NUR 102: Respiratory

Mr. Winchell's cough is non-productive. After Mr. Winchell stops coughing, the nurse continues the interview. To assess the client's history related to dyspnea on exertion (DOE), what question should the nurse ask Mr. Winchell?

"What activities cause you to feel short of breath?"

The respiratory therapist is notified about the HCP's prescription for drawing arterial blood gases (ABGs) on Mr. Hannigan. Which actions should be implemented after the specimen is drawn?

- Arrange for immediate transport of the specimen to the laboratory - Ensure an airtight seal for the blood specimen container - Apply direct pressure to the puncture site

According to Centers for Disease Control (CDC) guidelines, which isolation precautions are indicated for Mr. Hannigan at this time?

- Standard - Droplet - Contact

Standard precautions, droplet precautions, and contact precautions apply for Mr. Hannigan. Besides a private room, which of the following infection control requirements are indicated?

- Wear a mask with close contact - Wear a gown when assisting Mr. Hannigan with bathing - Wear gloves when handling tissues containing sputum

. Which nursing measures should you incorporate into Mr. Hannigan's care?

- frequent position changes - encourage oral fluids - use of side rails - bed in low position - assist with activities of daily living

Mr. Hannigan is receiving the broad-spectrum antiinfective drug levofloxacin. Levofloxacin is active against Strep pneumonia. Based on your knowledge of the potential complications of this drug, you will be alert for which adverse effects? (Select all that apply)

- loose, watery stools - tendon rupture - photosensitivity

You are conducting a physical assessment of Mr. Hannigan. Which findings would the nurse expect?

- lung crackles - tachypnea - nasal flaring pneumonia

Mr. Hannigan will be discharged very soon. Which discharge instructions are indicated?

- take frequent rest periods as needed - drink lots of fluid each day

Which considerations are critical for the nurse to make when assigning a room to a client with community acquired pneumonia (CAP)?

1) Mr. Hannigan's confusion 2) Infection control Mr. Hannigan's confusion is an important consideration for room assignment. The fact that Mr. Hannigan is confused places him at risk for injury. An initial assessment found Mr. Hannigan to be disoriented to time, place, and person. Bed placement as close to the nurses' station as possible is important. Infection control is an important consideration for room assignment. Mr. Hannigan has pneumonia, although the specific organism responsible for infection is not known at this time. The means of transmission is not yet known. To decrease risk for hospital-acquired pneumonia or other nosocomial infections in other clients, Mr. Hannigan was assigned to a private room.

A nurse is caring for a patient who has a tracheostomy. Which of the following must the nurse use when administering oxygen to this patient?

A tracheostomy collar A tracheostomy collar is designed to provide high humidity and the oxygen concentration prescribed for the patient. It is a small oxygen-delivery apparatus that fits over the tracheostomy site and is held in place by an adjustable elastic strap that fits around the patient's neck.

liquid oxygen system

Advantages: - enough oxygen for 8 hrs use - does not require electricity - stored in a large stationary vessel from which the patient can fill a small portable tank - this is a good choice for more active patients Disadvantages: - they are expensive - evaporation occurs when not in use & in warm weather

Oxygen concentrator

Advantages: - takes nitrogen, water vapor, and hydrocarbons from room air and delivers oxygen that is "concentrated" from room air - the least expensive mode of delivery - good choice for homebound patients as it is not an ambulatory unit Disadvantages: - oxygen concentration decreases as liter flow increases - most units can deliver 4 or 5 L/min - needs to be close to a power source

Compressed gas cylinders or tanks

Advantages: - tanks are being fairly inexpensive - do not requiring an electrical source - deliver oxygen up to 15 L/min Disadvantages: - bulky and heavy - patients need to know how to read the regulator so they know when to call for a new tank - there are different sizes of tanks available

A patient has a long history of chronic obstructive pulmonary disease (COPD). During the assessment, the nurse will most likely observe which of these?

Anteroposterior-to-transverse diameter ratio of 1:1 An anteroposterior-to-transverse diameter ratio of 1:1 or barrel chest is observed in individuals with COPD because of hyperinflation of the lungs. The ribs are more horizontal, and the chest appears as if held in continuous inspiration. Neck muscles are hypertrophied from aiding in forced respiration. Chest expansion may be decreased but symmetric. Decreased tactile fremitus occurs from decreased transmission of vibrations.

