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Oxygenation - ch 28
Fundamental Concepts - Chapter 28
| Question | Answer |
|---|---|
| What is the structure of the airway | Nasal passages; mouth; pharynx; larynx; trachea; bronchi; bronchioles |
| What are the natural defenses of the airway? | Moisten, warm, & filter inhaled air; Blood flowing through the vessels of airway walls transfers body heat to inhaled air; Specialized cells in the lining of airways secrete sticky mucus to trap foreign particles; Cilia |
| What is Cilia? | Tiny hair-like projections from walls of airways, move rhythmically to sweep trapped debris up and out of the airway. |
| What does the upper airway consist of? | Located above the larynx; nasal passages; mouth;pharynx, nasopharynx, oropharynx, laryngopharynx; larynx. |
| What is the purpose of the nasal passage? | Contain coarse haris that filter air and vascular mucous membranes that warm and moisten air. |
| What is the purpose of the mouth associated with the airway? | When nasal passages blocked, we use mouth breathing, which is not efficient at warming and moistening inhaled air, and has no filtering capacity. (dry mouth) |
| What is the pharynx (throat)? | Contain lymphoid tissue (tonsils) on both sides; contains the openings to the esophagus and trachea. |
| Where is the trachea? | Lies just in front of the esophagus. |
| What is the epiglottis? | It closes off the trachea during swallowing to prevent food and fluid from entering the lower airway. Opens during breathing to allow air to move through the airway. |
| What is the larynx? (KNOW) | THE NARROWEST PORTION OF THE UPPER AIRWAY. Common site for airway obstruction. Composed of cartilage and muscles. Spasm of these muscles (laryngospasm) can close off the entire lower airway and create a respiratory emergency. |
| What causes irritation to the the upper respiratory tract? | Exposure to the outside environment (smoke, smog, chemicals, microorganisms). |
| What does the lower airway consist of? | The trachea and the bronchial tree. |
| What is the trachea? | Supported by horseshoe shaped rings of cartilage that keep it from collapsing during inhalation. lies just under the skin of the anterior neck. accessible for creation of emergency surgical airway opening, divides to form right and left mainstem bronchi. |
| What makes up the bronchial tree? | Mainstem bronchus, bronchioles, alveolar ducts, alveoli |
| What is the left mainstem bronchus? | Narrower, longer, and leaves the trachea at a sharper more horizontal angle than the right. |
| What is the right mainstem bronchus? (KNOW) | Shorter and fatter than the left and leaves the trachea at a more vertical angle. MAKES IT MORE SUSCEPTIBLE TO ASPIRATION OF FOREIGN BODIES, FOOD AND FLUID THAN THE LEFT. Most common for aspirated pneumonia. |
| What is the bronchial tree? | Both bronchi are supported by carilage rings, however as the airways branch and become smaller, the cartilage becomes progressively thinner until it disappears in the smaller bronchioles. Walls of bronchi and bronchioles contain layers of smooth muscle. |
| What are bronchospasms? | Spasms of the smooth muscles along the walls of the bronchi and bronchioles. |
| What are the lungs? | Lungs are soft, spongy organs that lie on each side of the chest cavity, seperated by the mediastinum, which contains the heart and great vessels. Consists of the right lung, left lung, apex and base. |
| How many lobes are in the right and left lung? | Right lung composed of three lobes, left lung composed of two lobes. |
| What is the apex? | The upper part of the lungs extends above clavicles. |
| What is the base? | Lower part of lungs that rest on the diaphragm. |
| The lungs are composed of millions of what? | alveoli. |
| What is alveoli? | tiny air sacs with thin walls surrounded by a fine network of capillaries. Gases easily pass back and forth between the alveoli and capillaries. |
| Where does inhaled air in the lungs come in contact with the blood of the pulmonary circulation? | In the alveolar-capillary membrane. |
| What is the alveoli composed of? | Two types of cells. Type I alveolar cells are the gas exchange cells. Type II alveolar cells are not involved in gas exchange, they produce surfactant(surface tension). |
| What is atelectasis? | alveolar collapse. (bubbles popping-crackle sound you may hear when auscilating) The larger the area of atelectasis, the greater the risk hypoxemia. Anything that reduces venilation can cause atelectasis. |
| What causes alveolar collapse? | It may be caused by compression from a tumo, fluid accumulation, abdominal distention, obstructed or hypoventilated alveoli. |
