Gas exchange and Oxygenation ATI, Wk 4 Gas exchange-Perfusion study guide

Hydration

•Airway maintenance requires adequate hydration to prevent thick, tenacious secretions. Proper coughing techniques remove secretions and keep the airway open. A variety of interventions, such as suctioning, chest physiotherapy, and nebulizer therapy, assist patients in managing alterations in airway clearance.

A nurse is discussing atrial fibrillation with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates an understanding of atrial fibrillation?

"Atrial fibrillation is caused by electrical signals outside of the SA node".

A nurse is providing teaching for a client who has a new prescription for a continuous positive airway pressure (CPAP) machine to treat obstructive sleep apnea. Which of the following statements should the nurse include?

"Cover your nose with the CPAP mask".

A nurse is providing teaching for a client who has a new prescription for an incentive spirometer. Which of the following instructions should the nurse include?

"Use the incentive spirometer every hour while awake."

A nurse is obtaining a health history from a client. Which of the following findings should the nurse identify as risk factors for heart disease?

- A diet high in saturated fats - A history of smoking for 25 years - A sedentary lifestyle

A nurse is explaining the sequence of electrical conduction in the heart to a newly licensed nurse. What should the nurse include as the correct sequence of the transmission of electrical impulses?

- SA node - AV node - Bundle of His - Right and left bundle branches - Purkinje fibers

A nurse is providing teaching for a client who has a prescription for home oxygen. Which of the following instructions should the nurse include?

1. Post a "No smoking" sign inside the home 2. Attach oxygen containers to a fixed object 3. Notify the fire department that oxygen is used in the home

A nurse is teaching a client who has an abdominal incision about coughing and deep breathing. In which order should the nurse instruct the client to perform the following steps?

1. Take a deep breath 2. Hold your breath for several seconds 3. Exhale slowly 4. Brace the incision with a pillow and try to cough deeply

Partial and Nonrebreather Mask- Flow Rate Setting- Oxygen Concentration- Advantages- Disadvantages-

10-15L 80-95% High levels of concentration without carbon dioxide. Nor for resp failure or COPD, O2 toxicity

A nurse is planning care for a group of clients on a cardiopulmonary unit. Which of the following clients should the nurse plan to see first?

A client who reports dyspnea when walking to the bathroom

A nurse is suctioning a client's tracheostomy using an open system. Which of the following actions should the nurse take?

Administer 100% oxygen before the procedure

A nurse is discussing ventilation and perfusion withe a newly licensed nurse. The nurse should include in the discussion that the exchange oof oxygen and carbon dioxide occurs at which of the following locations?

Alveoli

Wheezing

Is a whistling or a musical noise that is heard on exhalation. It is caused by constricted airways. Asthma and COPD.

A nurse is performing chest percussion therapy on a client. Which of the following actions should the nurse take?

Listen for a hollow sound when performing chest percussion therapy

Kussmaul breathing

Metabolic acidosis Hyperpnoea Ketones Uremia Sepsis Salicylates Methanol Aldehydes Lactic acid/Lactic acidosis

A nurse caring for a client who has a chest tube. Which of the following actions should the nurse take

Monitor the client for subcutaneous emphysema

A nurse is auscultating a client's heart sounds and hears low-pitched whooshing or blowing sound over the apex of the heart. The nurse should identify that this indicates which of the following?

Murmur

A nurse is caring for a client who requires 1 L of oxygen. Which of the following oxygen delivery devices should the nurse expect to us?

Nasal cannula

A nurse is assessing a client who is being discharged. The nurse notes the client has a regular and quiet breathing. The nurse should identify this breathing pattern as which of the following?

Normal breathing

A nurse is caring for a client who has a history of asthma and is wheezing. Which of the following actions should the nurse take first?

Obtain the oxygen saturation

A nurse is assessing a client who is receiving oxygen therapy. The nurse should identify that which of the following findings can indicate oxygen toxicity?

Ringing in the ears

Describe positions that assist with difficulty breathing.

Semi-Fowlers and High Fowlers

Lifestyle factors: · Nutrition

Severe obesity decreases lung expansion, and increased body weight increases tissue oxygen demands. The malnourished patient experiences respiratory muscle wasting, resulting in decreased muscle strength and respiratory excursion

A nurse is caring for a client who requires 7 L of oxygen saturation. Which of the following oxygen delivery devices should the nurse expect to use?

Simple face mask

A nurse is caring for a client who is receiving supplemental oxygen for hypoxia. The nurse should identify that which of the following can cause hypoxia?

Smoke inhalation

Rhonchi

Sound like rattling and are caused by obstruction of the airway.