The nurse monitors the pulse oximetry to assess for which value?

Arterial oxygen saturation

rhonchi

Coarse, low-pitched breath sounds heard in patients with chronic mucus in the upper airways

A patient admitted with community-acquired pneumonia has been receiving oxygen therapy for several days. Which of the following assessment findings indicates an adverse effect of oxygen therapy?

Cracks in the oral mucosa. Oxygen, especially when delivered long-term and/or without sufficient humidification, is extremely drying and can cause cracks in the nasal and oral mucosa.

The nurse knows that a normal finding when assessing the respiratory system of an older adult is:

Decreased mobility of the thorax. The costal cartilages become calcified with aging, resulting in a less mobile thorax. Chest expansion may be somewhat decreased, and the chest cage commonly shows an increased anteroposterior diameter.

A nurse is caring for a patient who is dyspneic and slightly cyanotic, with a respiratory rate of 28/min. The nurse determines that the patient has impaired gas exchange during which of the following phases of the nursing process?

Diagnosis During the diagnosis phase, the nurse analyzes and interprets data gathered from the nursing assessment to formulate a nursing diagnosis, in this case, impaired gas exchange.

The primary muscles of respiration include the:

Diaphragm and intercostals The major muscle of respiration is the diaphragm. The intercostal muscles lift the sternum and elevate the ribs during inspiration, increasing the anteroposterior diameter. Expiration is primarily passive. Forced inspiration involves the use of other muscles, such as the accessory neck muscles—sternomastoid, scaleni, and trapezii muscles. Forced expiration involves the abdominal muscles.

Oxygen therapy is prescribed for a patient who is brought to an emergency department in the early stages of hypoxia. When assessing this patient, the nurse should expect to find which of the following clinical indicators?

Elevated blood pressure During the early stages of hypoxia, blood pressure is usually elevated (unless shock is the cause of the patient's hypoxia). In the late stages of hypos, patients are likely to develop hypotension.

The nurse is reviewing the characteristics of breath sounds. Which statement about bronchovesicular breath sounds is true? Bronchovesicular breath sounds are:

Expected near the major airways Bronchovesicular breath sounds are heard over major bronchi where fewer alveoli are located posteriorly—between the scapulae, especially on the right; and anteriorly, around the upper sternum in the first and second intercostal spaces.

The nurse is auscultating the chest in an adult. Which technique is correct?

Firmly holding the diaphragm of the stethoscope against the chest. Firmly holding the diaphragm of the stethoscope against the chest is the correct way to auscultate breath sounds. The patient should be instructed to breathe through his or her mouth, a little deeper than usual, but not to hyperventilate.

Despite being given an NSAID, acetaminophen for pain, Mr. Hannigan continues to complain of chest soreness when coughing. What action by Mr. Hannigan would you suggest to him to decrease his discomfort?

Hold a pillow across his chest when coughing Splinting sore chest muscles with a pillow during coughing should lessen musculoskeletal pain experienced when coughing, without interfering with chest expansion on an ongoing basis.

compliance (lung)

How stretchy the lung material is EX) new pair gym shorts waist band- not very compliant but very elastic - some diseases will affect compliance and leave elasticity alone

You've noticed that Mr. Hannigan is restless, confused, and picks at his sheets. What cause would be suspected for these behaviors?

Hypoxia Mr. Hannigan's confusion is probably due to hypoxia. Restlessness and confusion are often early signs of hypoxemia, and reflect cerebral hypoxia.

Indications for oxygen therapy

Indicated for patients who are at risk for developing hypoxia: - patients who are recovering from surgery and may be in pain or still sedated - patients who have a respiratory illness that causes excessive secretions to accumulate in the lungs or conditions that reduce the circulation of blood through the lungs - many patients with cardiac conditions are also at risk of developing hypoxia The patient's age, general health, current disease process, and history of chronic illness also play a role in how the patient responds to hypoxia. Early Stages: - restless, confused, anxious, agitated - getting sleepier even - vital signs might also vary from baseline, with heart rate, respiratory rate, and blood pressure elevated Late Stages: - cardiac arrhythmias - hypotension - bradycardia - metabolic acidosis - cyanosis - LOC - AMS - coma Chronic: manifestations differ and develop over time: - clubbing of their fingers and toes - peripheral edema - right-sided heart failure - oxygen saturation below 87%

What is the pathophysiology of pneumonia?

