Nursing-111: Gas Exchange, Oxygenation – Flashcards
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Hypoxemia by definition is...
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Low partial pressure of oxygen in arterial blood (low oxygen level), which may lead to hypoxia
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Hypoxia by definition is...
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Shortage of oxygen in the body's tissue and cells
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Anoxia by definition is...
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The absence of oxygen, i.e. anoxic brain injury
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Dyspnea by definition is...
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Difficulty breathing, shortness of breath, labored breathing
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Oxygenation involves what three processes?
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1) The exchange of respiratory gases occurs between the environment and the blood 2) The airways transfer oxygen from the atmosphere to the alveoli where there is an exchange for carbon dioxide 3) Through the alveolar capillary membrane O2 transfers to the blood provides oxygenation and perfusion to the body
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Oxygenation is based on what factors?
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1) Ventilation 2) Perfusion 3) Diffusion
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Ventilation is what type of body process?
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Mechanical
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Ventilation is what kind of process and requires what kind of activity to be performed?
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Ventilation is the process of moving gases into and out of the lungs Requires musculature activity
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What major nerve and muscle participate in successful ventilation? What do they do?
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1) The phrenic nerve, located in the spinal cord (C4)-it innervates the diaphragm 2) The diaphragm is the major muscle of respiration, helps a person breath in and out appropriately
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What are some factors that would affect the patient's ability to ventilate?
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1) Chest trauma 2) Obstructed airways 3) Spinal cord injuries (like from C4-C5)
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What are some of the BIGGEST factors relating to a patient's ability to properly ventilate?
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1) Ineffective cardiovascular system 2) Ineffective gas exchange
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What system provides transport mechanisms to distribute the oxygen to cells and tissues of the body?
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The cardiovascular system is responsible for this function
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Perfusion is what?
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Relates to the ability of the cardiovascular system to pump oxygenated blood to the tissues and return deoxygenated blood to the lungs
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What factors will affect perfusion?
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1) Cardiovascular diseases 2) Heart failure 3) Shock 4) Loss of blood volume
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Diffusion is what?
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Diffusion is the movement of gases from one area to another based on concentration gradient
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What are some factors that will negatively affect diffusion?
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1) Pulmonary embolus
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Is inspiration or breathing in an active or passive process?
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Inspiration is an active process
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T or F: Expiration is a passive process
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True
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What kind of symptoms will arise with labored breathing?
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1) Elevated respiratory rate 2) Use of accessory muscles 3) Sub-sternal retractions 4) Head bobbing 5) Nasal flaring
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Factors Affecting Oxygenation Physiologically include:
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1) Decreased oxygen-carrying capacity (e.g.anemia & carbon monoxide poisoning) 2) Hypovolemia (Blood loss) 3) Decreased inspired oxygen concentration (Decreased O2 levels in the environment) 4) Increased metabolic rate (exercise, fever)
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What are some conditions that affect the movement of the chest wall?
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1) Pregnancy 2) Obesity 3) Neuromuscular disease 4) Muscoskeletal abnormalities 5) Trauma 6) CNS alteration
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What is an example of influences of chronic disease?
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COPD-air trapping-barrel chested
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T or F: Any condition that affects the cardiopulmonary functioning directly affects the body's ability to meet oxygen demands
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True
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What types of factors or conditions may affect the body's cardiopulmonary function?
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1) Conduction defects 2) Valvular dysfunction 3) Myocardial ischemia 4) cardio myopathy 5) tissue hypoxemia on the cardiac side 6) hyperventilation on the respiratory side 7) hypoventilation 8) hypoxia Among other things...
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T or F: Any condition that reduces chest wall movement will result in increased ventilation?
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FALSE-Any condition that reduces chest wall movement will result in decreased ventilation. -If the diaphragm is unable to descend fully with breathing, the volume of inspired air decreases, delivering less oxygen to the alveoli and tissues
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Do some nervous system diseases such as myasthenia gravis, Guillian Barr, and polio affect breathing?
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Yes
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What substance may affect the respiratory center?
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Opioids, it depresses the respiratory system
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What factors affect oxygenation developmentally?
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1) Infants and Toddlers 2) School age and adolescents 3) Young and middle age adults 4) Older adults
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What type of factors affect oxygenation as lifestyle choices?
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1) Nutrition 2) Exercise 3) Smoking 4) Substance abuse 5) Stress
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What factors influence oxygenation environmentally?
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1) occupational pollutants 2) Urban vs Rural areas
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What are some examples of nursing diagnoses for respiratory issues or dysfunction?
