Term
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Definition
Clear, odorless gas that constitutes apporximately 21% of the air we breathe.
Necessary to sustain life.
A drug with potentially toxic effects.
The goal of oxygen therapy is to provide optimal O2 saturation with the lowest, most effective dose. |
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Term
| How much oxygen does each form deliver? |
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Definition
Non-rebreather 100% oxygen to Pt
Face Mask - 40%-60% concentration
Nasal Cannula - 24-48% (1L-24%) Goes up by fours.
Venturi mask - Allows precise concentration of oxygen. 50% and below. (Change settings right in mask by changing the colored tubes.) |
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Term
| What is an example of oxygen toxicity? |
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Definition
| Premature infants were receiving high concentrations of O2 to sustain life, only the levels were too high and caused membranes to form behind the eye. Children were becoming blind because of this. |
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Term
| What are the 3 steps in Oxygenation/Respiration? |
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Definition
Ventilation
Diffusion
Transport of Respiratory Gases |
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Term
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Definition
The movement of air between the atmosphere and the alveoli of the lungs as we inhale and exhale.
Mechanical breathing in and out. |
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Term
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Definition
Gas exchange which involves diffusion of oxygen and CO2 between the alveoli and the pulmonary capillaries.
-Alterations in capillary membrane (thickening) will cause problems with diffusion.
Pneumonia=causes problems with diffusion. |
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Term
| Transport of Respiratory Gases |
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Definition
Transport of oxygen from the lungs to the tissues and transport CO2 from the tissues to the lungs.
Normally 97% of oxygen binds with hemoglobin. (Forms oxy-hemoglobin)
-Function of resp system is gas exchange
-O2 transport consists of the lungs and the CV system. |
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Term
| How does the cardiovascular system help with oxygenation. |
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Definition
Need good circulation for the heart to pump the oxygentated blood to different parts of the body.
Good ventilation, good diffusion, good lungs, and good heart. |
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Term
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Definition
| The process of moving gases into and out of the lungs. |
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Term
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Definition
| Inspiration an active process stimulated by chemical receptors in the aorta and a passive process for expiration. |
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Term
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Definition
| Moves blood to and from the alveolar capillary membranes for gas exchange. |
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Term
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Definition
| Exchange of respiratory gases in the alveoli and pulmonary capillaries. |
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Term
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Definition
| Lungs and Cardiovascular System |
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Term
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Definition
| Diffuses into red blood cells and is hydrated into carbonic acid. |
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Term
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Definition
Neural and chemical regulators control the rate and depth of respiration.
Strongest stimulus for breathing is CO2 |
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Term
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Definition
| Maintains rhythm and depth of respiarions and balance between inspiration and expiration. |
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Term
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Definition
Voluntary control of respiration, delivers impulses to the respiarotry motor neurons by way of the spinal cord.
Accomodates speaking, eating, and swimming. |
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Term
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Definition
| Automatic control of respiration, occurs continuously. |
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Term
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Definition
Maintains rate and depth based on changes in O2, CO2, and hydrogen ion concentration.
Chemoreceptors - Located in medulla, aortic body, and carotid body.
Changes in hydrogen ions will stimulate receptors to change depth and rate of ventilation. |
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Term
| Factors that affect Oxygenation |
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Definition
Physiological
Decreased O2 capacity
Decreased O2 concentration
Hypovolemia
Increases metabolic rate |
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Term
| Factors affecting chest wall movement? |
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Definition
Pregnancy
Obesity
Musculoskeletal abnormalities
Trauma
Neuromuscular alterations |
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Term
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Definition
| Ventilation in excess of that required to eliminate CO2 produced by cellular metabolism. |
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Term
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Definition
| Alveolar ventilation inadequate to meet the body's oxygen demand or to eliminate sufficent CO2. |
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Term
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Definition
| Inadequate tissue oxygenation at the cellular level. |
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Term
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Definition
Blue discoloration of the skin and mucous membranes.
Not 1st sign of a problem, this is a late sign that something is severly wrong. |
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Term
| What does hypoxia result from? |
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Definition
Hypoxemia which is a deficiency of arterial blood oxygen.
