Lecture 9 - Oxygenation

‭Pulmonary System‬ ‭Upper Respiratory Tract‬ ‭Components‬ ‭‬ N ● ‭ ose‬ ‭●‬ ‭Pharynx‬ ‭○‬ ‭Laryngopharynx‬ ‭○‬ ‭Oropharynx‬ ‭○‬ ‭Nasopharynx‬ ‭●‬ ‭Larynx‬ ‭○‬ ‭Epiglottis‬ ‭Functions‬ ‭‬ M ● ‭ ucus: Warming and humidifying‬ ‭●‬ ‭Cilia: Filtering; hold onto debris to be coughed out (clearance)‬ ‭●‬ ‭Protection: Cough protects from inhalation of foreign objects, and‬ ‭epiglottis folds over larynx to prevent aspiration‬ ‭●‬ ‭Sensation: ex. Triggering olfactory nerve to sense smell‬ ‭●‬ ‭Phonation: Vocal cords vibrate to produce sound‬ ‭●‬ ‭Digestion: Deliver food to the esophagus through swallowing‬ ‭Lower Airway‬ ‭Components‬ ‭‬ ● ‭●‬ ‭●‬ ‭●‬ ‭●‬ ‭ rachea‬ T ‭Right and left mainstem bronchi‬ ‭Segmental bronchi‬ ‭Terminal bronchioles‬ ‭Alveoli‬ ‭Functions‬ ‭‬ M ● ‭ ucociliary clearance: Process by which the airways remove mucus and foreign particles‬ ‭●‬ ‭Production of pulmonary surfactant‬ ‭Pulmonary Surfactant‬ ‭●‬ ‭Produced by alveolar cells‬ ‭●‬ ‭Reduce surface tension, minimizing surface area‬ ‭●‬ ‭Prevent atelectasis, in which alveoli collapse‬ ‭●‬ ‭Produced in the infant around the 37th week of pregnancy‬ ‭○‬ ‭Preterm babies are born before this week and are susceptible to atelectasis/RDS‬ ‭●‬ R ‭ espiratory distress syndrome (RDS):‬‭Rapid, shallow breathing and sharp pulling in of‬ ‭chest; requires surfactant replacement therapy‬ ‭Major Organs/Structures‬ ‭Lungs‬ ‭‬ L ● ‭ ocated in thoracic cavity and made of elastic tissue‬ ‭●‬ ‭Left lung shorter due to liver‬ ‭Phrenic Nerve‬ ‭‬ S ● ‭ pinal nerves = C3-C5‬ ‭●‬ ‭Innervates diaphragm‬ ‭Diaphragm‬ ‭●‬ ‭Primary respiration muscle that ontracts to draw in air and relaxes to expel air‬ ‭Trachea‬ ‭●‬ ‭Main airway where air goes from the larynx to the R/L bronchi‬ ‭Bronchi & Bronchioles‬ ‭‬ B ● ‭ ronchus divides into bronchioles (terminal and respiratory)‬ ‭●‬ ‭Distribute air throughout the lung‬ ‭Alveoli‬ ‭‬ B ● ‭ ronchioles divide into alveoli‬ ‭●‬ ‭Where gas exchange of O‬‭2‬ ‭and CO‬‭2‬ ‭occur through diffusion‬ ‭Airway Subdivision‬ ‭Respiratory Activity‬ ‭Ventilation‬ ‭●‬ ‭The movement of air in and out of the lungs; two phases‬ ‭Inspiration‬ ‭‬ A ● ‭ ctive phase of ventilation‬ ‭●‬ ‭Involves movement of muscles and thorax to bring air into the lungs‬ ‭Expiration‬ ‭‬ P ● ‭ assive phase of ventilation‬ ‭●‬ ‭Movement of air out of the lungs‬ ‭ uestion:‬‭Pulmonary ventilation is the process by‬‭which oxygenated capillary blood passes‬ Q ‭through bodily tissues.‬ ‭a.‬ ‭True‬ ‭b.‬ ‭False‬ ‭Respiration‬ ‭‬ ● ‭●‬ ‭●‬ ‭●‬ ‭ as exchange (O‬‭2‬ ‭and CO‬‭2‬‭) between the air in the alveoli‬‭and blood in the capillaries‬ G ‭Occurs via diffusion; high concentration to low‬ ‭External respiration: In the lungs between alveoli and capillaries‬ ‭Internal respiration: At cellular levels within tissues‬ ‭Perfusion/Internal Respiration‬ ‭‬ T ● ‭ he process by which oxygenated capillary blood passes through body tissues‬ ‭●‬ ‭Allows for the delivery of oxygenated blood to organs‬ ‭●‬ ‭Capillaries surround alveoli‬ ‭Infants‬ ‭Chest/Airway Size‬ ‭‬ A ● ‭ spiration risk: Small chest and short airways → minimal space and high aspiration risk‬ ‭●‬ ‭As infant develops, alveoli numbers increase → adequate oxygenation at lower RR‬ ‭Respiratory Rate‬ ‭‬ R ● ‭ apid: 30-55 breaths/min‬ ‭●‬ ‭Abdominal breathing style‬ ‭URI and Asthma Risk‬ ‭●‬ ‭Secondhand smoke is the primary risk factor for infant URIs and asthma‬ ‭Abnormal Breath Sounds‬ ‭‬ C ● ‭ hange in anatomy: Fluid filled structures change into air-filled organs after birth‬ ‭●‬ ‭Breath sounds: Loud, harsh, crackles‬ ‭Children‬ ‭Chest Wall/Thorax‬ ‭‬ R ● ‭ ound in infants, then becomes more elliptical‬ ‭●‬ ‭Infant and early childhood (birth - 5 years): Thin with little muscle; visible sternum‬ ‭●‬ ‭Late childhood (6-12 years): Structures/landmarks