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227 Cards in this Set
- Front
- Back
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Partial rebreather mask
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plastic face mask w/a reservoir bag, can deliver from 60% to 100% O2 @ appropriate flow rates -maintains high-concentration O2 supply in the reservoir bag
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Face tent
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-alternative to aerosol mask -provides high humidity w/O2 -difficult to keep in place and the FiO2 cannot be controlled
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What is PaO2?
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arterial partial pressure -the partial pressure of O2 in arterial blood; arterial O2 concentration, or tension; usually expressed in millimeter of mercury (mmHg)
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Flowmeter
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-a device for measuring the movement of a gas/liquid -used esp. in monitoring the use of anesthetic gases.
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Cheyne-Stokes Respiration
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Resp. rate and depth irregular, characterized by alternating periods of apnea and hyperventilation. Resp. cycle begins w/slow, shallow breaths that gradually increase to abnormal rate and depth. The pattern reverses, breathing slows, and becomes shallow, climaxing in apnea before resp. resumes.
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Kussmaul's Respiration
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Resp. are abnormally deep, regular and increase in rate
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Biot's Respiration
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Resp. are abnormally shallow for 2-3 breaths, followed by irregular period of apnea.
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Pulse Oximeter
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permits the indirect measurement of oxygen saturation
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Pulse Pressure
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the difference between systolic and diastolic pressure (i.e. 120/80=40)
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Diastolic BP
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the minimal pressure exerted against the arterial walls at all times
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Systolic BP
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the peak of maximum pressure when ejection occurs
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the % of hemoglobin that is bound with oxygen in the arteries is the % of saturation of hemoglobin (SaO2)
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It is usually between 95% and 100%
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Hyperventilation
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rate and depth of respiration increase -hypocarbia may occur -state of ventilation in excess of that required to eliminate the normal venous carbon dioxide produced by cellular metabolism -can be induced by: anxiety, infections, drugs or an acid-based imbalance fever
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Hypoventilation
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-respiratory rate is abnormally low, and depth of ventillation may be depressed. -Hypercarbia may occur -alveolar ventillation is inadequate to meet the body's O2 demand or to eliminate sufficient carbon dioxide
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Tachypnea
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-rate of breathing is regular, but abnormally rapid (>12 breaths/minute)
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Hyperventilation
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-rate and depth of respiration increase -hypocarbia may occur -state of ventillation in excess of that required to eliminate the normal venous carbon dioxide produced by cellular metabolism -can be induced by: anxiety, infections, drugs or an acid-based imbalance fever
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Hypoventilation
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-respiratory rate is abnormally low, and depth of ventilation may be depressed. -Hypercarbia may occur -alveolar ventilation is inadequate to meet the body's O2 demand or to eliminate sufficient carbon dioxide
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Tachypnea
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-rate of breathing is regular, but abnormally rapid (>12 breaths/minute)
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Hyperpnea
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-respirations are labored -increased in depth -increased in rate -<20 breaths/minute -occurs normally during exercise
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Apnea
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-respirations cease for several seconds -persistant cessation results in repiratory arrest
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oxygen therapy
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-the administration of O2 @ higher levels than are normally found in the atmosphere to patient needing enhanced tissue O2 uptake
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atelectasis
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-collapse of the alveoli that prevents normal respiratory exchange of oxygen and carbon dioxide
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Humidification
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-the process of adding water to gas -gas flow is exposed to a material saturated with water
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Hemoptysis
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the expectoration of blood that arises from the larynx, trachea, bonchi, or lungs
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Simple Mask
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-used for short term O2 therapy -fits loosely & delivers O2 concentrations from 30% to 60% -mask is contraindicated for clients w/CO2 retention b/c retention can be worsened
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Dysrhythmias
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-deviation from the normal sinus heart rhythm. -may occur as a primary conduction disturbance; as a response to: ischemia, valvular abnormality, anxiety or drug toxicity--as a result of: caffeine, alcohol, or tobacco use, or a complication of acid-base or electolyte imbalance
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Cardiac Output
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-the amount of blood ejected from the left ventricle each minute -normal cardiac output is 4 to 6 L/min. in a healthy 150 lb. adult at rest.
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Electrocardiogram (ECG/EKG
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-reflects the electrical activity of the conduction system. -monitors the regulartity and path of the electrical impulse through the conduction system -the normal sequence is normal sinus rhythm (NSR
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Right-sided Heart Failure
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-results from impaired functioning of the right ventrical characterized by venous congestion in the systemic circulation. -more commonly results from pulmonary diseases or as a result of long-term left sided failure
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Left-sided Heart Failure
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-abnormal condition charaterized by impaired functioning of the left ventricle d/t elevated pressure and pulmonary congestion
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Hypovolemia
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a decreased blood volume that may be caused by internal/external bleeding, fluid losses or inadequate fluid intake.
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Oxygen Concentrator
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-a device used for home oxygen therapy that removes most of the nitrogen from the room air and delivers the oxgyen at a low flow rate
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Respiration
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-the interchange of gases between an organism and the medium in which it lives. -the act of breathing during which the lungs are provided with air through inhaling and the CO2 is removed through exhaling. Normal respiratory exchange of O2 and CO2 in the lungs is impossible unless the pulmonary tissue is adequately perfused with blood.
