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30 terms

Nurs. 1245- Oxygenation

STUDY
PLAY
Physiology Neurological Control
1.Medulla is primary stimulus in healthy person to breathe
-senses increase of CO2 and H+ ion
2. Chemoreceptors-measure O2 receptors
-aortic arch and carotid bodies
-sense decrease O2 levels
3. Proprioceptors
-respond to body movement and increase ventilation
- usually seen w/ increased activity

Chronic CO2 levels seen in COPD
-retain CO2, so have high levels, medulla eventually quits
-then chemoreceptors take over, making stimulus to breathe O2 when it's normally CO2
Essential for Normal Respiratory Function
-airway system integrity
-properly functioning alveolar-capillary system
-properly functioning cardiovascular & hematological systems
-healthy tissues
Steps in Gas Exchange
1. Ventilation- air moves in & out of lungs
2. Diffusion (Alveolar-> capillary)
-gas moves from areas of high to low concentration. Alveolar surface area, alveolar capillary membrane integrity affect it.
3. Perfusion- amt. of blood flow
-influenced by position and activity level
4. Gas Transport
-Oxygen-3% plasma bound, 97% oxyhemoglobin
-CO2- 5-10% plasma bound, 5-30% carboxyhemoglobin, 60-90% bicarbonate
5. Diffusion (Capillary-> Tissue)
-influnced by quality of RBCs and tissue chemistry
Factors Affecting Respiratory FX
Levels of health- renal disease, heart damage, lung disease, neuromuscular disease, brain injury, anema, skeletal problems, obesity
Lifestyle- activity levels, smoking
Enviornment- air pollution, occupational exposure
Psychological
Developmental Considerations
-infant-short airways, aspiration risk
-Children- eustachian tubes, bronchi, and bronchioles elongated and less angular; frequent colds and infections
-Older Adults- stiffer lung tissues, decrease muscle strength, skeletal alterations, digestive changes
Medications
1. Narcotics & sedatives- decrease stimulus to breathe
2. ACE inhibitors- dry cough
3. Amiodarone- pulmonary fibrosis
4. Bronchodilators- dilate bronchioles
5. Oxygen- need order
Nursing Assessment
History-
defer if evidence of distress
usual breathing pattern
cough
sputum
chest pain
dyspena
fever
fatigue
weight loss
Physical Exam
Inspect- skin, chest, RR and rhythm
Palpate
Percuss
Auscultate
Hypoxia
-decreased O2
Restlessness (early sign)
altered LOC
Dizziness
Behavioral Changes
Respiratory arrest (late sign)
Noninvasive Diagnostic tests
Pulse Ox- measure SaO2
normally 95-99%
Treat if <92%
Must know Hgb
Chest Xray
Sputum for Cytology
Pulmonary Fx Studies
-group of test that measure lung volumes, identify gas exhange problems, evaluate neuromuscular problems and dyspena

Spirometry- lung volume and airflow
Peak Expiratory Flow- evaluates asthma, records highest flow
Invasive Diagnostic Tests
1. ABGs.
pO2- O2 in blood, btwn 80-100
2. Bronchoscopy- scope to respiratory tract
-visualize structures, remove susbtances, NPO before (4-8 hrs), no food or fluids until gag returns
3. CT scan
-check iodine allergy if contrast to be used
-check metformin level
-if allergic to iodine, get certain prep; steroids and benedryl
4. Ventilation- Perfusion Scan
-radioactive substance injected and inhaled
-measure to blood flow and airflow
-8 hrs to eliminate
5. Skin Tests
-evaluate antigen-antibody reactions
Thoracentesis
-usually @ bedside
-needle or catheter inserted into intrapleural space to aspirate fluid
-monitor respirations after- improve or distress?
-may puncture lung and cause pneumothorax
Interventions
1. Teaching
-stop smoking, avoid pollutants
2. Promote Optimal Function
-control anxiety, nutrition, vaccines, balance activity and rest, pulmonary rehab
Promote Comfort
Positioning- semi-fowlers or fowlers position
Adequate fluids- 2-3L/24 hrs
Humidified Air- breeds bugs, changed every 24 hrs
Promote Proper Breathing
Deep breathing
Incentive Spirometry- forces deep breathing by intake
Purse Lip breathing- sitting or walking, helps Co2 retainers get rid of CO2
Abdominal Breathing
Promote or Control Coughing
Voluntary- cough and deep breathe
Involuntary
Medications
-Expectorant- loosen secretions (Robitussin)
-Suppressant- cough suppressent (Codeine, Robitussin DM)
-Lozenges- tickles for back in throat. Local anesthetic
Perform Chest PT
Cup hands, pad areas on position or chest to loosen secretions
Suctioning
-Device to clear secretions
-Can relieve or promote respiratory distress
-suction 10-15 seconds, wait 1 minute inbetween, done 3x only
Respiratory Medications
1. Bronchodilators- open narrowed airways
-albuterol (Proventil)
-montelukast (Singulair)
-theophylline (Slo-bid)
-tiotropium (Spriva)
2. Steroids
-Anti-inflammatory
-budesonide (pulmicort)
-prednisone
3. Mast Cell stablizers- inhibits histamine release from mast cells
-Cromolyn sodium (instal, Nasalcrom)
4. Antihistamines- inhibit histamines
-Diphenhydramine (Benadryl)
-Loratadine (claratin)
-Cetrizine (zyrtec)
Types of Inhalers
1. Nebulizer
2. Metered Dose Inhaler (MDI)
3. Dry power Inhaler (has tablet or capsule that is punctured in inhaler and released)
Use:
steps vary
bronchodilatort first-> opens up more surface area
Supplemental Oxygen
Benefits: increase oxygen, reduces work of breathing, decreases work of heart
Risks: damages pulmonary tissue, impairs stimulus to breathe, constricts retinal blood vessels, combustion, increase infection
Therapeutic goal:
-Arterial pO2 btwn 80-100 mmHg
-Arterial pCO2 < 45 mmHg
Desired Response:
Normal HR and rhythm
Normal RR
A & O
Normal Color
Nasal Cannula
ROOM AIR= 21%

1L= 24%
2L= 28%
3L= 32%
4L= 36%
5L= 40%
6L= 44%
-may need humdification
-check pressure points and pad them
Simple Face Mask
-delivers 35-60% O2 @ 6-10L/min
-less comfortable
Partial Non-Rebreather
-Reservoir bag mixes 100%O2 w/ some expired air
-70-90% O2
0Partial bag deflation indicates optimal fx
-flow meter set at 10-15 L/min
Non-Rebreather
-exhale through side ports
-inhale only oxygen from reservoir
-60-100% O2
-set flow meter at 15L/min
Venturi Mask
-adjust dial to change diameter of tube and size of side ports
-set flow meter according to dial
-delivers precise oxygen concentration
-most precise O2 concentration delivered by mask
Interventions related to O2 Therapy
Assess- RR, pulse ox, skin, mm
Use NC w/ meals if possible- must be able to convert btwn O2 devices
Hygiene- face, nares, mask
Artifical Airways
-oral
-nasopharyngeal
-endotracheal- intubated for 14 days

must have no gag reflex
Trach Care
-Cleaning- inner cannula, insertion site skin
-Communication
-Tube security
-Emergency Equipment- obturator at bedside, spare trach tube at bedside