become‬ ‭less visible as more subcutaneous fat is deposited‬ ‭ natomical Differences Between Children and Adults‬ A ‭Eustachian Tubes‬ ‭‬ S ● ‭ maller, elongated, and less angular (flatter) in children‬ ‭●‬ ‭Effect: Number of colds and ear infections decreases until‬ ‭school → clogging‬ ‭Bronchioles and Bronchi‬ ‭‬ S ● ‭ horter length, less rigid, and narrower in diameter‬ ‭●‬ ‭Potential problems with aspiration/obstructions‬ ‭More Frequent Infections During School‬ ‭‬ ● ‭●‬ ‭●‬ ‭●‬ ‭ hildren with daycare experience are less likely to have developed Abs/immunity‬ C ‭Most common: Colds, upper respiratory infections‬ ‭Less common, more serious: Otitis media, bronchitis, pneumonia‬ ‭Encourage good hand hygiene and tissue etiquette‬ ‭Older Adults‬ ‭Bony Landmarks‬ ‭●‬ ‭More prominent (ex. Spine and sternum)‬ ‭Kyphosis‬ ‭‬ H ● ‭ umpback common in older adults‬ ‭●‬ ‭Curvature in the spine and lack of respiratory ventilation‬ ‭Increased Anteroposterior (AP) Diameter‬ ‭●‬ ‭Should be less than the transverse diameter of the chest cavity‬ ‭Barrel Chest‬ ‭‬ T ● ‭ he AP chest diameter measures larger than the transverse‬ ‭●‬ ‭Leads to an outward enlargement of the chest‬ ‭●‬ ‭A factor of age or COPD‬ ‭Decreased Elasticity‬ ‭‬ A ● ‭ s adults age, tissue and airways (alveoli) lose elasticity‬ ‭●‬ ‭The diaphragm is unable to move as efficiently‬ ‭Risk for Atelectasis‬ ‭‬ B ● ‭ ecause the lungs are not maximally inspiring and expiring, it has greater risk of collapse‬ ‭●‬ ‭Leading to an increase in respiratory infections, especially pneumonia‬ ‭○‬ ‭Tissues are rigid and unable to clear secretions/particles‬ ‭ uestion:‬‭A nurse is assessing an older adult’s respiratory‬‭status. Which of the following is not a‬ Q ‭normal age-related in the respiratory system?‬ ‭a.‬ ‭Stiffening of the chest wall‬ ‭b.‬ ‭Increased resistance to airflow‬ ‭c.‬ ‭Decreased respiratory rate‬ ‭i.‬ ‭Usually higher‬ ‭d.‬ ‭Loss of elastic recoil‬ ‭Factors Affecting Respiratory Functioning‬ ‭Developmental Considerations‬ ‭ ‬ I‭ nfants’ chests are small, causing shorter respirations‬ ● ‭●‬ ‭School-aged children have elongated and angular bronchi/bronchioles‬ ‭●‬ ‭Older adults have less elastic tissues and airways → more difficulty breathing‬ ‭Health Status‬ ‭‬ R ● ‭ enal and cardiac issues can lead to fluid overload, which impairs respiratory function‬ ‭●‬ ‭Anemia can lead to a lack of oxygen being delivered to the organs‬ ‭●‬ ‭Chronic asthma often involves issues with breathing, particularly while exercising‬ ‭Medications: Narcotic and Sedative‬ ‭●‬ ‭Narcotic/sedative meds depress respiratory rate; important to monitor for safety‬ ‭Lifestyle‬ ‭●‬ ‭More physical activity → increased respiratory ease/function‬ ‭○‬ ‭Access dependent on socioeconomic status‬ ‭●‬ ‭Good nutrition can have a positive impact on respiratory ease‬ ‭Environment‬ ‭●‬ ‭Air pollution → coughing, choking, and dizziness‬ ‭Psychological Health‬ ‭●‬ H ‭ igh stress can lead to hyperventilation, increasing respiratory rate and action → low‬ ‭arterial carbon dioxide‬ ‭Common Diagnostic Methods‬ ‭‬ ● ‭●‬ ‭●‬ ‭●‬ ‭●‬ ‭●‬ ‭●‬ ‭ rterial blood gas analysis (ABGA)‬ A ‭Cytologic study: Study of cells‬ ‭Bronchoscopy‬ ‭Radiography‬ ‭Lung scan‬ ‭Pulmonary function test (spirometry)‬ ‭Thoracentesis‬ ‭Arterial Blood Gas Analysis (ABGA)‬ ‭‬ A ● ‭ pply pressure to the puncture site for 3-5 minutes because of high pressure‬ ‭+‬ ‭-‬ ‭●‬ ‭CO‬‭2‬ ‭+ H‬‭2‭O ‬ → H‬‭2‬‭CO‬‭3‬ ‭→ H‬ ‭+ HCO‬‭3‬ ‭Normal Results‬ ‭‬ ● ‭●‬ ‭●‬ ‭●‬ ‭●‬ ‭ aO‬‭2‬‭: 80-100 mmHg‬ P ‭PaCO‬‭2‬‭: 35-45 mmHg‬ ‭pH: 7.35-7.45‬ ‭SpO‬‭2‭:‬ 94-100%‬ ‭HCO‬‭3‬‭-‬‭: 22-28 mEq/L‬ ‭Spirometry‬ ‭‬ A ● ‭ measure of pulmonary function‬ ‭●‬ ‭Measures how fast and how much air one can breathe in and out‬ ‭●‬ ‭Identify pulmonary disease, check severity of disease, and determine