Chapter 39: Oxygenation
What is a bronchoscopy used for?
- To examine and collect specimens
What is the room air FIO2?
21%
The pediatric nurse is caring for four clients. Which client will receive the greatest benefit from the use of an oxygen analyzer to assure that the client is receiving the prescribed amount of oxygen?
3-year old in croup tent An oxygen analyzer is used most commonly when caring for newborns in isolettes, children in croup tents, and clients who are mechanically ventilated. Other answers are incorrect.
How many liters does a venturi mask deliver? NSG 321 ppt
4 to 10 liters
How many liters does a simple face mask deliver? NSG 321 ppt
6 to 10 liters
When do you start humidifying air from nasal cannula? NSG 321 ppt
After 4 liters
When is the best time to collect sputum? NSG 321 ppt
In the am before breakfast
What is a nebulizer? NSG 321 ppt
It disperses medication and adds moisture to medication to inspired air by mixing particles of varying sizes with the air
When reviewing data collection on a client with a cardiac output of 2.5 L/minute, the nurse inspects the client for which symptom?
Rapid respirations Normal cardiac output averages from 3.5 L/minute to 8.0 L/minute. With decreased cardiac output, there is a reduction in the amount of circulating blood that is available to deliver oxygen to the tissues. The body compensates by increasing respiratory rate to increase oxygen delivery to the tissues. The client with decreased cardiac output would gain weight, have decreased urine output, and display mental confusion.
What are normal findings when inspecting a patient's chest?
The adult chest contour is slightly convex, with no sternal depression. The skin of the thorax should be warm and dry, and the anteroposterior diameter of the chest should be less than the transverse diameter. The contour of the intercostal spaces should be flat or depressed.
What are some things to remember with oxygen safety? NSG 321 ppt
- Supports combustion - NO SMOKING - Avoid static electricity - Place an "oxygen in use" sign on the door
What are the normal ranges for: - pH - PCO2 - PO2 - HCO3 NSG 321 ppt
- pH: 7.35-7.45 - PCO2: 35-45 - PO2: 80-100 - HCO3: 22-26
The nurse must obtain a blood specimen for blood gas analysis. What is the most important thing for the nurse to do immediately after the needle has been removed?
Apply steady, firm pressure on the puncture site for 5 to 15 minutes.
What is thoracentesis? NSG 321 ppt
Insertion of a large bore needle through the chest wall into the pleural space to obtain specimen for diagnostic evaluation, remove pleural fluid, or instill medications into the pleural space.
A health care provider orders the collection of a sputum specimen from a client with a suspected bacterial infection. Which action best ensures a usable specimen?
Instruct the client to inhale deeply and then cough. The client should be instructed to inhale deeply and cough; if this results in sputum, it should be collected in the container. The client should be placed in a semi-Fowler's position and instructed to clear the nose and throat and rinse the throat with water.
What is diaphragmatic breathing? NSG 321 ppt
- It is used with COPD patients - It strengthens the diaphragm during breathing, reducing respiratory rate and volume - Uses pursed lip breathing to lengthen the expiration time - Repeat for 1 minute and rest for 2 minutes
When doing a bronchoscopy, what is important for the nurse to remember? NSG 321 ppt
- Observe for difficulty breathing - NPO until cough reflex returns
What are some issues that specifically older patients deal with as a result of age? NSG 321 ppt
- Reduced ventilation and gas exchange - Decreased cilia action and cough reflex - Chest wall compliance decreased - These can be related to posture
Which dietary guideline would be appropriate for the older adult homebound client with advanced respiratory disease who informs the nurse that she has no energy to eat?
Eat smaller meals that are high in protein. The client should consume a diet in which the body can produce plasma proteins. The client should have sufficient caloric and protein intake for respiratory muscle strength.
How many liters per minute can nasal cannula oxygen deliver? What are the different concentrations? NSG 321 ppt
- 1 to 6 L/min - 1 liter per minute: 24% - 2 liter per minute: 28% - 3 liter per minute: 32% - 4 liter per minute: 36% - 5 liter per minute: 40% - 6 liter per minute: 44% - Typically 24-28%*
What is the typical wall suction for an adult? Infant? NSG 321 ppt
- Adult: 100 to 120 mmHg - Infant: 80 to 100 mmHg
What does a pulse oximeter measure? NSG 321 ppt
- Arterial hemoglobin oxygen saturation (SAO2 or SpO2) - This does NOT replace ABG's - Use the index, middle, or ring finger - Might have to use earlobe, forehead, bridge of nose - Hypotension, BP cuff, cold extremity, and bright lights can interfere with reading
What are some ideas to keep in mind when handling preoperative respiratory management?
