oxygenation

oxygenation depends on:

airway/alveolar integrity, optimal CV functioning

Nose, pharynx, larynx, epiglottis, used to Warm, Filter, Humidify inspired air

upper respiratory system

Trachea, right and left main stem bronchi, segmental bronchi, and terminal bronchioles, main function is air conduction

lower respiratory system

right lung has 

3 lobes 

left lung has

2 lobes

is always lower than the atmospheric pressure (negative pressure). For air to flow into the lungs, this becomes more negative, setting up a pressure gradient between the atmosphere and alveoli

intrapleural pressure

The diaphragm and external intercostal muscles contract (move downward and outward) to create negative pleural pressure and increase the size of the thorax for—

inspiration

Relaxation of the diaphragm and contraction of the internal intercostal muscles allow air to escape from the lung for —-

exhalation

movement of gases into and out of the lungs, first phase of respiration, Inspiration is an active process stimulated by chemoreceptors that monitor pH, PaCO2, and PaO2 in the blood. Expiration is a passive process that depends on the elastic recoil properties of the lungs requiring little or no muscle work

ventilation

disruption in ventilation:

edema, poor neck positioning, asthma, obstruction

is the ease with which the lungs can be filled with air, the ability of the lungs to expand in response to increased intraalveolar pressure.Conditions like pulmonary edema and cystic fibrosis decrease this

compliance 

a condition created when there is obstruction in the airway, any condition that decrease the diameter of airways. Diseases causing airway obstruction such as asthma, tracheal edema, or COPD increase airway resistance. When airway resistance increases, the amount of oxygen delivered to the alveoli decreases

airway resistance

is the movement of respiratory gases from one area to another by concentration gradients (from areas of high pressure to low pressure) second phase of respiration

diffusion

ANY change in surface area at the alveolar capillary membrane hinders——, (Pneumonia, pulmonary edema, atelectasis, pulmonary effusion, empyema)

diffusion

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

perfusion

Adequate blood supply and CV function are critical to optimal—- (Alterations include hypoxia, anemia, shock, pulmonary embolism)

perfusion

respiratory center is in the —-

medulla

breathing primarily stimulated by the increase of —- in the blood

CO2

in the medulla, aortic and carotid bodies respond to changes in arterial blood gas levels (CO2, O2,  and blood pH), which in turn stimulate neural regulators the adjust the rate and depth of ventilation to maintain normal arterial blood gas levels

chemoreceptors 

inadequate amount of oxygen available to cells

hypoxia

shortness of breath, difficulty breathing

dyspnea

difficulty breathing when lying flat, relieved by sitting up or standing

orthopnea

decreased oxygen carrying capacity =

anemia

shock and severe dehydration reduce circulating blood volume; this results in hypoxia to body tissues

hypovolemia 

occurs when alveolar ventilation is inadequate to meet the oxygen demand of the body or to eliminate sufficient carbon dioxide, As alveolar ventilation decreases, the body retains CO2

hypoventilation

In patients with COPD, the administration of excessive amounts of oxygen can result in

hypoventilation

Administration of oxygen greater than —- L/min prevents the PaO2 from falling to a level that stimulates the peripheral chemoreceptors, thus destroying the stimulus to breathe

1-3

cyanosis is a late sign of —-

hypoxia 

clubbing in the nails can occur with —-

chronic hypoxia

pneumothorax -deviates to the side where there is less pressure (unaffected side)

tracheal deviation

soft, whooshing, low pitched during expiration heard over most of lung

vesicular 

high pitched during expiration heard over trachea

bronchial

medium pitched during expiration over upper anterior chest

broncho vesicular

abnormal sounds such as crackles (fluid) or wheezing (constriction)

adventitious

non invasive method for monitoring patient oxygenation status receiving O2 therapy 

pulse ox 

COPD patient’s pulse ox norm:

88-92

a technique that encourages deep nasal inspiration to increase air flow to the lower lungs; for patients with COPD, this technique increases the patient’s tidal volume and oxygen saturation, reduces dyspnea, and improves exchange of respiratory gases

diaphragmatic breathing

deep inspiration and a prolonged expiration through pursed lips to prevent alveolar collapse; exhalation should be longer than inhalation, improves exercise tolerance and increases arterial oxygen saturation

pursed lip breathing 

The radial artery is punctured and a blood sample is obtained, used to assess acid-base balance, ventilation status, need for O2 therapy

