Chapter 40 Oxygenation and Perfusion
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Nasal Cannula = low or high flow: most commonly used, 1-6 Lpm, high flow 30-60 Lpm up to 100% humidified air Simple Mask = low-flow, used when nasal cannula is contraindicated, 5-10 Lpm, don’t set flow rate <5Lpm possible Co2 retention. Nonrebreather = Gives highest concentration of O2 via low flow mask. Valves on the side of mask to prevent breathing in exhaled air, one way valve over reservoir bag prevent exhaled gas to enter bag. Flow rare 10-15, no less than 10Lpm Venturi Mask = High flow fixed performance device, allows mask to deliver most PERCISE concentrations of oxygen. The different barrels control O2 concentrations. Make sure ports on barrels are always open. Flow rate 4-6 Lpm= 24-40%

Suppressants = Codeine, Dextromethorphan Expectorant = Guaifensin Lozenges = Benzocaine Bronchodilator = Albuterol

Corticosteroid = Prednisone, Dexamethasone Antihistamine = fexofenadine, cetirizine, diphenhydramine Leukotriene receptor antagonist = Montelukast Blank = Blank

Normal Breath Sounds

<p>Vesicular = normal breath sound which is low-pitched, soft sound during expiration heard over most of the lungs Bronchial = normal breath sound which is high-pitched and longer, heard primarily over the trachea Bronchovesicular = normal breath sound which is medium pitch and sound during expiration, heard over the upper anterior chest and intercostal area Blank = Blank</p> Signup and view all the answers

Abnormal Breath Sounds

<p>Wheezes = continuous abnormal sounds heard on expiration and sometimes on inspiration as air passes through airways constricted by swelling, secretions, or tumors Crackles = intermittent abnormal sounds occurring when air moves through airways that contain fluid Wheezes Classification = sibilant or sonorous Crackles Classification = fine, medium, or coarse</p> Signup and view all the answers

Administering inhaled medications

<p>Bronchodilators = Open narrowed airways Nebulizers = disperse fine particles of liquid medication into the deeper passages of the respiratory tract MDI (Meter-dose inhalers) = deliver a controlled dose of medication with each compression of the canister Dry Powder inhalers = breath-activated delivery of medications</p> Signup and view all the answers

Medications

<p>Suppressants = for irritating non-productive cough w/o congestion depress a body function such as cough reflux. Expectorants = reduce the viscosity of secretions with congestion, make it easier to cough up mucus. Increased fluids and humidified air are also as effective Lozenges = used for nonproductive coughs w/o congestion, controls cough by local anesthetic Leukotriene receptor antagonists = Prevents asthma attacks</p> Signup and view all the answers

<p>Tidal Volume VT = This is the amount of air inhaled or exhaled during normal breathing. Vital Capacity VC = This is the total volume of air that can be exhaled after inhaling as much as you can. Forced Vital Capacity FVC = This is the amount of air exhaled forcefully and quickly after inhaling as much as you can. Forced expiratory volume FEV = This is the amount of air expired during the first, second, and third seconds of the FVC test.</p> Signup and view all the answers

<p>Residual Volume = This is the amount of air left in the lungs after exhaling as much as you can. Peak Expiratory Flow Rate PEFR = This is the fastest rate that you can force air out of your lungs. Mucolytic agents = liquefy or loosen thick secretions Corticosteroids = reduce inflammation in the airways</p> Signup and view all the answers

Factors Influencing Diffusion of Gases in the Lungs and their examples

<p>Change in surface area available = removal of lung, or diseased lung can decrease the surface area. Thickening of alveolar = capillary membrane- pneumonia or pulmonary edema Partial pressure = high altitude, presence of toxic fumes Solubility and molecular weight of the gas = Solubility and molecular weight of the gas</p> Signup and view all the answers

Match the following respiratory conditions with their descriptions:

<p>Hypoxia = Inadequate amount of oxygen available to the cells Dyspnea = Difficulty breathing Hypoventilation = Decreased rate or depth of air movement into the lungs Hyperventilation = Increased rate or depth of respiration</p> Signup and view all the answers

Match the breathing technique with its purpose:

<p>Coughing = Important for pre and postop care Tracheal suctioning = Maintains patent airway, removes secretions Humidification = Recommended for flowrates &gt;35%, trach pt's Prone position = Improves oxygenation for COVID and ARDS patients</p> Signup and view all the answers

What is the recommended position for a patient experiencing difficulty breathing?

<p>High Fowler's position</p> Signup and view all the answers

In patients with COVID and ARDS, which position is suggested to enhance oxygenation?

<p>Prone position</p> Signup and view all the answers

What is the primary purpose of tracheal suctioning in patients?

<p>Removing respiratory secretions</p> Signup and view all the answers

When should humidification be recommended for patients?

<p>Patients with artificial airways having sputum clearance issues</p> Signup and view all the answers

What is identified as the most common cause of airway obstruction in adults?

