oxygenation

foundations NURS 411

pulse ox

measurement of precentage of hemoglobin saturated with oxygen in the blood, refelcts oxygenation and how much O2 is being perfused to body.

normal range → 91-100%

exhaled air and determines if pt is ventilating

too high causes pt to get tired + stop breathing

what does CO2 meausre?

exchange O2 and CO2

alveoli

inhalation

air into lungs (O2- lungs to tissues), diaphragm contracts (goes down), decrease in pulmonary pressure

exhalation

air out of lungs (CO2- tissues to lungs), diaphragm relaxes (goes up), increase in pulmonary pressure

partial pressure of oxygen (PaO2)

measurement of dissolved oxygen in arterial blood that reflects how well oxygen moves form the lungs to the blood stream.

normal range → 80-100 mmHg

partial pressure of CO2 (PaCO2)

measurement of dissolved carbon dioxide in arterial blood that reflects how well the lungs are ventilating (removing CO2)

normal range → 35-45 mmHg

hypoxemia

low oxygen in the blood, leads to hypoxia

hypoxia

low oxygen in the tissues

atelectasis

collapse of alveoli

SOB, heart attack, cyanosis, tachycardia, restlessness

signs and symptoms of hypoxia

prone

what positioning helps promote respiratory function?

wheezing

caused when breathing passages get narrow so it will make it harder to breath

bronchodilators

opens bronchioles, helps with wheezing

expectorants

loosens secretions and makes pt cough

postural drainage

a technique that uses gravity and specific positioning to drain mucus from the lungs and improve airway clearance. Often combined with chest percussion and vibration.

CO2 retainers

chronic high levels of CO2 due to factors like smoking. These pts will lose drive to breath if O2 is too high so we must minimize O2 therapy and pulse O2 will be low.

Pursed lip breathing

opti-flow (high-flow nasal cannula)

heated/humidifeid high-flow oxygen system delivered via nasal cannula that improves oxygenation and decreases work of breathing. Delivers high FiO2

fraction of inspired oxygen (FiO2)

the fraction or percentage of oxygen in the air that is delivered to a patient during inhalation.

room air → 21%

nasal cannula

low-flow oxygen delivery device that administers oxygen through prongs in the nostrils to increase patient’s oxygen levels

flow rate → 1-6 L/min

FiO2 delivered → 22-44%

non-rebreather mask

a high-flow oxygen mask with a reservoir bag that delivers up to near- 100% oxygen using one-way valves

FiO2 delivered → 90-100%

CPAP

provides one continuous level of positive airway pressure during both inspiration and expiration to keep airways (alveoli) open

Used for → sleep apnea

BiPAP

a device that delivers two levels of airway pressure, higher on inspiration and lower on expiration, to assist with breathing and ventilation

used for → COPD, CHF, respiratory failure (short-term)

oropharyngeal airway

airway inserted through the mouth to prevent tongue obstruction in an unconscious patient.

nasopharyngeal airway

nasal airway used to maintain airway patency in conscious or semi-conscious patients.

endotracheal tube

tube inserted into the trachea via mouth or nose to maintain a secure airway and provide ventilation

tracheostomy

surgically created opening in the trachea through the neck for long-term airway management

2L

what is the max amount of O2 a Co2 retainer pt can recieve?

causes swelling

what is the biggest issue with suctioning?

pulse ox, strength of cough, give time between each pass, assess how much O2 is needed between each pass

what is important to assess pre and post suctioning?

key suctioning points

suction ONLY when needed, DO NOT take breath away for more than 3 seconds

coughing and deep breathing

how do we prevent atelectasis?

chest tube

flexible tube inserted into the pleural space to remove air, blood, or fluid, allowing the lung to re-expand and restore normal breathing. Coughing and deep breathing is important!

used for → pneumothorax, hemothorax, pleural effusion, after chest surgery or trauma

tube drains air/fluid from the pleural space (space between lung and chest wall) → connected to a drainage system (water seal and/or suction) → water seal prevents air from flowing back into chest → as pressure is relieved the lung re-inflates

how do chest tubes work?

continuous bubbling in water seal (indicates air leak) and sudden increase in drainage

abnormal findings for chest tubes?

pneumothorax

air in pleural space that causes partial or complete lung collapse

hemothorax

blood in pleural space, usually from trauma or surgery, that compresses the lung.

pleural effusion

excess fluid in the pleural space that interferes with normal lung expansion.

infection (vaccinations are important)

always going to be a breathing related issue

biggest problem for COPD pts

have pt take deep breath and cough

what do we do if pts pulse ox suddenly drops?

cough + deep breath with medication and use of incentive spirometer to help open alveoli

interventions for preventing atelectasis and pneumonia after surgery

breath sounds should be clear

findings with trache suctioning

oxyegnation (pulse ox)

we do we assess first with confused pts?

biggest concern is pneumothorax

what is the biggest concern within the first 12 hrs of a PICC line instertion?