O2

Surfactant

A liquid substance produced by the lung that reduces surface tension in the alveoli. Surfactants prevents lung collapse and decreases the effort needed to expand the lungs (inhale).

Anoxia

A total lack of oxygen availability to the tissues

Chemical Regulation =

Chemicals that respond to chemical changes of CO2, O2, and H+ in body

Compliance of Lungs

Ease with which lungs and chest wall expand and contract depends on elasticity of lungs and surface tension.

Hypercapnia

Excessive carbon dioxide in the blood

Suction Fact

Cant delegate Nasopharyngeal Suctioning to CNA

Chemoreceptors

Located in the medulla of the brainstem, the carotid arteries, and the aorta detect changes in blood pH, H+, O2, and CO2 levels, and they send messages back to the central respiratory center in the brain stem.

Environmental Factors

Location (Urban - pollution Rural - Fungal Resp Diseases ↑ Altitude = ↓ O2 & ↑ Resp, Heat/humidity = hard to breath, & allergens) Occupational Exposure (Paint, Glues, Aspestis)

Expectorants

Loosen bronchial secretions by reducing surface tension of secretions; used for dry nonproductive cough, used in many OTC cold remedies along with analgesics, antihistamines,decongestants, antitussives

Route of O2 Delivery to body

Lungs → Heart → Body

Transportation of CO2 & O2 is influenced by

Lungs, Pt Abilities, Hgb Content

High Flow Oxygen Therapy

Meets entire O2 needs; delivers higher concentration of O2 for Critically ill Ex) Venturi Mask, Face Tent, Aerosal Mask, Tracheostomy Mask

Ventilation Factors

Neural/Chemical Regulators Factors for work of breathing Degree of Compliance of Lings Ability of Active Expiration Airway Resistance Ability of Accessory Muscles

Respiration is controlled by

Neuro-regulation - Nerve supply that balances breathing

Nonrebreather Mask

Nonrebreather mask delivers oxygen concentrations of 95-100% O2 at flow rates of 6-10 L/min. CO2 exits mask upon exhalation and is not inhaled again. Low flow system & Short-Term. Covers mouth and nose. Used for unstable pt

Eupnea

Normal breathing

Lifestyle Factors

Nutrition (Iron/Adequate Fluids to thin secretions) Exercise Smoking (↓ cillia, ↑ sputum production, ↑ Bronchio Spasms, 10x more at risk for lung cancer) Substance Abuse (Alcohol depresses Resp system / risk for aspiration D/T vomiting) Stress (Emotion depress Resp; Anxiety - ↑ Resp, ↑ Metabolic Rate, ↑ O2 Demand)

Factors affecting Respiratory Function

Physiological Developmental Lifestyle Environmental

Decreased Diffusion

Pneumonia

Physiological conditions affecting chest wall movement

Pregnancy Obesity Musculoskeletal Abnormalities (Doesnt allow full expansion of lungs) Trauma NMS Disease CNS Alterations Chronic Disease Drugs (Narcotic/Sedative) Pain

NSAIDS for asthmatics

Prevent airway inflammation from occurring by stabilizing lung mucosa and prevent release of histamines, not for acute attacks, not to be taken on daily basis

General care for O2 devices

Provide good oral care, keep device clean (secretion in mask/tubes), change device as per protocol, disposable-can replace

Late Signs of O2 Toxicity

Pulmonary Edema & Progressive Fibrosis of Lungs

Kussmaul Respiration

Related to diabetic acidosis, Deep, rapid respirations, occurs in metabolic acidosis to decrease CO2 and thereby reduce carbonic acid.

Developmental Factors for School Age/Adolescents

Respiratory Infections Common, Start to Smoke

Oxygen Therapy

Room Air = 21% O2 Respiratory Device = 22 - 100% O2 Supplement

Phrenic Nerve

Supplies the Diaphragm muscle

Suctioning

Takes no longer than 15 seconds, Allow 20-30 between suctions, Insert Cath 4-6 inches

What O2 device delivers the most precise O2 concentration?