Stridor

Sounds much like wheezing but is caused constriction in the upper airways and is heard on inhalation. Medical Emergency. It can be caused by and inflammation of the epiglottis or by croup, a viral infection.

A nurse is reviewing the medical history of a client who has heart disease and a narrowed valve. Which of the following findings should the nurse expect?

Stenosis

A nurse is planning to measure the cardiac output of a client who had a myocardial infarction. Which of the following data should the nurse use to calculate the client's cardiac output?

Stroke volume

A nurse is caring for a client who has atelectasis. The nurse should identify that which of the following substances is required to keep the client's alveoli from collapsing and causing atelectasis?

Surfactant

afterload

The amount of resistance or force that occurs when the heart ejects blood from the left ventricle.

preload

The blood remaining in the left ventricle at the end of diastole causing it to stretch.

contractility

The force required to eject blood from the left ventricle.

A nurse is teaching a newly licensed nurse about pulmonary function tests. The nurse should include that which of the following is the vital capacity?

The maximum volume of air that is expired after a maximum inspiration

Simple Mask- Flow Rate Setting- Oxygen Concentration- Advantages- Disadvantages-

The simple face mask (Fig. 41-16) is used for short-term oxygen therapy. It fits loosely and delivers oxygen concentrations from 6 to 12 L/min (35% to 50% oxygen). The mask is contraindicated for patients with carbon dioxide retention because retention can be worsened. Flow rates should be 5 L or more to avoid rebreathing exhaled carbon dioxide retained in the mask. Be alert to skin breakdown under the mask with long-term use.

What would you expect your patient's vital signs to be when they have difficulty breathing? Explain

The vitals would be elevated, with a low oxygen saturation.

Biot's respirations

aka ataxic respiration Periodic breathing: hyperpnoea and apnoea poor prognosis Neuron damage

Atelectasis

collapse of airways and small sections of the lung as a result of shallow breathing. The collapsing of the lung during expansion.

Bradypnea

is defined as a heart rate less than 60 beats per minute.

Tachypnea

is defined as a heart rate of 100 beats per minute or greater.

Hypoxemia

occurs when there is a decreased amount of oxygen in the blood and can lead to hypoxia.

stroke volume

volume of blood ejected by the left ventricle during one contraction.

Diaphragmatic breathing

• is useful for patients with pulmonary disease, postoperative patients, and women in labor to promote relaxation and provide pain control. The exercise improves efficiency of breathing by decreasing air trapping and reducing the WOB.

A nurse is assessing a client who has COPD. The nurse should identify that which of the following is an expected finding?

Clubbing of the fingers

A nurse is caring for a client who has left-sided heart failure. Which of the following findings should the nurse expect?

Crackles in the lungs

Nasal Cannula- Flow Rate Setting- Oxygen Concentration- Advantages- Disadvantages-

1-6 L 24-44% Inexpensive, may use while eating Can cause breakdown behind ears or around the nares.

Crackles

are caused by fluid filling the air sacs; they sound like popping and crackling. Clients with pneumonia or infection may cause this.

A client with chronic obstructive pulmonary disease (COPD) is prescribed oxygen at 2 L/min. Which is the best method to administer oxygen to this client?

•B) Nasal cannula The oxygen delivery device that would safely administer oxygen at the flow rate of 2 liters per minute is through nasal cannula. The other delivery devices are better suited for higher percentages of oxygen and higher flow rates.

Lifestyle factors: · Smoking

•Cigarette smoking and secondhand smoke are associated with a number of diseases, including heart disease, COPD, and lung cancer.

The nurse assigned to the newborn nursery is conducting shift assessments. While assessing one newborn, the nurse notes the respiratory rate is 52 breaths per minute. Which action by the nurse is appropriate?

•D) Continue to monitor the newborn per facility policy. A respiratory rate of 52 breaths per minute is a normal finding in a newborn. Respiratory rates are highest and most variable in newborns. The respiratory rate of a neonate or newborn is 30-60 breaths per minute.

Gas Exchange

•Delivery depends on the amount of oxygen entering the lungs (ventilation), blood flow to the lungs and tissues (perfusion), rate of diffusion, and oxygen-carrying capacity. •Three things influence the capacity of the blood to carry oxygen: the amount of dissolved oxygen in the plasma, the amount of hemoglobin, and the ability of hemoglobin to bind with oxygen.

What diagnostics would you like to have for your patient and why? What would they tell you?

•Impaired Gas exchange •Ineffective Breathing Pattern Due to airway being the biggest concern.

