Oxygen therapy
Terms
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- Normal functioning of the lungs depends on what three factors?
- patent respiratory tree, functioning alveoli system, well functioning cardiovascular system
- What is meant by a patent respiratory tree?
- 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.
- What is the main function of the upper airway?
- warms air, humidifies, filters air, and helps get microorganisms out
- What are cilia and what are their main function?
- hair like projections in the airway that help get contaminants out of the respiratory tree.
- What are the functions of mucus and coughing?
- Mucus helps to capture microbs while coughing helps move secretions out.
- What helps to thin mucus in the lungs?
- Hydration
- What is the function of surfactant?
- helps to keep the alveoli open/inflated and decreases surface tension
- What is ventilation?
- the movement of air in and out of the lungs
- define/describe inhalation
- active process, muscles contract, diaphragm moves down, pressure goes down and air rushes in
- define/describe exhalation
- passive process, muscles relax, diaphragm moves up, pressure goes up and air rushes out
- What are 3 factors that affect respiration?
- Accessory muscles, lung compiance, and airway resistance
- What are the accessory muscles and what do they do?
- They are the abdominal, intercostal, and sternocleidomastoid muscles which help the distressed pt. move air
- What is lung compliance?
- elasticity of lungs to expand; how easily the lungs expand. Decreased lung compliance means decreased elasticity
- What factors affect lung compliance?
- 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.)
- What is atelectasis?
- decreased expansion of the lungs
- What is pleural effusion?
- collection of fluid between lung and chest wall. Fluid collapses the lungs.
- What is pulmonary edema?
- 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.
- What is pulmonary fibrosis or pulmonary htn?
- after an injury occurs fibrin and collagen are laid down to repair which toughens lung tissue and decreasing compliance
- What is pneumothorax?
- a collapse of a portion of lung with air in the pleural space
- What is hemothorax?
- blood in the pleural space
- What can cause airway resistance?
- any obstructions to airflow: narrowed tube, tumor, infection, secretions, edema, foreign objects, bronchial constriciton, etc.
- define diffusion
- movement of SOLUTES from an area of greater concentration to an area of lesser concentration
- define osmosis
- movement of SOLVENT from and area of lesser concentration to an area of greater concentration
- define perfusion
- movement of fluid (blood) through or into a system (blood entering vessels through walls)
- Diffusion and perfusion are interrelated, therefore can you have one without the other?
- 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
- What things effect diffusion in the lungs?
- surface area (less area = less diffusion), disease, and a decrease in environmental O2
- What types of things can affect the amount of surface area in the lungs?
- body position, tumor, lung collapse, lung removal, muscus plug, immobility, etc.
- How is oxygen transported through the body?
- 97% is attached and transported via hemoglobin and 3% is dissolved into plasma
- The amount of oxygen that binds to hgb depends on what?
- PaO2 : more PaO2 the more oxygen that attached to Hgb
- What is a normal PaO2?
- between 80-100mmhg
- At a PaO2 of 60mmhg how saturated are the Hbg with oxygen (SaO2)?
- 90%
- What is hypoxemia?
- decreased O2 in blood and causes hypoxia
- What is hypoxia?
- decreased O2 in the tissues
- What are some sx/s of hypoxia?
- cyanosis, pale coloration of skin, apprehensive, restless, confused, c/o dyspnea
- What controls respirations in a healthy person?
- CO2: CO2 crosses the bbb and mixes with H2O. H+ ions increase which causes faster breathing.
- What controls respriation in a nonhealthy person?
- O2 : since a nonhealthy person lives with high levels of CO2 because of the build up, O2 must therefor control the respiratory drive. Low levels of O2 increases breathing
- Why is it important to monitor a pt. with COPD who is on oxygen?
- Because if the O2 levels get too high then their respriatory drive is not triggered and the pt. can stop breathing
- What are two ways of measuring O2 in the blood?
- ABG (arterial blood gas) and Pulse oximeter (saturation of O2)
- What are the normal ranges of PaO2 and PaCO2?
-
PaO2:80-100mmhg
PaCO2:35-45mmhg - What does and ABG tell us?
- How well diffusion is functioning in the lungs
- What would a venus draw(VBG) tell us?
- how much O2 is being used by the tissues; tells us the O2 demand in the peripheries
- True or false?ABG will help us make critical decisions and tells us if the pt. needs O2 therapy.
- True
- What is a normal level on a pulse ox?
- 95-100% but anything over 90% is good
- True or false? pulse ox will help us make critical decisions and tells us if the pt. needs O2 therapy.
- False. It does not help make critical decisions, but may determine if a ABG is needed
- How can a pulse ox give a misreading of O2 saturation?
- 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
- What types of pts need O2 therapy?
- 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
- What is the % of O2 (fraction of inspired air FiO2) in room air?
- 21%
- True or false? If over 2L/min of O2 is delivered then it needs to be humidified.
- True
- True or false? you need a dr. order to humidify but not to administer O2.
- False. Oxygen is considered a drug and you need a dr.s order for it however you do not need an order to humidify
- Up to how many L of O2 can be given with nasal prongs?
- 6L/min
- simple face mask
- delivers 5-8L/min O2, 40-60% FiO2, fits snugly, has vents to pull in room air and expel CO2
- Partial rebreather
- has reservoir bag and vents, needs humidity, delivers 5-11 L/min O2, 60-75% FiO2,
- Non-rebreather
- 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
- Venti mask
- 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
- What are 5 precautions when using oxygen?
- 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