Venturi Mask

Cerebral Cortex controls

Voluntary control of Breathing

Incentive Spirometry

a device that provides a visual goal encouraging the client to execute and sustain maximal inspiration. Opens airways, reduces actelectasis, stimulates coughing. Have client breath in deeply, hold for 3 seconds then exhale. Used frequently post-op. Use 5-10x while awake, Measures Inspiration volume

Pneumothorax

air in the pleural cavity caused by a puncture of the lung or chest wall

Corticosteroids

anti-inflammatory agents, Among the most widely used drugs in the world. Effective in many inflammatory and immune diseases. Most common use is in treatment of asthma where inhaled corticosteroids are used as first line therapy

Manifestations of O2 Toxicity

dry hacky cough, chest pain, N&V, parethesia, dyspnea, malaise (discomfort), sore throat, nasal stuffiness

FIO2

fraction of inspired oxygen

Oxygen Toxicity

this condition appears as tissue becomes soft/necrotic. it interferes with oxygen diffusion and reduces surfactant if too high of O2 level, Monitor ABGs to avoid this. It can result from prolonged exposure to O2, determined by pt's tolerance, exposure time, effective dose, can develop into Adult Resp Distress Syndrome →collapsed lung

Common causes of inaccurate pulse oximetry readings

not being properly attached to the patient's finger or ear lobe correctly, being placed on a patient who is shivering or frequently moving, being placed on skin with dark pigmentation, being attached to cold fingers or fingers with fake nails, bright room lighting and nail polish obstructing the laser.

Partial Rebreather Mask

patient to rebreathe 1/3 of exhaled air to conserve O2 by permitting it to be rebreathed from reservoir bag. Delivers 50-65% O2, 6-10 L/min. Shrot-Term

Route of Deoxygenated blood

Body → Heart → Lungs

Leukotriene modifiers

Used to reduce inflammation and ease bronchoconstriction. Inhibit inflammation. (Oral medications), Suppress the action of leukotrienes (substances that promote bronchocontriction, as wells as eosinophil infiltration, mucous production and airway edema

O2 Toxicity Fact

Can happen with delivery of >50% O2 concentration longer than 24 hrs

Where does Tissue Perfusion take place

Capillaries

Body needs adequate _____ to carry O2 and CO2

Hemoglobin

Venturi Mask

High Flow; Delivers fixed amounts of O2, meets all ventilation needs; May be used for extended period of time; use 4-12 L/min; 24-60% O2; have coded adapters that determine concentration; used with unstable COPD pt's

Safety with Oxygen

Is a drug, check liter flow, has necessary physiologic effects, Combustible, not stored in the body, Need an order, No Smoking Sign, H2O based lubricant/not oil, teach pt to use cotton clothes/blankets, avoid wool/synthetic materials that can cause a spark, have fire extinguisher, check electrical equipment is grounded

Face Tent

used with NICU/peds pts can replace O2 mask when they are poorly tolerated. Provides 30-50% concentration of O2 at 4-8L/min. Useful with fever pt b/c it has a cooling effect. High Flow

Developmental Factors for Older Adults

↓ Aveoli, ↓ Cough Reflex, ↓ Airway Reflex

What influences Transport of O2

-Amount of O2 coming into Lungs -Lung Tissue Perfusion -Pt ability to blow out CO2 -O2 carrying capacity of blood

Developmental Factors for Infants/Toddlers

2nd Hand Smoke, More Prone to Respiratory Infections, Risk for Aspiration (Toys in Mouth)

Bronchodilators

ACTION = Drugs used to increase airflow by dilating constricted airways through relaxation of the smooth muscles that surround the bronchioles and bronch

Hypovolemia

Abnormally low blood volume.

Bradypnea

Abnormally slow rate of respiration usually of less than 10 breaths per minute

Apnea

Absence of breathing

Antitussives

Act on the cough-control center in the medulla to suppress cough reflex; for nonproductive/irritating cough, Dextromethorphan (Robitussin DM, Contac Cold Formula), Codeine used in small amounts

Orthopnea

An abnormal condition in which a person must sit or stand to breathe deeply or comfortably.

Tachypnea

An abnormally rapid rate of respiration usually or more than 20 breaths per minute.

Medulla Regulates

Anomatic control of breathing

Hypoxemia

Arterial blood oxygen (paO2) level less than 60 mm Hg; low oxygen level in the blood.