Inflammation &/or infections of the lungs The pathophysiology of pneumonia involves excess fluid in the lungs associated with an acute inflammatory process that is usually a result of infection. Microorganisms (bacteria, viruses, fungi, parasites) gain entry into the respiratory tract either by inhalation (from airborne transmission with talking, sneezing, coughing) or aspiration (secretions from the oropharynx or nasopharynx). The organisms are not successfully cleared, and they become established.

Oxygen therapy supplies and equipment

Initiating oxygen therapy requires several pieces of equipment: - flow meter - extension tubing - oxygen-delivery device - if the flow rate is more than 4 L/min, sterile water for humidification Because most hospitals have outlets for both oxygen and air on the equipment panel at the bedside, it is important to confirm that the flow meter is attached to the oxygen outlet - this is designated by a green "oxygen" label The flow meter consists of several basic parts: - cylinder portion of the flow meter has numbers and lines indicating how many liters of oxygen are being delivered per minute (L/min). - the knob opposite the prongs and the green collar adjust the flow rate - as you turn the knob, a ball approximately the size of a small pea moves up and down the cylinder, indicating the flow rate. - when setting the flow rate, align the middle of the ball with the number corresponding to the amount of oxygen being administered - at the bottom of the flow meter is a green adapter commonly called a "Christmas tree." This adapter connects the extension tubing and oxygen-delivery device to the flow meter. - connect a piece of extension tubing to the oxygen-delivery device - one end of the tubing connects to the flow meter and the other end connects to the end of the tubing on the oxygen-delivery device. Many different types of oxygen-delivery devices are used to administer oxygen - the device used often is why the patient is receiving oxygen, the flow rate (L/min) prescribed, and the length of time the patient will receive oxygen therapy Depending on the flow rate prescribed, humidification might be required - usually accomplished by attaching a bottle of sterile water to the oxygen-delivery equipment

The nurse is reviewing the technique of palpating for tactile fremitus with a new graduate. Which statement by the graduate nurse reflects a correct understanding of tactile fremitus? "Tactile fremitus:

Is caused by sounds generated from the larynx Fremitus is a palpable vibration. Sounds generated from the larynx are transmitted through patent bronchi and the lung parenchyma to the chest wall where they are felt as vibrations. Crepitus is the term for air in the subcutaneous tissues.

The HCP prescribes oxygen therapy. As you implement the prescription for oxygen, the therapeutic effect of the nasal oxygen will be enhanced if Mr. Hannigan:

Is positioned in the Fowler's position The Fowler's position (head of bed 45 degrees or higher) promotes full lung expansion and decreases the work of breathing. It can enhance the effectiveness of oxygen therapy and help increase oxygenation. Resting his arms on an overbed table may increase Mr. Hannigan's tolerance for this position.

A patient who is prescribed oxygen therapy 24 hr/day is concerned about being confined to bed. Which of the following should the nurse do to provide mobility for this patient?

Make sure the patient has up to 50 feet of connecting tubing. Patients can use up to 50 feet of connecting tubing to attach the oxygen source to the delivery device. This length of tubing provides the patient with extra mobility.

When evaluating your plan of care for Mr. Hannigan with regard to the problem of impaired gas exchange, which criteria would indicate a successful outcome?

Mr. Hannigan has a PaO2 (arterial oxygen) above 80 mm Hg

During an assessment, the nurse knows that expected assessment findings in the normal adult lung include the presence of:

Muffled voice sounds and symmetrical tactile fremitus Normal lung findings include symmetric chest expansion, resonant percussion tones, vesicular breath sounds over the peripheral lung fields, muffled voice sounds, and no adventitious sounds.