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1) activity intolerance 2) impaired gas exchange 3) ineffective airway clearance 4) risk for aspiration 5) decreased cardiac output 6) impaired spontaneous ventilation 7) ineffective breathing pattern 8) risk for infection 9) fatigue 10) impaired verbal communication 11) ineffective health maintenance 12) risk for suffocation
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T or F: It is important to consider which goals are most important to achieve while the pt is in the hospital or primary care setting
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True
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In a community-based or primary care setting what priorities are mostly focused on when providing care for a pt?
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1) smoking cessation 2) exercise 3) diet modifications
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What kinds of implementations can be included in a pt's plan of care for health promotion and pt education?
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1) Vaccinations (e.g. pneumococcal, influenza) 2) Healthy lifestyle (e.g. Eliminating risk factors, eating right, exercising regularly) 3) Being aware of environmental pollutants (e.g. secondhand smoke, work chemicals, & pollutants)
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What are examples of health promotion?
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1) Vaccinations against the flu and pneumonia 2) Exercise programs 3) Nutrition support 4) Smoking cessation 5) Environmental assessments for pollutants and air quality
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What is the most important factor to avoid respiratory infections?
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Prevention; maintaining the patient's optimal level of health is important in reducing the number or severity of respiratory symptoms
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What part of the population is the flu shot recommended for?
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1) Children 6 months or older 2) For those persons with chronic illnesses 3) For those people who are in contact with high risk groups of population (health care providers) 4) For immunosuppressed individuals with HIV positive disease
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The pneumococcal vaccination is recommended for which population?
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1) For those over the age of 65 2) For those people with chronic illnesses 3) For those who are HIV positive or who have AIDs or who have immunosuppressed systems
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What is the key factor for promoting and maintaining a healthy heart and lungs?
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Exercise
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What is recommended for farmers, painters, or carpenters when doing their jobs?
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Wearing a particulate filter mask top reduce inhalation of particles
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What are some nursing implementations/interventions for respiratory dysfunctions?
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1) Turn, cough, deep breath 2) Splinting 3) Ambulation 4) Positioning 5) Use of the incentive spirometer
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Airway maintenance requires what?
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1) Mobilization of secretions by increased fluid uptake 2) humidification 3) nebulization
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What do breathing exercises improve?
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1) ventilation 2) oxygenation 3) sensations of dyspnea
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What technique will allow the patient's airway to be free from obstructions?
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Coughing
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T or F: The ability to mobilize a pt's pulmonary secretions does not make a difference between short-term and long-term illnesses and does not involve a long recovery of complications
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FALSE-The ability to mobilize a pt's pulmonary secretions does make a difference between short-term and long term illnesses and does involve a long recovery of complications.
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How would you describe a patient's pulmonary secretions with adequate hydration?
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Their pulmonary secretions are thin, white, watery, and easily removable with minimal coughing
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When is humidification appropriate in the care of a pt?
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Humidification is necessary for patient's receiving more than 4L/min oxygen. Bubbling oxygen through water adds humidity to oxygen
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What does nebulization do?
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Nebulization adds moisture or medications to inspired air by mixing particles of varying size with the air
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T or F: Directed coughing is a deliberate maneuver that is effective when spontaneous coughing is not adequate
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TRUE
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T or F: Diaphragmatic breathing or belly breathing is a technique encourages short breathing to decrease air in the lungs
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FALSE; Diaphragmatic or belly breathing is a technique that encourages deep breathing to increase air to the LOWER lungs
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What is chest physiotherapy? What does this physiotherapy include?
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-Chest physiotherapy is a group of therapies used to mobilize pulmonary secretions -These therapies include postural drainage, chest percussion, and vibration -Will want to work closely with a respiratory therapist when using these techniques
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What is an incentive spirometry? How does it work?
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-An incentive spirometry consists of one or more plastic chambers that contain freely moving colored balls -A pt inhales slowly and with an even flow to elevate the balls and keep them floating as long as possible to ensure a maximally sustained inhalation
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CPAP helps treat what type of pt's?
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1) Pts with obstructive sleep apnea 2) Pts with congestive heart failure 3) Pre-term infants with underdeveloped lungs
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What goes wrong in the body with obstructive sleep apnea? What does this problem cause in the pt?
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The airways of the lungs collapse, which causes shallow or absent breathing Any air that moves passed the obstruction typically causes snoring
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Maintenance and Promotion of oxygenation include:
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1) oxygen therapy 2) safety precautions 3) supply of oxygen 4) methods of oxygen delivery
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Oxygen therapy is used for what?
