Oxygenation

The process of providing oxygen to the body’s cells is called _____. This depends on the ___ of the airways/alveoli and ensuring there is optimal function of the _____ system and blood flow.

Disturbances of this resutls from ineffective gas ____ (lungs) or an ineffective pump like the ____

oxygenation; integrity; CV; exhange; heart

The upper respiratory system includes the ____, pharynx, larynx, and epiglottis. The function of it is to __, warm, and filter the air. 

The lower respiratory system includes the trachea, right/left, segmental, and terminal ____ These airways are lined with ____ and cilia which traps particles and pushes mucus to the upper airwyas. They also produce pulmonary ____ which covers the alveoli and reduces surface tension. 

The lung can be divided into the right/left lung. The right lung has ___ lobes. The left lung gas ____ lobes. 

The main _____ branches into each lung from the trachea and divides into secondary bronchi and then eventually the _____ bronchioles. At the end of these are ______ which are small air sacs. These are responsible for gas ______. 

The _____ pleura covers the lungs while the ___ pleura lines the thoracic cavity. There is a space between the layers called the pleural space and contains ____ that acts as a lubricant b/w the two layers and holds the lung in an expanded position.

The lungs stretch/recoil but remain partially ____ because of the pressure difference b/tw atmosheric and pleural space.

nose; humidify; bronchioles; mucus; surfactant; 3; 2; bronchi; terminal; alveoli; exchange; visceral; parietal; fluid; expanded

The process of respiration moves through 3 phases:

1. The movement of gases in/out of the lungs is called ______. Inspiration is an active process which is stimualted by _____ that monitor pH, PaCO2, and PaO2. The major muscle for this is the _____.  Expiration is a passive procecess that depends on the elastic ____ properties of the lungs. The _____ is the ease in which lungs can be filled and expand. Airway _____ is a condition created when there is an obstruction in the airway. Physical/physiological changes cause ____ of muscles involved in breathing. 

2. The gas exchange b/w air and blood in the alveoli is called _____. Any change in the alveolar capillary _____ can hinder gas diffusion 

3. The ability of the CV system to pump oxygenated blood to the tissues and return deoxygenated blood is called ______. This is affected ____ level and blood supply

ventilation; chemoreceptors; diaphragm; recoil; compliance; obstruction; weakness; diffusion; membrane; perfusion; activity

The respiratory system in the _____ controls involuntary respiration. The normal stimulus to breathe is an increase in ____ in the blood. The _______ respond to changes in blood gases and a stimulation of these receptors causes an ____ in rate/depth of ventilation.

Blood _____ is tighly regulated and must be in range to sustain life.

The cerebal cortex does ____ control of breathing.

medulla; CO2; chemoreceptors; increase; pH; voluntary

In the heart:

1. The ____ ventricle pumps deoxygenated blood through the pulmonary circulation.

2. The oxygen is then picked up in the ____. 

3. The ____ ventricle pumps oxygenated blood through the pulmonary circulation.

In tbe blood vessels:

1. The O2 is distributed ot the tissues via plasma and ____. 

2. Exchange of CO2 and O2 occurs in the _____ of the tissues. 

3. CO2 is delivered back to the lungs and exhaled as _____. 

right; lungs; left; RBCs; capillaries; waste

A bluish color in the skin, lips, and nail beds is called _____. It is due to a shortage of ____ in the blood. 

An inc RR of >24 is called ____

A dec RR of <10 is called ______

Inc CO2 levels in the blood is called _____

Dec CO2 levels in the blood is called _____

cyanosis; oxygen; tachypnea; bradypnea; hypercapnia; hypocapnia 

Physiological factors include any conditions that affect ______ functioning which affects the body’s ability to meet oxygen ____. 

Examples includes:

1. Dec oxygen _____ capacity which occurs in patients with _____ as they have lower than normal hemoglobin levels. Results in pallor, inc HR, etc. 

2. A chronic ____ disease like COPD which leads to overuse of accessory muscles to breathe. 

3. Shock and severe dehydration can lead to ______ which reduces the amount of circulating blood. 

4. ____ causes a heavy lower thorax/abdomen which reduces lung volumes and can lead to obstructive ____ apnea.

5. Changes in size/shape of the _____ cavity.

6. Trauma to the chest _____ like fractures or surgical incisioins. 

7. Neuromuscular disease 

8. CNS alterations

cardiopulmonary; demands; carrying; anemia; lung; hypovolemia; obesity; sleep; thoracic; wall

Developmental factors affect oxygenation:

For infants/toddlers, they at inc risk for ______ and upper respiratory tract ____ bc they are more likely to put foreign objects in their mouths. 