efficiency of meds‬ ‭Process‬ ‭‬ ● ‭●‬ ‭●‬ ‭●‬ ‭●‬ ‭ aise the head and chin‬ R ‭Clip the nose to prevent air from escaping the nostrils‬ ‭Take a deep breath, and hold it‬ ‭Place the spirometer’s mouthpiece between the teeth and seal lips around it‬ ‭Blast the air out of the lungs as hard and fast as possible until told to stop‬ ‭○‬ ‭Adults blow for at least 6 seconds‬ ‭○‬ ‭Children (< 10 years) blow for at least 3 seconds‬ ‭ ‬ ‭Perform correctly three times for accurate results‬ ● ‭Pulmonary Function Test‬ ‭Process‬ ‭‬ ● ‭●‬ ‭●‬ ‭●‬ ‭●‬ ‭●‬ ‭●‬ ‭ lace the device in the mouth and clip over the nose‬ P ‭Breathe normally, then take deep breaths, blowing the air out‬ ‭Breathe normally, then take deep and rapid breaths‬ ‭Breathe normally, then take a deep breath, blowing the air out‬ ‭Place a nebulizer with albuterol in the mouth, and breathe normally‬ ‭Post-medication, replace the device in the mouth and clip over the nose‬ ‭Breathe normally, then take deep breaths, blowing the air out‬ ‭Values Measured‬ ‭‬ ● ‭●‬ ‭●‬ ‭●‬ ‭●‬ ‭ otal lung capacity (TLC): Maximum air in the lungs after deep inspiration (VC + RV)‬ T ‭Vital capacity (VC): Deep breathing range‬ ‭Tidal volume (TV): Normal breathing range‬ ‭Residual volume (RV): Air left in the lungs after deep expiration‬ ‭Peak expiratory flow rate (PEFR): Maximum speed of airflow during exhalation‬ ‭ uestion:‬‭Which of the following lung values is the amount of air contained within the lungs at‬ Q ‭maximum inspiration?‬ ‭a.‬ ‭Vital capacity‬ ‭b.‬ ‭Total lung capacity‬ ‭c.‬ ‭Residual volume‬ ‭d.‬ ‭Peak expiratory flow rate‬ ‭Thoracentesis‬ ‭Indications‬ ‭‬ P ● ‭ leural effusion/empyema‬ ‭●‬ ‭Diagnostic purposes and therapeutic management‬ ‭Procedure‬ ‭●‬ ‭Instruct patient to stay still and not cough‬ ‭○‬ ‭Complications: Coughing, bloody sputum‬ ‭●‬ ‭Observe the patient’s vital signs‬ ‭●‬ ‭Anesthetize the skin and deep tissue‬ ‭●‬ ‭Identify the pleural space by the presence of pleural fluid aspirate in the syringe‬ ‭●‬ ‭Using sterile gloves, place the fingers at the point of insertion/exit to approximate the‬ ‭length of insertion for the needle/catheter‬ ‭●‬ ‭During needle insertion, the open stopcock valve allows aspiration of pleural fluid while‬ ‭minimizing the introduction of atmospheric air‬ ‭●‬ ‭Sample used for laboratory testing to help delineate a differential diagnosis‬ ‭●‬ ‭A chest radiograph may be used‬ ‭Promoting Patient Comfort‬ ‭‬ ● ‭●‬ ‭●‬ ‭●‬ ‭●‬ ‭ ositioning: To facilitate ease during treatment, maintain a stable/comfortable position‬ P ‭Adequate fluid intake: Top priority for patient progression‬ ‭Maintaining nutrition: Allows patient to achieve/maintain homeostasis‬ ‭Humidifiying air: To prevent discomfort and contraction of any infectious diseases‬ ‭Chest physiotherapy: Prevent further complications occuring within the chest‬ ‭Chest Physiotherapy‬ ‭Postural Drainage‬ ‭‬ U ● ‭ se gravity to mobilize secretions‬ ‭●‬ ‭Lie/sit using the pillow to elevate the part to be‬ ‭drained as high as possible‬ ‭○‬ ‭ex. L lobe to be drained → lay on R side‬ ‭○‬ ‭ex. Lower lobe → elevate feet‬ ‭ ‬ ‭ex. Anterior lobe → lay on back‬ ○ ‭ ‬ ‭Maintain for 5-15 minutes and, if in the ICU, perform every 4-6 hours‬ ● ‭●‬ ‭Used in combination with other treatments, less invasive‬ ‭Percussion‬ ‭‬ C ● ‭ lapping to loosen or mobilize secretions‬ ‭●‬ ‭Cupped hand, forceful with a steady beat; use the wrist and keep the arm relaxed‬ ‭●‬ ‭Have the patient sit/lie on their back/stomach/side/leaning forward‬ ‭○‬ ‭Maintain privacy with towel/thin clothing over the area‬ ‭●‬ ‭Each position should be done for 2 minutes twice daily‬ ‭●‬ ‭Avoid the spine, breastbone, stomach, lower ribs, and back to prevent injury‬ ‭●‬ ‭Used in combination with other treatments‬ ‭Vibration‬ ‭‬ ● ‭●‬ ‭●‬ ‭●‬ ‭●‬ ‭●‬ ‭ ently shakes mucus to