NUR1020 Oxygenation

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clugger
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268046
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NUR1020 Oxygenation
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2014-08-14 08:48:56
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NUR1020 Oxygenation
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NUR 1020 Oxygenation
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  1. How is breathing controlled?
    • Chemoreceptors in
    • -medulla of the brainstem
    • -carotid arteries
    • -aorta
    • detect changes in pH, O2, CO2-> sent info to respiratory center in brainstem

    • lungreceptors in
    • lung and chestwalls (breathingpatterns, lung expansion, airway resistance, respiratory irritance-> info to brainstem->adjust ventilation

    • motor cortex
    • -voluntary control can override involuntary control of respiratory center (temporarily)
  2. what factors influence pulmonary function?
    • developmental stage
    • environment
    • individual and lifestyle factors
    • medications
    • pathophysiological states
    • (the disordered physiological processes associated with disease or injury)
  3. infants
    • less than 35 weeks:
    • RDS respiratory distress syndrome (surfactant system not ready)
    • -> atelectasis (collapse of alveoli)
    • immature pulmonary circulation
    • + hypoventilation-> hypercarbia (high CO2 blood levels) + hypoxemia

    also narrow airways, central nervous system evtl. not ready, week immune system,
  4. toddler
    • URI Upper respiratory infection (immunesystem)
    • tonsillitis ( large tonsils and adenoids)
    • putting objects in mouth

    URI usually no problem to fight

    • also aspiration of small objects
    • drowning
  5. preschool and school age kids
    • croup and pneumonia common
    • asthma (with exercise)
    • middle school: tobacco
  6. adolescents
    • little risk for lung disease (mature system)
    • tobacco
    • fewer doctor visits-> no influenza shot
    • asthma (with exercise)
  7. young, middle, older adults
    • -tobacco, no exercise
    • -> problems can show after infection, surgery, anesthesia, emotional stress

    number of cells decline with age (exercising helps)

    • older ones:
    • reduced lung expansion
    • harder to remove mucus
    • lower ability to breath faster
    • declining immune response
    • gastroesophageal reflex disease-> inflammatory response
  8. stress
    higher release of catecholamines from sympathetic nervous system-> increase in risk of blood clot (pulmonary embolus)

    weaker immune system and inflammatory response
  9. allergic reactions
    • over-response to antigen
    • hay fever (eyes, nose, sinuses)
    • asthma (allergic reaction occurring in bronchioles)- most serious chronic disease in kids
  10. pregnancy
    • metabolism +15%
    • uterus pushes up
    • resp. rate increases
  11. obesity
    respiratory infections (fat presses upward->no full expansion-> hypoventilation + dyspnea-> poor ventilation)

    sleep apnea (laying down chest expansion is limited even more)
  12. tobacco
    • constricts bronchioles
    • paralyzes cilia
    • increase fluid secretion-> swelling, inflammation-> enzymes that break down alveolar wall contents

    cause of more than 80% of all lung cancer
  13. substance abuse
    • respiratory depressants:
    • opioids
    • sedatives
    • antianxiety agents
    • hypnotics
    • -> hypoventilation, apnea, respiratory failure (can be fatal)