Causes: Pneumonia and Pulmonary Edema |
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Term
| Clinical signs and symptoms of Hypoxia? |
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Definition
Early Signs
Changes in Behavior
Unexplained anxiousness or apprehension
Restlessness or irritability
Check Pulse Ox if signs are present.
Late Signs
Combativeness
Coma
Decrease in Consciousness |
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Term
| Respiratory Signs and Symptoms of Hypoxia? |
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Definition
Early Signs
Tachypnea = <20
Dyspnea on exertion
Late Signs
Dyspnea @ rest
Use of accessory muscles - Bulging, hypertrophy, Bigger b/c breathing so much.
Retractions on inspiration - Intercoastal muscles and Diaphragm, area between ribs will be sucking in.
Pausing for breath between sentences and words. |
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Term
| Cardiovascular signs and symptoms of hypoxia? |
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Definition
Early Signs
Tachycardia = >100
Mid-Elevated BP
Dyshythmias
Late Signs
Cyanosis
Cool, clammy skin
Other signs
Diaphoresis
Decreased urine output
Unexplained fatigue |
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Term
| Clinical Signs and Symptoms of hypercapnia? |
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Definition
Elevated CO2 levels in the blood
Restlessness
Hypertension
Headache
Lethargy
Temor |
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Term
| Developmental Factors of Infants and Toddlers |
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Definition
-@ risk for upper resp tract infections from second hand smoke and children.
-Nasal congestion during teething encourages bacterial growth and increases potential for resp tract infection. |
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Term
| Developmental Factors of school-aged children and adolescents |
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Definition
-Exposure to second hand smoke causes respiratory tract infection.
Adolescents who start smoking and continue to smoke through middle age are at higher risk for cardiopulmonary disease and lung cancer. |
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Term
| Developmental Factors for young and middle adults |
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Definition
| -Unhealthy eating, lack of exercise, stress, legal and illegal drugs, and smoking increases risk of cardio and pulmonary diseases. |
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Term
| Developmental factors for older adults |
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Definition
-Calcification of heart valves, SA node, and costal cartilage.
-Arterial system develops artherosclerotic plaques.
-Osteopororsis changes size of thorax.
-Trachea and large bronchi become enlarged from calicification of airways
-Reduced number of cilia causes decrease in effectiveness of cough mechanism, which results in resp infections. |
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Term
| Lifestyle risk factors with nutrition |
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Definition
Severe obesity decreases lung expansion
and increases tissue oxygen damage.
Malnourishment=resp muscle wasting and resp excursion.
@ risk for anemia. |
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Term
| Risk factors with exercise |
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Definition
Increases the body's metabolic activity and oxygen demand.
-Rate and depth of resp increase which allows inhalation of more oxygen.
-Lower pulse, bp, and cholesterol
-Increased blood flow and greater oxygen extraction by working muscles. |
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Term
| Nursing assessment for possible respiratory problems |
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Definition
| Pain, Dyspnea (pulmonary edema, Pneumonia, Pneumothorax, Peek Seeker (high altitudes), Wheezing, Resp infections, Health risks, Smoking, Cough, Allergies, Medications |
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Term
| What are key signs of respiratory problems with a patient? |
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Definition
Behavioral changes are KEY!
Person in respiratory distress will not be relaxed
Breathing will be noisy, which means obstructive breathing. |
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Term
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Definition
Inspection, Papaltation, Percussion, Auscultation
Chronic resp disease and cardiac disease will have clubbing. |
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Term
| Common Abnormalities with Respiratory Assessment? |
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Definition
Pursed-lip breathing
Tripod Position
Accessory muscle use (Neck)
Increased AP chest diameter
Tachypnea
Kussmaul Respirations (Fast,labored breathing)
Cyanosis
Clubbing
Abnormal breath sounds |
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Term
|
Definition
Usually with COPD Pt's
Smell a rose, blow out a candle
Helps with expiration and helps keep airways open, prevents collapse. |
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Term
|
Definition
Resting on knees in chair or resting on arms and leaned forward @ table.
Supported position |
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Term
| Ventilation and Oxygenation Diagnostic Studies |
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Definition
Pulmonary Function Studies
Peak expiratory flow rate
Thoracentesis
Bronchoscopy
Lung Scan
Sputum Specimans (C&S, Acid-fast,AFB) |
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Term
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Definition
Basic ventilation study
Determines the ability of the lungs to efficiently exchange oxygen and CO2. Used to differentiate pulmonary obstructive from restrictive disease. |
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Term
| Peak Expiratory Flow Rate |
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Definition
The point of highest flow during maximal expiration.
