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118 terms

Basic Nursing Ch 29: "Oxygenation"

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two main reasons for oxygenation problems
ineffective gas exchange (lungs) or ineffective pump (heart)
function of cardiopulmonary system
provides oxygen to the tissues and remove carbon dioxide and waste products from the body
ventilation
the movement of air in and out of the lungs
diffusion
the movement of gases between air spaces and the bloodstream
respiration
the exchange of oxygen and carbon dioxide during cellular metabolism
perfusion
the movement of blood into and out of the lungs to the body's organs and tissues
the right lung has how many lobes
three
the left lobe has how many lobes
two
oxygenation
oxygen entering the lung
what are the 3 main conditions that affect ventilation
hypoxia, hypoventilation, hyperventilation
hypoxia
inadequate tissue oxygenation
PaO2
partial pressure of oxygen
if your patient has low PaO2, what does this mean
the person is hypoxic
hypoventilation
inadequate ventilation to meet the body's oxygen demand or eliminate CO2 (so CO2 levels rise)
what happens when hypoxia is left untreated
cardiac dysrhythmias and/or death
what happens when hypoventilation is left untreated
hypoxia, hypercapnia, or respiratory acidosis
hypercapnia
elevated PaCO2 (arterial carbon dioxide) levels
S&S of hypoventilation
dizziness, occiptal headache upon awakening, lethargy, disorientation, decreased ability to follow instructions, cardiac dysrhythmias, electrolyte imbalances, convulsions, coma, cardiac arrest
what happens if you give a COPD pt too much oxygen
the stimulus to breathe is negated; resulting in hypoventilation; can lead to respiratory arrest
hyperventilation
an increase in respiratory rate, resulting in excess amounts of CO2 elimination (so your CO2 level drops)
what hapens when hyperventilation is left untreated
hypocapnia and respiratory alkalosis
S&S of hyperventilation
tachycardia, shortness of breath, chest pain, dizziness, lightheadedness, decrased concentration, paresthesia, extremity numbness, tinnitus, blourred vision, disorientation, and tetany
what is the function of the circulatory system
delivers oxygen, nutrients, and othe rsubstances to the body's tissues to support cellular life
systole
the contraction phase of the cardiac cycle, when blood is expelled from the heart's ventricles
diastole
the relaxation phase of the cardiac cycle, when the ventricles fill with blood
cardiac output (CO)
the amount of blood ejected from the left ventricle each minute
normal cardiac output for a healthy adult
4 to 6 L/min
angina is the result of what
decreased blood flow to the myocardium
myocardial infarction (MI) is the result of what
extensively decreased or completely blocked myocardial blood perfusion, leading to tissue necrosis
S&S of MI
severe or crushing chest pain, jaw pain, back pain, left arm pain, breathlessness, diaphoresis, and hypotension; pain usually lasts 30+ min
valvular heart disease
disorder of cardiac valve characterized by obstructed blood flow and regurgitation resulting in backflow of blood
left-sided heart failure
impaired functioning of the left ventricle, usually caused by increased preload or afterload
preload
fluid volume overload
afterload
increased systemic vascular resistance
S&S of left-sided heart failure
pulmonary complications (congestion, crackles), and fatigue, dyspnea, and orthopnea (difficulty breathing while lying down)
right-sided heart failure
impaired functioning of the right ventricle, usually caused by pulmonary disease
what kind of blood does the right side of the heart pump
deoxygenated blood
what kind of blood does the left side of the heart pump
oxygenated blood
pulmonary edema
fluid buildup inside the lungs/alveoli
what is the best way to treat pulmonary edema
diuretics; it draws the fluid out of tissues
plueral effusion
fluid buidup outside the lungs
if the left side of the heart is failing, symptoms will be what
pulmonary
if the right side of the heart is failing, symptoms will be what
bilateral lower extremities / pedal edema
hypovolemia
low blood volume
dysrhythmia
a disturbance in the elctrical impulse of the heart rhythm
sinus tachycardia
regular rhythm, rate 100-180 bpm
sinus bradycardia
regular rhythm, rate <60 bpm
atrial fibrillation (a-fib)
irregular rate and rhythm
ventricular tachycardia
rhythm slightly irregular, rate 100-200 bpm
ventricular fibrillation
irregular and chaotic rhythm
asystole
no discernable rate or rhythm
anemia
reduction in RBCs or decrease in hemoglobin
hypoxemia
low oxygen level in the blood
patients with pulmonary disease ar at risk for what
hypoxemia and hypercapnia
nervous system disease
a type of disease that impairs nervous and muscular control, causing reduced ventilation
surfactant
