Chapter 38: Oxygenation and Perfusion

A nurse caring for a patient with chronic obstructive pulmonary disease (COPD) knows that hypoxia may occur in patients with respiratory problems. What are signs of this serious condition?

A nurse is suctioning the nasopharyngeal airway of a patient to maintain a patent airway. For which condition would the nurse anticipate the need for a nasal trumpet?

The [blank_start]nasal[blank_end] [blank_start]trumpet[blank_end] will protect the nasal mucosa from further trauma related to suctioning.

A nurse is choosing a catheter to use to suction a patient's endotracheal tube via an open system. On which variable would the nurse base the size of the catheter to use?

A nurse is caring for a 16 year old male patient who has been hospitalized for an acute asthma exacerbation. Which testing methods might the nurse use to measure the patient's oxygen saturation?

[blank_start]Spirometers[blank_end] are used to monitor the health status of patients with respiratory disorders, such as asthma. [blank_start]Pulse[blank_end] [blank_start]oximetry[blank_end] is used to obtain baseline information about the patient's oxygen saturation level and is also performed for patients with asthma, along with [blank_start]PEFR[blank_end] to monitor airflow. These 3 tests may be administered by the nurse.

[blank_start]Diffusion[blank_end] [blank_start]capacity[blank_end] estimates the patient's ability to absorb alveolar gases and determines if a gas exchange problem exists. [blank_start]Maximal[blank_end] [blank_start]respiratory[blank_end] [blank_start]pressures[blank_end] help evaluate neuromuscular causes of respiratory dysfunction. Both tests are usually performed by a respiratory therapist.

The physician or other advanced practice professional can perform a [blank_start]thoracentesis[blank_end] at the bedside with the nurse assisting, or in the radiology department.

[blank_start]Thoracentesis[blank_end] is a procedure in which a needle is inserted into the pleural space between the lungs and the chest wall. This procedure is done to remove excess fluid, known as a pleural effusion, from the pleural space to help you breathe easier.

A patient with COPD is unable to perform activities of daily living (ADLs) wihtout becoming exhausted. Which nursing diagnosis best describes this alteration to oxygenation as the etiology?

A nurse working in a long-term care facility is providing teaching to patients with altered oxygenation due to conditions such as asthma and COPD. Which measures would the nurse recommend?

A nurse is providing postural drainage for a patient with cystic fibrosis. In which position should the nurse place the patient to drain the right lobe of the lung?

A nurse is teaching a patient how to use a meter-dosed inhaler for her asthma. Which comments from the patient assure the nurse that the teaching has been effective?

When planning care for a patient with chronic lung disease who is receiving oxygen through a nasal cannula, what does the nurse expect?

A rate higher than [blank_start]3[blank_end]L/min may destroy the hypoxic drive that stimulates respirations in the medulla in a patient with chronic lung disease.

A nurse is securing a patient's endotracheal tube with tape and observes that the tube depth changed during the retaping. Which action would be appropriate related to this incident?

What action does the nurse perform to follow the safe technique when using a portable oxygen cylinder?

A nurse providing care of a patient's chest drainage system observes that the chest tube has become separated from the drainage device. What would be the first action that should be taken by the nurse in this situation?

An emergency department nurse is using a manual resuscitation bag (Ambu bag) to assist ventilation in a patient with lung cancer who has stopped breathing on his own. What is an appropriate step in this procedure?

Which assessments and interventions should the nurse consider when performing tracheal suctioning?

Risks of tracheal suctioning include: [blank_start]atelactasis[blank_end], [blank_start]dysrythmias[blank_end], [blank_start]hypoxia[blank_end], [blank_start]infection[blank_end], and [blank_start]trachial[blank_end] [blank_start]tissue[blank_end] [blank_start]damage[blank_end].

The airway begins at the [blank_start]nose[blank_end] and ends at the [blank_start]terminal[blank_end] [blank_start]bronchioles[blank_end].

Each lung is divided into two [blank_start]lobes[blank_end]. Each lobe is subdivided into [blank_start]segments[blank_end] or [blank_start]lobules[blank_end].

The main [blank_start]bronchus[blank_end] branches to each lung from the [blank_start]trachea[blank_end]. It subdivides into [blank_start]secondary[blank_end] [blank_start]bronchi[blank_end], they subdivide again and again becoming smaller and smaller. The smallest of these branches are the [blank_start]bronchioles[blank_end], ending at the [blank_start]terminal[blank_end] [blank_start]bronchioles[blank_end].

The [blank_start]visceral[blank_end] pleura covers the lung, and the [blank_start]parietal[blank_end] pleura lines the thoracic cavity.

Pressure w/in the pleural space ([blank_start]intrapleural[blank_end] [blank_start]pressure[blank_end]) is always [blank_start]subatmospheric[blank_end] (a negative pressure).

[blank_start]Inspiration[blank_end] is the active phase, [blank_start]expiration[blank_end] is the passive phase.

During [blank_start]inspiration[blank_end]: the [blank_start]diaphragm[blank_end] contracts and descends, lengthening the throracic cavity; the [blank_start]external[blank_end] [blank_start]intercostal[blank_end] muscles contract, lifting the ribs upward and outward; and the [blank_start]sternum[blank_end] is pushed forward enlarging the chest. This combination of an increased lung volume and decrease of [blank_start]intrapulmonic[blank_end] pressure allows air to move in from an area of greater pressure (outside air) into an area of lesser pressure (w/in the lungs). The relaxation or [blank_start]recoil[blank_end] of these structures then results in [blank_start]expiration[blank_end]. This causes a [blank_start]decreased[blank_end] volume in the lungs and an increased in [blank_start]intrapulmonic[blank_end] pressure.