| How do you prevent atelectasis? | Deep breathing and coughing exercise, Frequent postion changes, and early ambulation after surgery. Increasing secretion removal, keeping surfactant distributed among alveoli, inflating obstructed alveoli through the pores between them. |
| What is surfactant? | A lipoprotein that lowers the surface tension within alveoli and prevents their walls from adhering together. |
| How does the surfactant work within the alveoli? | The moist, membranous inner walls of the alveoli tend to draw together because of the high surface tension inside the alveoli. Therefore, adequate surfactant levels are key to allowing the alveoli to inflate during breathing. |
| Why do infants born before 34 weeks of gestation have a higher risk for respiratory distress syndrome (RDS)? | Because premature infants are lacking surfactant. Surfactant is the last thing we make in the womb. |
| What is pleura? | A thin, double layered membrane. The parietal layer lines the inside of the chest cavity and the visceral layer covers the ouside of the lungs. The pleural space lies between the two layers. |
| What is pleural space? | A thin film of fluid athat allows the two layers to remain in contact but glide over each other during breathing movements. |
| How does the pleural space work? | As long as the pleural space is intact with negative pressure and only a thin film of fluid inside, the lungs expand and contract as the chest expands and contracts. |
| What happens if the pleural space fills with air or fluid, or if the chest cavity is opened? | The lungs will no longer be in contcat with the inside of the chest wall, altering lung expansion and pulmonary functions. |
| What is Ventilation? | Movement of air into/out of the lungs. The mechanical movement of breathing. Moving air to accomplish gas exchange. ventilation results in pressure/volume changes in the lung. controlled by respiratory centers in the brainstem. |
| What is Respiration? | Exchange of oxygen/carbon dioxide. Gas exchange. Alveolar capillary/capillary cell membrane. |
| What is inhalation? | Caused by expansion of chest cavity & lungs which creates neg pressure inside lungs. Neg pressure causes air to be drawn in through the nose or mouth & airways. Intercostal muscles contract on inhalation & pull the ribs outward, expanding chest cavity. |
| What is exhalation? | Causes pressure inside chest to rise above atmospheric pressure so air flows out of the lungs. Req no energy or effort. Occurs when the diaphragm and intercostal muscles relax, allowing chest and lungs to return to normal resting size. |
| What is the diaphragm? (KNOW) | MAJOR MUSCLE OF BREATHING. When it contracts chest cavitys pulled downward. Pleural membrane covering lungs adheres to pleural membrane lining chest cavity, lung bases descend w/chest cavity. Lung expansion creates neg pressure & draws air through trachea |
| What is the primary stimulus to breathe? | Normally the blood CO2 level. High CO2 levels stimulate breathing to eliminate excess CO2. |
| What is the secondary drive to breathe? | hypoxemia. Low blood O2 levels stimulate breathing to get more oxygen into the lungs. |
| Define normal breathing. | Is effortless and quiet; is smooth, even and regular; occurs 12-20 times a minute; exhalation is 2x as long as inspiration; increases during exertion. |
| How do we transport air into the blood? | Around 97% of o2 is carried by hemoglobin. |
| How do we remove gases from the blood | Around 72% of Co2 is carried as sodium bicarbonate in the plasma. Remaining is carried by hemoglobin. |
| What is lung compliance? | Refers to the ease of lung inflation. |
| What are some conditions that cause stretchy elastin fibers of the lung to be replaced with what? | Scar tissue (collagen); increased lung water (edema); loss of surfactant. All reduce lung compliance. |
| What is elastic recoil? | Tendency of the elastic fibers to return to their original position away from the chest wall after being stretched. |
| What happens with the elastic recoil of a person with emphysema? | Alveoli that have been overstretched, as with emphysema, lose their elastic recoil. Have a barrel shaped chest. Breathe in but can't breathe out. Allows the lungs to inflate easily, inhibits deflation and leaves stale air trapped in the alveoli. |
| What is airway resistance? | Resistance to airflow withing the airways. |
| What might cause airway resistance? | Decreases in airway diameter might occur with secretions in the airway or mild bronchospasm. |
| How does normal respiratory function work? | Replenishes oxygen supply, eliminates waste products (CO2). Promoting normal function is a major nurisng responsibility. |