    also caffeine, alcohol, glue, aerosols, other inhalants, amphetamines, cocaine, LSD, PCP, marijuana
  14. hemoptysis
    Coughing up of blood and bloody sputum
  15. Pulse oximatry
    • 95-100% normal
    • Below 94%-> further evaluation in healthy people
    • Can be placed on finger, ear, forehead, nose
    • Possible irritants false nails, cold extremities, movement, nail polish
  16. capnography
    • Measures CO2 level in inhaled and exhaled air
    • Provides information about ventilation
    • Common situations: during anesthesia, critical care patients, sleep apnea, infants with pulmonary distress, patient receiving opioids, validating endotracheal tube (ET) placement-> should be little or no CO2 present
  17. CO2 detectors
    • Chemically treated paper
    • Can only show a range of CO2
  18. ABG Arterial Blood Gases
    • Measures O2 and. CO2 in blood
    • Arteries brachial, radial or femoris
    • Measures hemoglobin/oxyhemoglobin, PO2 (partial pressure of oxygen, normal 80-100 arterial, venous 40mm Hg), SaO2 (saturation of oxygen)
    • Gas exchange impaired-> PO2 and SaO2 levels fall
  19. How much oxygen is in the air?
    21% sea level
  20. hypocarbia
    • Too less CO2 in blood
    • hyperventilation
  21. hypercarbia
    • Too much CO2 in blood
    • hypoventilation
    • Anesthetic effect
    • Severe-> Hypoxemia (too less oxygen)
  22. Peak flow monitoring
    • Amount of air that can be exhaled
    • Can be used frequently by asthma patients for monitoring
  23. Interventions without meds
    • Sitting up
    • Deep breathing and coughing
  24. Herbs found to help
    • Elderberry (sambucus nigra) against viruses especially flu
    • Vitamin C ( against cold symptoms only)
    • Honey  against cough, do not give to kids under 1 year
  25. URI Upper respiratory infections
    • Usually 10-21 days, self limiting
    • Can seriously compromise breathing in children and older adults
    • Can cause other resp. diseases
    • Do not overuse antibiotics here (and just for bacteria)
    • Antibiotics not effective for common cold
  26. Position for maximum ventilation
    • Overbid table-> tripod position, may need to rest their arms on overbed table
    • When patient on side, pillow for upper arm
    • Frequent position changes for ventilation of all areas of lung
  27. Incentive spirometry
    • Shows patient if berthing deep enough
    • Patients who had pelvic, chest, abdominal, surgery
    • Respiratory problems
    • Risk for pneumonia
  28. aspiration precaution
    • For patients who are/have
    • An increased level of consciousness
    • Diminished gag or COUGH REFLEX
    • Difficulty swallowing
  29. Mobilizing secretions
    • Deep inhalations
    • coughing
    • hydration
    • Chronic lung disease alter procedure! exhale through pursed lips, cough through expiration in several  short bursts to avoid lots of pressure (danger of collapse diseased airways)
  30. tracheostomy
    surgical opening of the trachea through the neck (permanent or temporary)

    transtracheal catheter placed into the tracheostomy to deliver O2 directly into trachea
  31. oxygen hazards
    • toxicity when > 50% for longer than 48-72 hours
    • alveolar colapse (reduces surfactant production)
    • oxygen supports combustion, fire precautions
    • oxygen tanks under pressure-> when it falls and ruptures it can cause harm!
  32. pregnancy
    • oxygen demand +15% last half of pregnancy
    • blood volume +30%
    • need for adequate iron intake, otherwise maternal anemia
  33. hypoxemia
    low arterial blood oxygen levels
  34. hypoxia
    poor oxygenation of tissues and organs
  35. hypercarbia
    excess of dissolved CO2 in the blood due to hypoventilation
  36. hypocarbia
    lowl level of CO2 in blood due to hyperventilation
  37. caridiac ischemia
    oxygen need of heart not met
  38. dyspnea
    • =shortness of breath
    • -sign of hypoxia
    • -provokes anxiety
  39. assess peripheral circulation
    • weak pulses
    • cool feet
    • lack of hair,
    • shiny skin on lower legs,
    • -> usually peripheral vascular disease

    edema on feet and ankles-> one symptom of heart failure
  40. dysrhythmias
    • abnormal heart rythms
    • based on patients baseline rate, so lower 60 per minute can be normal for a patient
  41. tachydysrhythmia
    rates>100 beats per minute
  42. bradydysrhythmias
    rates < 60 beats per minute
  43. ectopy
    extra beats
  44. manage anxiety
    • anxiety raises bp and oygen need and makes incident even more serious
    • do not leave patient alone
    • speak and act calmly
    • clear factual information
    • keep patient informed
  45. promote venous return
    • elevate legs above heart level
    • no flesion of legs-> use recliner
    • avoid sitting with legs crossed
    • early and frequent ambulation (after surgery)
    • range of motion exercises
    • apply compression devices
  46. what is thrombus
    what is embolus
    • thrombus= blood clott attached to wall
    • embolus= clott traveling within the blood stream
  47. prevent clot formation
    • turn patient frequently, change positions
    • sterile technique when intravenous lines
    • intravenous meds are deluded
    • adequate hydration (2000ml per day intake-> 1500ml output per day)
    • smoking cessation
    • evtl anticoagulant therapy
  48. hydration

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