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To prevent or relieve hypoxia
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The supply of oxygen in hypoxic pts comes from what source?
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A tank or wall-piped system
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Methods of oxygen therapy include:
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1) nasal cannula 2) oxygen mask
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The goal of oxygen therapy is what?
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-To prevent or relieve hypoxia by delivering oxygen at concentrations greater than ambient air or 21%
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What danger with oxygen therapy should pt's be aware of?
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Combustion. It can easily cause a fire and harm to the pt if it gets in contact with a spark from an open flame or from electrical equipment
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Who will you work with collaboratively when delivering oxygen to pts?
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Respiratory therapists
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What is a nasal cannula?
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It is a simple, comfortable device that is used for precise oxygen delivery It improve the pt's level of oxygenation to tissues
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What is an oxygen mask?
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An oxygen mask is a plastic device that fits snugly over the mouth and nose and is secured with a strap
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What is necessary for a pt when using a nasal cannula?
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Humidification of oxygen levels greater than 4 liters/minute
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What should you check for when a pt is using a nasal cannula?
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Watch for skin breakdown behind the ears
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When is a simple mask used for a pt?
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When the pt is using short-term oxygen therapy
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How does a simple mask fit and about how much oxygen does a simple mask deliver?
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It fits loosely It delivers oxygen concentrations anywhere from 35% to 50%
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When is the use of a simple mask contradicted?
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It is contradicted for pt's with carbon dioxide retention because this retention can be worsened
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When using a simple mask, how much should the flow rate be? What is the cause of this?
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When using a simple mask, the flow rate should be 5 L or more in order to avoid rebreathing exhaled carbon dioxide retained in the mask. Avoid using this mask for long term pts
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T or F: A plastic face mask with a reservoir bag is capable of delivering lower concentrations of oxygen
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FALSE; A plastic face mask with a reservoir bag is capable of delivering higher concentrations of oxygen
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What is a partial rebreather mask & delivers how much oxygen with what kind of flow rate?
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A partial rebreather mask is a simple mask with a reservoir bag that should be at least one third to one half full on inspiration -This partial rebreather delivers 40-70% of oxygen with a flow rate of 6 to 10 L/minute
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How is the simple mask used as a nonrebreather mask? How much oxygen delivered when using this and what is the flow rate?
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This similar face mask has one-way valves that prevent exhaled air from returning to the reservoir bag -This mask delivers 60-80% of oxygen and should have a minimum flow rate of 10 L/minute
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What should be checked frequently when a pt is using a mask with a reservoir bag?
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Inspect the reservoir bag to make sure it is inflated If the bag is deflated the pt is breathing in large amounts of exhaled carbon dioxide
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What are the benefits of using a OxyMask?
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1) Can deliver 24-90% oxygen 2) Patient can communicate easier 3) Device is more comfortable 4) Less likelihood of CO2 retention 5) Has a convenient swivel elbow to reposition tube 6) A NG tube can be threaded through an OxyMask 7) Allows suction for oral care through mask
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Who is the OxyMask designed for?
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-For pts who breath with their mouth and nose
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How much oxygen does a venturi mask deliver? What is the flow rate?
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-Venturi mask delivers higher oxygen concentration of 24-60% -Flow rates are typically 4-12 L/minute depending upon the flow control meter selected
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When evaluating the pt, what symptoms and signs should be present?
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1) Dyspnea is relieved 2) Oxygen saturation is improved 3) Pt appears better- color improved, more relaxed, able to converse easier with you 4) No evidence of labored breathing 5) Respiratory rate is within normal limits
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When evaluating a pt's condition and goals made, what tools should be considered in special situations?
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-Consider survey tools such as a COPD self-efficiency scale, a chronic respiratory disease questionnaire, and a pulmonary specific quality of life for a COPD scale
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What kinds of things need to be evaluated with pt during evaluation nursing process?
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-Need to evaluate pulse oximetry changes to decreases in oxygen delivery -Monitoring of arterial blood gas levels -Pulmonary function tests -Chest x-ray films -ECG tracings -physical assessment data to provide objective measurements of success of therapies and treatments
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What kind of oxygen safety precautions should be taken when treating a pt?
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1) Educate pt on oxygen combustibility 2) Sign should be placed on pt door 3) Transport oxygen appropriately in holder so it doesn't fall 4) Do not use petroleum based products around oxygen (i.e. Vaseline for nose, use WATER soluble product like KY jelly) 5) NO SMOKING 6) Oxygen is a medication, need a prescription