Oxygen delivery devices

Nasal cannula = 24% to 44% - Flow: 1 to 6 L Simple face mask = 40% to 60% - Flow: 5 to 8 L Partial rebreather mask = 60% to 75% - Flow: 6 to 11 L Non-rebreather mask = 80% to 95% - Flow: Liter maintaining reservoir bag 2/3 full or 10 to 15 L Venturi mask = 24% to 50% - Flow: 4 to 10 L Aerosol mask, face tent = 24% to 100% - Flow: min. 10 L T-piece = 30% to 100% - Flow: 8 to 10 L

The nurse applies oxygen at 2 liters per minute via nasal cannula and ensures that the client is comfortable. His oxygen saturation is stable at 95%, and his respiratory rate decreases to 24 breaths per minute. Mr. Winchell reports that he feels able to continue with the admission interview and assessment. After answering a few questions, the client begins to cough. What assessment should the nurse perform?

Note the amount and appearance of any sputum

Mr. Winston Winchell is a 70-year-old Black man. He has a history of emphysema and has been admitted to an inpatient medical unit with an acute respiratory infection. The nurse prepares to complete the client's admission assessment after Mr. Winchell's transfer from the emergency department (ED). To ensure the client's respiratory status is stable upon his arrival on the medical unit, the nurse should complete which assessment first?

O2 sat

Administering oxygen therapy with a nonrebreather mask has which of the following advantages?

Offers the highest oxygen concentration of the low-flow systems. A nonrebreather mask delivers oxygen concentrations greater than 90%. Thus, it provides a higher fraction of inspired oxygen than a nasal cannula (also low-flow, but delivering about 24-44%) or a simple mask (low-flow, delivers 40-60%)

Preparing an oxygen cylinder for use

Oxygen cylinders are available in different sizes and have various pressure capacities - the cylinders are identified by letters according to their size - the E cylinder is the most common size used in the home setting and in hospitals when transporting patients You will need several pieces of equipment to prepare the cylinder for use. These include: - a regulator - a pressure gauge - a flow meter - a cylinder key - an oxygen-delivery device To open and close the oxygen cylinder, you must use a special key made specifically for oxygen cylinders - slide the hexagon opening on the key over the valve and slowly turn it to either start or stop the flow of oxygen - you can also use the key to tighten the regulator to the cylinder neck The pressure gauge indicates the pressure, or amount of oxygen, in the cylinder in pounds per square inch (psi) - when the oxygen cylinder is almost empty, the needle on the gauge will be in a red zone The flow meter, also usually part of the regulator, is used to control the rate of oxygen delivered in liters per minute (L/min) - when you turn the knob on the flow meter to the left, oxygen begins to flow from the cylinder to the patient, and you can increase the flow rate Before placing the oxygen-delivery device on the patient, make sure the oxygen cylinder is functioning properly and the flow rate is set at the prescribed L/min - also make sure the cylinder is properly secured

As you care for Mr. Hannigan, which intervention is the most important to implement?

Promoting oxygenation

A home health nurse is instructing a patient who has just started receiving oxygen therapy via mask. The nurse should emphasize that the patient must...

Reposition the elastic band frequently. Tubing and elastic bands that are part of oxygen-delivery devices can cause pressure on the skin that can lead to breakdown. Padding them and changing their positions often can help prevent this complication.

The results of Mr. Hannigan's arterial blood gases, taken on admission, are available. You expect results to reflect which type of acid-base imbalance?

Respiratory alkalosis On admission, Mr. Hannigan was breathing rapidly. His increased respiratory rate was an effort to compensate for hypoxemia and take in more oxygen. An increase in the rate of breathing causes a decrease in arterial carbon dioxide levels. This can lead to respiratory alkalosis.

A patient has been receiving oxygen PRN via nasal cannula for 4 hr. Which of the following assessment findings helps indicate that oxygen therapy has been effective?

Respiratory rate 14/min The normal range of respirations is 12 to 16/min. Stabilization of the RR, especially if the patient was previously tachypneic, is an indication that oxygen therapy is effective.

Which risk factors for community acquired pneumonia does Mr. Hannigan have in his medical history?

