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Chapter 28
Assisting with Respiration and Oxygen Delivery
| Question | Answer |
|---|---|
| inspiration | movement of air into the lungs |
| expiration | movement of air out of the lungs |
| What are the structures of the respiratory system? | - Upper airway -nose. mouth, pharynx, trachea -trachea divides into right/left mainstem bronchi -lungs (left has 2 lobes, right has 3) -each lobe of lung, bronchi divide into bronchioles which divide into alveoli |
| Cont. structures of the respiratory system (Alveoli): | -lined with mucous membranes, are function units of air exchange. |
| How does inspiration and expiration occur? | Contraction of the diaphragm enlarges thoracic cavity - inspiration Relaxation of diaphragm causes thoracic cavity to become smaller - expiration |
| Respiratory muscles depend on what from the spinal cord? | nerve impulses |
| Function of upper airway | -carries air to and from lungs -warms and humidifies air |
| Function of the bronchi | -channel air to and from the lungs -mucous membrane lining bronchial tree has cilia |
| Function of cilia | -(tiny hairlike projections) trap and help remove small foreign particles -mucous membrane helps cilia cleanse foreign substances from respiratory tract |
| Function of alveoli | -contain macrophages that quickly phagocytize inhaled bacteria/foreign particles |
| How does the CNS control respiration? (1) | -chemoreceptors in the aorta/carotid arteries sense changes in oxygen or carbon dioxide and send signals to brainstem SEE CNS-MEDULLA card for more info |
| How does the CNS/MEDULLA control respiration? (2) | -changing levels of hydrogen ions, carbon dioxide, & oxygen in blood trigger respiratory center in medulla to send signals through spinal cord to nerves that control respiratory muscles. This causes an increased or decreased rate of respiration. |
| How many mL of air move in and out of the lungs with each breath? | 500mL |
| Where is oxygen and carbon dioxide transported? | -blood transports oxygen to the cells and carries carbon dioxide from cells to the lungs |
| What should the nurse be aware of with oxygen therapy? | -dries the respiratory passages, and should pass through water before entering the system |
| What happens to inhaled bacteria when they come into contact with the blood in the alveoli? | -white blood cells destroy or contain bacteria and keep them from spreading throughout the body |
| The filtering action of the respiratory system is one of the body's ___________ defenses | strongest |
| What are changes in the respiratory system that occur with aging? (1) | -decreased elasticity of thorax/respiratory muscles -decrease in total body water, drier mucous membranes -loss of elastic recoil during exhalation |
| What are changes in the respiratory system that occur with aging? (2) | -thickening of alveolar membrane; less efficient gas exchange -less respiratory reserve |
| Anoxia | condition of being without oxygen |
| What is the most common cause of respiratory insufficiency? | obstruction of airway |
| Respiratory insufficiency | body's inability to meet its oxygen needs and remove excess amounts of carbon dioxide |
| Hypoxemia | decreased amount of oxygen in the bloodstream |
| Hypoxia | decreased amount of oxygen available to meet cellular needs |
| Hypercapnia | increased level of carbon dioxide in the blood |
| What are common causes of Hypoxia | -obstruction of the airway -restricted movement of the thoracic cage or the pleura -decreased neuromuscular function -disturbances in diffusion of gases -environmental causes |
| How does obesity affect respiration in the chest cavity and in the cells? | restricts thoracic movement |
| What are the signs of Hypoxia? | -restlessness, irritability, confusion -dyspnea, tachypnea, stridor -abnormal lung sounds -cyanosis, retractions, dysrhythmias -acid-base imbalance -decreased oxygen saturation |
| Tachypnea | fast breath rate |
| Stridor | hight pitched, harsh, or musical sounds on inspiration |
| Cyanosis | blue tinge to skin or mucous membrane |
| retractions | muscles moving inward on inspiration |
| What is a pulse oximeter used for? | -monitor patients at risk for hypoxia -measures changes in serum oxygen continuously -sensor attached to fingers, toes, ears, or skin -helps track changes in oxygen therapy |
| What are the four ways to remove airway obstruction? | -abdominal thrusts (Heimlich maneuver) -finger sweep of airway opening -CPR to cause artificial cough -for infant, five blows between shoulder blades |
| What are the common causes of airway obstruction in children and adults? | food or foreign objects |
| What is COPD? | -chronic obstructive pulmonary disease Respiratory secretions are common obstructions - usually can be cleared by coughing |
| How do you cough effectively? | -most effective in sitting position -two deep breaths then inhale deeply again -breathe rapidly/forcibly exhale as quickly as possible with mouth open |
| What are concerns with ineffective coughing? | -may produce hypoxia -lead to rupture of alveoli -possibly precipitate the collapse of air passages |
| Expectorate | cough up and spit out |
| Nebulizer | a device that dispenses liquid in a fine spray |
| What is postural drainage? | -different positions drain different segments of the lungs -specific segments drained into bronchi to facilitate coughing -keep each position for 5-15 minutes 2-4 times a day as tolerated -percussion is used |
| Percussion (in relation to respiratory system) | rhythmic clapping with cupped hands over the thoracic area, avoiding spine or sternum |