loosen and mobilize‬ G ‭Both hands flattened; tense muscles on arm and shoulder‬ ‭Use a fine shaking motion with light pressure‬ ‭Perform in various positions‬ ‭Coarse vs. fine, usually done upon exhalation (slow and complete)‬ ‭Used in combination with other treatments‬ ‭Promoting Proper Breathing‬ ‭‬ D ● ‭ eep breathing‬ ‭●‬ ‭Incentive spirometry‬ ‭Incentive Spirometer‬ ‭‬ T ● ‭ ool used to improve lung function by expanding and exercising their capacity‬ ‭●‬ ‭Surgery, anesthesia, and bedrest put a patient at risk for decreased lung activity and PNA‬ ‭Procedure‬ ‭‬ ● ‭●‬ ‭●‬ ‭●‬ ‭●‬ ‭●‬ ‭ ave the patient sit up as far as possible (in bed or chair)‬ H ‭Hold the spirometer upright, and exhale before beginning‬ ‭Place the mouthpiece in the mouth and seal lips around it‬ ‭Breathe in as slowly and deeply as possible, raising the main piston (goal at better/best)‬ ‭Hold breath at the end of inhalation for at least five seconds, piston should fall to zero‬ ‭Put the yellow marker at the highest level the piston rose to, which will be a goal point‬ ‭○‬ ‭Raise with increasing volume‬ ‭ ‬ ‭At least every ten times or hour, practice coughing to ensure the lungs are cleared‬ ● ‭○‬ ‭Splint any incisions while coughing; do the same while walking‬ ‭Promoting Coughing‬ ‭Nonproductive Cough‬ ‭●‬ ‭A cough that does not produce any sputum; often dry and irritating‬ ‭Productive Cough‬ ‭●‬ ‭A cough that brings up mucus (sputum/phlegm) from the lungs/airways‬ ‭Involuntary Coughing‬ ‭●‬ ‭Spontaneous coughing that is often triggered by irritants, such as allergens‬ ‭Voluntary Coughing‬ ‭‬ P ● ‭ re/postoperative: Encouraged before and after surgery to keep lungs clear‬ ‭●‬ ‭Effective to combine with deep breathing, expanding the lungs and mobilizing secretions‬ ‭●‬ ‭Splint an incisional site with a pillow while coughing to reduce discomfort‬ ‭Types of Cough Medication‬ ‭Expectorants‬ ‭‬ ● ‭●‬ ‭●‬ ‭●‬ ‭ educe viscosity: Removal of respiratory tract secretions‬ R ‭Extremely thick secretion → liquified‬ ‭Not for a patient without congestion‬ ‭Ex. guaifenesin (Mucinex, robitussin)‬ ‭Cough Suppressants‬ ‭‬ ● ‭●‬ ‭●‬ ‭●‬ ‭ epress cough reflex‬ D ‭For irritating, nonproductive cough‬ ‭Not for a patient with congestion → risk of pulmonary infection‬ ‭Ex. codeine (addictive, drowsiness), dextromethorphan (nonaddictive, OTC)‬ ‭Lozenge‬ ‭‬ S ● ‭ mall, solid medication‬ ‭●‬ ‭For mild, nonproductive coughs without congestion‬ ‭●‬ ‭Mechanism of action: Benzocaine, local anesthetic effect on‬ ‭sensory/motor nerves‬ ‭●‬ ‭Hold in mouth until dissolved; do not cut/crush/chew (not a candy)‬ ‭Chronic Obstructive Pulmonary Disease (COPD)‬ ‭‬ R ● ‭ espiratory disease causing difficulty breathing; often worsens over time‬ ‭●‬ ‭Characterized by bronchial inflammation, smooth muscle‬ ‭constriction, and severely limited air flow‬ ‭●‬ ‭More mucus produced than usual → clogged airways‬ ‭●‬ ‭Damaged alveolar walls and loss of elasticity‬ ‭●‬ ‭As air spaces enlarge, air gets trapped → fewer alveoli to‬ ‭supply oxygen to the blood (low PaO‬‭2‬‭)‬ ‭●‬ ‭Difficult for lungs to deflate and get fresh air in‬ ‭●‬ ‭Administering O‬‭2‬ ‭at high levels can be dangerous‬ ‭Group of Conditions‬ ‭‬ C ● ‭ hronic bronchitis, asthma/COPD, and emphysema‬ ‭●‬ ‭Often, patients have both bronchitis and emphysema‬ ‭●‬ ‭Fewer patients have asthma and COPD‬ ‭Causes‬ ‭‬ S ● ‭ moking‬ ‭●‬ ‭Long-term exposure to irritants:‬ ‭○‬ ‭Second-hand smoke‬ ‭○‬ ‭Air pollution‬ ‭○‬ ‭Dust/workplace fumes‬ ‭○‬ ‭Biomass exposure (ex. wood smoke)‬ ‭●‬ ‭Ɑ‭1‬ -antitrypsin deficiency: Rare genetic disorder‬ ‭Signs and Symptoms‬ ‭‬ W ● ‭ ith progression, SOB, wheezing, chest tightness (with exercise), ongoing/chronic cough‬ ‭●‬ ‭With worsening, difficulty with routine activities, weight loss, muscle loss, fatigue‬ ‭COPD Management‬ ‭‬ C ● ‭ onsult healthcare provider early; seek diagnosis and intervention therapies‬ ‭●‬ ‭Quit smoking, maintain a healthy diet, and exercise‬ ‭●‬ ‭Pulmonary rehabilitation‬ ‭Promoting Proper Breathing for COPD‬ ‭Abdominal/Diaphragmatic Breathing‬ ‭‬ L ● ‭ ay down on back with one hand on the chest and the other on the abdomen‬ ‭●‬ ‭Take a slow, deep breath in and out through the nose, feeling the belly rise‬ ‭‬ B ● ‭ reathe out, feeling the belly flatten; keep the hand on the chest as flat as possible‬ ‭●‬ ‭Can also be done sitting or standing‬ ‭●‬ ‭Repeat for 10 breaths twice daily in each position‬ ‭Pursed-Lip Breathing‬ ‭‬ H ● ‭ elps patients with asthma/COPD experiencing dyspnea or SOB‬ ‭●‬ ‭Gets oxygen into the lungs, moves carbon dioxide out, and slows respirations‬ ‭●‬ ‭Keeps airways open longer, allowing the removal of trapped air in the lungs‬ ‭Procedure‬ ‭●‬ ‭Sit down with the neck and shoulders relaxed‬ ‭●‬ ‭Breathe in slowly through the nose with the mouth closed‬ ‭●‬ ‭Pucker the lips as if whistling and exhale all air out slowly through the mouth‬ ‭●‬ ‭Continue until breath becomes normal‬ ‭Inhalers‬ ‭Types‬ ‭‬ N ● ‭ ebulizers‬ ‭●‬ ‭Metered-dose inhalers (MDIs)‬ ‭●‬ ‭Dry powder inhalers (DPIs)‬ ‭Administering Inhaled Medications‬ ‭Bronchodilators‬ ‭●‬ ‭Open narrowed airways and administered with an MDI (ex. Albuterol, theophylline)‬ ‭Administration‬ ‭●‬ ‭Shake inhaler well‬ ‭●‬ ‭Breathe out slowly and completely‬ ‭●‬ ‭Place mouthpiece in the mouth, and breathe in slowly and deeply‬ ‭●‬ ‭Press dose release button while inhaling‬ ‭●‬ ‭Hold breath for 5-10 seconds, and expire slowly through the mouth‬ ‭Mucolytic Agents‬ ‭●‬ L ‭ iquefy/loosen thick secretions and administered through a‬ ‭nebulizer (ex. ambroxol)‬ ‭○‬ ‭The nebulizer turns solution into mist, and medication is‬ ‭then inhaled through a face mask, moiuthpiece, or‬ ‭tracheostomy‬ ‭Administration‬ ‭●‬ ‭Pour medication of the required dosage into the medicine cup‬ ‭●‬ ‭Attach the top piece to the medicine cup, and then the mouthpiece/mask‬ ‭●‬ ‭Connect the tubbing from teh compressor to the medicine cup‬ ‭●‬ ‭Place the mask over the face or mouthpiece in the mouth between the teeth‬ ‭●‬ ‭Turn on the compressor and take normal breaths through the mouth until the medication‬ ‭has been depleted‬ ‭Corticosteroids‬ ‭●‬ R ‭ educe inflammation in the airways and‬ ‭administered with a DPI‬ ‭Administration‬ ‭●‬ ‭Activate the inhaler if necessary‬ ‭●‬ ‭Breathe out slowly and completely‬ ‭●‬ ‭Place the teeth over the mouthpiece, and seal the lips around it‬ ‭●‬ ‭Take a strong, steady, and deep breath through the mouth for 2-3 seconds‬ ‭●‬ ‭Hold the breath for 5-10 seconds, then slowly exhale‬ ‭●‬ ‭Rinse mouth with water after usage, and wait 5 minutes before the next puff‬ ‭Providing Supplemental Oxygen‬ ‭Sources of Oxygen‬ ‭‬ W ● ‭ all outlet‬ ‭●‬ ‭Portable cylinder‬ ‭Oxygen Flow Rate‬ ‭‬ O ● ‭ xygen dries and dehydrates the mucous membranes‬ ‭●‬ ‭Humidification should be used when higher than 2 L/min‬ ‭○‬ ‭Distilled or sterile water‬ ‭Oxygen Delivery Systems‬ ‭Nasal Cannula‬ ‭‬ M ● ‭ ost common; patients can still comfortable eat and sleep‬ ‭●‬ ‭Used when needs are low; low-flow or high-flow‬ ‭○‬ ‭High-flow: Higher concentrations‬ ‭●‬ ‭2 prongs in nostrils with tubing around ears and under chin‬ ‭○‬ ‭Should not be too tight‬ ‭○‬ ‭Preventive care for pressure injuries‬ ‭‬ D ● ‭ elivers 1-6 L/min (24-44% FiO‬‭2‬‭)‬ ‭●‬ ‭Can dry out airways (humidification) or be dislodged‬ ‭●‬ ‭May not be best choice for heavy “mouth breathers” or those with blocked nasal passages‬ ‭Nasopharyngeal Catheter‬ ‭‬ ● ‭●‬ ‭●‬ ‭●‬ ‭●‬ ‭ hin, flexible tube inserted into the nostril‬ T ‭For oxygen supplementation or airway suctioning‬ ‭Less comfortable and can dry out airways (humidification)‬ ‭Bypasses obstructions