| What is respiration? | Refers to gas exchange in the lungs. Oxygenation of blood, elimination of carbon dioxide. |
| What is external respiration? | Occurs in the lungs at the alveolar-capillary membrane, O2 diffuses across the alveolar-capillary membrane into the blood of the pulmonary ccapillaries. CO2 ddiffuses into the alveoli to be exhaled. |
| What is diffusion? | tendency of molecules of a substance to move from a region of high concentration to one of lower concentration. O2 & CO2 diffuse more rapidly through thin membrane. |
| What slows the rate of O2 & CO2 diffustion? | Conditions that thicken the membrane itself or create a greater distance for gases to travel, such as fluid or secretions, slow the rate of gas diffusion. |
| What happens with the loss of a functional lung? | Reduces the total surface area available for gas exchange. Secretions, lung collapse, bronchospasm. |
| What is the difference between O2 and CO2? | CO2 is much more soluble in water than O2. CO2 diffuses 20 times more rapidly than O2. Continues to diffuse across abnormal membrane long after O2 diffusion has slowed dramatically. |
| What is internal respiration? | Occurs in body organs and capillary cellular membrane into the cell wehre it is used for metabolism. From the cells, CO2(waste product) diffuses into the blood, from where it is transported to the lungs and exhaled. |
| What does tissue oxygenation require? | Both adequate external respiration and adequate peripheral circulation. |
| What is Hypoxemia? | low blood oxygen levels. blood not adequately oxygenated at the alveolar-capillary membrane. |
| What is hypoxia? | Poor oxygenation of organs and tissues. May be due to hypoxemia or ciculatory disorders. Low saturations. Hypoxia refers to inadequate oxygen levels in the tissues and organs. |
| What is hypercarbia (hypercapnea)? | Excess of dissolved CO2 in the blood due to hypoventilation. |
| What causes hypoventilation? | Caused by abnormalities affecting the lungs or chest cavity or by neuromuscular abnormalities that interfere with normal breathing. Can occur suddenly as in acute airway obstruction, drug overdose. Can occur chronically in chronic lung disease. |
| What is hypocarbia (hypocapnia)? | Low level of dissolved CO2 in the blood due to hyperventilation. |
| What is hypoventilation? | Occurs when a decreased rate or depth of breahing moves only a small amt of air into and out of the lungs. Could lead to hypoxia. |
| What is hyperventilation? | Rate and depth of breathing increase enough to move a large amt of air through the lungs. As ventilation increases, carbon dioxide levels fall. (because we're breathing out CO2. |
| What is perfusion? | Refers to the circulation of blood to all body regions. Like a rubber band on finger, breathing fine, but the finger is not getting any oxygen. |
| What makes up the cardiovascular system? | Hear, blood vessels, red blood cells, hemoglobin (carries oxygen), arteries and veins. |
| What's the purpose of arteries? | oxygenated blood to tissues. |
| What's the purpose of veins? | Deoxygenated blood back to heart/lungs. |
| What is the right ventricle? | The right ventricle pumps blood through the pulmonary semilunar valve to the lungs through the pulmonary artery. |
| What is the pulmonary artery? | The only artery that carries deoxygenated blood. |
| What is the left atrium? | Left atrium gets oxygenated blood back from the 4 pulmonary veins. |
| What are the pulmonary veins? | Only veins that carry oxygenated blood. |
| What is Tidal Volume (VT)? | Amount of air moved into and out of the lungs with each normal breath. Normally around 500mL. |
| What is Inspiratory Reserve Volume (IRV)? | Maximum amt of air that can be inhaled above and beyond the normal tidal volume. Ranges from 2000 to 3000 mL (taking deep breaths) |
| What is Expiratory Reserve Volume (ERV)? | The maximum extra amt of air that can be forcefully exhaled after the end of a normal tidal expiration. Ranges from 1000 to 1500mL. Disease causes collapse of alveoli and airways which traps extra air in lungs. Trapped air connot be exhaled & lowers ERV. |
| What is Residual Volume (RV)? | amt of air remaining in lungs after most forceful exhalation. Diseases that reduce ERV lead to increased RV. As more air is trapped in the lungs and cannot be exhaled even with forceful attempt, it becomes part of the RV that is never completely exhaled. |
| What is inspiratory capacity (IC)? | The combination of the tidal volume and inspiratory reserve volume. (VT + IRV). The amt of air that can be inhaled w/maximum effort. |
| What is Functional Residual Capacity (FRC)? | Combination of expiratory reerve volume and residual volume (ERV + RV). The amt of air that stays in the lungs at the end of normal passive quiet exhalation. Disorders that cause air trapping increase the FRC. |
