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56 Cards in this Set
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- Back
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Positioning of patient with dyspnea
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Page 920
Dyspnea, indicates that these clients often use multiple pillows when lying down or must sit with the arms elevated and leaning forward to breathe. |
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What is the best position for lung expansion?
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Lung expansion, the 45 degree semi-Fowler's position is most effective for lung expansion provided the patient doesn't slide down in bed which creates pressure on the abdomen and diaphragm
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What is the best position for patients with pneumothorax?
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Page 952
-indicates that semi-fowler's is optimal for patients with a pneumothorax to facilitate the evacuation of the pleural air |
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Why would you position a patient with pnuemothorax on high fowler's position?
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to drain fluid from a hemothorax.
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Pursed-lip breathing is for what?
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Pursed-lip breathing is an exercise most effective for patients/clients with obstructive lung disease, particularly emphysema. Recall, these patients retain carbon dioxide due to the restrictive nature of their disease
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How is pursed lip breathing performed?
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Pursed lip breathing is performed by breathing through the nose and then prolonging exhalation through “pursed-lips”.
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What is the purpose of prolongation of exhalation during pursed lip breathing?
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to promote alveoli to remain open longer, enhancing the elimination of trapped CO2.
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How long should the exhalation period for pursed lip breathing?
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2-3 times longer than inhalation
and can be demonstrated by exhaling against a lit candle, making the flame gently flicker but not extinguishing it. (Optimally, gas exchange is improved but essentially, intake of oxygen is not significantly improved because the exercise does not reduce the restrictiveness of the injured lung tissue.) |
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Atelectasis
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Collapse of alveoli (hyperventilation)
-Collapse of smaller airways. Thiss is due to secretions in the lung that acturally obstruct the airway -Prevents normal CO2 and O2 exchange |
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Hypoxia
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Inadequate oxygenation at the CELLULAR level
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Hypoxemia
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Decrease oxygen levels in the BLOOD measured by PaO2
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Hypoventilation
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decrease in the rate and or depth of air movement into the lungs
Alveoli ventilation inadequate |
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Heyperventilation
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increased rate and depth of ventilation
Too much CO2 |
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What induces hyperventilation?
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anxiety
infection drugs acid-base imbalance |
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What causes hyperventilation?
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fever (increase temperature--> Increase metabolic rate-->Increase CO2 production)
CHEMICAL (Salicylate and amphetamine) Metabolic Acidosis (DKA -respiratory tries to correct acid/base balance |
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What are signs and symptoms of hypoventilation?
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Mental status changes
Dysrythmias Cardiac arrest |
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What is the goal for ventilation?
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PaCO2 = 35-45 mm Hg
PaO2 = 95-100 mm Hg |
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What factors affect respiratory function?
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Health status
Developmental level Medications Lifestyle Environment Psychological health |
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How does health status affect respiratory function?
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1. Weakened states, don't deep breath
2. CRF/CHF-predisposed to extra fluid 3. Respiratory conditions such as COPD/Asthma |
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How does age affect respiratory function?
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as we age, our RR decreases
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Give an example how lifestyle affect respiratory function?
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Exercise- increases depth
Cigarette smoking- prone to illness/CA and pulmonary complications |
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Examples how environment affect respiratory function?
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Air pollutants
coal miners asbestos 2nd hand smoke middle ear infection |
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How does stress affect respiratory function?
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Stress causes asthma attacks and hyperventilation
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Physical Assessment
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History (smoking, use of O2, cough/sputum, chest pain, dyspnea, positioning, environmental exposure)
Physical Exam Patient with shortness of air |
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What are the methods used for assessing respiratory function?
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Pulse ox( SAO2)
Arterial Blood Gasses (ABCs) Complete blood count (CBC) Incentirve spirometry Chest Xray Bronchoscopy Sputum analysis Lung scan (V/Q scan) |
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What can you see using an X-ray?
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you can see tumors, pheumonia, fluid
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Bronchosopy
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Lighted camerea inserted throughthe MOUTH into the mainstem BRONCHUS
-can see tumors, obtain specimens, suction out lower airways |
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Sputum Analysis
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from lungs, bronchi, trachea
-NOT oral secretions-so teach pt to cough down and deep |
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Best time to collect sputum for analysis
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typically want 3 early morning specimens, before antibiotics
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What is used to scan lung?
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V/Q scan to assess for pulmonary emboli
V=Ventilation (air into and out of lungs) Z=perfusion-blood flow through lungs |
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How would you promote healthy respirations?
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Deep breathing
Incentirve spirometry Pursed-lip breathing Abdominal breathing Coughing |
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When do we need to help our patients breath deeply?
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after anesthesia, on bedrest, on narcotics, in pain fructured ribs
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How do you teach someone how to deep breath?
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breath deep enough to move bototm ribs.
1. Inhale through nose 2. Exhale through mouth 3. Open all alveoli sacs |
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Pursed lipped breathing
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for patients in pain, labor, panic attacks and SOA
1. goal is to prolong expiration and stop air trapping Inhale through nose counting to 3 Exhale through mouth counting to 7 |
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Abdominal breathing
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Taught to COPD patients who are very SOA
1. Goal is to decrease rate and increase depth of breathing 2. 1 hand on abd and 1 on chest 3. Exhale through nose protruding the abd. As much as possible 4. Breath out through pursed lips contracting abdominal muscles 5. Do for 1 minute then rest 2 minutes |
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What are nebulizers and MDIs for?
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-hand held machines attached to oxygen and humidity that give patients meds into the respiratory track.
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What are examples of nebulizers/ metered dose inhalers?
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bronchodilators
Mucolytic agents corticosteroids |
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Brochodialators are for what?
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to pen narrow airways
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Mucolytic agents
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to liquidify and loosen thick secretions
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Steroids
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to decrease inflammation and swelling
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Who administer and chart Nebulizers and MDIs?
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Respiratory therapist
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O2 Administration
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nasal cannula
Simple mask Partial rebreather mask non-rebreather mask venturi mask |
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Nasal Cannula
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2 prongs in nostrils
deliveres lose doses -ordered in liters Ball in middle of low metere shows amount pg. 1404 |
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Simple Mask
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Lower doses of O2 for every short periods of time
Ex. Waking up from minimal anesthesia |
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Partial re-breather mask
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bag and oxygen msk
-Ordered by % of inspired oxygen -The bag conserves oxygen as it collects the first part of the patient's exhaled air -That mixes with the % oxygen from the wall -KEEPING BAG FULLY INFLATED |
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Which is the only mask that can deliver 100% oxygen to patients with extreme SOB?
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Nonbreather mask- Only mask that can deliver 100% oxygen
for those patients extremely SOA-may need vent soon -All exhaled air leaves mask and bag fills with only oxygen from wall |
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Which is the only oxygen mask that can deliver precise amount of oxygen?
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Venturi Mask -great for COPD patients
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How often would you check oxygen level flow?
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every 4 hrs
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How often should you remove mask to assess pt's skin?
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every 4 hours
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How often should you assess pt's respiratory rate and effort
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every 4 hours and as needed
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What should you do if your patient leaves the room?
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provide portable oxygen
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Patient care on oxygen
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Do not allow anyone to smoke
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what should you do before apply mask to patient?
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allow bag to fill with oxygen before applying
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Treatments: Weaning off oxygen
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1. decrease % of O2
2. Monitor ABgs 3. Monitor SaO2 |
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Artificial airways
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Oropharyngeal/nasopharangeal
Endotracheal tube (ETT) Tracheostomy (Trach) |
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While oxygen is weaning off, what should you assess?
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assess vital sign, anxiety level, skin color
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