| How would you prepare the patient for postural drainage? | use a nebulizer with bronchodilator or liquefying medications can be used as inhalation therapy to thin out secretions and relax spasms within bronchial tree |
| What is oxygen considered, and how should it be administered? | -drug -administered following a prescribed order, noting flow rate, frequency, and route |
| What is a danger with overuse of oxygen? | -can create damaging free radicals or physiologic changes in breathing |
| cannula | tube for insertion into a cavity |
| What are disadvantages to oxygen use? | -high concentrations cause fires to burn very rapidly -very drying to the tissues of the respiratory tract |
| What equipment is needed for oxygen therapy? | -oxygen source -flowmeter -humidifier -tubing -appropriate appliance for the method ordered |
| Why is humidification important in oxygen administration? | unhumidified oxygen dries the tissues of the respiratory tract |
| What is range of oxygen flow ordered, and what is the common rates? COPD patient rates? | -ranges from 2-12 L/min -common rates are 4-6 L/min -COPD patients given 2-3 L/min to prevent causing respiratory arrest |
| What are the different ways oxygen can be administered? | -nasal cannula, mask, tent, croupette, or catheter |
| Oxygen administration: Cannula | -plastic tube with short, curved prongs extend into nostril 1/4-1/2 inch -held in place by looping over ears and cinching under chin -this can be easily adjusted for patient's comfort |
| Oxygen administration: Masks | -various types available, concentrations ranging from 24-55% at flow rate of 3-7 L/min -oxygen concentrations above 60% rarely used, danger of oxygen toxicity -patients may dislike this method, may feel mask is suffocating |
| What are the purposes of oxygen administration through artificial airways? | -relieve an obstruction -protect airway -facilitate suctioning -provide artificial ventilation |
| Nasopharyngeal and oropharyngeal airways are used for patients who: | -are able to breathe on their own -these keep the tongue from falling back into throat |
| Endotracheal tubes are used for patients who: | -cannot breathe on their own -unconscious -typically removed after 48-72 hours -may cause mucosal ulcer after 5-7 days depending of cuff/cuff pressure |
| Tenacious | sticky |
| What type of suction tip/catheter size should suctioning be performed with? | -Yankauer suction tip -14 to 16 Fr. suction catheter |
| What technique should be used for all suctioning of the airway structures? | -aseptic |
| Nasopharyngeal suctioning is used most often for which patients? | -infants -gravely debilitated or unconscious patients -those who have an ineffective cough |
| What technique is mandatory for deep suctioning in the tracheobronchial tree and for the intubated patient? | sterile |
| What must patients on a positive-pressure ventilator to treat respiratory failure have? | a cuffed tracheostomy or endotracheal tube for effective use of the ventilator |
| When should pharyngeal suctioning be performed? | -before deflating the cuff |
| When is deep suctioning performed? | when a patient has been intubated or has a tracheostomy |
| Tracheostomy | -surgical opening into trachea -facilitates insertion of cuffed tube -cuff enables controlling airway/prevents aspiration -maintains patent airway -facilitates suctioning/mechanical ventilation -temporary or permanent |
| What are chest drainage tubes used for? | remove air, fluid, blood from chest cavity so lungs can expand -remove air from patient with pneumothorax or hemothorax or after chest surgery -may require suction to operate or gravity drainage -occlusive dressing is applied -must be airtight |
| How can suction be applied with a chest drainage tube? | -wall suction -portable suction machine |
| Why is respiratory assessment intertwined with cardiac assessment? | because if the heart is not functioning properly, oxygenated blood will not be delivered to the tissues in adequate amounts |
| Heimlich chest drain valve | -used in place of chest drainage unit for small, uncomplicated pneumothorax with little or no drainage -no need for suction -flutter valve allows escape of air/prevent re-entry into pleural space |
| atelectasis | collapsed area of the lung |
| What are common nursing diagnoses for patients who have respiratory problems? (1) | -ineffective airway clearance related to muscle weakness and impaired cough, decreased level of consciousness, or thick secretions -impaired gas exchange related to retained respiratory secretions -risk for infection related to alteration in airway |
| What are common nursing diagnoses for patients who have respiratory problems? (2) | -deficient knowledge related to use of oxygen equipment, tracheostomy, ventilator, or incentive spirometer -risk for injury related to improper safety precautions when using oxygen |
| Patients with respiratory problems or potential for one should turn, cough, and deep breathe how often? | every 2 hours |
| What are two forms of deep breaths that help expand the alveoli in the lungs? | -yawns -sighs |
| Nurses can help patients with dyspnea to relax, expand the chest more fully, and use less of their limited oxygen supply by using what? | good positioning |
| Obturator | curved guide that facilitates tube placement when it is inserted -removed after tube insertion -extras are often taped to the head of the bed so they are handy |
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ahoyyitbeaddi
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