Discuss the following factors that influence oxygenation Developmental factors: · Infants and toddlers

•Infants and toddlers are at risk for upper respiratory tract infections as a result of frequent exposure to other children, an immature immune system, and exposure to secondhand smoke.

Suctioning techniques:

•Oropharyngeal and Nasopharyngeal Suctioning

Lifestyle factors: · Substance Abuse

•Second, excessive use of alcohol and certain other drugs depresses the respiratory center, reducing the rate and depth of respiration and the amount of inhaled oxygen.

The nurse is instructing a hospitalized client with a respiratory disorder about measures that will enhance the effectiveness of breathing during dyspneic periods. Which of the following positions will the nurse instruct the client to assume?

•Sitting on the side of the bed and leaning on the over bed table This is a description of the orthopneic position.

Lifestyle factors: · Stress

•The body responds to anxiety and other stresses with an increased rate and depth of respiration.

Nebulization

•adds moisture or medications to inspired air by mixing particles of varying sizes with the air.

Discuss the following factors that influence oxygenation Developmental factors: · Young and middle aged adults

•are exposed to multiple cardiopulmonary risk factors: an unhealthy diet, lack of exercise, stress, over-the-counter and prescription drugs not used as intended, illegal substances, and smoking.

Discuss the following factors that influence oxygenation Developmental factors: · School Age Children and adolescents

•are exposed to respiratory infections and respiratory risk factors such as cigarette smoking or secondhand smoke.

Discuss the following factors that influence oxygenation Developmental factors: · Older adults

•experience alterations in cardiac function as a result of calcification of the conduction pathways, thicker and stiffer heart valves caused by lipid accumulation and fibrosis, and a decrease in the number of pacemaker cells in the SA node.

Explain the benefits of Cardiopulmonary rehabilitation for patients.

•helps patients achieve and maintain an optimal level of health through controlled physical exercise, nutrition counseling, relaxation and stress-management techniques, and prescribed medications and oxygen.

Lifestyle factors: · Exercise

•increases the metabolic activity and oxygen demand of the body. The rate and depth of respiration increase, enabling the person to inhale more oxygen and exhale excess carbon dioxide.

Pursed Lip breathing

•involves deep inspiration and prolonged expiration through pursed lips to prevent alveolar collapse. While sitting up, instruct the patient to take a deep breath and exhale slowly through pursed lips as if blowing through a straw. Have him or her blow through a straw into a glass of water to learn the technique.

Chest physiotherapy:

•is a group of therapies used to mobilize pulmonary secretions. These include postural drainage, chest percussion, and vibration. You will want to work collaboratively with respiratory therapists when using these techniques.

Orthopnea

•is an abnormal condition in which a patient uses multiple pillows when reclining to breathe easier or sits leaning forward with arms elevated.

Dyspnea

•is associated with exaggerated respiratory effort, use of the accessory muscles of respiration, nasal flaring, and marked increases in the rate and depth of respirations. The use of a visual analogue scale (VAS) helps patients objectively assess their dyspnea.

Dyspnea management:

•is difficult to measure and treat. Treatments are individualized, and more than one therapy can be implemented. •Oxygen therapy reduces dyspnea associated with exercise and hypoxemia.

Coughing and deep breathing techniques:

•is effective for maintaining a patent airway. Directed coughing is a deliberate maneuver that is effective when spontaneous coughing is not adequate.

Apnea

•is the absence of respirations for lasting for 15 seconds or longer.

Humidification:

•is the process of adding water to gas. Humidification is necessary for patients receiving oxygen therapy at greater than 4 L/min (check agency protocol). It might be necessary to add humidification at lower oxygen concentrations if the environment is dry and arid. Bubbling oxygen through water adds humidity to the oxygen delivered to the upper airways.

Artificial airways: Maintenance and promotion of Oxygenation:

•is to prevent or relieve hypoxia by delivering oxygen at concentrations greater than ambient air (21%). •Oxygen has dangerous side effects such as oxygen toxicity. The dosage or concentration of oxygen is monitored continuously. Routinely check the health care provider's orders to verify that the patient is receiving the prescribed oxygen concentration. The six rights of medication administration also pertain to oxygen administration.

Venturi Mask- Flow Rate Setting- Oxygen Concentration- Advantages- Disadvantages-

•mask delivers higher oxygen concentrations of 24% to 60% and usually requires oxygen flow rates of 4 to 12 L/min, depending on the flow-control meter selected.

Cheyne-Stoke respirations

•occurs when there is decreased blood flow or injury to the brainstem. •Conditions such as emphysema, advancing age, and COPD cause the chest to assume a rounded "barrel" shape.