The respiratory center is located in the [blank_start]medulla[blank_end] in the [blank_start]brainstem[blank_end]. It is stimulated by an increased concentration of [blank_start]carbon[blank_end] [blank_start]dioxide[blank_end] and [blank_start]hydrogen[blank_end] [blank_start]ions[blank_end], and to a lesser degree, by the decreased amount of [blank_start]oxygen[blank_end] in the arterial blood. In addition chemoreceptors in the [blank_start]aortic[blank_end] [blank_start]arch[blank_end] and [blank_start]carotid[blank_end] bodies are also sensitive to the same [blank_start]arterial[blank_end] [blank_start]blood[blank_end] [blank_start]gas[blank_end] and can activate the medulla.

Atria receive blood from the veins: superior/inferior [blank_start]vena[blank_end] [blank_start]cav[blank_end] and the left/right [blank_start]pulmonary[blank_end] [blank_start]veins[blank_end].

Contractions of the heart start in the [blank_start]atria[blank_end], followed by contraction of the [blank_start]ventricles[blank_end], with a subsequent resting of the [blank_start]heart[blank_end].

Deoxygenated blood flows from the [blank_start]right[blank_end] side of the heart to the lungs.

Oxygenated blood is returned to the [blank_start]left[blank_end] side of the heart and pumped out to all other parts of the body.

[blank_start]97[blank_end]% of oxygen is carried by red blood cells as part of [blank_start]hemoglobin[blank_end] in the form of [blank_start]oxyhemoglobin[blank_end]. Hemoglobin also carries [blank_start]carbon[blank_end] [blank_start]dioxide[blank_end] in the form of carboxyhemoglobin.

Be alert for the possibility of [blank_start]respiratory[blank_end] [blank_start]depression[blank_end] or [blank_start]arrest[blank_end] when administering any narcotic or sedative.

Generalized [blank_start]anxiety[blank_end] has been show to cause enough bronchospasm to produce an episode of bronchial asthma.

Be aware of the patient's [blank_start]hemoglobin[blank_end] level before evaluating oxygen saturation because the test measures only the percentage of oxygen carried by the available hemoglobin. Thus even a patient with a [blank_start]low[blank_end] hemoglobin level could appear to have a [blank_start]normal[blank_end] SpO2, because most of that hemoglobin is saturated. However the patient may not have enough oxygen to meet body needs. A range of [blank_start]95[blank_end]% to [blank_start]100[blank_end]% is considered normal SpO2; values <= [blank_start]90[blank_end]% are abnormal.

The max amt of fluid removed with Thoracentesis is generally [blank_start]1,000[blank_end] mL.

People who work hard at breathing often do not have much energy for [blank_start]eating[blank_end]. Many of the medications used for treatment can cause [blank_start]anorexia[blank_end] and [blank_start]nausea[blank_end].

Research has demonstrated that, in patients with pulmonary disease who are acutely ill, turning to the [blank_start]prone[blank_end] position on a regular basis promotes oxygenation. In this position the posterior dependent sections of the lungs are better ventilated and perfused.

Patients can help keep their secretions thin by drinking [blank_start]2[blank_end] to [blank_start]3[blank_end] quarts ([blank_start]1.9[blank_end] L - [blank_start]2.9[blank_end] L) of clear fluids daily. However, encourage patients with heart failure and low sodium levels to limit their fluid intake to [blank_start]1.5[blank_end] L / day.

Some health care providers consider adequate [blank_start]fluid[blank_end] intake and air [blank_start]humidification[blank_end] as effective expectorants.

Suctioning irritates the mucosa and removes [blank_start]oxygen[blank_end] from the respiratory tract, possibly causing hypoxemia. Thus it is important to [blank_start]preoxygenate[blank_end] the patient before suctioning.

In an [blank_start]emergency[blank_end] situation the absence of a [blank_start]prescription[blank_end] should not delay the administration of oxygen to the patient.

Removal of chest tubes can be a painful and stressful process for patients. Whenever possible, administer [blank_start]analgesics[blank_end] prior to the tube removal and apply [blank_start]cold[blank_end] to the chest.

The [blank_start]oropharyngeal[blank_end] airway is used to keep the tongue clear of the airway.

A [blank_start]nasopharyngeal[blank_end] airway is inserted through the nare and protrudes into the back of the pharynx. The [blank_start]nasal[blank_end] [blank_start]trumpet[blank_end] allows for frequent [blank_start]nasotracheal[blank_end] suctioning without trauma to the nasal passageway.

Patients w/tracheostomies frequently have an infective [blank_start]cough[blank_end] mechanism and copious [blank_start]secretions[blank_end].

Exercise care when changing the [blank_start]tracheostomy[blank_end] ties to prevent accidental decannulation or [blank_start]expulsion[blank_end] of the tube.

During tracheal suctioning: to prevent hypoxia, [blank_start]hyperoxigenate[blank_end] before/after suctioning and limit the application of suction [blank_start]10[blank_end] to [blank_start]20[blank_end] seconds. Suction catheter should be limited to no further than [blank_start]1[blank_end] [blank_start]cm[blank_end] past the length of the tracheal/endotrachel tube to avoid damage.