in the upper airway (ex. Relaxed tongue)‬ ‭Long-term NPAs are typically changed every 4-6 weeks‬ ‭Simple Face Mask‬ ‭‬ P ● ‭ lastic mask that covers the nose and mouth without a reservoir mask‬ ‭●‬ ‭Simple tubing with an elastic strap around the head‬ ‭●‬ ‭Flexible metal nose piece to ensure fitting‬ ‭○‬ ‭Otherwise, more room air mixes with O‬‭2‬ ‭(dilute)‬ ‭●‬ ‭Delivers 6-12 L/min (~60% FiO‬‭2‬‭)‬ ‭○‬ ‭If lower, CO‬‭2‬ ‭cannot gets trapped and is rebreathed‬ ‭●‬ ‭Often has an attachment to a nebulizer for meds‬ ‭●‬ ‭Small opening on sides‬ ‭○‬ ‭Facilitates proper mixing of room air and O‬‭2‬ ‭○‬ ‭Allows CO‬‭2‬ ‭to escape‬ ‭●‬ ‭Often used after extubation for surgical procedures; more intrusive than NC‬ ‭Venturi Mask‬ ‭●‬ ‭Tubing attaches to adjustable connection that changes the size of the hole for RA mixing‬ ‭○‬ ‭More precise control over delivered O‬‭2‬‭; most precise/accurate‬‭concentration‬ ‭●‬ ‭Deliver 4-12 L/min (24-60% FiO‬‭2‭)‬ ‬ ‭Oxygen Tent/Hood‬ ‭‬ S ● ‭ hield/tent around face that the oxygen fills at set concentrations‬ ‭●‬ ‭Good for patients who cannot tolerate masks but need higher flow than an NC‬ ‭gives‬ ‭Partial Rebreather Mask‬ ‭●‬ ‭Like simple mask but has reservoir bag with 100% O‬‭2‬ ‭○‬ ‭Holes on sides to allow RA air and out‬ ‭○‬ ‭Minimum 6 L/min flow‬ ‭●‬ ‭Delivers 6-10 L/min (~80% FiO‬‭2‬‭)‬ ‭Non-Rebreather Mask‬ ‭●‬ ‭Delivers highest concentrations of oxygen with low amounts of flow‬ ‭○‬ ‭Quickly gives high levels of oxygen for emergencies (O‬‭2‬ ‭desaturation)‬ ‭●‬ ‭Like partial rebreather with reservoir but one-way valves instead of holes on sides‬ ‭○‬ ‭Allows expired CO‬‭2‬ ‭to escape‬ ‭○‬ ‭Prevents RA back in‬ ‭●‬ ‭Delivers 6-16 L/min (~100%)‬ ‭○‬ ‭Minimum 6 L/min flow‬ ‭Precautions for Oxygen Administration‬ ‭Avoid Open Flames in the Patient’s Room‬ ‭●‬ ‭Remove candles, lighters, matches, etc.‬ ‭Place “No Smoking” Signs‬ ‭‬ S ● ‭ hould be on the door and inside the room‬ ‭●‬ ‭Make sure all visitors and staff are aware‬ ‭Check Electrical Equipment in Room‬ ‭ ‬ I‭ ncluding monitors, beds, and ventilators‬ ● ‭●‬ ‭Look for signs of damage, such as frayed wires or sparks‬ ‭Avoid Using Synthetic Fabrics‬ ‭‬ N ● ‭ ylon, acrylic, and polyester can generate static electricity‬ ‭●‬ ‭Choose natural, static-resistant fabrics like cotton for bedding and patient clothing‬ ‭Avoid Using Oils in the Area‬ ‭●‬ ‭Keep petroleum-based products, including Vaseline, lotions, and certain ointments away‬ ‭Monitor Oxygen Levels in the Room‬ ‭●‬ U ‭ se oxygen sensors or monitoring equipment to ensure the concentration of oxygen in‬ ‭the room remains at safe levels‬ ‭●‬ ‭High concentrations increase flammability‬ ‭Store Oxygen Tanks Safely‬ ‭‬ A ● ‭ void leaving tanks near heat sources‬ ‭●‬ ‭Ensure they are kept in a well-ventilated area to prevent oxygen-buildup if there’s a leak‬ ‭Educate Patients and Visitors‬ ‭●‬ ‭Provide clear instructions to patients and visitors about the dangers of oxygen use‬ ‭●‬ ‭Emphasize the importance of following these precautions for their safety‬ ‭Chest Tubes‬ ‭Types‬ ‭‬ ● ‭●‬ ‭●‬ ‭●‬ ‭ leural effusion: Fluid‬ P ‭Hemothorax: Blood‬ ‭Pneumothorax: Air‬ ‭Empyema: Pus‬ ‭Management‬ ‭‬ ● ‭●‬ ‭●‬ ‭●‬ ‭●‬ ‭ emove air/fluid from pleural cavity; creates vacuum‬ R ‭Should be kept below chest-level to facilitate drainage‬ ‭Encourage coughing and deep breathing‬ ‭Reposition patients every hour‬ ‭3-bottle/chamber system‬ ‭3 Chest Tube Chambers‬ ‭Collection Chamber‬ ‭●‬ ‭Collects drainage, which should be serosanguineous‬ ‭●‬ ‭Should be assessed q4h for color and amount‬ ‭●‬ ‭Notify provider if drainage is bright red or greater than 100 mL/hr (hemorrhage)‬ ‭Water Seal Chamber‬ ‭●‬ ‭Has ~2 cm of water‬ ‭●‬ ‭A one-way valve that allows air to come out but not in‬ ‭●‬ ‭There should not be continuous bubbling, indicating