EXAM 3: Oxygenation

NURS207: Foundations

ventilation

physical process of moving air in and out of the lungs so gas exchange can take place (motion)

inspiration

negative pressure pulls air in, an active process/muscles contract

expiration

a passive process/muscles relax

adequate ventilation depends on…

clear airways, intact CNS, intact thoracic cavity, adequate lung compliance

what is lung compliance and what allows for it?

stretchability of the lungs, surfactant

hypoventilation

decreased rate of depth of air movement into the lungs

what does hypoventilation result in?

hypercapnia

what is hypercapnia?

increased CO2 levels in the blood

hyperventilation

increased rate and depth of ventilation, CO2 levels fall

what is hyperventilation caused by?

anxiety, injuries to the respiratory center in the medulla, fever, compensation for metabolic acidosis

symptoms of hyperventilation

tachycardia, SOB, dizziness, lightheadedness, paresthesia, blurred vision, extremity numbness

interventions for hyperventilation

rebreathe exhaled CO2, breathing into a paper bag

airway obstruction

completely blocked upper (nose, pharynx, larynx) or lower respiratory tract (bronchi and lungs)

causes of airway obstruction

aspiration, constriction of the airway, secretions in the airway

respiration

the gas exchange of breathing, swapping CO2 for O2

diffusion

spontaneous movement of gases without energy or effort

adequate respiration/gas exchange depends on…

surface area available for perfusion, lung expansion and contraction, CO2 diffuse faster than O2, thin alveolar membranes

what do chemoreceptors in the medulla, carotid and aortic bodies do?

sense changes in oxygen, carbon dioxide, and hydrogen

perfusion

the flow of blood driven by the cardiopulmonary system

perfusion depends on…

person’s position and activity (more activity means more perfusion), adequate blood supply

normal oxygenation depends on proper functioning of…

airways, alveoli, cardiovascular system

hypoxia and what is it most caused by?

not enough oxygen at the cellular level, most often caused by insufficient oxygen within arterial blood

EARLY symptoms of hypoxia

dyspnea, increased BP/pulse/RR, pallor, cyanosis

LATE symptoms of hypoxia

low BP/HR/RR, cyanosis, dysrhythmias, metabolic acidosis

symptoms of chronic hypoxia

clubbing of fingers and toes, peripheral edema, RSHF, O2 sat < 87%

how is hypoxia treated?

administering oxygen, treating underlying cause

which of the following is true?

• Hypoxia is almost always caused by hypoxemia.

• Late symptoms of hypoxia are tachycardia, hypertension, and tachypnea

• Respiration and ventilation are synonyms (they mean the same thing)

• Inhalation is a passive process.

hypoxia is almost always caused by hypoxemia

ventilation along the respiratory tract is impaired by…

asthma, emphysema, chronic bronchitis, COPD

asthma

narrowing of the bronchi, inflammation, excess mucous

emphysema

sacs in the alveoli rupture, decreasing surface area for gas exchange (pink puffers)

chronic bronchitis

long-term inflammation on the bronchi resulting in swelling and cyanosis, (blue bloater")

pleural effusion

excess fluid in the pleural space

pulmonary embolism

one or more arteries in the lung are blocked by a blood clot

pneumonia

fluid in the alveoli caused by infection

pneumothorax

air outside of the lung in the space between lung and the chest wall

what is a pneumothorax caused by?

air blebs on the surface of the lung that burst or trauma to the lung that tears its surface and releases air

tension pneumothorax

pressure on the heart and vessels causing a collapsed lung

hemothorax

blood in the pleural cavity

pulmonary embolism

blood clot that breaks off and becomes lodged in the small vessels of the lungs

pulmonary edema

fluid in the alveoli

physical assessment of lungs: look, listen, and feel

RR (12-20), breathing pattern and effort, chest symmetry, lung sounds

additional indicators of lung issues

HR and BP, LOC, color of skin and mucous membranes, use of accessory muscles, positioning

orthopnea

inability to breathe except in an upright sitting or standing position

cyanosis and why it happens

a bluish discoloration of skin, nail beds, mucous membranes due to decreased oxygen saturation of hemoglobin