School age children and adolescents have risk factors including _____ or secondhand smoking. 

Young/middle-aged adults have cardiopulmonary risks like an unhealthy _____, lack of exercise, stress, illegal substances, and smoking. 

Older adults have dec respiratory muscle ____, a decrease in the ____ mechanism/reflex, dec chest wall compliance, loss of elastic ___, and inc risk of respiratory risks.

Lifestyle factors like nutrition, exercise, hydration, etc are often ____ for patients to modify as these are usually enjoyable habits. 

Environmental factors include occupational/environmental ____ like smog, asbestos, etc. 

choking; infections; smoking; diet; strength; cough; recoil; difficult; pollutants

______ is a decrease in alveolar ventilation meaning the body ____ CO2 and is unable to meet O2 demand. 

In normal patients, the stimulus to breathe is an increase of ____ in the blood. In COPD patients, the stimulus to breathe is low levels of blood _____. This is bc inc levels of CO2 is normal and so the CO2 chemoreceptors ar eless ____ to changes in theese. 

For COPD patients, hypoventilation can be caused by giving O2 greater than _____ liters/min bc it destroys the stimulus to breathe, so you want to keep O2 sat at about __ to 92%.

This can lead to respiratory ____ and other signs/symptoms include ____ status changes, dysrhythmias, and potential cardiac ____.

hypoventilation; retains; CO2; oxygen; sensitive; 3; 88; acidosis; mental; arrest

Inadequate amounts of oxygen in the tissues is callled _____. This can be due to dec ______ levels in the blood, diminished O2 levels at ____ altitudes, pneumonia, etc.

An early sign of hypoxia is a change in ____ status like anxiety, inactility to concentrate, dec LOC, and _____ changes as well as inc PR and ____.

A late sign is ____.

Chronic hypoxia causes the ___ of nails such as in emphysema, cystic fibrosis, etc.

hypoxia; hemoglobin; high; mental; behavioral; RR; cyanosis; clubbing

Difficulty breathing is called _____. Signs and symptoms include:

1. An ____ in HR, RR, and BP.

2. Pallor or _______

3. A feeling of ____, impending doom, or restlessness.

4. The use of ____ muscles for breathing or the ___ of the nares. 

The first think you do to help patients is to have them ____ or standing up. You can also teach ____ lip breathing and address the underlying cause. 

dyspnea; increase; cyanosis; anxiety; accessory; flaring; sitting; pursed

SOB that begins/inc when the patient lies does is called_____. This improves with the patient sits up or is in the ____/orthopneic position. 

Patients often time use multiple ____ when reclining to alleviate the symptoms. 

Other nursing interventions include using ____ O2 as ordered and treating the underlying cause. 

orthopnea; tripod; pillows; supplemental

When taking the pt’s history, include Q’s abt heart, lung, asthma, allergies, and their ____ history.

IF the patient is in distress, initate appropriate actions to relieve symptoms ____ taking the history.

During the physical assessment:

1. Inspect the chest contour and _____ like the diameter, and the RR and _____. These should be quiet and non-labored. Inspect if their cough is ______ and if so what is the amount, color, consitency, odor, etc. Look to see if they have ____ of nails and note their skin color and cap refill. Inspect their appearance like their ____ and orientation

2. Palpate their peripheral ______, skin temp, for edema, and any trachial deviation.

3. Percussion can be used to detect the presence of abnormal ____ or air in the lungs.

4. The most important is auscultation in which you listen for lung _____.

smoking; before; shape; rhythym; productive; clubbing; LOC; pulses; fluid; sounds

____ ____ measures the arterial oxyhemoglobin saturation. This is a _____ method of monitoring patient oxygenation status of those receiving ____ therapy.

The normal levels should be ___ to 100%.

If you walk in and see the levels are low, you want to first ____ your patient as low levels can be due to motion, acrylic nails, anemia, or a poor ____ to the probe.

pulse oximetry; noninvasive; O2; 95; assess; connection

You can prevent respiratory infections by encouraging you patients to get their annual ____, ensuring that they are maintaining a healthy ____, and are avoiding exposure to environmental ____ like smoke, pollen, etc. 

You can also teach your patients to do ___ breathing which encourages deep nasal _____ to inc air flow to the lower lungs for patients w COPD. You can also teach your patients to do ____ lip breathing which allows for a deep inspiration and a ____ expiration. 