Most common Antihistamine

Benadryl

Decongestants

Block Alpha receptors which cause vasoconstriction of capillaries of nasal mucosa, Shrinks nasal mucosa membranes, Reduce fluid secretions (runny nose), act promptly, cause few side effects.

Antihistamines

Block H1 receptors : block dilation of vessels; block increased thin mucus (runny nose), dryness of mouth, nasal itching/tickling that causes sneezing, In many OTC drugs, may cause drowsiness

Pulmonary Perfusion

Blood flow through pulmonary vessels

Aspiration

Breathing fluid, food, vomitus, or an object into the lungs

Theophylline

Bronchodilator - requires drug concentrations drawn

Nail Clubbing =

Chronic Hypoxia

Atelectasis

Collapsed lung; incomplete expansion of alveoli

What is Worst DAR or DOE?

DAR

Pulse Oximetry

Determines % of Hgb saturated by O2 via sensor over translucent area of arterial pulsation (finger, toe, & earlobe)

Dyspnea

Difficult or labored breathing

Tissue Perfusion takes place in the Body by

Diffusion

Diffusion Fact

Diffusion can be decreased if have thick secretions that impair O2 & CO2 exchange

Hypoxia

Diminished O2 availability to body cells R/T deficiency in use of O2 or delivery of O2 to body

Low Flow Oxygen Therapy

Doesnt supply all O2 for needs / Partial supply w room air Ex) Nasal Cannula, Simple Face Mask, Partial Rebreather Mask, Non-Rebreather Mask

DAR

Dyspnea at Rest

DOE

Dyspnea on exertion

Basic Nursing Respiratory Measures

Encourage Vaccinations (Flu/Pne) Encourage Life Changes Teach ways to Prevent Occupational Exposures Dyspnea Management (Pursed Lip Breathing) Airway Maintenance Pt Mobilization (Up & About, TCDB - Turn/Cough/Deep Breath, Re/Positioning - Head of Bed up) Maintain O2 Devices (Incentive Spirometry, Nasal Cannula, Mask)

Most Common Expectorant

Guaifenesin -(Mucinex)

Oxygen Subjective Assessment

Hx Resp Disease, Resp Problems, Chest Pain, Fatigue, Cough, Wheezing, Dyspnea, Smoking Hx, Environment factors,Meds that effect Resp, Allergies, Resp Infections, Health Risk

Mobilization of Pulmonary Secretions

Hydration (6-8 glasses/day) Humidification (O2 Flow Rate > 2 L = Bubbler) Aerosolization Nebulation (Med w O2 = mist that soothes irritated airway) Oropharyngeal Suction Chest physiotherapy Meds

Airway Resistance

Increase in pressure that occurs as the diameter of the airways decreases from the mouth or nose to the alveoli Ex: Vasoconstriction from Asthma attack

Developmental Factors for Young/Mid Adult

Increases Respiratory Problems; Lifestyle Choices

Oxygen Objective Assessment

Inspection, Auscultation, Dx Test, Pulse Ox, Throat/Sputum Culture, CBC, ABG,

CNS Alterations Fact

Spinal Cord injuries at the C3/C4 level can effect phrenic nerve (Diaphragm); Lower than C5 level effects inner costal muscles between ribs

Suction Fact

Too much suctioning can cause irritation to resp system due to Cath - puts pt at risk for hypoxemia (suctioning away O2) ↓ B/P, arrhythmias

General Rule of using O2

Use lowest O2 concentration or flow rate to reach acceptable blood O2 levels

Simple Face Mask

covers nose and mouth allows room air to enter mask through air holes, for flows greater than 5 L/min. usually runs at 5->8 L/min. 40-60% oxygen. short-term < 12 Hrs

Alveoli Collapse =

↑ O2 = ↓ Nitrogen

Physicological Factors

Cardiac Disorders (Effect conduction, cardiac output, valves, Ischemia) Respiratory Disorders (Hyper/Hypo-ventilation, Hypoxia) Disorders causing ↓ O2 Carrying Capacity (Anemia) Decreased Inspired O2 Hypovolemia Increased Metabolic Rate - Fever / Infection (↑ O2 Demand)

Nasal Cannula

Low flow system; May be used for extended period of time; Use only 1-6 Liters; Usually apply up to 4 L; Provides 24-44% O2