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A client isusing a concentrator oxygen delivery system at home. Which of the following statements when made by the client indicates understanding of client education?
1. If my concentrator does not reach the outlet in my house, I will use an extension cord. 2. I think I will move my concentrator into the closet because it is the first thing everyone who comes into my house sees. 3. I need to make sure my breaker box will meet the electrical requirements of the concentrator. 4. I don't need to worry about having a back up system because my concentrator will always work. |
3 I need to make sure my breaker box will meet the electrical requirements of the concentrator.
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Ventilation
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the movement of gases in and out of the lungs
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Hypoxia
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-an oxygen deficiency in body tissues
-a decreased concentration of oxygen in inspired air -inadequate tissue oxygenation at the cellular level |
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Hypoxemia
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low levels of arterial oxygen
-decreased oxygen concentration of arterial blood, measured by arterial oxygen partial pressure (Pa02) values. -it is sometimes associated with decreased oxygen content |
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Orthopnea
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-an abnormal condition in which the person must use multiple pillows when lying down or must sit with the arms elevated and leaning forward to breathe.
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Dyspnea
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clinical sign of hypoxia and manifest as breathlessness
-subjective sensation of difficult or uncomfortable breathing |
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Noninvasive Ventilation
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-maintains positive airway pressure and improves alveolar ventilation without the need for an artificial airway.
-reduces and reverses atelectasis, improves cardiac funtion. |
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Positive-pressure Ventilation
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assists in reinflation
-delivers positive pressure to inflate the lungs |
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Tidal Volume
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-amount of air inpired and expired with each breath
-usually set at 8-15 mL/Kg of ideal body weight. |
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Cyanosis
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-blue discoloration of the skin and mucous membranes caused by the presence of desaturated hemoglobin in capillaries
-a late sign of hypoxia |
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Poor O2 of the blood ordinarily will affect the pulse rate & cause it to become:
1. bounding 2. irregular 3. faster than normal 4. slower than normal |
3-the pulse is the palpable bounding of blood flow noted @ various points on the body. the blood flows through the body in a continuous circuit. the pulse is an indicator of circulatory status such as asthma or chronic obstructive pulmonary disease (COPD), cause an increase in pulse rate.
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Nursing interventions, such as removing excess blankets form the client & applying cool cloths to the axilla to decrease body temp. through:
1. conduction 2. convection 3. evaporation 4. radiation |
1-conduction is the transfer of heat from one object to another w/direct contact. heat conducts through contact w/solids, liquids & gases. when the warm skin touches a cooler object, heat is lost. conduction normally accounts for a small amount of heat loss. the nurse increases conductive heat loss when applying an ice pack or bathing a client w/cool water
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A nurse is taking VS & notes the client has a strong radial pulse that disminishes in intensity & has an interruption in rhythm about q4-6 beats. the nurse's immediate action is to:
1. report the findings to a physician 2. measure a 60 second Ap. pulse. 3. connect the client to a cardiac monitor 4. obtain a 60 second Ap & radial pulse |
4-when assessing the pulse, the nurse must consider the variety of factors influencing the pulse rate. A combination of the factors may cause significant changes. If the nurse detects an abnormal rate while palpating a peripheral pulse, the next step is to assess the Ap. pulse.
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The nurse obtained a supine BP reading of 130/64. One hour later, the BP (supine) 134/62, and sitting BP 95/62. The nurse's immediate action is to:
1. assist the client to return to a supine position. 2. obtain a BP in the other arm. 3. report the findings to the nurse in charge. 4. question the client about lightheadedness |
1-if orthostatic hypotension is assessed the client is assisted to a lying positon and the physician or nurse in charge is notified. while obtaining orthostatic measurements, the nurse observes for other symptoms of hypotension; such as fainting, weakness, or light-headedness. b/c the skill of orthostatic measurements requires critical thinking and ongoing nursing judgement, this procedure is not delegated to unlicensed assistive personnel
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Client's w/apnea experience:
1. difficult respirations requiring more effort 2. slowness of breathing followed by rapid breathing 3. cessation of breathing that may be temporary 4. lack of O2 to body tissue and organs |
3-respirations cease for several seconds. persistant cessation results in resp. arrest. and irregular resp. pattern/periods of apnea are symptoms of underlying disease in the adult and must be reported to the physician or nurse in charge.
