Chapter 30 Respiration

Front 1

Normal Blood Gas Levels:
pH
PCO2
HCO3
PO2
SaO2

Back 1

pH 7.35-7.45
PCO2 35-45 mmHg
HCO3 22-26 mEq/L
PO2 80-100 mmHg (breathing room air)
SaO2 90-100%

Front 2

The most common clinical manifestations indicative of inadequate ventilation are:

Back 2

Tachycardia (100+)
Tachypnea (24+)
Anxiety
Restlessness or confusion
Use of accessory breathing muscles
Change in cognition or response
Increased blood pressure

Front 3

Name the Respiratory Nursing Diagnosis for the following related factors:

Imbalance between oxygen supply and demand

Back 3

activity intolerance

Front 4

Name the Respiratory Nursing Diagnosis for the following related factors:

Fatigue; excessive secretions; pain; immobility; neuromuscular disease; chronic obstructive pulmonary disease

Back 4

Inefective airway clearance

Front 5

Name the Respiratory Nursing Diagnosis for the following related factors:

Depressed airway protective mechanisms; presence of artificial airway; enteral feedings; neuromuscular disease

Back 5

Aspriation, risk for

Front 6

Name the Respiratory Nursing Diagnosis for the following related factors:

Immobility; fatigue; pain; nueromuscular impairment; chronic respiratory disease; pharmacological agents

Back 6

Ineffective breathing patterns

Front 7

Name the Respiratory Nursing Diagnosis for the following related factors:

Ventilation/perfusion imbalance; hypoventilation, COPD; airway obstruction; heart failure; pulmonary edema

Back 7

Impaired gas exchange

Front 8

Name the Respiratory Nursing Diagnosis for the following related factors:

Disturbed sleep pattern

Back 8

obstructive airway (sleep apnea)

Front 9

Low flow systems:
What is this?

Back 9

better tolerated and may be humidified but often not if run @ less than 5 L/min

The nasal cannula, or nasal prongs, is used at flow rates of 1 to 6 L/min. Approxi­mate oxygen concentrations of 24% (at 1 L/min) to 44% (at 6 L/min) can be achieved. Flow rates greater than 6 L/min do not significantly increase oxygenation because the anatomic dead space (places where air flows but the structures are too thick for gas exchange; includes the oral and nasal cavities, pharynx, trachea, mainstem bronchi, secondary bronchi, and smaller airways down to the alveolar ducts) is full. In addi­tion, high flow rates increase mucosal irritation. With the use of a nasal cannula, an effective oxygen concentration can be delivered to both nose breathers and mouth breathers.
The nasal cannula is frequently used for chronic lung dis­ease and for long-term maintenance of clients with other ill­nesses. The client who retains carbon dioxide rarely receives oxygen at a rate higher than 2 to 3 L/min because of the con­cern for losing the drive to breathe, increasing the risk for apnea or respiratory arrest. The nurse places the nasal prongs in the nostrils, with the openings facing the client.

Front 10

Low flow systems:
What is this?

Back 10

Delivers 35 to 55 % O2 at flows of 5 to 12 L/min
**Must never be used at flows less than 5 L/min to prevent rebreathing of CO2

A simple face mask is used to deliver oxygen concentrations of 40% to 60% for short-term oxygen therapy or in an emergency. A mini­mum flow rate of 5 L/min is needed to prevent the rebreathing of exhaled air. The nurse gives special attention to skin care and to the proper fitting of the mask so that inspired oxy­gen concentration is maintained.

Front 11

Low flow systems:
What is this?

Back 11

A partial rebreather mask provides oxygen concentrations of 60% to 75%, with flow rates of 6 to 11 L/min. It consists of a mask with a reser­voir bag but no flaps. The client first rebreathes one third of the exhaled tidal volume, which is high in oxy­gen, thus providing a high fraction of inspired oxygen (Fio2). The nurse ensures that the bag remains slightly inflated at the end of inspiration; otherwise, the client will not be getting the desired oxygen prescription. If needed, the nurse calls the res­piratory therapist for assistance.