a chemical in the lungs that keeps the alveoli dry and keeps them from collapsing
eupnea
12-20 breaths per min; normal breathing rate
tachypnea
>35 breaths per min
bradypnea
<10 breaths per min
apnea
periods of no resp lasting >15 sec
Kussmaul's
usually >35; may be slow or normal
Cheyne-Stokes
abnormal pattern of breathing, varying btwn apnea and tachypnea
when is humidification necessary
when pts are receiving oxygen therapy at more than 4 L/min
nebulization
using the aerosol principle to suspend a maximum number of water drops or particles of the desired size in inspired air
what are the three interventions to maintain a patent airway
coughing techniques, suctioning, insertion of artificial airway
coughing is beneficial for what patient
pts with chronic pulmonary diseases or resipratory tract infections
suctioning is beneficial for what patient
pts who are unable to effectively clear respiratory tract secretions with coughing
artificial airways are beneficial for what patient
pts with decreased levels of consciousness, airway obstruction, mechanical ventilation
what is incentive spirometry useful for
to promote lung expansion; prevents atelectasis in a post-op patient
breathing exercises are beneficial for what patient
pts who need to improve ventilation and oxygenation; improves respiratory strength and andurance, resulting in improved activity tolerance
what techniques are good for COPD pts/why
breathing exercises/may prevent respiratory failure
what are the 3 typres of breathing exercises
deep breathing/coughing, pursed-lip breathing, and diaphragmatic breathing
nasal cannula
simple, comfortable device to deliver low-concentration O2
nasal cannula flow rate
<6 L/min
simple face mask
device for short-term O2 therapy
flow rate for simple face mask
5-8 L/min
partial non-rebreather
device that delivers high concentrations of O2
flow rate of partial non-rebreather
6-10 L/min
Venturi mask
device that delivers precise, high-flow rates of O2
flow rate of Venturi mask
4-12 L/min
simple face masks are contraindicated for what pt
pts with carbon dioxide retention
pathway of pulmonary circulation
right ventrical -> pulmonary artery -> pulmonary vein -> left atrium
subcutaneous emphysema
air that has leaked into the tissues surrounding the lungs, usually from a chest tube that is leaking
how to fix subcutaneous emphysema
plug the hole, and it will reverse itself
how to assess for subcutaneous emphysema
palpate upper chest area; it will feel like they have rice krispies under the skin
how to fix pleural effusion
if not severe it may go away on its own; if severe, thoracentesis can draw more than a liter off
S&S of hypoxia
restlessness, increased agitation, hyper-respiratory response
cyanosis is a sign of what
hypoxia
S&S of altered respiratory function
mental status change, decreased LOC, dysrhythmia, respiratory and/or cardiac arrest
interventions for altered respiratory function
treat underlying cause, restore ventilation/ tissue oxygenation, restore acid-base balance
what is the #1 cause of infant cardiac arrest
repiratory failure
why can't a simple mask be run at <5 lpm
the pt will re-breathe CO2
what is perfused during systole
body tissue
what is perfused during diastole
cardiac tissue
S&S of angina
radiating pain that lasts 1-15 min
how to fix angina
give nitroglycerin SL
why is nitroglycerin given for angina
vasodilator; more blood can get through
myocardial ischemia
a narrowing in coronary artery blood flow; usually reversible
myocardial necrosis
heart tissue is destroyed due to blocked cardial perfusion; irreversible
how to read a 6-second strip
count the numberof beats, and multiply by 10
dependent lower edema may be a sign of what
right-sided heart failure
dependent edema
edema present even when someone's lying down
what is a COPDer's trigger to breathe
oxygen
what is a healthy person's trigger to breathe
carbon dioxide
what should you do for someone with COPD who has low O2 stats
put them on LOW O2 (like 2 L or less)
right sided heart failure results from what
impaired functioning of the right VENTRICLE
what is a LATE sign of hypoxia
cyanosis
left sided heart failure results from what
impaired functioning of the left VENTICLE
pneumothorax
air in the pleural space
pleural effusion
fluid in the plueral space
what should you tell the pt to do if a chest tube becomes disconnected
cough
restlessness is a sign of what
hypoxemia
splinter hemorrhages can be a sign of what
cardiopulmonary abnormality
pulmonary congestion can be due to what
left ventricular CHF
peripheral bilateral pedal edema can be due to what
right ventricular CHF
pain with inspiration can be a sign of what
inflammation of the pericardial sac
how often is the pnuemococcal vaccine given
every 10 years
the movement of gases into and out of the lungs depends on what
pressure gradient between the atmosphere and the alveoli