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If a BP cuff is too narrow, or wrapped too loosely, the BP reading will be:
1. falsely low 2. falsely high 3. difficult to hear b/c sounds will be muffled. 4. dependent on the examiner's hearing acuity |
2-BP mesurements will not be accurate unless the correct size BP cuff is applied appropriately. If a cuff is too small/tends to come loose, the result is a false high reading
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The nursing assistant reports to the nurse that a client is "feeling funny". the nurse's first action would be:
1. obtain the VS herself. 2. instruct the nurse assistant to retake VS. 3. instruct the nursing assistant to continue to assess the client and report any further complaints. 4. notify the physician. |
-careful measurement techniques ensure accurate findings. VS & other physiological measurements are the basis for clinical problem solving. VS assessment is an essential ingredient when nurses & physician collaborate to determine the client's health status
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A pulse deficit provides information about the heart's ability to adequately perfuse the body. A pulse deficit is:
1. the difference between the radial and apical pulse rates. 2. the digital pressure felt when taking radial and ulnar pulses. 3. the amount of pressure felt when taking radial and ulnar pulses. 4. the difference between the systolic and diastolic BP readings |
1-an insufficient contraction of the heart that fails to transmit a pulse wave to the periperal pulse site creates a pulse deficit. to assess a pulse deficit, the nurse and a collegue assesses radial and apical rates simultaneously and then compare rates. the difference between the Ap and radial pulse rates is the pulse deficit. pulse deficits are frequently associated w/abnormal rhythms
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During a nursing assessment an adult client is noted to have shallow resp. @ a rate of 8 beats/min. His heart rate is 46 beats/min. His VS would be described as:
1. bradycardia & apnea 2. Tachycardia & apnea 3. Bradycardia & bradypnea 4. Tachycardia & bradpnea |
3-bradycardia is a slow HR below 60 beats/min in adults.
-bradypnea is abnomally slow rate of breathing, less than 12 breaths/min. |
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The skin plays a role in temperature regulation by:
1. insulating the body 2. constricting blood vessels 3. sensing external temperature variations 4. all above |
4- all
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The nurse bathes a client who has a fever w/cool water. the nurse does this to increase heat loss by means of:
1. radiation 2. convection 3. condensation 4. conduction |
4-conduction
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The nurse is assessing a client who she suspects has the nursing diagnosis of hyperthemia due to vigorous exercise in hot weather. in reviewing the data, the nurse knows that the most important sign of heatstroke is:
1. confusion 2. hot, dry skin 3. excess thirst 4. muscle cramps |
2- hot, dry skin
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When the nurse takes the client's radial pulse, he notes dysrhythmia. his most appropriate action is:
1. inform the physician immediately 2. wait 5 minutes & retake the radial pulse. 3. take the pulse Ap. for one full minute. 4. check the client's record for the presence of a previous dysrhythmia |
3-take the pulse Ap. for one full minute
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The nurse is ausculating Mrs. McKinnon's BP. the nurse inflates the cuff to 180mmHg. AT 156mmHg, the nurse hears the onset of a tapping sound. At 130mmHg, the sound changes to a murmur or swishing. @ 100mmHg, the sound momentarily becomes sharper and @ 92 mmHg, it becomes muffled. @ 88mmHg, the sound dissappears. Her BP is:
1. 180/92 2. 180/130 3. 156/88 4. 230/88 |
3-156/88
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Cyanosis, the blue discoloration of the skin and mucous membranes caused by the presence of desaturated hemoglobin in capillaries is a/an:
1. early s/o hypoxia 2. late s/o hypoxia 3. reliable measure of O2 status. 4. non-life threatening event |
2--late s/o hypoxia. the presence/absence of cyanosis is not a reliable measure of oxygenation status
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What is the primary factor in R-sided Failure?
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elevated pulmonary vasular resistance (PVR). as the PVR increases, the R ventricle must generate more work and the O2 demand in the heart increases. as the failure continues, the amount of blood ejected from the R ventricle decreases & blood begins to "back up" in systemic circulation. Clinically, the client has weight gain, distended neck veins, hepatomegally, and slenomegally, and dependant peripheral edema
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Right-sided heart failure results form:
1. impaired funtioning on the R ventricle 2. impaired functioning of the R atrium 3. severe weight loss 4. lowered pulmonary vascular resistance |
1- R-sided heart failure results from impaired funtioning of the R ventricle, characterized by venous congestion in the systemic circulation. R-sided heart failure more commonly results form pulmonary disease or as a reult of long term L-sided failure
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Left-sided heart failure is an abnormal condition characterized by:
1. impaired functioning of the L ventricle 2. impaired functioning of the L atrium 3. lowered cardiac pressures 4. increased cardiac output |
1-L-sided heart failure is an abnormal condition characterized by impaired funtioning of the L ventricle d/t the elevated pressures and pulmonary congestion. If L ventricular failure is significatnt, the amount of blood ejected from the L ventricle drops greatly, resulting in decreased cardiac output
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Fever increases the tissues' need for oxygen, and as a result:
1. carbon dioxide decreases 2. carbon dioxide increases 3. cyanosis occurs 4. there is increase muscle mass |
2-fever increases the tissues' need for O2, & as a result, carbon dioxide production also increases. if the febrile state persists, the metabolic rate remains high and the body begins to breakdown protein stores, resulting in muscle wasting and decreased muscle mass. Resp. muscle such as the diaphram and intercostal muscles are also wasted
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Conditinos such as shock and severe dehydration resulting from extracellular fluid loss and reduced circulating blood volume cause:
1. hypovolemia 2. hypervolemia 3. uncontrolled bleeding 4. hypoxia |
1-conditions such as shock and severe dehydration resulting from extracellular fluid loss & reduced circulating blood volume cause hypovolemia. w/a significant loss the body tries to adapt by increasing the heart rate and peripheral vasoconstriction to the increase of the volume of blood returned to the heart and in turn increasing cardiac output.
