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55 Cards in this Set

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Positioning of patient with dyspnea

indicates that the client often use multiple pillows when lying down or must sit with the arms elevated and leaning forward to breathe.

What is the best position for lung expansion?

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

What is the best position for patients with pneumothorax?


-indicates that semi-fowler's is optimal for patients with a pneumothorax to facilitate the evacuation of the pleural air

Pursed-lip breathing is for what?

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

How is pursed lip breathing performed?

by breathing through the nose and then prolonging exhalation through “pursed-lips”.

What is the purpose of prolongation of exhalation during pursed lip breathing?

to promote alveoli to remain open longer, enhancing the elimination of trapped CO2.

How long should the exhalation period for pursed lip breathing?

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.)

Atelectasis

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

Hypoxia

Inadequate oxygenation at the CELLULAR level

Hypoxemia

Decrease oxygen levels in the BLOOD measured by PaO2

Hypoventilation

decrease in the rate and or depth of air movement into the lungs
Alveoli ventilation inadequate

Heyperventilation

increased rate and depth of ventilation
Too much CO2

What induces hyperventilation?

anxiety
infection
drugs
acid-base imbalance

What causes hyperventilation?

fever (increase temperature--> Increase metabolic rate-->Increase CO2 production)

CHEMICAL (Salicylate and amphetamine)

Metabolic Acidosis (DKA -respiratory tries to correct acid/base balance

What are signs and symptoms of hypoventilation?

Mental status changes
Dysrythmias
Cardiac arrest

What is the goal for ventilation?

PaCO2 = 35-45 mm Hg
PaO2 = 95-100 mm Hg

What factors affect respiratory function?

Health status
Developmental level
Medications
Lifestyle
Environment
Psychological health

How does health status affect respiratory function?

1. Weakened states, don't deep breath
2. CRF/CHF-predisposed to extra fluid
3. Respiratory conditions such as COPD/Asthma

How does age affect respiratory function?

as we age, our RR decreases

Give an example how lifestyle affect respiratory function?

Exercise- increases depth
Cigarette smoking- prone to illness/CA and pulmonary complications

Examples how environment affect respiratory function?

Air pollutants
coal miners
asbestos
2nd hand smoke
middle ear infection

How does stress affect respiratory function?

Stress causes asthma attacks and hyperventilation

Physical Assessment

History (smoking, use of O2, cough/sputum, chest pain, dyspnea, positioning, environmental exposure)
Physical Exam
Patient with shortness of air

What are the methods used for assessing respiratory function?

Pulse ox( SAO2)
Arterial Blood Gasses (ABCs)
Complete blood count (CBC)
Incentirve spirometry
Chest Xray
Bronchoscopy
Sputum analysis
Lung scan (V/Q scan)

What can you see using an X-ray?

you can see tumors, pheumonia, fluid

Bronchosopy

Lighted camerea inserted throughthe MOUTH into the mainstem BRONCHUS
-can see tumors, obtain specimens, suction out lower airways

Sputum Analysis

from lungs, bronchi, trachea
-NOT oral secretions-so teach pt to cough down and deep

Best time to collect sputum for analysis

typically want 3 early morning specimens, before antibiotics

What is used to scan lung?

V/Q scan to assess for pulmonary emboli
V=Ventilation (air into and out of lungs)
Z=perfusion-blood flow through lungs

How would you promote healthy respirations?

Deep breathing
Incentirve spirometry
Pursed-lip breathing
Abdominal breathing

Coughing

When do we need to help our patients breath deeply?

after anesthesia, on bedrest, on narcotics, in pain fructured ribs

How do you teach someone how to deep breath?

breath deep enough to move bototm ribs.
1. Inhale through nose
2. Exhale through mouth
3. Open all alveoli sacs

Pursed lipped breathing

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

Abdominal breathing

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

What are nebulizers and MDIs for?

-hand held machines attached to oxygen and humidity that give patients meds into the respiratory track.

What are examples of nebulizers/ metered dose inhalers?

bronchodilators
Mucolytic agents
corticosteroids

Brochodialators are for what?

to pen narrow airways

Mucolytic agents

to liquidify and loosen thick secretions

Steroids

to decrease inflammation and swelling

Who administer and chart Nebulizers and MDIs?

Respiratory therapist

O2 Administration

nasal cannula
Simple mask
Partial rebreather mask
non-rebreather mask
venturi mask

Nasal Cannula

2 prongs in nostrils
deliveres lose doses -ordered in liters
Ball in middle of low metere shows amount pg. 1404

Simple Mask

Lower doses of O2 for every short periods of time
Ex. Waking up from minimal anesthesia

Partial re-breather mask

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

Which is the only mask that can deliver 100% oxygen to patients with extreme SOB?

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

Which is the only oxygen mask that can deliver precise amount of oxygen?

Venturi Mask -great for COPD patients

How often would you check oxygen level flow?

every 4 hrs

How often should you remove mask to assess pt's skin?

every 4 hours

How often should you assess pt's respiratory rate and effort

every 4 hours and as needed

What should you do if your patient leaves the room?

provide portable oxygen

Patient care on oxygen

Do not allow anyone to smoke

what should you do before apply mask to patient?

allow bag to fill with oxygen before applying

Treatments: Weaning off oxygen

1. decrease % of O2
2. Monitor ABgs
3. Monitor SaO2

Artificial airways

Oropharyngeal/nasopharangeal
Endotracheal tube (ETT)
Tracheostomy (Trach)

While oxygen is weaning off, what should you assess?

assess vital sign, anxiety level, skin color