Splenectomy 10 years ago The spleen normally serves important immunologic functions, keeping the blood free of unwanted substances and infecting organisms. Individuals without a spleen are at increased risk of bacterial infection, especially those caused by Streptococcus pneumoniae, Haemophilus influenzae, and others. Mr. Hannigan received the pneumococcal vaccine (which helps prevent infection due to the bacteria Streptococcus pneumoniae) about 10 years ago, when his spleen was removed. To maintain immunity, a one-time repeat vaccination is recommended. However, Mr. Hannigan was never revaccinated.

A nurse is providing discharge teaching to a patient who will continue oxygen therapy at home. The nurse should instruct the patient that turning the knob on the oxygen flow meter all the way to the right...

Stops the flow of oxygen. Turning the knob on the flow meter all the way to the right allows no oxygen at all to flow from the oxygen cylinder to the patient. Righty tighty, lefty loosey

How can the nurse best alleviate Mr. Hannigan's discomfort?

Suggest that acetaminophen be prescribed to alleviate chest discomfort An analgesic such as acetaminophen should reduce Mr. Hannigan's chest discomfort without suppressing his cough and gag reflexes. Cough and gag reflexes are needed to expectorate secretions and avoid aspiration. Sedatives and narcotic analgesics suppress these reflexes. Restriction of chest movement with a chest binder would limit airflow and increase hypoxia, predisposing Mr. Hannigan to more serious respiratory complications. Mr. Hannigan needs full lung expansion to insure maximum lung inflation and optimal gas exchange.

A nurse should recognize that which of the following is an indication for oxygen therapy?

Tachypnea; SaO2 90% Oxygen therapy is indicated for patients who are at risk for or have developed hypoxia. In the early stages of hypoxia, heart rate rises and arterial oxygen saturation (SaO2) falls below 94%.

Hazards of oxygen therapy

The most common: - fire - equipment malfunction - pressure hazards It is important that oxygen is not used around fire or in an environment where there's a potential for sparks. It is recommended that oxygen delivery systems be kept 10 feet from any open flames. Caution patients when using electrical equipment in such as razors or radios when oxygen is in use. The electrical equipment must be functioning properly and well grounded. In both the hospital and home settings, display an "oxygen in use" sign on the patient's door or the front door of the home to notify visitors and other family members that oxygen is in use and they must take extreme caution. Always handle oxygen tanks with caution. Keep them upright and secured with a chain or in an appropriate holder to keep them from falling and the valve rupturing. Store empty oxygen tanks upright as well and secure them appropriately. Before initiating oxygen therapy, make sure all equipment is checked. The oxygen should be turned on and the flow meter and regulator checked to make sure they are functioning properly. The gauge indicating the level of oxygen in the tank should also be checked to make sure there is an adequate amount remaining.

The initial assessment of Mr. Winchell continues. The nurse measure the client's vital signs. Mr. Winchell's respiratory rate is 32 breaths per minute. What follow-up assessment data should the nurse obtain first?

Use of accessory muscles

Home oxygen use

Use of oxygen in the home would be required if the patient is unable to maintain an oxygen saturation (SaO₂) of 88% or more - patients with COPD, emphysema and advanced cardiac disease may require home oxygen therapy. Home oxygen benefits the patient by improving their exercise tolerance and they don't tire as easily - oxygen therapy at home may also be used for hospice patients to assist in the management of dyspnea - nasal cannula or face masks are most commonly used for administering oxygen in the home - if a patient has a tracheostomy, a T-tube or trach collar would be used There are three types of home oxygen therapy delivery systems available: 1) compressed gas cylinders or tanks 2) liquid oxygen systems (6 L/min) 3) oxygen concentrators The oxygen therapy system in the home should be in an area that is well ventilated, free of clutter, and at least 10 feet away from a heat source - the most common safety concerns include fire, equipment malfunction, and pressure hazards

A nurse is caring for a critically ill patient with COPD who requires delivery of a precise concentration of oxygen. Which of the following types of oxygen-delivery device is indicated for this patient?

Venturi mask A venturi mask is most often used for critically ill patients who require administration of a specific concentration of oxygen. Because this device delivers a precise oxygen concentration and carbon dioxide buildup is minimal, it is commonly used for patients who have COPD.