| What is vital capacity? | The combination of inspiratory reserve volume and expiratory reserve volume. (IRV + ERV) The maximum amount of air that can be forcefully exhaled after filling the lungs to their maximum level with the deepest possible inspiratory effort. |
| What is spirometry? | A measure of air that moves into and out of the lungs. |
| When do people breathe the most effectively? | In an upright position, in a stable atomospheric invironment, away from industrialized areas, away from substances causing allergic responses. |
| How many weeks of gestation are required for a fetus to develop fully functional lungs? | 34 - 35 weeks |
| What is newborns respiratory rate and pattern of respirations? | respiratory rate is 30-60. Pattern may include short pauses between breaths. |
| What is toddlers and preschoolers rate of respiration? | Pattern becomes even and rate slows down to 20-30. |
| What is a major nursing concern for infants? | Apnea (Temporary cessation of breathing) Stop breathing for at least 10 seconds. |
| What is a major nursing concern for toddlers and preschoolers? | Aspiration of foreign objects. |
| What is child and adolescents rate of respiration? | Rate reaches adult rate of 12-20. |
| What are the safety concerns r/t maintaining integrity of respiratory system? | Common irritants include: environmental substances. (cigarette smoke and chemical irritants used for bagging or huffing. |
| What happens to adults respiratory system as they age? | As people age thoracic wall becomes more rigid, lung tissue is less flexible, decreased ciliary activity (hairs that clear the airway), cough is less "propulsive", gas exchange is decreased. |
| What is the subjective data of an assessment regarding respiration? | Immunization status, smoking habits (pack years - 1 pack year = smoking 1 pack/day/year), Nutritional status, work history(farmer?coal miner?), family history, sleep history (sleep apnea?) onset/duration. |
| What is the objective data of an assessment regarding respiration? | rate/pattern of respiration, respiratory effort: position the client assumes, gasping, wheezing, panting, flaring of the nostrils (trying to get air), retractions (tissues on the side goes in instead of out) |
| Where do you check for cyanosis on a patient? | nailbeds, lips/buccal cavities. |
| What does normal sputum look like? | Normal sputum is clear/white, no odor, medium consistency. yellow/green is infection. |
| Where do you listen for normal breath sounds? | Breath sounds clear. Bronchovesicular (those heard over the central chest or back), vesicular (the soft, rustling sounds heard in the periphery of the lung fields. bronchial. |
| How do you promote respiratory health? | Good nutrition. Avoid high exposure @ peak flu season, HANDWASHING, Covering coughs or sneezes, proper tissue disposal. stop smoking, decrease inhalant allergies, drink water, be active, deep breathing, incentive spironmetry, pursed lip breathing, vaccine |
| What is pursed lip breathing? | Inhale slowly through nose to 2, exhale slowly through pursed lips to 4. Counting distracts pt, reducing panic. Helps keep airway open during exhalation, promotes CO2 excretion, Should be done w/diaphragmatic breathing. Used if pt feels short of breath. |
| Respiratory function requires involvement of what 4 systems? | Musculoskeletal system (muscles in chest), Neurological system (detecting CO2), Respiratory system (Lungs) and cardiovascular system. |
| How do you assess oxygenation status? | Arterial blood gases (ABG's), peak flow monitoring, cardiac monitoring (Electrocardiogram); Diagnostic testing (chest x-ray, ultrasonic nebulizer, aerosol medications, oxygen therapy) |
| What is ultrasonic nebulizer? | Delivers a continuous moist fog, SVN (small volume nebulizer) |
| What are aerosol medications? | MDI's (Metered Dose Inhaler), Dry Powder Inhaler (DPI) |
| What is oxygen therapy? | Improves tissue oxygenation, decreases work load of breathing in clients with dyspnea, decreases cardiac workload, can be life saving, relieves dyspnea & promotes comfort, presc by flow or concentration, use lowest flow/conc to achieve acceptable levels. |
| What is low flow oxygen delivery systems? | Nasal cannula, Simple face mask. |
| What is high flow oxygen delivery systems? | venturi mask, non-breather mask, partial rebreather. |
| What are the flow rates and O2 concentrations for a nasal cannula? | Flow rates of 1-6L/min. O2 concentrations of 24% at 1L to 44% at 6L. |