an air leak‬ ‭○‬ ‭Should be gentle tidaling and inhalation/expiration‬ ‭Suction Control Chamber‬ ‭●‬ ‭Indicates how much suction is being applied‬ ‭●‬ ‭Also contains water; should be bubbling, which means suction is functional‬ ‭Things to Avoid‬ ‭‬ M ● ‭ ilking the chest tube to get drainage down; can create a pneumothorax‬ ‭●‬ ‭If a client pulls their chest tube out, cover the incision site with a gloved hand, then place‬ ‭an occlusive dressing on the area‬ ‭○‬ ‭Do not try to replace the chest tube‬ ‭Assisting with Insertion and Removal‬ ‭‬ E ● ‭ nsure sterile technique‬ ‭●‬ ‭Support patient comfort and safety throughout the procedure‬ ‭●‬ ‭Measure/document the chest tube insertion point and alert the provider of any changes‬ ‭Monitor Respiratory Status and Vital Signs‬ ‭‬ R ● ‭ egularly check respiratory rate, heart rate, blood pressure, and oxygen saturation‬ ‭●‬ ‭Look for signs of distress or complications‬ ‭Check Oclusive Dressing‬ ‭‬ C ● ‭ onfirm dressing is secure and airtight‬ ‭●‬ ‭Prevent air leaks or infection risks‬ ‭●‬ ‭Assess skin for erythema, edema, irritation, swelling, or crepitus‬ ‭○‬ ‭Crepitus occurs when gas/air leaks into the subcutaneous layer‬ ‭Maintain Patency/Integrity of Drainage System‬ ‭‬ A ● ‭ ssess tubing for kinks, clots, or bloackages‬ ‭●‬ ‭Ensure system is functioning properly to facilitate drainage‬ ‭Artificial Airways‬ ‭Oropharyngeal Airway‬ ‭●‬ M ‭ anaging the airway of an unresponsive patient without a gag‬ ‭reflex‬ ‭●‬ ‭Several sizes; determine by measuring against side of face‬ ‭○‬ ‭Should go from the corner of lips to the bottom of ear lobe/angle of jaw‬ ‭●‬ ‭Open the patient’s jaw with a cross/scissor finger technique‬ ‭●‬ ‭Insert with the tip pointing toward the roof of the mouth‬ ‭●‬ ‭Once it touches the soft palate, rotate 180° into anatomical position‬ ‭○‬ ‭Flange should rest against lips/teeth‬ ‭●‬ ‭May also use tongue depressor to move tongue forward and down, then insert the airway‬ ‭into anatomical position‬ ‭●‬ ‭Once inserted, check for adequate air exchange‬ ‭Nasopharyngeal Airway‬ ‭●‬ U ‭ sed in responsive/unresponsive patients when oropharyngeal cannot‬ ‭be used‬ ‭●‬ ‭Several sizes; determine by comparing diameter to the patient’s nares‬ ‭(should be slightly smaller then largest one) then measuring from the‬ ‭tip of the nose to that of the earlobe‬ ‭‬ L ● ‭ ubricate the distal surface with a water-soluble lubricant‬ ‭●‬ ‭Insertion into right nare:‬ ‭○‬ ‭Follow anatomical curvature of nasopharynx with bevel toward the septum‬ ‭○‬ ‭Direct the airway along the floor of the nose into the oropharynx‬ ‭●‬ ‭Insertion into left nare:‬ ‭○‬ ‭Invert the airway so the bevel remains along the septum‬ ‭○‬ ‭Once the airway reaches the nasopharynx, rotate it 180° degrees to resume‬ ‭alignment with anatomical curvature‬ ‭○‬ ‭Continue to insert into the oropharyhnx‬ ‭○‬ ‭Once in place, check for adequate air exchange‬ ‭Endotracheal Tube‬ ‭●‬ I‭ ntubation/mechanical ventilation given in emergency situations involving severe‬ ‭respiratory problems (low O‬‭2‬ ‭or high CO‬‭2‬‭) and during‬‭general anesthesia‬ ‭●‬ ‭Endotracheal intubation is done with a laryngoscope, which has a light and dull blade, to‬ ‭guide the endotracheal tube to its proper position‬ ‭●‬ ‭Tilt the head back and insert the laryngoscope into the mouth and down the throat‬ ‭●‬ ‭Using the blade, gently raise the epiglottis and advance the tip of the endotracheal tube‬ ‭into the trachea‬ ‭●‬ ‭Once in the trachea, a balloon is inflated around the tube to secure it in place‬ ‭●‬ ‭The laryngoscope is then removed, and the tube is taped outside of the mouth‬ ‭●‬ ‭By inflating the lungs with an ambubag and listening for breath sound, proper positioning‬ ‭can be confirmed; an XR may also be used‬ ‭●‬ ‭The endotracheal tube is then connected to a