UTHSCSA N3802 Oxygenation Questions
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| What are the basic structures of the upper respiratory tract?(7) | nose, pharynx, adenoids, tonsils, epiglottis, larynx, trachea
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| What are the basic structures of the lower respiratory tract? (4) | bronchi, bronchioles, alveolar ducts, alveoli
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| What are the key processes in the respiratory system?(4) | ventilation, diffusion, perfusion, transport
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| What are the 2 forms of transport of oxygen? | dissolved in plasma and in chemical combination with hemoglobin
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| What factors influence the capacity of the blood to transport of oxygen?(3) | amt of dissolved O2 in plasma, amt of hemoglobin, the tendency of hemoglobin to bind with O2
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| How is the tendency of hemoglobin to bind with oxygen measured? | On an oxygen-hemoglobin dissociation curve (graph of oxyhemoglobin % vs PaO2)
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| What is PaO2? | the partial pressure of oxygen in arterial blood measured in mm Hg
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| What is SaO2? | the % of hemoglobin attachments that have oxygen attached (Hb w/ O2 ÷ total Hb O2 carrying capacity)
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| What laboratory values are in an ABG? | blood pH, PaO2, SaO2, PaCO2, HCO3-
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| What is normal blood pH? | 7.35-7.45
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| What is normal PaO2? | 80-100 mm Hg
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| What is normal SaO2? | >95%
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| What is normal PaCO2? | 35-45 mm Hg
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| What is normal HCO3-? | 22-26 mEq/L
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| What is normal SpO2? | >95%
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| What is normal Hg level? | 12-16 g/100mL in women and 14-18 g/100mL in men
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| What regulates depth, rate, and rhythm of breath? | CNS: cerebral cortex and medulla; chemical receptors at aorta and carotid measure CO2
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| In normal physiology, what does an increased CO2 level cause? | breaths to get faster and deeper
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| What phase of respiration is active? | inspiration
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| What phase of respiration is passive? | expiration
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| What factors affect oxygenation? | decreased oxygen carrying capacity(anemia), decreased inspired oxygen concentration(altitude), hypovolemia, increased metabolic rate(fever, injury), conditions that affect chest wall movement (obesity, age)
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| What are common respiratory issues of infants and toddlers? | uri, asthma, croup, airway obstruction (put things in nose, etc), rsv, second hand smoke, premature birth (not enough surfactant)
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| What are common respiratory issues of school-age children and adolescents? | smoking
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| What are common respiratory issues of adults? | obesity, work-related influences, recreational drug use, allergies, lack of exercise
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| What respiratory physiologic changes occur with aging? | calcification of heart valves, decreased compliance, resp muscles weaker, alveoli enlarge, less alveoli, functional ciliae reduces, decreased effectiveness of cough
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| What are common respiratory issues of older adults predisposed to? | pneumonia, aspiration, infections, influenza
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| How would ABG values of an older adult differ from the normal? | expect lower PaO2 and SaO2 but normal pH and PaCO2
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| What lifestyle factors affect oxygen carrying capacity? | nutrition(muscular atrophy, anemia), exercise, smoking, substance abuse(dpressants suppress breathing, malnourished), chronic stress
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| What environmental factors affect oxygenation? | smog, occupational pollutants
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| What are 6 alterations in respiratory functioning? | atelectasis, aspiration, hyperventilation, hypoventilation, hypoxemia/hypoxia, pneumonia
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| What is atelectasis? | collapse of the alveoli that prevents normal gas exchange
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| What causes atelectasis? | airway obstruction from retained mucus or secretions OR compression from the outside OR lack of sufficient spread of surfactant
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| How is atelectasis prevented and treated? | deep breathing, encourage coughs, ambulation for lung inflation, sitting up, splinting of painful incisions
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| What are the signs and symptoms of atelectasis? | shallow breathing, cough, dyspnea, low SaO2, fever, tachycardia
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| What patients are at risk for atelectasis? | post-op, smokers, older adults, bedridden or immobile patients
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| What is aspiration? | an inflammatory condition of the lungs and bronchi caused by inhaling foreign material or vomitus
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| What patients are at risk for aspiration? | patients with neurologic conditions that impair swallowing or the epiglottis, ex: stroke