| What are the flow rates and O2 concentrations for a simple face mask? | Used to deliver O2 concentrations of 40% to 60% for short term O2 therapy or in an emergency. MINIMUM FLOW RATE OF 5L IS NEEDED TO PREVENT RE-BREATHING OF EXHALED AIR. |
| What is a non-breather mask and the flow rate? | Provides the highest oxygen level of the low flow systems and can deliver an FIO2 greater than 90%. Has a one-way valve between the mask and the reservoir, and two flaps over the exhalation ports. Flow rate of 10-15L/min. |
| How does a non-breather mask work? | 1 way valve btw mask & reservoir & 2 flaps over exhalation ports. Valve lets client draw needed O2 from reservoir bag, flaps prevent room air from entering exhalation ports. During exhalation, air leaves thru ports & valve prevents CO2 entering reservoir. |
| What is a partial rebreather? | Uses a reservoir to capture some exhaled gas for rebreathing. Vents on the sides of the mask allow room air to mix w/oxygen. 50% O2 concentration or greater. |
| What is the venti mask? | Delivers the most accurate O2 concentration, works by pulling in a proportional amt of room air for each liter of O2. Adapter located btw bottom of the mask & the O2 source detrmines the needed flow rate, & allows specific amts of air to mix w/O2. |
| What is transtracheal oxygen therapy? | A long-term method of delivering oxygen directly into the lungs. A small, flexible catheter is passed into the trachea via a small incision under local anesthesia. |
| What is transarcheal delivery? | Does not interfer w/drinking, eating or talking. Delivers O2 throughout the respiratory cycle. No O2 lost to the atmosphere. Many clients req decreased flow rate. especially suited for home use. Concealed under shirt. |
| What do you inspect transtracheal tract for? | erythema (red), edema (swollen), excessive exudate (drainage). |
| How often should you clean the transtracheal tract and what do you clean it with? | You would clean it 2x/day with cotton tipped applicator. H2O2 may be used for dried exudate (hydrogen peroxide). |
| What is a CPAP machine? | Continuous Positive Airway Pressure. Uses positive pressure to keep alveoli open and improve gas exchange w/o the need for airway intubation. Most often used for sleep apnea. |
| What is the BiPap? | Used in hospitals. Step before ventilator. Cycling machine delivers a set inspiratory positive airway pressure ea time cliient begins to inspire. As the client begins to exhale, machine delivers lower set end-expiratory pressure. 2 pressures improve Vt. |
| What are the safety issues for using oxygen? | O2 in use/no smoking signs,use proper liter flow, reservoir is used, keep filled, keep connections tight, avoid use of electrical appliances. Ensure electrical equip is functioning properly, if using portable, secure system to prevent falling over. |
| What is the nursing care r/t O2 therapy? | Maintain padding, Maintain slack in tube, assess client's response to therapy, assess cannula for obstruction, assess nasal area and ears for skin impairment, cleanse nares and lubricate nares, check flow rate order, check humidifier, listen lung sounds. |
| What are artificial airways? | Device inserted through the mouth, nose or throat providing access to the lungs. Oral/nasal pharyngeal, endotracheal tubes (can't talk-comes out through mouth), tracheostomy. |
| What is a tracheostomy? | surgical opening thru base of neck into trachea, pt breathes thru this opening, bypassing upper airway, some may have balloon like cuffs that are inflated to prevent air escape during mechanical ventilation and to prevent aspiration of food or secretions. |
| What are cuffed tubes? | ALLOWS VENTILATION AND PREVENTS ASPIRATION. High cuff pressure can be damaging, check pilot cuff. DO NOT BLOCK THIS TUBE.Inflatable cuffs are used when an air-tight seal is req around the tube. The cuff is not to hold the tube in position. |
| When are tubes w/inflatable cuffs used? | When the pt is unable to breathe on their own & requires artificial respiration. Unless there is an air-tight seal around the tube, the air being blown into the lungs by the respirator escapes around the sides of the tubes. |
| What are disadvantages of cuffed tubes? | Easily become blocked. pt cannot speak when the cuff is inflated as no air can go past the coval cords. Can cause tissue damage. |
| What are un-cuffed tubes? | Maintains airway once aspiration risk has passed. Increase airflow to the larynx. |
| Which pts get un-cuffed tubes? | Long term traheostomy pts, patients who do not require a seal, pediatrics. Unable to maintain seal in an emergency situation. |
| What are fenestrated tubes? | Increase airflow to larynx/vocal, cuffed or un-cuffed, these are used for weaning, enables speaking, the fenestrated tube can be used if the pt is tolerating the cuff down. To suction always use the non fenestrated inner tube. can be occluded. |