- Assessment - Improving airway clearance - Teaching the patient
What are some breathing exercises for chest physiotherapy? NSG 321 ppt
- Diaphragmatic - Pursed lip - Effective coughing
What is chest physiotherapy? NSG 321 ppt
- It is a group of treatments to mobilize pulmonary secretions - Includes postural drainage - Chest percussion and vibration - Diaphragmatic breathing - Pursed lip breathing - Effective coughing
What is important to know about supplemental oxygen? NSG 321 ppt
- It is a medication - It requires a doctor's order - A patient can experience oxygen toxicity
What is diaphragmatic breathing and what is it used for? NSG 321 ppt
For COPD patients - It strengthens the diaphragm during breathing, reduce respiratory rate and tidal volume
Which diagnostic procedure measures lung size and airway patency, producing graphic representations of lung volumes and flows?
Pulmonary function tests Pulmonary function testing is used to measure lung size and airway patency. Chest x-rays are used to detect pathologic lung changes. Bronchoscopy allows the visualization of the airways directly. Skin tests are used to detect allergies.
The nurse is planning a diet for a client with chronic obstructive pulmonary disease (COPD). Which recommended nutritional guidelines would the nurse discuss with the client? Select all that apply.
The diet should be rich in antioxidants and vitamins A, C, and B. The diet should contain 12% to 20% protein. The diet should consist of 40% to 55% carbohydrates. Clients who have COPD require a high-protein/high-calorie diet to counter malnutrition. Obese clients with COPD should be encouraged to lose weight using a calorie-controlled diet. Diets for COPD clients should be 40% to 55% carbohydrates, 30% to 40% fat, and 12% to 20% protein. A diet rich in antioxidants, vitamins A and C, and the B vitamins is important to maintain health and fight off infection.
A nurse is volunteering at a day camp. A child is stung by a bee and develops wheezing in the upper airways. The child is experiencing:
a bronchospasm. When allergic responses take place in the lungs, breathing difficulties are far more severe. Small airways become edematous, mucus production increases, and inflammatory chemical mediators cause bronchospasm.
How many liters does a nonrebreather mask deliver? What is the concentration? NSG 321 ppt
- 6 to 15 liters - 60 to 100%
What is special about COPD patients? NSG 321 ppt
- Stimulus is decreased with oxygen rather than carbon dioxide level - Their O2 Stat level may only be able to be at 93%
Which guideline is recommended for determining suction catheter depth when suctioning an endotracheal tube?
Using a suction catheter with centimeter increments on it, insert the suction catheter into the endotracheal tube until the centimeter markings on both the endotracheal tube and catheter align, and insert the suction catheter no further than an additional 1 cm.
The nurse is caring for a client with a 35% Venturi mask. Which administration considerations should the nurse use? Select all that apply.
- Ensure that air intake valves are not blocked. - Examine the needed flow rate on the mask matches the rate on the oxygen flow meter. Use gauze pads under elastic strap to relieve irritation to scalp or ears.
The client demonstrates soft, high-pitched, discontinuous sounds in the left lower lobe of the lung. How will the nurse accurately document this finding?
Crackles Crackles are soft, high-pitched, discontinuous sounds. Wheezes are a whistling or rattling sound in the chest as a result of obstruction in the air passages. Rales are small clicking, bubbling, or rattling sounds in the lungs. They are heard when a person breathes in (inhales). Vesicular breath sounds are heard across the lung surface.
The health care provider has prescribed an oropharyngeal airway for a client with a decreased level of consciousness. The health care provider has noted gurgling respirations and the client's tongue is in the posterior pharynx. The client vomits as the airway is inserted. Which actions should the nurse take? Select all that apply.
Provide oral suctioning and mouth care. Position client onto the side immediately. Remove oropharyngeal airway.
The nurse is caring for a client with respiratory acidosis. Which arterial blood gas data does the nurse anticipate finding?
pH less than 7.35; HCO3 high; PaCO2 high
Normal Ranges ABG's
pH: 7.35-7.45 PCO2: 35-45 PO2: 80-100 HCO3: 22-26
A client with closed-angle glaucoma and a cough has a prescription for a cough medicine. The nurse would question which cough medicine if prescribed for this client?
Cough medicine with an antihistamine The client with closed-angle glaucoma should avoid cough medicine because of its anticholinergic action. The client with diabetes should avoid cough medicine with a high sugar content. The client with thyroid disorders should avoid cough medicine containing iodine. The client with hypertension should avoid cough medicine with decongestants.
The nurse is preparing a client for a complete blood count test. Which actions would the nurse perform? Select all that apply.
Inform the client that this test can assist in evaluating the body's response to illness. Inform the client that specimen collection takes approximately 5 to 10 minutes. Explain that, based on results, additional testing may be performed. The complete blood count (CBC) measures several hematologic factors such as white blood cell count, red blood cell count, hematocrit, and hemoglobin. The test indicates the body's response to illness, and may take 5 to 10 minutes to collect. The results of the CBC may indicate that further testing is needed. There may be some discomfort experienced during the venipuncture, but not to the point of the client needing analgesics prior to the test. Food and fluid does not need to be withheld prior to this test.