When auscultating the lungs of an adult patient, the nurse notes that low-pitched, soft breath sounds are heard over the posterior lower lobes, with inspiration being longer than expiration. The nurse interprets that these sounds are:

Vesicular breath sounds and are normal in that location Vesicular breath sounds are low-pitched, soft sounds with inspiration being longer than expiration. These breath sounds are expected over the peripheral lung fields where air flows through smaller bronchioles and alveoli.

The nurse is listening to the breath sounds of a patient with severe asthma. Air passing through narrowed bronchioles would produce which of these adventitious sounds?

Wheezes Wheezes are caused by air squeezed or compressed through passageways narrowed almost to closure by collapsing, swelling, secretions, or tumors, such as with acute asthma or chronic emphysema.

Care of patients receiving oxygen therapy

When oxygen at too high a flow rate, carbon dioxide narcosis (a complication that causes confusion, tremors, convulsions, and coma) can result: - this can ultimately lead to respiratory arrest if left untreated Positioning is also very important: - having the patient in a semi- or high-Fowler's position helps facilitate lung expansion - turning and repositioning - coughing and deep breathing Delivering oxygen should help prevent or resolve the manifestations of hypoxia - with effective oxygen therapy for patients who have hypoxia, vital signs and oxygen saturation should move closer to normal or to the patient's baseline readings Oxygen is considered a medication, you must obtain an order from the provider before adjusting the flow rate Perform a respiratory assessment: - complete set of vital signs, including oxygen saturation indicated via pulse oximetry - document the patient's skin color - level of consciousness - any manifestations of hypoxia - inspect the nose, the ears, and under the chin for redness, irritation, and skin breakdown Keeping the patient's skin clean and dry can also help reduce the risk of skin irritation and breakdown. Since oxygen tends to cause drying of the mucous membranes consider humidification if the flow rate is 4 L/min or more - increasing the patient's fluid intake, if not contraindicated, and providing oral care frequently can also help alleviate dryness of the mucous membranes

During auscultation of the lungs, the nurse expects decreased breath sounds to be heard in which situation?

When the bronchial tree is obstructed Decreased or absent breath sounds occur when the bronchial tree is obstructed, as in emphysema, and when sound transmission is obstructed, as in pleurisy, pneumothorax, or pleural effusion.

oxygen tent

a canopy that surrounds the patient, providing oxygen, humidification, and a cool environment to help control body temperature - usually encloses a child - used to help treat airway inflammation, croup, or other respiratory infections - consists of a disposable vinyl box - it is important to ensure that there is enough space between the curve of the hood and the child's neck to allow carbon dioxide to escape - FiO₂: Approximately 50% — Flow: 10 to 15 L

oxygen mask

a device that fits over the patient's nose and mouth and delivers oxygen, humidity, and/or heated humidity

flow meter

a device used to control the rate of oxygen being delivered in liters per minute

hypoxemia

a diminished amount (reduced saturation) of oxygen in arterial blood

manual resuscitation bag

a hand-held device consisting of a flexible air chamber attached to a face mask via a shutter valve and used to provide ventilation to a patient who is not breathing or who is breathing inadequately - often referred to as an Ambu bag - used to provide high concentrations of oxygen to a patient prior to a procedure, such as suctioning or intubating, and during respiratory or cardiac arrest - can also be used to assist patients who are breathing but not adequately - consists of a mask that fits over the nose and mouth, and has a soft air-filled cushion around the mask that forms an airtight seal when placed on the patient's face - a self-inflating bag that is compressed to ventilate the patient - an oxygen port where the oxygen tubing is connected - might also have an adapter that fits onto an oxygen port where the oxygen tubing is connected - might also have an adapter that fits onto an endotracheal tube when it is going to be used for an intubated patient - there is also a valve on the bag that ensures one-way pressure into the mask and then allows the bag to reinflate from ambient air or from an oxygen source - 10 to 15 L/min when performing manual resuscitation

pulse oximeter

a noninvasive device that measures oxygen saturation indirectly via a finger or ear probe with a light-emitting diode (LED) and a photo detector attached by a cable to the device

continuous positive airway pressure (CPAP)