| What is the inner cannula? | Allows maintenance of tube patency, aids tube hygiene, close observation. allows fenestrated tubes to be used earlier. |
| What is the use of the inner cannula? | Provides vital safeguard against life-threatening complications of tube obstruction in a cuffed tube and must be present at all times. Trach tubes w/o an inner cannula should be avoided wherever possible,may be impossible to achieve w/all pts. |
| How do you take care of an inner cannula? | If copious secretions-check every 4 hours (more if indicated)check every 15-30 minutes if coughing up alot, Remove and clean using sterile water and replace as soon as possible, if tube is kinked or damaged replace w/new sterile inner tube. |
| What is an adjustable flange? | for people w/different anatomy. Provide a longer tube-offer secure placementof tube in a deep set trachea.Essential for pts w/difficult anatomy. Usually inserted surgically. |
| When is suctioning required? | Required for patients unable to clear secretions from their own airway effectively. |
| What type of suction is commonly used for patients unable to clear secretions for their own airway effectively? | Can be performed w/a Yankauer suction tip or with a 14-16Fr. suction catheter attached to wall suction. Negative pressure set btw 80-120 mmHg. Aseptic technique used for airway suctioning. |
| What is nasopharyngeal suctioning? | Through nose to back of throat. Maintain patent airway by removing accumulated secretions, involves upper air passages of nose, mouth, and pharynx. |
| The nasopharyngeal suction is most commonly used for? | Used most often for infants, gravely debilitated or unconscious patients, and those who have an ineffective cough. |
| What is the suction pressure set between for the nasopharyngeal suction? | Between 80 and 120 mmHg. |
| What is tracheobronchial suctioning? | Deep suctioning to remove secretions from the trachea and bronchi using sterile technique, most often performed on intubated pts or pts w/a tracheostomy. Pts need preoxygenation. |
| How do you perform tracheobronchial suctioning? | Should be performed no longer than 10 seconds at a time, w/oxygenation in between. Sterile technique is mandatory. |
| What should the size of the tracheobronchial suction catherter be? | Depends on the size of the tracheostomy tube. The catheter should be the largest that fits the trach tube size. |
| What is the typical size for pediatrics on the tracheobronchial suction catheter? | 8 Fr to 10 Fr are typical. |
| What is shallow suctioning? | Suction secretions at the opening of the trach tube that the patient has coughed up. |
| What is pre-measured suctioning? | Suction the length of the trach tube. Suction depth varies depedning on the size of the trach tube. The obturator can be used as a measuring guide. |
| What is deep suctioning? | Insert the catheter until resistance is felt (deep suctioning is usually not necessary). Be careful to avoid vigorous suctining, as this may injure the lining of the airway. |
| What are signs that a patient needs to be suctioned? | Rattling mucus sounds from the trach, fast breathing, bubbles of mucus in trach opening, dry raspy breathing or a whistling noise from trach, any sign of respiratory distress (1st sign is restlessness), Low O2 saturations. |
| How do you change the trach tube? | Insert the new tube in a smooth curving motion directing the tip of the tube toward the back of the neck in a downward and inward arc (like inserting a suction catheter). DO NOT FORCE THE TUBE!!! |
| What are six simple words to remember when wondering about changing a trach? | WHEN IN DOUBT, CHANGE IT OUT! |
| How does speech occur? | Speech is obtained by a steady stream of air that goes from the lungs and passes by the vocal cords as we exhale. this air is modified by the vocal cords which vibrate as the air passes through to produce sound. |
| How is speech affected when a child has a trach? | When a child has a trach the trach tube re routes some or all of the exhaled air stream way from the vocal cords and affects the childs speech. |
| How does a child speak w/a trach tube? | Plugging the trach tube by holding a finger or place a cap over the tube for short periods of time. They can also use a speech valve. |
| What is a Passy muir speech valve? | A one-way valve that allows air in, but not out. This forces air around the trach tube, through the vocal cords and out the mouth upon expiration, enabling the patient to vocalize. |
| What is pneumothorax? | Occurs when air enters the pleural space through a tear or hole in the pleural membrane. Air leakage can come from within the air-filled lung tissue itself, from outside the lung through the chest wall, or from both sources. |