Normal based on age and body weight.
Reflects changes in large airway sizes and is an excellent predictor of overall airway resistance in the client with asthma. Daily measurement is early detection of asthma exacerbations. |
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Term
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Definition
Normal airways without masses, pus, or foreign bodies.
Visual exam using narrow, flexible, fiber optic scope.
Performed to obtain sputum or biopsy samples or remove mucuos plugs or foreign bodies. |
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Term
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Definition
| Used to identify abnormal masses by size and location. |
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Term
|
Definition
Surgical perforation of chest wall and pleura space with a needle to aspirate fluid.
Aseptic technique and local anesthetic with Pt siting upright supported by pillows.
Obtained for cytological examination.
May indicate infection or neoplastic disease. |
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Term
|
Definition
Normal=Negative
Sputum Culture and Sensitivity - Identifies specific organism in sputum
Identifies drug resistance
Sputum for acid-fast bacillus -
Used to screen for detection of TB by early morning specimens for 3 days
Sputum for Cytology -
Identifies abnormal lung cancer
Differentiates type of cancer cells. |
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Term
|
Definition
Provides an indirect measurement of arterial O2 saturation, non-invasive.
Normal = >95%
Photodetector detects amount of O2 bound to hemoglobin molecules.
Reliable when saturation is over 70%
Earlobe probes have a greater accuracy at lower saturations. |
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Term
| Factors that can affect Pulse Oximeter |
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Definition
| Motion or movement, cold rooms cause vasoconstriction, Nail Polish, Datk skin tone, anemia, bright flourescent light. |
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Term
| How to decreases factors that can affect pulse oximeter? |
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Definition
Make sure alarms are on
Proper alignment of the sensor is essential for accurate measurement.
Inspect location of probe q2-4h.
Change fingers |
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Term
| Red Flags with pulse oximetry |
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Definition
| Notify health care provider of +/- 4% change from baseline or decrease to 90% or below 95% |
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Term
|
Definition
Vaccinations -
Influenza > 6 months or older
Pneumococcal >65, chronic disease, smokers.
Eliminate risk factors
Eat right with regular exercise
Avoid second hand smoke, work chemicals, and pollutants. |
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Term
| Acute care and basic nursing interventions which promote oxygenation |
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Definition
Position client to allow for maximal chest expansion.
Change position q2h
Encourage deep breathing and coughing
Promote comfort so client can tolerate above activities. |
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Term
|
Definition
Treatment individualized based on the underlying process causing.
Treatment: Medication, Bronchodilators, inhaled steroids, mucolytics.
Oxygen and Physical Therapy
Relaxation Techniques
Less O2 with weight |
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Term
|
Definition
Adequate hydration
Proper Cough
Suctioning
Chest Pt
Nebulizer treatments - Breaks up medications finely and will push medication deeper into lungs.
Postural Drainage
Humidification |
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Term
|
Definition
Oropharyngeal and Nasopharengeal -
Used when PT can cough effectively but cannot clear secretions
Orotracheal and Nasotracheal -
Used when PT is unable to manage secretions by coughing
Tracheal -
Used with artificial airway, ET tube or tracheostomy |
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Term
| Signs and symptoms indicating need for suctioning? |
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Definition
Based on clinical need not schedule.
Signs of resp distress or evidence that PT is unable to cough up secretions.
Dyspnea, bubbling, or rattling breath sounds
Poor skin color/cyanosis
Decrease in O2 saturation.
Terminally Ill |
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Term
|
Definition
Moisten tip with sterile water or saline.
Used in mouth but not to go past back teeth
Run along the edges and be sure your not sucking out the person's oxygen.
May need to suction under tongue. |
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Term
| Suctioning PT with Trachea |
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Definition
Suctioning removes O2 from airway as well as secretions which can lead to hypoxemia, dysrythmias, and hypotension.
Avoid excess suctioning
Do not suction for more than 10-15 secs.
Do it intermittently only when catheter is being removed.