a noninvasive, ventilation-assistance modality that provides a set positive airway pressure throughout the patient's respiratory cycle - commonly used for patients who experience sleep apnea because the continuous positive pressure keeps the airway open and prevents the upper airway from collapsing - usual CPAP pressure is between 5 and 20 cm of water

bi-level positive airway pressure (BiPAP)

a noninvasive, ventilation-assistance modality that provides higher airway pressure during inspiration and lower pressure during expiration, usually delivered by a face mask - benefits of BiPAP include an increase in the amount of air in the lungs at the end of expiration, reduced airway closure, and improved oxygenation

hypoxia

a reduced supply of oxygen to tissues below physiological levels despite adequate perfusion of the tissue by blood

incentive spirometer

a resistive breathing device that helps patients exercise their breathing muscles

tracheostomy collar

a small oxygen-delivery apparatus that fits over a tracheostomy site and is held in place by an adjustable elastic strap that fits around the patient's neck - also called a tracheostomy mask - the mask has an exhalation port that remains patent at all times and a port that connects to the oxygen source with large-bore tubing - patients who have artificial airways require continuous humidification since the airway bypasses the normal filtering and humidification process of the nose and mouth - the flow rate is usually set at 10 L/min, with a nebulizer set at the appropriate oxygen concentration

face tent

a soft, oxygen-delivery mask that fits under the patient's chin, loosely covers the mouth and nose, and is held in place by an adjustable elastic strap - this is an alternative to an aerosol mask for patients who feel claustrophobic, but it is sometimes difficult to keep in place - it is convenient for providing humidification and oxygenation - oxygen concentration cannot be controlled. - it is composed of a soft mask that fits under the patient's chin and loosely covers the mouth and nose - an adjustable elastic strap holds it in place - often used after nasal and oral surgery - FiO₂: 24% to 100% — Flow: At least 10 L

t-tube

a t-shaped conduit with a piece that connects an oxygen source to the patient's artificial airway - the recommended flow rate when using a t-tube is 10 L/min, with a nebulizer set at the appropriate oxygen concentration

positive-pressure ventilation

a technique that uses a mechanism such as a mechanical ventilator to force air into the lungs to provide breathing assistance

noninvasive ventilation

a type of breathing assistance used to maintain positive airway pressure and improve alveolar ventilation without the need for an artificial airway - an alternative to mechanical ventilation - commonly used for patients who have congestive heart failure, sleep disorders, and pulmonary diseases - used to improve oxygenation, reduce and reverse atelectasis, reduce pulmonary edema, and improve cardiac function - the two types of noninvasive ventilation are CPAP and BiPAP

atelectasis

airlessness or collapse of a lung, usually as a result of hypoventilation or obstruction "grape is now a raisin"

hypercapnia

an excess of carbon dioxide in the blood

Venturi mask

an oxygen-delivery apparatus consisting of a mask with holes on each side that allow exhaled air to escape and color-coded entrainment ports that are adjustable to allow regulation of the concentration of oxygen delivered - uses different size adaptors to deliver a fixed or predicted FiO₂; the FiO₂ delivered depends on the flow rate and/or entrainment port size - is used for patients who have COPD when an accurate FiO₂ is essential & carbon dioxide buildup must be kept to a minimum - humidifiers are not usually used with this device - consists of a mask with holes on each side that allow exhaled air to escape - this is the most accurate form of oxygen delivery - FiO₂: 24% to 50% — Flow: 4 to 10 L

partial nonrebreather mask

an oxygen-delivery apparatus similar to a nonrebreather mask, but with a two-way valve allowing the patient to rebreathe exhaled air - has ports, so most of the expired air escapes - there is no inspiratory valve, so some of the exhaled air returns to the bag and mixes with the inspired air - while partial rebreather masks are used infrequently, it is important to check provider orders carefully to determine which kind of rebreather mask to use - may also be used to deliver an FiO₂ of 60% to 75% with a flow rate of 6 to 11 L/min