pulse oximetry

measures the percent of oxygenated hemoglobin in arterial blood (oxygen saturation)

normal pulse oximetry

95-100%

<92% pulse oximetry

hypoxemia

<70% pulse oximetry

life threatening

newborn RR

30-60/min

abnormals of infant breathing

greater than 20 second pauses are considered apnea

3 year old RR and risk

20-30/minute, aspiration is a huge safety risk

health risks for child and adolescent

smoking and vaping

lifespan considerations for older adults

thoracic wall is more rigid, lungs not as stretchy

positions to promote oxygenation

fowler’s, orthopneic, prone, good lung down

incentive spirometry

measures and shows the flow of air inhaled through the mouthpiece

how to instruct the client on incentive spirometry

sit up, take a slow and deep breath to elevate the balls in the device, hold breath for 2-6 seconds to keep balls elevated, change mouthpieces every 24hr

chest tubes

evacuate air or blood from the pleural cavity, restores negative intrapleural pressure and re-inflates the lung

oxygen therapy

administering more oxygen than is present to prevent or relieve hypoxemia

equipment needed for oxygen therapy

flowmeter, oxygen analyzer, humidifier

oxygen analyzer

use to measure the concentration of O2 in the room

nursing interventions to promote oxygenation

facilitate ventilation (positioning), hydration, patent airway promotion, administer oxygen

how to promote safety when administering oxygen

no smoking, no static blankets, no alcohol or petroleum-based products

nasal cannula

for O2 rates of 1-6 L/minute

advantages of a nasal cannula

allow client to eat and talk, easy to apply, comfortable

simple face mask

delivers oxygen concentrations 40-60%

venturi mask

delivers O2 concentrations of 24-50% at flow rates of 4-10 L/min

green jet adapters

35% concentration at 8 L/min

face tent

delivers concentration of 30-50% at 4-8 L/min

nonrebreather mask

delivers the highest O2 concentration possible (95-100% flow rates at 10-15 L/min)

partial rebreather mask

delievers O2 concentrations of 60-90% at flow rates of 6-10 L/min

CPAP, BiPAP

provides air under pressure to keep the airways open

which of the following is true?

• When using incentive spirometry, the patient breathes out through the mouthpiece in the device.

• When using pursed lip breathing, the patient inhales longer than they exhale.

• Chest tubes are placed in the intrapleural space to evacuate air or fluid

• The best position for promoting oxygenation is left lateral.

Chest tubes are placed in the intrapleural space to evacuate air or fluid

which of the following is true?

• A non-rebreather mask gives the most precise levels of oxygen

• There is no such thing as too much oxygen

• CPAP and BiPAP machines deliver pure oxygen

• If a patient is receiving oxygen by simple face mask, the flow rate must be at least 5 L/min

If a patient is receiving oxygen by simple face mask, the flow rate must be at least 5 L/min

chest tubes are used when there is a…

pneumothorax or pleural effusion

tension pneumothorax

air accumulates quicker than it can be evacuated

cardiac tympanade

blood accumulating in the mediastinum after heart surgery

purpose of the chambers in a chest tube

keeps track of the amount of drainage from the chest and where it is flowing from

purpose of the water seal chamber

allows air to exit from the pleural space on exhalation and prevents air from entering on inhalation

what does bubbling indicate?

air leak from chest cavity

purpose of the suction control chamber

regulates the amount of suction

purpose of a tracheostomy

to bypass an upper airway obstruction, prevent aspiration, manage tracheobroncial secretions, allow for prolonged ventilation

assess the tracheostomy site for…

amount, color, consistency, odor

how do we know the airway needs clearing of a tracheostomy?

coarse breath sounds, noisy breathing, prolonged expiratory sounds

how to collect a sputum specimen

obtain early in the morning before eating or drinking, have client rinse mouth, wear proper PPE, have client breath in and out deeply 2-4 times to facilitate a deep cough

how many tsp of sputum should we contain?

1-2, and deliver to lab within 30 minutes