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The most common toxic inhalant that decreases the oxygen-carrying capacity of blood is:
1. carbon dioxide 2. carbon monoxide 3. nitrogen 4. mustard gas |
2-carbon monoxide is the most common toxic inhalent that decreases the oxygen-carrying capacity of blood. the affinity for hemiglobin to bind w/carbon monoxide is greater than 200 times its affinity to bind w/O2, creating a functional anemia b/c of the bonds strength, carbon monoxide is not easily disassociated from hemoglibin, making the hemoglobin unavailable for O2 transportation
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Clients with anemia my c/o:
1. lack of energy 2. increased activity tolerance 3. decreased breathlessness 4. increased activity tolerance |
1-anemia, a lower than normal hemoglobin level is a result of decreased hemoglobin produciton, increased RBC destruction, c/o fatigue, decreased activity tolerance and increased breathlessness, as well as pallor (esp. seen in conjuctiva of the eye) and increased heart rate
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The client's EKG shows an abnormal rhythm that slows during inspiration & increases w/expiration. the rate is 70-80 beats/minute. the P-wave, PR interval, and QRS complexes are normal. this is referred to as:
1. sinus tachycardia 2. sinus dysrhythmia 3. supraventricular tachycardia 4. premature ventricular contraction |
2-sinus dysrythmia -
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The movement of gases into and out of the lungs depends on:
1. a 50% O2 content in the atmospheric air 2. Pressure gradient between the atmosphere & the alveoli 3. use of accessory muscles of respiration during expiration 4. amount of carbon dioxide dissolved in the fluid of the alveoli |
2-pressure gradient between the atmosphere & the alveoli
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Afterload refers to:
1. the amount of blood ejected from the L ventricle each minute 2. the amount of blood ejected from the L ventricle w/each contraction 3. the resistance to L ventricle ejection 4. the amount of blood in the L ventricle @ the end of diastole. |
3-the resistance to L ventricle ejection
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Ventilation, perfusion & exchange of gases are the major purposes of:
1. respiration 2. circulation 3. aerobic metabolism 4. anerobic metabolism |
1- respiration
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The most effective positon for a client w/cardiopulmonary disease is the:
1. supine position 2. prone position 3. high fowlers 4. 45 degree semi-fowler's |
4-the most effective position for a client w/cardiopulmonary diseases is the 45 degree semi-fowler's position, using gravity to assist in lung expansion & reduce pressure from the abdomen on the diaphram.
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A person who starts smoking in adolescence & continues to smoke in middle age:
1. has in incrased risk for cardiopulmonary disease and lung cancer. 2. has an increased risk for obesity & diabetes 3. has an increased risk for stress-related illness 4. has in increased risk for alcoholism |
a person who starts smoking in adolescence & continues to smoke in middle age has an increased risk for cardiopulmonary disease and lung cancer
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Your client has a large amount of pulmonary secretions. over the last hour, you note that the secretions are thicker & the volume has increased. during the last 30 minutes, the pressure alarm on the mechanical ventilator has triggered repeatedly. what action is appropriate to correct this problem?
1. manually vent the client 2. change the sensitivity setting on the ventilator 3. suction the client's airway 4. call the physician |
3-suction the client's airway
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Your client is on mechanical ventilation. suddenly he develops severe resp. distress, his VS changes, his O2 saturation suddenly decreases and his trachial tube is no longer midline. you suspect a tension pneumothorax. your immediate actions are to:
1. begin manual ventilation & obtain VS & pulse asap 2. keep the ventilator settings the same & notify physician 3. notify the physician 4. suction the client & obtain VS |
1-begin manual ventilation and obtain VS and pulse ox. ASAP
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The use of noninvasive ventilation (CPAP/BiPap) has the potential to cause carbon dioxide retention in selected clients. which clients are @ greatest risk for carbon dioxide retention?
1. clients w/an underlying diagnosis of CHF 2. Clients w/an underlying diagnoses of Pulmonary fibrosis 3. clients w/an underlying diagnosis of COPD 4. clients w/an underlying diagnosis of pulmonary edema |
3-clients w/an underlying diagnosis of COPD
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BiPap differs from CPAP in that:
1. positive pressure is only given during inhalation 2. positive pressure is only given during exhalation 3. it uses negative pressure during inhalation & exhalation 4. it uses positive pressure during inhalation & exhalation |
4-it uses positive pressure during inhalation and exhalation
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2 L/m of O2 via nasal cannula or simple face mask is given to clients w/underlying chronic obstructive lung disease in order to:
1. decrease the risk of O2 toxicity. 2. decrease the risk of carbondioxide retention 3. increase PH level 4. increase diaphragmatic excursion |
2-reduce the risk of carbon dioxide retention
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Partial assessment of a dyspenic client would not include which of the following?