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| What is the sign that a patient is at risk for aspiration? | dysphagia, pts receiving enteral feeding
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| How is aspiration prevented? | during meals, elevate head of bed, observe for choking, gagging, or coughing, keep sitting up for 30 min after eating, give thickened liquids, for enteral feedings keep sitting up for 2 hours
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| What is hyperventilation? | state of ventilation in excess of that required to eliminate the carbon dioxide produced by cellular metabolism (too much CO2 lost)
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| What causes hyperventilation? | anxiety, infection, fever, pain, drugs, metabolic acidosis
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| What are the signs of hyperventilation? | deep and/or rapid breathing, numbness or tingling of fingers and around mouth, blurred vision, disorientation, dizziness or light-headedness
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| What is the eventual outcome of hyperventilation? | respiratory alkalosis and may cause hypocalcemia
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| What are interventions to treat/help hyperventilation? | intervene to correct underlying cause; instruct patient to breathe slowly; if necessary, rebreathe CO2 in paperbag; administer sedative; emotional support for anxiety
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| What is hypoventilation? | when alveolar ventilation is not keeping up with the body’s oxygen demand
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| What are the signs and symptoms of hypoventilation? | shallow and/or slow breathing, lethargy, dizziness, disorientation
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| What are the causes of hypoventilation? | depression of central respiratory drive (drugs, sedatives), atelectasis (esp post-op), inappropriate administration of excessive oxygen to COPD patient
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| What is the eventual outcome of hypoventilation? | respiratory acidosis
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| What are interventions for prevention of hypoventilation? | cautiously oxygenate patient with COPD and possible desensitization to hypercapnia
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| What are interventions to treat/help hypoventilation? | position in Fowler’s to ease breathing, administer supplemental oxygen, administer bronchodilators, encourage turning, coughing and deep breathing every 2 hours
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| What leads to hypoxia? | hypoxemia
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| What precedes hypoxia? | hypoxemia
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| What are signs and symptoms of hypoxemia? | apprehension, confusion, inability to concentrate, declining level of consciousness, cyanosis (late)
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| What causes hypoxemia? | lowered O2 carrying (low Hb), less O2 in inspired air (altitude), inability of the tissues to extract O2 from blood (cyanide), decreased diffusion from alveoli to blood (pneumonia), poor tissue perfusion (shock), impaired ventilation (rib Fx)
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| What interventions for hypoxemia? | place on continuous pulse ox, administer O2, withhold sedatives, monitor RBC, provide support and reassurance to help decrease anxiety
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| What is pneumonia? | an acute inflammation of the lungs usually caused by a microbial organism
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| During assessment of the lungs, what should be inspected? | respiratory rate, rhythm, depth, pattern; skin color including nail beds; breathing posture; chest wall movements; muscles used in breathing; clubbing of fingers; capillary refill time; level of consciousness
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| What 4 methods are used for lung assessment? | Inspection, palpation, percussion, auscultation
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| What laboratory tests are used to assess the lungs? | Hb, pulse ox, ABG, chest x-ray, pulmonary function studies, lung scan, bronchoscopy, throat culture, sputum specimens
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| When should a sputum specimen be collected? | first thing in the AM
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| What causes a falsely increased pulse ox? | anemia, any process where Hb bonds with another molecule like cyanide or carbon monoxide poisoning
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| What causes a falsely decreased pulse ox? | hypoperfusion, vasoconstriction, cold fingers, highly calloused fingers, shaking, fingernail polish
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| When should you not apply a pulse ox a finger? | if the finger is edematous or has compromised skin integrity
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| What regulates blood pH by using CO2? | lungs
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| What regulates blood pH by using HCO3? | kidneys
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| What value is elevated in metabolic alkalosis? | HCO3
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| What value is decreased in metabolic acidosis? | HCO3
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| What are some respiratory nursing diagnoses? | ineffective airway clearance, ineffective breathing pattern, impaired gas exchange, anxiety, risk for infection, risk for aspiration
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| What is the vaccination schedule of the influenza vaccine? | annually for children 69 months, adults >50 years, and those with chronic illness
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| What is the vaccination schedule of the pneumococcal vaccine? | once for a lifetime for >65 years, immunosuppressed and those with chronic illness
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