Front 12

Low flow systems:
What is this?

Back 12

NON-REBREATHER MASK. A non-rebreather mask provides the highest concentration of the low-flow systems and can deliver an Fio2 greater than 90%, depending on the client's breathing pattern. The non-rebreather mask is used most often with deteriorating respiratory status who might soon require intubation.
The non-rebreather mask has a one-way valve between the mask and the reservoir and two flaps over the exhalation ports. The valve allows the client to draw all needed oxygen from the reservoir bag, and the flaps prevent room air from entering through the exhalation ports. During exhalation, air leaves through these exhalation ports while the one-way valve prevents exhaled air from re-entering the reservoir bag. It is crucial for the nurse to ensure that the valve and flaps are intact and functional during each breath. Some manufacturers include only one flap on the mask, or one of the exhalation flaps may be removed for safety purposes. If the oxygen source should fail or be depleted when both flaps are in place, the client would not be able to inhale room air. The flow rate is maintained at a high-enough level to keep the bag inflated during inhalation. The nurse assesses for this safety feature.

Front 13

High Flow Systems:
What is this?

Back 13

VENTURI MASK. The Venturi mask (commonly called Venti mask) delivers the most accurate oxygen concentration. Its operation is based on a mechanism that pulls in a specific pro­portional amount of room air for each liter flow of oxygen. An adaptor is located between the bottom of the mask and the oxy­gen source. Adaptors with holes of different sizes allow only specific amounts of air to mix with the oxygen. Pre­cise delivery of oxygen results. Each adaptor also specifies the flow rate to be used; for example, to deliver 24% of oxygen, the flow rate must be 4 L/min. Another type of Venturi mask has one adaptor with a dial that the nurse uses to select the amount of oxygen desired. Humidification is not necessary with the Ven­turi mask. The Venturi system is best for the client with chronic lung disease because it delivers a precise oxygen concentration.

Front 14

High Flow Systems:
What is this?

Back 14

A face tent fits over the chin, with the top extending halfway across the face. The oxygen concentration varies, but the face tent, instead of a tight-fitting mask, is useful for facial trauma or burns.

Front 15

High Flow Systems:
What is this?

Back 15

An aerosol mask is used when high humidity is re­quired after extubation or upper airway surgery or for thick secretions.

Front 16

High Flow Systems:
What is this?

Back 16

The tracheostomy collar can be used to deliver high humidity and the desired oxygen to the client with a tra­cheostomy.
A special adaptor, called the T-piece, can be used to deliver any desired Fio2 to the client with a tracheostomy, laryngectomy, or endotracheal tube. The flow rate is regulated so that the aerosol does not disappear on the exhalation side of the T-piece.

Front 17

What type of oxygen therapy is this?

Back 17

TRANSTRACHEAL OXYGEN THERAPY
Transtracheal oxygen (TTO) is a long-term method of deliv­ering oxygen directly into the lungs. The physician passes a small, flexible catheter into the trachea via a small incision with the use of local anesthesia. TTO allows better compliance and avoids the irritation that nasal prongs cause. Clients also report it to be more cosmetically accept­able. A TTO team provides formal client education, including the purpose of TTO and care of the catheter. The physician prescribes a TTO flow rate for rest and for activity and a flow rate for the nasal cannula, to be used when the TTO catheter is being cleaned. The average client will have a 55% reduc­tion in required oxygen flow at rest and a 30% decrease with activity.

Front 18

Inserting an Oropharyngeal AIrway

Back 18

http://www.youtube.com/watch?v=SvoJfxRbpkg&playnext=1&list=PLFB148F69B3C4AF71&feature=results_main

Front 19

Inserting a Nasopharyngeal Airway

Back 19

http://www.youtube.com/watch?v=En2sXsOLzCs&list=PLFB148F69B3C4AF71