1. respiratory risk 2. sputum 3. chest x-ray 4. breathing pattern |
4-chest x-ray
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The use of chest physiotherapy to mobilize pulmonary secretions involves the use of:
1. hydration 2. percusssion 3. nebulization 4. humidification |
2-percussion
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Mr. Isaac comes to the ER c/o difficulty breathing. An objective finding associated w/his dyspnea might include:
1. statements about a sense of impending doom. 2. c/o SOB 3. feelings of heaviness in the chest 4. use of accessary muscles of respiration |
4-use of accessary muscles of respiration
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Humidification is added to O2 therapy via nasal cannula O2 in order to:
1. prevent drying of the nasal mucosa 2. liquefy pulmonary secretions 3. increase the clients cough 4. improve oxygentation |
1-prevent drying of the nasal mucosa
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Normal functioning of the lungs depends on what three factors?
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patent respiratory tree, functioning alveoli system, well functioning cardiovascular system
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What is meant by a patent respiratory tree?
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open, able to move air. If there is an occlusion or obstruction it is not patent and will have a negative impact on the respiratory sys
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What is the main function of the upper airway?
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warms air, humidifies, filters air, and helps get microorganisms out
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What are cilia and what are their main function?
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hair like projections in the airway that help get contaminants out of the respiratory tree.
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What are the functions of mucus and coughing?
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Mucus helps to capture microbs while coughing helps move secretions out
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What helps to thin mucus in the lungs?
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Hydration
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What is the function of surfactant?
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helps to keep the alveoli open/inflated and decreases surface tension
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define/describe inhalation
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active process, muscles contract, diaphragm moves down, pressure goes down and air rushes in
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define/describe exhalation
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passive process, muscles relax, diaphragm moves up, pressure goes up and air rushes out
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What are 3 factors that affect respiration?
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Accessory muscles, lung compliance, and airway resistance
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What are the accessory muscles and what do they do
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They are the abdominal, intercostal, and sternocleidomastoid muscles which help the distressed pt. move air
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What is lung compliance?
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elasticity of lungs to expand; how easily the lungs expand. Decreased lung compliance means decreased elasticity
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What factors affect lung compliance?
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chest wall factors (position of the body-MS, obesity, lying in bed, etc.) and lung factors (problems in the lungs- pneumonia, fibrosis, pulmnary edema, etc.)
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What is atelectasis?
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decreased expansion of the lungs
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What is pleural effusion?
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collection of fluid between lung and chest wall. Fluid collapses the lungs.
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What is pulmonary edema?
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fluid inside the respiratory tree such as with lf. side heart failure- blood gets backed up into the lungs and dumped into the alveoli because heart can't pump it out properly
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What is pulmonary fibrosis or pulmonary htn?
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after an injury occurs fibrin and collagen are laid down to repair which toughens lung tissue and decreasing compliance
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What is pneumothorax?
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a collapse of a portion of lung with air in the pleural space
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What is hemothorax?
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blood in the pleural space
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What can cause airway resistance?
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any obstructions to airflow: narrowed tube, tumor, infection, secretions, edema, foreign objects, bronchial constriction, etc.
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define diffusion
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movement of SOLUTES from an area of greater concentration to an area of lesser concentration
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define osmosis
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movement of SOLVENT from and area of lesser concentration to an area of greater concentration
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define perfusion
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movement of fluid (blood) through or into a system (blood entering vessels through walls)
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Diffusion and perfusion are interrelated, therefore can you have one without the other?
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Yes, it is possible to have diffusion but not perfusion however diffusion will not be effective. For example air is moving into the lungs, but there is a blocked area of tissue so perfusion is not happening
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What things effect diffusion in the lungs?
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surface area (less area = less diffusion), disease, and a decrease in environmental O2
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What types of things can affect the amount of surface area in the lungs?
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body position, tumor, lung collapse, lung removal, muscus plug, immobility, etc.
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How is oxygen transported through the body?
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97% is attached and transported via hemoglobin and 3% is dissolved into plasma
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The amount of oxygen that binds to hgb depends on what?
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PaO2 : more PaO2 the more oxygen that attached to Hgb
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What is a normal PaO2?
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between 80-100mmhg
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At a PaO2 of 60mmhg how saturated are the Hbg with oxygen (SaO2)?
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90%
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What are some s/s of hypoxia?
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cyanosis, pale coloration of skin, apprehension, restlessness, confusion, c/o dyspnea
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What controls respirations in a healthy person?
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CO2: CO2 crosses the bbb and mixes with H2O. H+ ions increase which causes faster breathing
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What controls respiration in a nonhealthy person?
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O2 : since a nonhealthy person lives with high levels of CO2 because of the build up, O2 must therefore control the respiratory drive. Low levels of O2 increases breathing
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Why is it important to monitor a pt. with COPD who is on oxygen?
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Because if the O2 levels get too high then their respiratory drive is not triggered and the pt. can stop breathing
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What are two ways of measuring O2 in the blood?
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ABG (arterial blood gas) and Pulse oximeter (saturation of O2)
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What are the normal ranges of PaO2 and PaCO2?