For patients with upper/lower respiratory infections, encourage them to deep breathe and ___ every 2 hours to prevent accumulation of secretions. Also have them ____ to get the secretions out. 

You can also do various pharmacological, psychosocial, breathing techniques, and measures to manage _____ and reduce anxiety associated w it. 

You also want to ensure that the patients are adequatley _____ which helps to keep the secretions thin, white, watery, and easily ___ with minimal coughing. 

vaccines; lifestyle; pollutants; diaphragmatic; inspiration; pursed; prolonged; cough; ambulate; dyspnea; hydrated; removable

Nursing interventions to promote lung expansion include:

1. Encourage your patient to ____ which improves respiratory ____ and lung expansion.

2. Frequently ____ your patients reduces the stasis of pulmonary secretions and decreases chest wall ____ which both inc the risk of pneumonia. The best position to put your patient is ___ fowler.

3. The use of _____ spirometry promotes voluntary deep breathing by providing ____ feedback to patients abt inspiratory volume.

ambulate; strength; repositioning; expansion; semi; incentive; visual

The ___ test is the most accurate way to measure the adequace of ventilation/perfusion of the ____. This is because this blood is sampled from the ____ artery. 

This helps to assess:

1. The acid-base ____

2. The _____ status

3. The need for ____ therapy.

ABG; tissues; radial; balance; ventilation; O2

A _____ is used to obtain specifmen of pleural fluid for diagnosis, to remove ____ fluid, or remove a specimen for biopspy.

This is a _____ procedure that is done by the provider at the _____. You want to obtain consent and position the patient _____ with their elbors on the overbed table and feet suppported.

Ensure that the patient does not ____ or cough and monitor your patient closely. Monitor the patient’s pulse, O2 _____, and RR.

The needle is placed b/w the_____ and the through the intercostal muscles and into the pleura to ____ the pleural fluid. 

Complications include pain, hypotension, pulmonary ____, and a _____ if the lung is punctured. 

If ____ appears in the sputum or if the patient is severely ____, then notify the healthcare team prompty. 

thoracentesis; pleural; sterile; bedside; upright; talk; saturation; ribs; aspirate; edema; pneumothorax; blood; coughing

_____ tubes are used to make an artificial airway for patients who have dec LOC, airway ____ or who is in need or prolonged ventilator support. It could also be used for those with a ____ or neuromuscular disease.

These do put the patients at higher risk for ___ and airway injury. You must use ____ technique for care/maintenance. 

There are diferent tube types: 

1. A ____ tube is used for short term and to administer invasive ____ ventilation. 

2. A tracheostomy tube is used for ____ term assistance. Patients can either receive mech ventilation or breathe ______. Most of these patients cannot ____ bc they are inserted below the vocal cords so use written/nonverbal _____. 

Complications include partial/total airway obstruction due to build up of _______. To prvent this you can do ____ but this can also lead to hypoxemia, hyper/hypotension, pain, bradycardia, etc. 

If the tube becomes disloged/extubated, remain w paitent while calling for help, ventilate patient with an ____ bag, assess the patient for airway ____, vital signs,and spontaneous breating. Prepare to re-insert or ____the patient. 

tracheostomy; obstruction; SCI; infection; sterile; endotracheal; mechanical; long; spontaneously; talk; communication; secretions; suctioning; ambu; patency; intubate

Tracheal ____ is needed when the patient is unable to clear respiratory secretions. This based on the patient’s _____ so you need to asses for this by look at the presence of any secretions or changes in breath _____. 

If suctioning is needed, ____ the procedure and collect the proper equipment. 

You want to adjust the pressure and assess ____ signs and SpO2. You want to ____ the patient by either setting the ventilatory to 100% for 30-60s or by using an ___ bag. 

When inserting the catheter,  do ____  apply suctioning and advance the catheter until the patient ____ and then pull back. You want to try to time insertion with ____. 

Apply ____ suctioning for 10-15 seconds. Suctioning removes ___ from the airway so monitor for respiratory distress. 

You want to hyper-oxgenate _____ each suction mass and allow for ___ minute between each pass. You can oxygenate via 30-60 sec via mech ventilation or over 30 seconds w ambu bad. 

Rinse/suction catheter with normal _____. You also want to ____ to assess changes in lung sounds. 