Limit to 2 or 3 passes and be quick. |
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Term
|
Definition
Adults = 12 - 18
Children = 8 - 10
Infants = 5 - 8
Use smallest size possible.
Usual Pressure setting 80 - 120 mmHg. |
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Term
|
Definition
Oral Airway -
Prevents obstruction of trachea by displacing the tongue. Critical to use correct size. (from corner of mouth to the angle of the jaw, just below the ear.)
Endotracheal Airway -
Short-term, relieve upper airway obstruction, protect against aspiration.
Tracheostomy -
Surgical incision made into trachea, long term assistance. |
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Term
| How to promote lung expansion for maximum respiratory fuction? |
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Definition
Position reduces pulmonary stasis and maintains ventilation and oxygen.
Seni-Fowler's is most effective position (elevate HOB and support with pillows to decrease workload and minimize fatigue.
Unilateral disease positioned with good lung down.
Client with abscess or hemorrhage affected lung down. |
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Term
|
Definition
Goal is to achieve and maintain maximal inspiration.
Encourages voluntary deep breathing.
Open collapsed alveoli.
Repeat 10x qh/while awake. |
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Term
|
Definition
To prevent or relieve hypoxia.
Reduce the work of breathing.
Reduce myocardial workload.
TO provide optimal O2 saturation with lowest, most effective dose. |
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Term
|
Definition
Prolonged exposure in high concentrations can lead to structural damage to the lungs.
High concentrations can damage alveolar capillary membranes.
Signs and symptoms:
Substernal pain, cough, sore throat, dyspnea, and pulmonary edema.
-Levels over 50% for over 24h potential for toxicity. |
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Term
| What are some things to remember about oxygen therapy? |
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Definition
It is medication and must be administered as prescribed.
Dose should be continously monitored.
Humidification necessary for >4L/min (greater force dries out airways)
Must check O2 when you assess client.
If transporting PT make sure portable tank has enough oxygen in the tank. |
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Term
|
Definition
Is not delegated to UAP.
May reapply the oxygen delivery device. |
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Term
|
Definition
| Oxygen in high concentrations has a great combustion potential and readily fuels fires. |
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Term
|
Definition
Most common, Most convenient
Delivered O2 can vary with breathing pattern.
Nasal passage must be patent for client to receive O2.
Can cause skin breakdown over the ears and nares. |
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Term
|
Definition
Face mask covers the clients nose and mouth.
To avoid rebreathing CO2 while wearing mask, a min of 5L oxygen flow rate.
(Push CO2 out of the mask.)
Find appropriate mask size or Pt could be losing oxygen. |
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Term
|
Definition
40-60% when operated at 6-10L
Most common midrange O2 deliver device.
Minimun of 5L/min O2 required to prevent inhaling CO2.
Actual delivery varies with breathing pattern. |
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Term
|
Definition
5-6L/min = 40%
6-7L/Min = 50%
7-8L/Min = 60%
>8L/min = 60% |
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Term
| Face mask with reservoir bags |
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Definition
Provide higher concentration on client.
Portion of client's expired air is directed to the bag.
Its oxygen concentration remains the same as the inspired air. |
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Term
|
Definition
Delivers Oxygen at 60-90% at liter flows of 6-10L per minute
O2 reservoir bag allows client to rebreathe first third of exhaled air.
Do not allow bag to deflate during inspiration to avoid CO2 buildup.
If bag deflates pick up flow. |
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Term
| Non-rebreathing face mask with reservoir bag |
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Definition
Nonrebreather delivers the highest oxygen concentration 95-100% at liter flows of 10-15L/min.
One way valves on mask prevent room air from entering the bag.
Must not deflate.
Used for critically ill clients. |
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Term
|
Definition
Provides precise and consistent O2 concentration.
O2 concentration will be decreased if the mask does not fit correctly.
Delivers between 24-46%
4L=24-48%
8L=35-40%
12L=50-60%
Hot and confining. |
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Term
|
Definition
Can be used when masks are not tolerated.
Provide 30-50% concentrations of O2 at 4-8L/min
Keep skin dry |
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Term
|
Definition
| Be aware of Confusion, fatigue, restlessness, sleepiness, dyspnea, nasal flaring, tachypnea, diaphoresis, pallor, descreased resp. excursion. |
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Term
|
Definition
Expanding diaphragm during controlled inspiration.