simple face mask

an oxygen-delivery apparatus used for patients who require a moderate flow rate for a short period of time via a plastic mask that fits snugly over the mouth and nose - requires a fairly high oxygen flow to prevent rebreathing of carbon dioxide - about 75% of the inspired volume is room air that the patient breathes through the holes in the side of the mask - composed of a plastic mask that fits snugly over the patient's mouth and nose - mask has holes (vents) on each side that are used for exhalation and for air entrainment if the flow rate is too low - an adjustable elastic strap that fits over the patient's head holds the mask in place - a piece of tubing connects the mask to the oxygen source; extension tubing is usually added to allow the patient more freedom of movement - do not use a flow rate lower than 6 L/min with this type of mask - FiO₂: 40% to 60% — Flow: 5 to 8 L

nonrebreather mask

an oxygen-delivery apparatus used to deliver high flow rates and high concentrations of oxygen via a mask that fits snugly over the patient's mouth and nose - the reservoir bag allows a higher FiO₂ to be administered - a valve closes during expiration so that exhaled air does not enter the reservoir bag and is not rebreathed - the valves on the side ports of the mask allow exhalation but close on inspiration to prevent inhalation of room air - mask fits snugly over the patient's mouth and nose - adjustable elastic strap that fits over the patient's head holds the mask in place - between the mask and the bag is a one-way valve that allows the patient to breathe in the oxygen supplied by the source as well as oxygen from the reservoir - do not allow the reservoir bag to deflate or the oxygen source to deplete; the patient will likely breathe in large amount of exhaled CO2 - FiO₂: 80% to 95% — Flow: Liter maintaining reservoir bag 2/3 full or 10 to 15 L/min

mechanical ventilator

breathing assistance provided by a ventilator, one of various types of devices that support and maintain respiratory function

surfactant

chemical we produce in the lungs that surround the alveoli to help create surface tension during inhalation and exhalation

Hemptysis

coughing up blood

Hypovolemia

decreased blood volume - not enough fluid - blood is too thick

dyspnea

difficult or labored breathing

expiration

exhalation

adventitious sounds

extra breath sounds that are not normally heard - crackles (rails), rhonchi, wheezes, and pleural friction rubs - most are caused by moving air colliding with secretions in passageways or by popping open of previously deflated airways

pleural rub

grating sound made when the two layers of the pleura rub together during respiration - almost bubbly - scratchy

lung volumes

how much a person can inhale or exhale

inspiration

inhalation

bronchovesicular breath sounds

medium-pitched and quieter sounds normally heard over the mainstem bronchi

bronchial breath sounds

normal breath sounds made by air moving through the bronchi - loud, high-pitched, hollow sounds - heard best on top - also called tracheal or tubular - Darth Vader sound

crackles (rales)

popping sounds heard on auscultation of the lung when air enters diseased airways and alveoli - high-pitched, intermittent - coarse or fine - almost wet sound?

vesicular breath sounds

soft, fine, breezy, low-pitched sounds heard over peripheral lung tissue

stridor

strained, high-pitched sound heard on inspiration caused by obstruction in the pharynx or larynx

tidal volume

the amount of air normally breathed in and out with each respiratory cycle either spontaneously or delivered via mechanical ventilation

airway resistance

the increase in pressure that occurs as the diameter of the airways decreases from mouth/nose to alveoli

intubation

the insertion of a tube into a body canal or cavity

pulse oximetry

the measurement of oxygen saturation indirectly via a finger or ear probe with a light-emitting diode (LED) and a photo detector attached by a cable to the oximeter device

nasal cannula

the most commonly used oxygen-delivery device consisting of a length of tubing with two small prongs that are inserted into the patient's nares - most patients tolerate this device well; simpler - has nasal prongs, slide adjuster, & end adapter - available in a range of sizes and can be used for various age groups - length is 7-14 ft - concentrations of 24% to 44% with flow rates from 1 to 6 L/min through the cannula

fraction of inspired oxygen (FiO₂)

the oxygen level inhaled by or delivered to the patient, expressed in a percentage of atmospheric air

ventilation

the process of the exchange of air between the lungs and the environment, including inhalation and exhalation

wheeze

whistling or sighing sound heard on auscultation that results from the narrowing of the lumen of the respiratory passageway - high-pitched, musical sound - almost humming-like sound - usually heard on expiration, but can be on inhalation, or even both

purulent sputum

yellowish or greenish sputum