NR 224 Chapter 40 - Oxygenation Questions with expert curated solutions with 100% Accuracy (PASSED)

Ventilation

The process of moving gases into and out of the lungs. It requires coordination of the muscular and elastic properties of the lung and thorax.

Perfusion

Relates to the ability of the cardiovascular system to pump oxygenated blood to the tissues and return deoxygenated blood to the lungs.

Diffusion

Responsible for moving the respiratory gases from one area to another by concentration gradients. For the exchange of respiratory gases to occur, the organs, nerves, and muscles of respiration need to be intact; and the central nervous system needs to be able to regulate the respiratory cycle.

Work of Breathing (WOB)

The effort required to expand and contract the lungs

Inspiration

Active process, stimulated by chemical receptors in the aorta. INHALE

Expiration

Passive process that depends on the elastic recoil properties of the lungs, requiring little or no muscle work. EXHALE

Surfactant

Chemical produced in the lungs to maintain the surface tension of the alveoli and keep them from collapsing

Atelectasis

Collapse of the alveoli that prevents normal exchange of oxygen and carbon dioxide.

Hypovolemia

Reduced circulating blood volume. Can be caused by conditions such as shock and severe dehydration cause extracellular fluid loss

Hypoventilation

Occurs when alveolar ventilation is inadequate to meet the oxygen demand of the body or eliminate sufficient carbon dioxide

Signs/Symptoms of Hypoventilation

Mental status changes, dysrhythmias, and potential cardiac arrest

Hyperventilation

A state of ventilation in which the lungs remove carbon dioxide faster than it is produced by cellular metabolism. Severe anxiety, infection, drugs, or an acid-base imbalance induces hyperventilation

Signs/Symptoms of Hyperventilation

Rapid respirations, sighing breaths, numbness and tingling of hands/feet, light-headedness, and loss of consciousness

Hypoxia

Inadequate tissue oxygenation at the cellular level. It results from a deficiency in oxygen delivery or oxygen use at the cellular level

Causes of Hypoxia

-A decreased hemoglobin level and lowered oxygen-carrying capacity of the blood

-A diminished concentration of inspired oxygen, which occurs at high altitudes

-The inability of the tissues to extract oxygen from the blood, as with cyanide poisoning

-Decreased diffusion of oxygen from the alveoli to the blood, as in pneumonia

-Poor tissue perfusion with oxygenated blood, as with shock

-Impaired ventilation, as with multiple rib fractures or chest trauma.

Signs/Symptoms of Hypoxia

Apprehension, restlessness, inability to concentrate, decreased level of consciousness, dizziness, and behavioral changes

Dyspnea

Clinical sign of hypoxia. It is the subjective sensation of difficult or uncomfortable breathing. Dyspnea is shortness of breath usually associated with exercise or excitement, but in some patients it is present without any relation to activity or exercise

Orthopnea

Abnormal condition in which a patient uses multiple pillows when reclining to breathe easier or sits leaning forward with arms elevated

Myocardial Ischemia

Results when the supply of blood to the myocardium from the coronary arteries is insufficient to meet myocardial oxygen demands. Two common outcomes of this ischemia are angina pectoris and myocardial infarction

Humidification

Process of adding water to gas. Temperature is the most important factor affecting the amount of water vapor a gas can hold

Nebulization

Adds moisture or medications to inspired air by mixing particles of varying sizes with the air

Chest Physiotherapy (CPT)

Group of therapies for mobilizing pulmonary secretions. These therapies include postural drainage, chest percussion, and vibration. CPT is followed by productive coughing or suctioning of a patient who has a decreased ability to cough. It is recommended for patients who produce greater than 30 mL of sputum per day or have evidence of atelectasis on chest x-ray examination

Postural Drainage

Component of pulmonary hygiene. Consists of drainage, positioning, and turning and is sometimes accompanied by chest percussion and vibration. It improves secretion clearance and oxygenation

Artificial Airways

for a patient with a decreased level of consciousness or airway obstruction and aids in removal of tracheobronchial secretions. The presence of an artificial airway places a patient at high risk for infection and airway injury

Oral Airway

Simplest type of artificial airway, prevents obstruction of the trachea by displacement of the tongue into the oropharynx. Extends from the teeth to the oropharynx, maintaining the tongue in the normal position

Endotracheal (ET) Tube

Short-term artificial airway to administer mechanical ventilation, relieve upper airway obstruction, protect against aspiration, or clear secretions. The tube is passed through the patient's mouth, past the pharynx, and into the trachea. It is generally removed within 14 days. However, it is sometimes used for a longer period of time if the patient is still showing progress toward weaning from mechanical ventilation and extubation

Incentive Spirometry

Encourages voluntary deep breathing by providing visual feedback to patients about inspiratory volume. It promotes deep breathing and prevents or treats atelectasis in the postoperative patient

CPAP

Continuous Positive Airway Pressure. Treats patients with obstructive sleep apnea, patients with heart failure, and preterm infants with underdeveloped lungs. In obstructive sleep apnea, airways collapse, causing shallow or absent breathing

Chest Tube

Catheter inserted through the thorax to remove air and fluids from the pleural space, to prevent air or fluid from reentering the pleural space, or to reestablish normal intrapleural and intrapulmonic pressures

CDU

Traditional chest drainage unit. Has three chambers for collection, water seal, and suction control

Nasal Cannula

Simple, comfortable device used for precise oxygen delivery. The two nasal prongs are slightly curved and inserted in a patient's nostrils