If the patient develops respirtaory distress during the procedure, immediately ____ the catheter and supply additional O2/breaths. 

suctioning; need; sounds; explain; vital; preoxygenate; ambu; not; coughs; inspiration; intermittent; oxygen; between; 1; saline; auscultate; withdraw

_____ ventilation is ventilation performed by a machine. Invasice mech ventilation uses ______ pressure ventilation to fully/partially control ventilation and are used with patients who have ___ or tracheal tubes. 

This helps to improve ____ and ventilation and supports breathing function for both ____ episodes or long term. 

Indications include reversing _____, acute respiratory acidosis, allowing for sedation, and relieving severe respiratory _____

mechanical; positive; endotracheal; oxygenation; acute; hypoxia; distress

Chest tubes or catheters are inserted into the chest ____ to ___ the blood/fluid/air from the ___ space. A lot of the times trauma causes the ____ pressure in the lungs to be disturbed which prevents the lungs from being ____.

Chest tubes allow the compressed lung to re-_____ by restoring that pressure. 

Air in the pleural space is called a _____ which causes the lung to _____ usually caused by stabbing, gunshot wound, riib fracture, or spontaneous. 

A ____ pneumothorac occurs when air enters into the pleura space and cannot escape. This causes ____ deterioration of respiratory status and there is ____ deviation to the unaffected lung, and ____ of breath sounds on the affected lung side. 

A _____ is blood/fluid in the pleural space and prevents full lung expansion. 

wall; drain; pleural; negative; inflated; expand; pneumothorax; collapse; tension; rapid; tracheal; absence; hemothorax

The chest tube is a ____ tube that is placed in the pleural space. It is ____ into the chest with an ___ dressing. It is attached to a closed one-way ____ system.

This chest tbe is always placed ____ the level of the chest to allow for drainage. You want to avoid kinks in the tubing and routinely assess for ____, breath sounds, and SpO2 levels. You want to ensure the ____ of the drainage system and ensure it is always _____

You want to prepare for emergent situations by having ___ dressings nearby. If they are removed, ____ the site w gloved hand. If the tube is disconnected from the drainage system, then you want to ____ the tubing and get a new drainage system attached to chest tube. 

Do not ____ milk/strip the chest tubes as this inc thoracic pressure and can cause ____ damage.

hollow; sutured; airtight; drainage; below; RR; patency; upright; occlusive; cover; clamp; routinely; tissue

The goal os O2 therapy is to prevent/relieve _____ by delivering the ____ amount of O2 possivle to achieve adequate tissue oxygenation. This requires an ______ unless it is a rly small amount.

O2 can be supplied via an oxygen ____ or through a permanent wall-piped system. Oxygen flow is expressed in ___ perminute and you want to continually assess the patient via ___ ox. You want o provide ____ to reduce drying and discomfort of the nasal mucous membranes.

The flow rate varies depending on the condition and the _____ will prescribe the rate.

Home precautions including keeping oxygen tanks away from open ____, telling the patient not to ____, and keep oxygen tanks positioned _____.

hypoxemia; lowest; order; tank; liters; pulse; humidification; provider; flames; smoke; upright

The most common O2 delivery device is via the ____ cannula. It is safe, simple, and does not impede ____ or drinking. A disadvantage is that it is easily ____ and cause ____ of the mucous membranes which you can use humification to combad. It may cause skin breakdown/irritation around the _____ and nares due to the constant contact of the tubes w the skin. 

Nursing considerations include:

1. Checking to make sure the ____ are in place

2. Check for skin _____

3. The rate should not exceed ____ liters/minute. 

nasal; rating; dislodged; drying; ears; prongs; breakdown; 6

A simple face mask is used for ____ term oxygen therapy. It delivers oxygen concentrations of 6 to ___ liters/min. 

It is contraindicated for patients who ___ CO2 like COPD patients. It can cause feelings of ____ and prevents the patient from being able to ____ or drink.

short; 12; retain; claustrophobia; eat

A partial/non- _____ masks are simple masks with a reservoir bag that are used for ____ periods of time to deliver ____ concentrations like 10 to ___ L/min.

Frequently inspect to make sure that the bag is ____ to prevent the patient from breathing large amounts of exhaled _____. 

These masks can be ____, confining, can irritate the skin, and a ___ seal is necessary. 

These interfere with ____ and talking. 

rebreather; short; higher; 15; inflated; CO2; hot; tight; eating

A ____ mask delivers high flow and more precise oxygenconcentations and requires flow rates of ____ to 12 L/min. These are typically reserved for patients with__ who need low, constant oxygen concentrations. 

Monitor your patient to ensure that they have the correct ____ rate and monitor SpO2.

venturi; 4; COPD; flow