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PaO2:80-100mmhg
PaCO2:35-45mmhg |
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What does an ABG tell us?
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How well diffusion is functioning in the lungs
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What would a venus draw(VBG) tell us?
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how much O2 is being used by the tissues; tells us the O2 demand in the peripheries
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True or false?ABG will help us make critical decisions and tells us if the pt. needs O2 therapy.
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True
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What is a normal level on a pulse ox?
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95-100% but anything over 90% is good
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True or false? pulse ox will help us make critical decisions and tells us if the pt. needs O2 therapy
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False. It does not help make critical decisions, but may determine if a ABG is needed
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How can a pulse ox give a misreading of O2 saturation?
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If Hgb is low but still 90% saturated it could read 90%SaO2 when the pt. is actually hypoxic or hypoxemic because of the low Hbg levels
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What types of pts need O2 therapy?
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if they are hypoxic or hypoxemic, someone with a non-respiratory problem and demands more O2 to the tissues such as a febrile pt, someone with low levels of Hgb such as with blood loss or burn victims, someone with reduced O2 carrying ability such as a post-op pt, someone with decreased cardiac output
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What is the % of O2 (fraction of inspired air FiO2) in room air?
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21%
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True or false? If over 2L/min of O2 is delivered then it needs to be humidified.
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True
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True or false? you need a dr. order to humidify but not to administer O2
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False. Oxygen is considered a drug and you need a dr.s order for it however you do not need an order to humidify
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Up to how many L of O2 can be given with nasal prongs?
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6L/min
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simple face mask
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delivers 5-8L/min O2, 40-60% FiO2, fits snugly, has vents to pull in room air and expel CO2
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Partial rebreather
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has reservoir bag and vents, needs humidity, delivers 5-11 L/min O2, 60-75% FiO2
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Non-rebreather
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same as partial rebreather except it has vents, prevents outside air and exhaled CO2 from mixing with O2, needs to be monitored, delivers 6-15 L/min O2, 80-90% FiO2
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Venti mask
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only delivers up to 50% FiO2 but is more accurate than other masks because you can control the amount of O2 and room air that is given
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What are 5 precautions when using oxygen?
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1. no open flames 2. make sure electrical equ. is working properly 3. don't use metallic tools 4. avoid oils 5. avoid static electricity
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treatment of respiratory alkalosis
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treat underlying condition, support renal function w/ fluids, breath into bag or rebreather, sedatives
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s/s of respiratory alkalosis
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numbness & tingling around mouth, extremities, resp. effort normal or incr
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causes of respiratory alkalosis
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hyperventilation - anxiety, fear, mechanical ventilation; hypoxemia - asphyxiation, shock, high altitude
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treatment of respiratory acidosis
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increase CO2 excretion: bronchodilators, steroids, Mucomyst, O2, pulmonary hygiene, PAP
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s/s of respiratory acidosis
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skin pale to cyanotic & dry, incr. PaCO2
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causes of respiratory acidosis
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head injury, Rx overdose, chest injury, electrolyte imbalance, severe obesity, ascites, hemothorax, COPD, aspiration, pneumonia, pulm edema, TB, PE
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treatment of metabolic alkalosis
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treat the cause: fluid/electrolyte replacement, NS IV, Ca++, K-sparing diuretics, antiemetics
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s/s of metabolic alkalosis
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anxiety, irritability, hyperreflexia, muscle cramps/weakness, tachycardia, normal or low BP, shallow resps, hypokalemia, hypocalcemia
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causes of metabolic alkalosis
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antacid overuse, IV LR overuse, NaHCO3 overuse, vomiting, NG suctioning, thiazide diuretics
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treatment of metabolic acidosis
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treat the cause: insulin, hydration/electrolytes, antidiarrheals, sodium bicarbonate, dialysis
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s/s of metabolic acidosis
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lethargy, confusion, stupor, coma, hyporeflexia, muscle weakness, bradycardia, thready pulses, low BP, Kussmaul resp, warm/flushed/dry skin, hyperkalemia
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causes of metabolic acidosis
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diabetic ketoacidosis, starvation, lactic acidosis, excess ETOH or ASA, renal failure, diarrhea
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values of respiratory alkalosis
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pH is high, PaCO2 is low
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values of respiratory acidosis
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pH is low, PaCO2 is high
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values of metabolic alkalosis
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pH is high, HCO3 is high
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values of metabolic acidosis
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pH is low, HCO3 is low
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oxyhemoglobin curve
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changes in pH alter ease with witch hemoglobin releases O2 to plasma
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ABG analysis step 3
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pH is normal: fully compensated
pH & opposite number out of range: partially compensated pH out of normal range, opposite number in normal range: no compensation |
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ABG analysis step 2
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if CO2 is abnormal, respiratory
if HCO3 is abnormal, metabolic |
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ABG analysis step 1
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if pH is <7.35, acidosis
if pH is >7.45, alkalosis |
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normal HCO3
normal PaO2 normal PaCO2 |
normal HCO3 22-26 mEq/L
normal PaO2 83-100 mmHg normal PaCO2 35-45 mmHg |
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metabolic component of acid-base balance
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HCO3 (bicarbonate
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metabolic alkalosis
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Decreased HCO3 results in decrease in pH
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metabolic acidosis
