved with bipap what should you do

consider mechanical ventilation

diff between bipap and cpap

CPAP delivers a single, continuous level of air pressure, while BiPAP delivers two different pressure levels: a higher pressure for inhalation and a lower pressure for exhalation

oral airway

don’t use on awake patients

laryngeal mask

short-term for surgery

ETT (endotracheal)

goes down to the lung

trach tube

corrogated tubing, HAS TO BE HUMIDIFIED/WARM

nasotracheal tube

causes you to cough but not gag, keep airways open

what is suctioning for

to clear airways

what does suction cause

swelling and inflammation

when should you suction

ONLY when needed

what should you avoid when suctioning

saline (unless needed)

how long should you suction for 

NO MORE THAN 3 SECONDS

what should you assess for pre and post suctioning

pulse oximetry levels, strength of cough, time between each pass, assess how much o2 is needed btwn passes

reasons to suction

junky cough, drop in pulse ox

how many passes should you give max

2 is about the max (pass= passing in and out)

who gets trachs

when you cant get to the airway, cant put tube thru trachea, usually happens during anaphylaxis or have broken their face bones 

after how many days will the trach stay open

after 7 days

what will happen to the trach before 7 days

it will close

why are trachs good

helps pts get things in and out quicker bcs only has to get it up to the throat, not any higher than that

chest tubes

drainage systems, pneumothorax, hemothorax, pleural effusion

what should you do if you insert a chest tube

medicate, cough, and deep breath

effusion

collection of fluid within the tissues, lung doesn’t inflate right away

always ask

if pt is on suction or room air

what is a priority action if pt is getting worse when suction is taken off

turn suction back on, if pt immediately gets better, then it was that 

how should drainage look in a patient administered a pneumothorax chest tube

no drainage in tube box is normal

how should drainage look like in a pt administered a hemothorax chest tube

the tube should be lower, blood clots are common, look at drainage, slowly decreasing= fine, suddenly stops= might be a clot

pneumothorax chest tubes

to allow a collapsed lung to re-expand

hemothorax chest tube

drains blood from the lungs

pleural effusion

to drain the excess fluid from the space between the lungs and chest wall