ABG

needle is placed between ribs through the intercostal muscles and into the pleura, used to remove fluid in the pleural space, can obtain specimen for diagnostic purposes, assess vital signs the whole time, have patient sit on bed and lean over tray table with elbows

thoracentesis

is used for patients who have a decreased level of consciousness, airway obstruction, or who is in need of prolonged ventilator support, require the use of sterile technique because patient is at high risk of infection and airway injury

artificial airway

a short-term (usually 14 days, but can be long-term) artificial airway used to administer invasive mechanical ventilation

endotracheal tube

used when a patient needs long-term assistance from an artificial airway. It is a surgical opening in the trachea for the purposes of establishing an airway (level of the second or third cartilaginous ring then a curved tracheostomy tube is inserted, most patients cannot talk because it is inserted below the vocal cords

tracheostomy

Reasons for——: upper airway obstruction secondary to tumor or trauma, spinal cord injury or neuromuscular disease

tracheostomy

If the tube becomes ——: Remain with patient while calling for help, Ventilate patient with ambu bag, Assess patient for airway patency, spontaneous breathing, and vital signs, Prepare to re-insert/intubate patient

dislodged

(positive pressure ventilation) is used to partially or fully control ventilation and are used with patient who have endotracheal (or tracheal) tubes in place, Indications include reversing hypoxia and acute respiratory acidosis, allowing for sedation, & relieving severe respiratory distress

invasive mechanical ventilation

A catheter inserted into the chest wall to drain blood, fluid, or air from the pleural space, Negative pressure that normally keeps the lungs inflated in the chest cavity is disrupted by trauma (including chest surgery, allows collapsed lung to re-expand 

chest tube 

is a life-threatening condition in which air enters the pleural space and cannot escape, Rapid deterioration of patient’s respiratory status (dyspnea, decreased oxygenation, tachycardia), Tracheal deviation (to the side of the unaffected lung), Absence of breath sounds on the side of the affected lung

tension pneumothorax

The chest tube is always placed —- the level of the chest to promote drainage

below

Use lowest possible —- to achieve optimal SpO2

flow rate

The rate varies depending upon the condition of the patient and the route of the delivery systems. The provider will prescribe the rate of O2 administration as it is a therapeutic gas that can only be adjusted by a the provider’s order

flow rate 

Keep oxygen tanks —-away open flames, no smoking, avoid synthetic fabrics that build up static electricity, avoid using oils that can ignite spontaneously, keep oxygen tank upright

10 ft

Most common delivery device, safe and simple, does not impede eating or talking, Disadvantage: Easily dislodged, Causes drying mucous membranes, Unable to sue with nasal obstruction, May cause skin breakdown or irritation around ears or nares

nasal cannula

Rate should not exceed — L/min (24-44% oxygen) with nasal cannula

6

is used for short-term oxygen therapy. It fits loosely on the face and deliver oxygen concentrations from 6-12 L/min (35%-50% oxygen), Contraindicated for patients for retain CO2 (COPD patients), May cause feelings of claustrophobia, Pt unable to eat and drink while mask is on

simple face mask

are simple masks with a reservoir bag that are capable of delivering higher concentrations for a short period of time (60%-90% oxygen at flow rates of 10-15 L/min), Frequently inspect bag to make sure that it is inflated (if it is deflated, the patient is breathing large amount of exhaled carbon dioxide), Hot and confining, may irritate skin, tight seal necessary

non rebreather mask

delivers high-flow, more precise oxygen concentrations of 24%-60% oxygen and requires flow rates of 4-12 L/min. Its use is typically rserved for patients with COPD who need low, constant oxygen concentrations

venturi mask 

room air is about ——, increases by 4% every L/min

21%

low flow, 1-6 L/min (24-44%)

nasal cannula

low flow, 6-12 L/min, 35-50%

simple mask

low flow, 10-15 L/min, 60-90%

non rebreather mask 

high flow, 4-12 L/min, 24-60%

venturi mask