<p>Meat</p> Signup and view all the answers

What is the main organ of circulation in the cardiovascular system?

<p>Heart</p> Signup and view all the answers

Which condition is characterized by an inadequate amount of oxygen available to the cells?

<p>Hypoxia</p> Signup and view all the answers

What causes the appearance of leaning forward and limits respiratory ventilation in elders?

<p>Kyphosis</p> Signup and view all the answers

What can stress lead to, that results in low CO2 levels in arterial blood gas (ABG)?

<p>Hyperventilation</p> Signup and view all the answers

Which factor in older adults makes bony landmarks more prominent?

<p>Loss of subcutaneous fat</p> Signup and view all the answers

Why is it important for patients on CNS-affecting medications to be monitored?

<p>To ensure proper CNS function</p> Signup and view all the answers

_________ is carried via red blood cells due to binding between the hemoglobin in RBCs and oxygen

<p>Oxygen</p> Signup and view all the answers

What is the potential impact of medications that decrease heart rate on blood flow to body tissues?

<p>Decrease blood flow</p> Signup and view all the answers

What is a common issue associated with stress that can lead to an episode of bronchial asthma?

<p>Bronchospasms</p> Signup and view all the answers

How does barrel chest deformity in older adults affect their chest anatomy?

<p>Enlarges anteroposterior diameter</p> Signup and view all the answers

What is a common consequence of aging on the diaphragm's efficiency in older adults?

<p>More rigid movements</p> Signup and view all the answers

What effect can incorrect trach suctioning have on patients?

<p>Increased risk of respiratory arrest</p> Signup and view all the answers

Which organ is responsible for carrying oxygen to the body tissues in the cardiovascular system?

<p>Heart</p> Signup and view all the answers

Why is it recommended for patients on CNS-affecting medications to consume small, frequent meals throughout the day?

<p>To manage nausea caused by medications</p> Signup and view all the answers

In pre and postoperative care, why is coughing considered important?

<p>To clear secretions from the lungs</p> Signup and view all the answers

What is the primary purpose of a mechanical ventilator in patients with ET tubes or trach tubes?

<p>To assist with breathing</p> Signup and view all the answers

How can patient comfort be promoted according to the text?

<p>By positioning them properly</p> Signup and view all the answers

Older adults have an increased risk for disease, especially _________.

<p>Pnemonia</p> Signup and view all the answers

Hemoglobin also carries carbon dioxide

<p>True</p> Signup and view all the answers

Have patients eat 1-2 hours after breathing treatment and exercise

<p>True</p> Signup and view all the answers

Study Notes

Promoting Patient Comfort

  • Ways to promote patient comfort include proper positioning, humidifying oxygen, breathing techniques, pacing exercise, and allowing rest periods
  • Patients with difficulty breathing should be placed in high Fowler's position
  • For patients with COVID and ARDS, placing them in prone position will improve oxygenation
  • Coughing is important for pre and postop care
  • Humidification is recommended for flowrates >35%, trach pt's, artificial airways having difficulty coughing up sputum

Respiratory System

  • Hypoxia: inadequate amount of oxygen available to the cells, symptoms include dyspnea, anxiety, tachycardia, cyanosis, pallor, elevated B/P, and increased respiratory and pulse rate
  • Dyspnea: difficulty breathing
  • Hypoventilation: decreased rate or depth of air movement into the lungs
  • Hyperventilation: increased rate or depth of respiration

Cardiovascular System

  • The cardiovascular system is vital for exchange of gases
  • Oxygen is carried via red blood cells due to binding between the hemoglobin in RBCs and oxygen
  • Hemoglobin also carries carbon dioxide
  • Medications that decrease HR decrease CO potential to alter blood flow to body tissues

Complications in Older Adults

  • In older adults, bony landmarks are more prominent due to loss of subcutaneous fat
  • Kyphosis contributes to appearance of leaning forward and limits respiratory ventilation
  • Barrel chest deformity may result in increased anteroposterior diameter
  • Older adults have an increased risk for disease, especially pneumonia
  • Tissues and airways become more rigid; diaphragm moves less efficiently

Medication Considerations

  • Medications that affect the CNS need to be monitored
  • Medications can cause nausea and anorexia, so patients should consider small frequent meals throughout the day (not 3x day)
  • Have patients eat 1-2 hours after breathing treatment and exercise

Mechanical Ventilation and Tracheal Suctioning

  • Mechanical ventilator: used to assist or completely control ventilation in patients with ET tubes or trach tubes
  • Tracheal suctioning: maintains patent airway, removes pulmonary secretions, blood, vomitus, and foreign material
  • If done incorrectly, trach suctioning can lead to anxiety, pain, or respiratory arrest

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Test your knowledge on terms related to the respiratory system such as hypoxia, dyspnea, hypoventilation, and hyperventilation. Learn about the importance of the cardiovascular system in the exchange of gases and the role of the heart in circulation.

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