May be used in conjunction with pursed lip breathing. |
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Term
| Controlled and huff coughing? |
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Definition
Inhale deeply and hold breath for a few seconds.
Cough twice the first loosens the mucous and the second expels the secretion.
For huff coughing lean forward and exhale sharply with a huff, keeps airway open while moving secretions. |
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Term
| Which medications need 2nd nurse verification? |
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Definition
Narcotics, Opiates, Anticoagulants, Insulins, Sedatives, and Concentrated electrolyte solutions.
Too much results in respiration distress or depression. |
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Term
| Medication legislation and standards |
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Definition
FDA key players and enforcers
Approval for new meds when benefits outweigh the risks.
All meds have risks. |
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Term
|
Definition
Chemical Name - Identifies drugs atomic and molecular structure.
Generic Name - Assigned by the manufacturer that first develops the drug.
Official Name - Name by which the drug is identified in official publications.
Trade Name - brand name copyrighted by the company that sells the drug.
Always use generic name. |
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Term
|
Definition
ALways classify your drugs.
Drug classifications or groups of drugs share similiar characteristics.
Can be classified by effect on body system, chemical composition, or clinical indication. |
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Term
|
Definition
Solid - Caplet, Capsule, Tablet, Pills
Liquid-Elixer, extract, syrup, tincture (alcohol extract from plant or vegetable.
Oral - Troche(Lozenge)
Aerosol, Sustained release
Topical - on the skin (patches)
Parenteral - Injected (Iv is the fasted way for meds to reach body.)
Oral Forms |
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Term
|
Definition
Protective coating that doesn't allow meds to break down in the stomach, pill will break down in intestines.
Don't crush, defeats the purpose of the coating. |
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Term
|
Definition
| The study of how medications enter the body, are absorbed and distributed into cells, tissues, and organs, and how they alter physioligical functions. |
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Term
|
Definition
| The passage of medication molecules into the blood from the site of administration. |
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Term
| Factors that influence absorbtion |
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Definition
Route of administration (Biggest factor of impact on absorbtion)
Ability to dissolve
Blood flow to site of administration
Body surface area
Lipid solubility of medication. |
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Term
|
Definition
After absorbtion, distribution occurs within the body tissues, organs, and to specific sites of action.
Distribution depends on circulation, membrane permeability, and protein binding. |
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Term
|
Definition
Medications are metabolized into a less potent or inactive form.
Biotransformation occurs under the influence of enzymes.
Most biotransformation occurs in the liver. |
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Term
|
Definition
| Kidney(most excretion), Liver, Bowel, Lungs, Exocrine glands |
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Term
| Types of medication action |
|
Definition
Therapeutic effect: Expected/predictabl
Side effect: Unintended, secondary (Nauseas and vomiting)
Adverse effect: Severe response to med
Toxic effect: Accumulates in blood (kidney or liver problems)
Idiosyncratic: Over/Under reaction (like kids and nyquil, hyperness)
Allergic: Unpredicatable response to medication |
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Term
|
Definition
Urticaria - Raised irregular shaped skin eruption with various size and shapes.
Rash - Small raised vesicles that are usually red.
Pruritis - Itching of skin, accompanies most rashes
Rhinitis - Inflammation of mucous membranes lining nose, causing swelling, and watery discharge. |
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Term
|
Definition
Shortness of breath
Dysphagia
Tachycardia |
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Term
|
Definition
Occur when one medication modifies the action of another.
A SYNERGIST effect occurs when the combined effect of two medications is greater than the effect of the medications given seperately. |
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Term
| Medication Dose responses |
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Definition
Serum Half-Life = time for serum medication to be halved.
Onset = Time it takes for med to produce a response.
Peak = Time it takes for med to reach it's highest effect.
Trough = Minimun blood serum concentration reached just before next scheduled dose.
Duration = TIme when med is great enough to produce a response.
Plateau = Blood serum concentration of medication reached and maintianed after repeated fixed doses. |
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Term
|
Definition
Oral - most convenient, inexpensive, most frequent
(sublingual - Under tongue to dissolve, rapid effect, does not break down in liver.
Parenteral - ID, Sub-Q, IM, IV
Epidural
Topical
Inhalation
Introcular |
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