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Increased HCO3 results in increase in pH
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respiratory component of acid-base balance
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CO2 (carbon dioxide)
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respiratory alkalosis
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Decreased CO2 results in increase in pH
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respiratory acidosis
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Increased CO2 results in decrease in pH
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normal ratio of carbonic acid to bicarbonate
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1:20
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most common buffer system
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CO2 + H2O --- H2CO3 --- H+ + HCO3-
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hypercalcemia
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calcium greater than 12mg/dl
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hypocalcemia
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calcium less than 8.5 mEq/L
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hyperkalemia
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potassium greater than 5.5 meq/l
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hypokal
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pot. less than 3.5
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hypernatremia
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sod greater than 147
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hyponatremia
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sodi less than 135
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hypermagnesemia
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mag greater than 2.5
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hypomagnesemia
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mag less than 1.5
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hyperphosphatemia
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phosphate greater than 4.5
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hypophosphatemia
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phos less than 2.0
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strong acid vs weak acid
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a strong acid separates completely in solution and releases all of it's H+ ions, a weak acid loses only a few
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3 major homeostatic regulators of hydrogen ions
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1) buffer systems
2) respiratory mechanisms 3) renal mechanisms |
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3 buffer systems for pH
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1) carbonic acid-sodium barcarbonate
2) Phosphate buffer system 3) Protein buffer system |
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what is the most important pH buffer system
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carbonic acid-sodium barcabonate buffer system
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how much of the H+ of ECF does the carbonic acid-sodium bicarb system buffer?
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up to 90%
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where is the phosphate buffer system active?
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in the intracellular fluids
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what does the phosphate buffer system do?
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converts alkaline sodium phosphate, a weak base, to acid-sodium phosphate in the kidneys
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What is the protein buffer system?
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a mix of plasma proteins and the globin portion of hemoglobin in RBCs
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How does the protein buffer system work?
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plasma proteins and hgb have chemical groups that can combine with or liberate H+ ions and tend to minimize changes in pH
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How well does the protein buffer system work?
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excellent buffering agents over a wide range of pH values.
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excess H+ ions cross over the plasma membrane of RBCs and bind to the hgb molecules that are plentiful in each RBC
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example of how the protein buffer system can work
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Body reactions at different ph levels...
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< 6.8 = death; 6.8-7.35 = acidosis; 7.35-7.45 = normal; 7.45-7.8 = alkalosis; > 7.8 = death!
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carbonic anhydrase inhibitor that decreases H+ ion secretion and increases HCO3 excretions by the kidneys, causing a diuretic effect
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Diamox
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An unusual awareness of heart beat, usually brought on by cardiac arrhythmias
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Cardiac palpitations
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acid/base ratio w/ Resp. and Renal Buffer
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1 pt. acid / 20 pts. base
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mEq
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(10-3) of a gram equivalent of a chemical element, an ion, a radical or a compound
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B.E.
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base excess, amount of excess or insufficient level of HCO3 in system. -2 to +2 mEq/L
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Normal blood HCO3
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22 - 46 mEq/L
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Normal blood PaCO2
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35 - 45 mmHg
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Normal blood SaO2
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95% - 100%
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Normal blood PaO2
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80 - 100 mmHg
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An abnormal passage leading from an abscess or hollow organ to the body surface or from one hollow organ to another and permitting passage of fluids or secretions
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fistula
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1. The absence of gas from all or a part of the lungs, due to failure of expansion or resorption of gas from the alveoli.
2. A congenital condition characterized by the incomplete expansion of the lungs at birth |
atelectasis
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Any of a group of amines that have important physiological effects as neurotransmitters and hormones and include epinephrine, norepinephrine, and dopamine
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catecholamines
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A carbonic anhydrase inhibitor that decreases H+ ion secretion and increases HCO3 excretions by the kidneys, causing a diuretic effect.
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acetazolamide (Diamox
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The process of supplying, treating or mixing with oxygen.
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Oxygenation
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Abnormal breathing pattern brought on by strenuous exercise or metabolic acidosis, and is characterized by an increased ventilatory rate, very large tidal volume, and no expiratory pause
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Kussmaul's respirations
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THE ROUTE THAT BLOOD CIRCULATES THROUGH THE ALVEOLI IS CALLED?
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PULMONARY CIRCULATION
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BRONCHIAL CIRCULATION TERMINATES WHEN?
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WHEN VENOUS BLOOD ENTERS PULMONARY VEINS
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THE PRESSURE WITHIN THE PLEURAL SPACE IS GREATER THAN OR LESS THAN THE OUTSIDE AIR?
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LESS THAN( WHICH CREATES SUCTION PREVENTING THE LUNGS FROM COLLAPSING
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THIS TERM REFERS TO THE EXCHANGE OF GASES BETWEEN THE AIR IN THE ALVEOLI AND THE BLOOD IN THE PULMONARY CAPILLARIES?