Oxygen Mask

Delivers oxygen as the patient breathes through either the mouth or nose by way of a plastic tubing at the base of the mask that is attached to an oxygen source

Venturi Mask

Delivers higher oxygen concentrations of 24% to 60% with oxygen flow rates of 4 to 12 L/min, depending on the flow-control meter selected

Home Oxygen Therapy

Arterial partial pressure (PaO2) of 55 mm Hg or less or an arterial oxygen saturation (SaO2) of 88% or less on room air at rest, on exertion, or with exercise. Home oxygen therapy is administered via nasal cannula or face mask. Patients with permanent tracheostomies use either a T tube or tracheostomy collar

Types of Home Oxygen Therapy

Compressed gas cylinders, liquid oxygen, and oxygen concentrators

Pursed Lip Breathing

Involves deep inspiration and prolonged expiration through pursed lips to prevent alveolar collapse. While sitting up, instruct the patient to take a deep breath and exhale slowly through pursed lips as if blowing through a straw

Diaphragmatic Breathing

Useful for patients with pulmonary disease, postoperative patients, and women in labor to promote relaxation and provide pain control. The exercise improves efficiency of breathing by decreasing air trapping and reducing the WOB

A patient has been diagnosed with severe iron deficiency anemia. During physical assessment for which of the following symptoms would the nurse assess to determine the patient's oxygen status?

A. Increased breathlessness but increased activity tolerance

B. Decreased breathlessness and decreased activity tolerance

C. Increased activity tolerance and decreased breathlessness

D. Decreased activity tolerance and increased breathlessness

D. Decreased activity tolerance and increased breathlessness

-Hypoxia occurs because of decreased circulating blood volume, which leads to decreased oxygen to muscles, causing fatigue, decreased activity tolerance, and a feeling of shortness of breath

A patient is admitted to the emergency department with suspected carbon monoxide poisoning. Even though the patient's color is ruddy, not cyanotic, the nurse understands that the patient is at a risk for decreased oxygen-carrying capacity of blood because carbon monoxide does which of the following:

A. Stimulates hyperventilation, causing respiratory alkalosis

B. Forms a strong bond with hemoglobin, creating a functional anemia

C. Stimulates hypoventilation, causing respiratory acidosis

D. Causes alveoli to overinflate, leading to atelectasis

B. Forms a strong bond with hemoglobin, creating a functional anemia

-Carbon monoxide strongly binds to hemoglobin, making it unavailable for oxygen binding and transport

A 6-year-old boy is admitted to the pediatric unit with chills and a fever of 104°F (40°C). What physiological process explains why the child is at risk for developing dyspnea?

A. Fever increases metabolic demands, requiring increased oxygen need.

B. Blood glucose stores are depleted, and the cells do not have energy to use oxygen.

C. Carbon dioxide production increases as result of hyperventilation.

D. Carbon dioxide production decreases as a result of hypoventilation.

A. Fever increases metabolic demands, requiring increased oxygen need

-When the body cannot meet the increased oxygenation need, the increased metabolic rate causes breakdown of protein and wasting of respiratory muscles, increasing the work of breathing

A patient is admitted with the diagnosis of severe left-sided heart failure. The nurse expects to auscultate which adventitious lung sounds?

A. Sonorous wheezes in the left lower lung

B. Rhonchi midsternum

C. Crackles only in apex of lungs

D. Inspiratory crackles in lung bases

D. Inspiratory crackles in lung bases

-Decreased effective contraction of left side of heart leads to back up of fluid in the lungs, increasing hydrostatic pressure and causing pulmonary edema, resulting in crackles in lung bases

The nurse is caring for a patient who has decreased mobility. Which intervention is a simple and cost-effective method for reducing the risks of stasis of pulmonary secretions and decreased chest wall expansion?

A. Antibiotics

B. Frequent change of position

C. Oxygen humidification

D. Chest physiotherapy

B. Frequent change of position

-Movement not only mobilizes secretions but helps strengthen respiratory muscles by impacting the effectiveness of gas exchange processes

A patient is admitted with severe lobar pneumonia. Which of the following assessment findings would indicate that the patient needs airway suctioning?

A. Coughing up thick sputum only occasionally

B. Coughing up thin, watery sputum easily after nebulization

C. Decreased independent ability to cough

D. Lung sounds clear only after coughing

C. Decreased independent ability to cough

-Impaired ability to cough up mucus caused by weakness or very thick secretions indicates a need for suctioning when you know the patient has pneumonia

A patient was admitted after a motor vehicle accident with multiple fractured ribs. Respiratory assessment includes signs/symptoms of secondary pneumothorax, which includes which of the following?

A. Sharp pleuritic pain that worsens on inspiration

B. Crackles over lung bases of affected lung

C. Tracheal deviation toward the affected lung

D. Increased diaphragmatic excursion on side of rib fractures

A. Sharp pleuritic pain that worsens on inspiration

-When the lung collapses, the thoracic space fills with air on each inspiration, and the atmospheric air irritates the parietal pleura, causing pain

The nurse goes to assess a new patient and finds him lying supine in bed. The patient tells the nurse that he feels short of breath. Which nursing action should the nurse perform first?

A. Raise the head of the bed to 45 degrees.

B. Take his oxygen saturation with a pulse oximeter.

C. Take his blood pressure and respiratory rate.

D. Notify the health care provider of his shortness of breath.

A. Raise the head of the bed to 45 degrees

-Raising the head of the bed brings the diaphragm down and allows for better chest expansion, thus improving ventilation