305 Chap 40 Oxygenation

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

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

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

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

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

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

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.)

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

Inadequate oxygenation at the CELLULAR level

Decrease oxygen levels in the BLOOD measured by PaO2

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

increased rate and depth of ventilation
Too much CO2

anxiety
infection
drugs
acid-base imbalance

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

CHEMICAL (Salicylate and amphetamine)

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

Mental status changes
Dysrythmias
Cardiac arrest

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

Health status
Developmental level
Medications
Lifestyle
Environment
Psychological health

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

as we age, our RR decreases

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

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

Stress causes asthma attacks and hyperventilation

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

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

you can see tumors, pheumonia, fluid

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

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

typically want 3 early morning specimens, before antibiotics

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

Deep breathing
Incentirve spirometry
Pursed-lip breathing
Abdominal breathing

Coughing

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

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

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

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

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

bronchodilators
Mucolytic agents
corticosteroids

to pen narrow airways

to liquidify and loosen thick secretions

to decrease inflammation and swelling

Respiratory therapist

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

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

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

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

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

Venturi Mask -great for COPD patients

every 4 hrs

every 4 hours

every 4 hours and as needed

provide portable oxygen

Do not allow anyone to smoke

allow bag to fill with oxygen before applying

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

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

assess vital sign, anxiety level, skin color