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EXTERNAL RESPIRATION
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ONCE OXYGEN DIFFUSES ACROSS THE MEMBRANE FROM THE ALVEOLI TO ALVEOLAR CAPILLARY NETWORK AND HEMOGLOBIN, WHAT % IS LEFT TO DISSOLVE INTO PLASMA?
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1-3%
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CHEMORECEPTORS INITIATE RESPIRATION IN RESPONSE TO RISING LEVELS OF ___IN THE BLOOD?
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CARBON DIOXIDE
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BY WHAT % DOES NORMAL PAO2 DECREASE IN THE OLDER ADULT?
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10-15 %
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WHAT IS THE RESPIRATORY RESPONSE TO HYPERCAPNIA? AND WHY?
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INCREASED RESPIRATORY RATE SECONDARY TO THE BODY SENSING THE NEED TO GET RID OF CO2
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WHAT PACO2 IS EXPECTED WITH HYPOVENTILATION?
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>45mmHg
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WHAT RR WOULD DEFINE HYPOVENTILATION ?
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<10
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WHAT MECHANISM WOULD BE TRIGGERED IF A METABOLIC DISEASE SUCH AS RENAL FAILURE CAUSED ACIDOSIS?
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HYPERVENTILATION
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IF A PERSON HYPERVENTILATES WHAT TYPE OF ACID-BASE IMBALANCE DOES HE HAVE?
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RESPIRATORY ALKALOSIS
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WHAT PACO2 VALUE CONSTITUTES HYPERVENTILATION?
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< 35 MMHG
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WHICH HOMEOSTATIC MECHANISM FOR HYDROGEN BALANCE IS THE FASTEST AND WHICH IS THE SLOWEST?
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BUFFERS ARE THE FASTEST AND KIDNEYS ARE THE SLOWEST
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WHAT ARE THE 3 MECHANISMS BY WHICH THE BODY MAINTAINS HOMEOSTASIS OF HYDROGEN CONCENTRATION?
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BUFFER SYSTEMS, EXHALATION OF CO2, AND KIDNEY EXCRETION
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WHEN POSITIONING A PERSON WITH UNILATERAL LUNG PROBLEMS WHAT IS THE BEST POSITION?
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GOOD LUNG DOWN--TO PROMOTE OPTIMAL MATCHING OF VENTILATION AND PERFUSION
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WHAT ARE THE 5 MAIN SIGNS AND SYPMTOMS OF CO POISONING?
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CHERRY RED SKIN,
TINITIS, THROBBING TEMPLES, HEADACHE, DILATED PUPILS |
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HOW MANY TIMES GREATER IS THE AFFINITY OF CO FOR HGB THAN O2 IS?
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200X
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WHY MUST O2 LEVELS ADMINISTERED TO A COPD PT BE CLOSELY MAINTAINED?
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BECAUSE THESE PATIENTS BREATHE PRIMARILY AS A RESPONSE TO HYPOXEMIA
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WHAT SHOULD THE GOAL OF PAO2 BE WHEN OXYGENATING A PT?
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>60MMHG OR SAO2 93%OR>
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One of the most common electrolyte imbalances is?
1. hypokalemia 2. Hyperkalemia 3. Hyponatremia 4. Hypocalcemia |
1. Hypokalemia
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The client most at risk for fluid volume deficits (FVDs) is a (an)?
1. adolescent 2. adult 3. child 4.infant |
infant
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One reason older adults experience fluid and electrolyte imbalance and acid-base imbalances is they?
1.eat poor-quality food 2.have a decreased thirst sensation 3. have more stress response 4. have an overly active thirst response |
2. have a decreased thirst sensation
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Output recorded on an intake and output record includes?
1.urine, vomitus, diarrhea, & drainage from wounds 2. diarrhea, gastric suction, & drainage from wounds 3. medications, juices and water 4. Urine, diarrhea, vomitus, gastric suctin & drainage from wounds or tubes. |
4. Urine, diarrhea, vomitus, gastric suctin & drainage from wounds or tubes
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Health promotion activities in the area of fluid and electrolyte imbalances focuses primarily on?
1. client teaching 2. dietary intake 3. medication regimen 4. physician involvement in care |
1. client teaching
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Causes of Respiratory Acidosis
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Asthma
Atelectasis Brain trauma Bronchiectasis Bronchitis Emphysema Hypoventilation medications Pulmonary edema |
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Causes of Respiratory Alkalosis
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Fever
Hyperventilation Hypoxia Hysteria Overventilation by mechanical ventilators Pain |
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Causes of Metabolic Acidosis
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Diabetes mellitus or diabetic ketoacidosis
Excessive ingestion of acetylsalicylic acid (aspirin) High-fat diet Insufficient metabolism of carbohydrates malnutrition Renal insufficiency or renal failure Severe diarrhea |
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Causes of metabolic Alkalosis
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Diuretics
Excessive vomiting or gastrointestinal suctioning Hyperaldosteronism Ingestion of excess sodium bicarbonate Massive transfusion of whole blood |