pump that aids respiration by delivering‬ ‭well-oxygenated air into the lungs and permitting CO‬‭2‬ ‭escape‬ ‭●‬ ‭Not removed until patient can breathe independently‬ ‭Tracheostomy‬ ‭‬ A ● ‭ surgical procedure that creates an opening through the neck into the trachea‬ ‭●‬ ‭Obstruction of the upper airway, impaired respiratory function, loss of consciousness‬ ‭Complications‬ ‭‬ ● ‭●‬ ‭●‬ ‭●‬ ‭●‬ ‭●‬ ‭ ecrosis/obstruction due to improper cuff inflation‬ N ‭Loss of function in the aerodigestive tract (ex. Loss of voice)‬ ‭Reduced sense of smell and taste → compromised nutrition‬ ‭Impaired swallowing/risk of aspiration‬ ‭Accumulation of secretions and inability to cough (requiring suction)‬ ‭Atelectasis due to lost positive end-expiratory pressure‬ ‭Parts of a Tracheostomy‬ ‭‬ O ● ‭ bturator: For guiding into the trachea‬ ‭●‬ ‭Outer cannula: Main shaft‬ ‭●‬ ‭Inner cannula: Sterile, within outer cannula; cleaned or replaced‬ ‭Tracheostomy Care‬ ‭‬ ● ‭●‬ ‭●‬ ‭●‬ ‭●‬ I‭ nitially held down with sutures, which are removed after 7 days‬ ‭Administer heated, humidified oxygen‬ ‭Patients have ineffective coughing, so suctioning may be needed to remove secretions‬ ‭Routine oral suction and hygiene‬ ‭Replace a disposal inner cannula/clean a nondisposable one at least q8h‬ ‭○‬ ‭More frequent cleaning may be required based on patient status‬ ‭ ‬ ‭Regularly change any wet dressings/ties to prevent skin breakdown‬ ● ‭●‬ ‭Use careful techniques when cleaning to avoid dislodging it‬ ‭●‬ ‭Routine cleaning of the stoma site and changing the site dressing‬ ‭Tracheal Suctioning‬ ‭‬ P ● ‭ erformed to remove secretions from a tracheostomy tube and airway‬ ‭●‬ ‭Maintains a patent airway and avoids tube blockages‬ ‭Open Suctioning Technique‬ ‭●‬ ‭Requires disconnecting the patient from the ventilator‬ ‭Closed Suctioning Technique‬ ‭ ‬ I‭ nvolves attachment of a sterile, closed, in-line suction catheter to the ventilator circuit‬ ● ‭●‬ ‭Keeps the patient connected to the ventilator‬ ‭Purpose/Indications‬ ‭‬ ● ‭●‬ ‭●‬ ‭●‬ ‭ aintenance of airway integrity‬ M ‭Deterioration of oxygen saturation and/or arterial blood gas values‬ ‭Acute respiratory distress‬ ‭Removal of pulmonary secretions, blood, vomitus, or foreign material‬ ‭Guidelines‬ ‭‬ ● ‭●‬ ‭●‬ ‭●‬ ‭ uction pressure should be no more than 150 mmHg for adults‬ S ‭Should not be done for more than 15 seconds‬ ‭Make sure to have the right suction size‬ ‭Pre-oxygenate the patient with 100% oxygen‬ ‭Complications‬ ‭‬ ● ‭●‬ ‭●‬ ‭●‬ ‭●‬ ‭●‬ ‭ ypoxia‬ H ‭Infection‬ ‭Tissue damage‬ ‭Dyrhythmias‬ ‭Atelectasis‬ ‭Pain, discomfort, anxiety‬ ‭Clearing an Obstructed Airway‬ ‭‬ ● ‭●‬ ‭●‬ ‭●‬ ‭●‬ ‭●‬ ‭●‬ ‭ eimlich maneuver: Abdominal thrusts done to clear the airway, such as when choking‬ H ‭Wrap your arms around from behind and place your pinky at their umbilicus‬ ‭Make a fist and roll it up so that the thumb knuckle is against the abdomen‬ ‭Repeatedly thrust by pulling in and upward until the foreign object is dislodged‬ ‭If the person is pregnant or obese, do the same thing at the breastbone‬ ‭Can be done on self with a chair or other surface that will reach the diaphragm‬ ‭If person falls unconscious, roll them over and perform the same process‬ ‭Cardiopulmonary Resuscitation‬ ‭ ‬ I‭ nitiated when there is no pulse and person is unresponsive‬ ● ‭●‬ ‭Includes chest compressions and mouth-to-mouth breathing‬ ‭○‬ ‭Circulates blood through b ody‬ ‭○‬ ‭Provides air ot the lungs‬ ‭Defibrillation‬ ‭‬ S ● ‭ ends electrical shocks to the heart‬ ‭●‬ ‭Corrects arrhythmias‬ ‭CAB Sequence‬ ‭‬ ● ‭●‬ ‭●‬ ‭●‬ ‭ hest compressions: 2-inch depth at a rate of 100-120 per minute; 30 compressions‬ C ‭Airway: Tilt head back and check for breathing‬ ‭Breathing: Give 2 breaths (may use ambubag with mask)‬ ‭Use instructions on AED to use the defibrillator‬