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NUR151-Oxygenation2
Oxygenation Part 2
| Question | Answer |
|---|---|
| Hypovolemia | body tries to adapt by increasing the heart rate and peripheral vasoconstriction to increase the volume of blood returned to the heart and, in turn, increase the cardiac output. |
| Increased metabolic rate | normal in pregnancy, wound healing, and exercise because the body is building tissue - work of breathing increases, and eventually displays signs and symptoms of hypoxemia. |
| Hyperventilation | Ventilation in excess of that required to eliminate carbon dioxide produced by cellular metabolism – acid/base imbalances |
| Hypoventilation | Alveolar ventilation inadequate to meet the body’s oxygen demand or to eliminate sufficient carbon dioxide – shallow breathing – hypothyroidism, atelectisis, post-op patients that had abdominal surgery. |
| Hypoxia | Inadequate tissue oxygenation at the cellular level |
| Cyanosis | Blue discoloration of the skin and mucous membranes – best place to look is the buccal cavity. – best place to check for central cyanosis. |
| Dyspnea | clinical sign of hypoxia - the subjective sensation of difficult or uncomfortable breathing. |
| CBC | A CBC determines the number and type of red and white blood cells per cubic millimeter of blood. |
| Cardiac enzymes | Providers use cardiac enzymes to diagnose acute myocardial infarcts. (Creatine kinase (CK) |
| Clients on diuretic therapy are at risk for | hypokalemia (low potassium). |
| Clients receiving angiotensin-converting enzyme (ACE) inhibitors are at risk for | hyperkalemia (elevated potassium). |
| Bronchoscopy | visual exam of traceobronchial tree through a narrow flexible fiberoptic bronchoscope. |
| Thoracentesis | surgical perforation of chest wall and pleural space with a needle to aspirate fluid for diagnostic or therapeutic purposes or to remove a specimen for bioposy. |
| Dyspnea Management | shortness of breath – difficult to measure and treat – subjective because it is hard to measure - Supplimental oxygen is a good way to manage, relaxation techniques. |
| Airway maintenance | patent when the trachea, bronchi, and large airways are free from obstructions. |
| Mobilization of pulmonary secretions | get them to cough and deep breathe (CDB) and suctioning. |
| Humidification | necessary for oxygen over 4 liters “high liter flow” – should have it added so that it is moist and doesn’t dry the mucus membranes. |
| Nebulization | small volume nebulizers (SVN) |
| Chest physiotherapy | a group of therapies used to mobilize pulmonary secretions. These therapies include postural drainage, chest percussion, and vibration. |
| Postural drainage | positioning and turning – consists of drainage, positioning, and turning and is sometimes accompanied by chest percussion and vibration. It improves secretion clearance and oxygenation. |
| Chest percussion | striking the chest wall – thrombocytopenia, rib or spinal fractures are not good candidates. |
| Oropharyngeal and nasopharyngeal suctioning | Used when the client can cough effectively but is not able to clear secretions |
| Orotracheal and nasotracheal suctioning | Used when the client is unable to manage secretions, cannot cough |
| Tracheal suctioning | Used with an artificial airway |
| Oral airway | Prevents obstruction of the trachea by displacement of the tongue into the oropharynx |
| How measure tubes? | from corner of mouth to the end of jaw under ear. |
| Endotracheal airway – ETT – endotrachial tube | Short-term use to ventilate, relieve upper airway obstruction, protect against aspiration, clear secretions, Lungs about to give out or closing due to anaphylaxis reaction, Connected to a ventilator that breathes for the patient as usually they are paraly |
| Tracheostomy | Long-term assistance, surgical incision made into trachea, Breathe through the hole in their trachea. |
| Incentive spirometry – IS | Encourages voluntary deep breathing by providing visual feedback to clients about inspiratory volume - promotes deep breathing and prevents or treats atelectasis in the postoperative client. |
| Pneumothorax | collection of air in the pleural space. – shortness of breath – lung is collapse – no sounds from lung – diminished or absent. Hypoxic, Absent lung sounds very common. |
| Chest tubes | catheter placed through the thorax to remove air and fluids from the pleural space or to prevent air from reentering or to reestablish intrapleural and intrapulmonic pressures |
| Hemothorax | accumulation of blood and fluid in the pleural cavity between the parietal and visceral pleurae, usually as a result of trauma - produces a counterpressure and prevents the lung from full expansion. |
| Clamping the chest tube will possibly result in | a tension pneumothorax. |
| Nasal Cannula Max flow rate is | 6 L/min |
| Every liter of oxygen is | 4% oxygen plus air is 20% so for each liter they receive 24% oxygen, 2 Liters are 48%. |
| Simple Face Mask | Delivers oxygen concentrations from 30-60% and Requires minimal flow rate of 5 L/min to prevent rebreathing of exhaled air. |
| Nonrebreather mask | Flow rates of 6-15 L/min and Delivers 60% - 90% oxygen |
| Venturi Mask | Delivers 24% - 60% oxygen |
| Purse Lipped-Breathing | frequently used with those that have COPD – it will also help prevent alveoliar collapse with positive flow. |
| Diaphragmatic breathing | making sure we are breathing with the diaphragm. |
| Atelectasis | Alveolar collapse impairing gas exchange, Can come from foreign body, cystic fibrosis, COPD, Pain upon inhalation and exhalation - Hypoxia, dyspnea, pleuritic chest pain, cyanosis, diaphoresis, substernal/intercostal retractions, anxiety, crackles/decreas |
| How do you manage atelectasis? | IS (inspiration spirometry) every hour, cough and deep breath (CDB) |
| Pnuemonia | Infection of the lung parenchyma (tissue) - Virus (most common), mycoplasmal agents, bacteria, aspiration - Fever, cough, malaise, wheezes/crackles/rhonchi, pleuritic chest pain, sputum production, chills |
| Chest x-ray (most simple way), sputum specimen (determine if viral/bacterial/pseudomonas/etc.), WBC (high), ABG, bronchoscopy (using endoscope with a tube), pulse oximetry | |
| Interventions for pneumonia | percussions, IS, supplemental oxygen, antibiotics, fluid intake, bed rest - People who have chronic illnesses: cancer, surgery, frequent bronchitis, are all prone to pneumonia. Patient could become septic if it spreads to the blood. Abscesses could form |
| Tuberculosis | Acute or chronic infection - Caused by exposure to Mycobacterium tuberculosis |
| How is TB Transmitted? | via the airborne route by droplet infection – First sign - Mucus-type of sputum (mucoid), might be rusty colored, but that comes later. Then night sweats. May not seek help till they see blood in their sputum. |
| Incubation period for TB is? | 4-8 weeks, usually asymptomatic - More common in males 2x more; also in unsanitary conditions; over crowding; prisons; homeless shelters |
| Management of TB | Antitubercular therapy – isoniazid (INH), rifampin, pyrazinamide; taken 6 months or longer – usually taken together, Isolate in negative pressure room. Particulate respirator mask. |
| Coccidioidomycosis (Valley Fever) | Fungal infection that occurs primarily as a respiratory infection – spores are in the soil and we breathe in the spores - Coccidioides immitus - dry cough, pleuritic chest pain, sore throat, chills, malaise, anorexia, HA (head aches), females- tender red |
| Sympathomimetic bronchodilations | Beta 2 dilators - dilate the airways, making air exchange and respiration easier, relax the smooth muscle of the bronchi. |
Created by:
Ladystorm