| How can air leakage be bad for the lung? | Air leakage destroys normal vacuum that keeps lungs pulled into contact w/the chest wall, causing the lung to recoil and collapse. A collpased lung (or portion of lung) can dramatically reduce ventilation, causing dyspnea, hypoventilation, and hypoxemia. |
| How would you treat pneumothorax? | Treatment includes chest tube insertion into the pleural space to re-establish negative pressure, so that breathing can gradually reinflate the lung. |
| What is a chest tube? | Chest tube is ext of plural space. To provide neg pressure w/in chest tube, open end is placed under water. (water seal) With ea exhalation, air is expelled through chest tube into water, no air is drawn in during inhalation. |
| What is a spontaneous pneumothorax? | Occurs unexpectedly as a result of the rupture of a bleb(blister like formation) on the surface of the lung. Air from the lung enters the pleural space, causing a pneumothorax. |
| Spontaneous pneumothorax is most common in who? | Young healthy men, and often does not collapse the entire lung. When the pneumothorax is small enough, it may heal on its own w/o invasive tx. If it acts like a one way valve, then a tension pneumothorax can develop, requiring immediate tx. |
| What is a traumatic or open pneumothorax? | Injury to chest wall that results in hole or "opening" in chest wall (gunshot wound) allow air to enter pleural space from atmosphere w/ea inhalation. If wound in chest wall remains open, lg amts of air enter pleural space. Making ventilation difficult. |
| What is the first thing you should do for a pt w/an open pneumothorax? | Initial emergency tx for such a wound is to cover it with an occlusive (air tight) dressing to keep air from entering into the pleural space. Open chest injury can lead to a tension pneumothorax. |
| What is tension pneumothorax? | Major Emergency! Air enters the plueral space, the lung collapses, and the air does not escape w/exhalation. Pressure accumulates and pushes on the heart, aorta, and vena cava, lowering venous return and cardiac output. |
| What are the 4 types of chest drainage systems available? | One bottle system, two bottle system, three bottle system and the disposable chest drainage systems. |
| How do you prevent chest tube complications? | If pt w/chest drainage system becomes acutely short of breath, immediately chk for occlusion of system. Relieve occlusion to prevent pressure build up. Re-collapse of lung can occur because loss of neg pressure w/in system. Usually caused by air leaks. |
| Would you clamp a test tube? | NO! Doing so can rapidly lead to tension pneumothorax. They should only be clamped for changing drainage system. Limit clamp time, monitor the resp status until clamp removed. Responsibility to monitor chest drainage system & patient status remains w/RN. |
| What in an allergic reaction? | Hypersensitive or over-response to an antigen. Dilation of blood vessels in areas affected(increase blood flow to areas). Attraction of eosinophils & neutrophils to reaction site. Damage of local tissues by protease. Increased permeability of capillaries. |
| What is hay fever? | Allergic reaction affecting the eyes, nose, and sinuses and causing the release of histamine. Histamine is largely responsible for accumulatio nof nasal fluid and swollen nasal membranes. Antihistamines are effective in combating hay fever. |
| What is asthma? | Allergic reaction occurring in the bronchioles of the lungs, causing release of slow reacting substance of anaphylaxis. Causes lower airway edema and spasms making breathing difficult and ineffective. |
| What do bronchospasms trigger? | Cold air, exercise, emotional upset, bronchial irritants. They cause airway obstruction, dyspnea, and poor oxygenation. |
| What can asthma attacks triggered by? | stimuli that do not cause symptoms in nonastmatic people. The person w/asthma as hyperresponsive airways. |
| What are some signs and symptoms of an asthma attack? | Wheezing, coughing, chest tightness, airway obstruction. |
| What is treatment for asthma aimed at? | Supporting ventilation and oxygenation, reversing bronchospasm, reducing inflammation through medicaiton and lifestyle adjustment. |
| What is the nursing role in airway support? | maintain patent airway, pts turned & encouraged to cough, deep breathe ev 2hrs in bed. Splint surgical pts w/pillow help deep breathe & cough. unconsc pts, use oral or nasal airway keep tongue from obstruct airway, & suction as necessary. |
Created by:
krislynn
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