Cardiac System Oxygenation Help....

Cardio – Oxygen Questions Study Guide

Question	Answer	Hint
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

Some Oxygenation Questions, Interventions....

Pneumothorax, Crushed Chest, Gunshot, Stab Wounds....


A chest tube is put in a pt’s chest when the pt has a pneumothorax because? It removes air from the pleural space which reinflates the lung by reestablishing negative pressure – know it is reinflated when nurse hears breath sounds

Crepitus- air trapped in tissues that crackles

When is a chest tube not used? For pneumonectomy

Following a right pneumonectomy, the pt is cool and clammy, resp. are labored, his skin is pale, he sits straight up in bed?  What does the nurse do?  Auscultates the left lung – a mediastinal shift with airway obstruction may occur b/c pressure builds up on the operative side, causing the trachea to deviate toward the unoperative side;  ASSESSMENT of the airway takes priority

What should the nurse do first when a pt wakes after a pneumonectomy?  Encourage deep breathing – helps keep the airway patent and prevents atelectasis of the remaining lung by raising intrapleural pressure

What positions should the pt be in following a right pneumonectomy? Supine or right side-lying position – permit ventilation of the remaining lung and prevent fluid from draining into the sutured bronchial stump

What should the nurse look for in a pneumonectomy pt?  signs of cardiac overload

The best coughing routine for a pneumonectomy pt is?  Q hr for 1^st 24 hrs then q 2 hrs

Pt has ph of 7.32, Pco2 of 53 and hco3 of 25. What should the nurse do?  Encourage the client to cough productively and take deep breaths-resp. acidosis can be caused by the depressant effects of anesthesia or a partially obstructed airway; these activities clear the airway and blow off CO2


If a water chamber in the pleu-evac stops fluctuating, the nurse should? Look for obstructions in the tube, the water should rise and fall with breathing, called tidaling

How does a nurse measure and document the amt of drainage from a chest tube?  Mark the time and fluid level on the outside of the drainage chamber of the closed chest drainage system

What is happening when a water-sealed drainage system has excessive bubbling? Check the system for air leaks

When a gunshot pt is expected in the ER, what equipment should be prepared? Chest tube equipment because the priority is to stabilize the respiratory status

In a crushing chest injury, what shows that treatment is working?  Increased breath sounds, chest tube normalizes intrathoracic pressure, drains fluid and air from the pleural space and improves pulmonary function.

What to do when a pt pulls out a chest tube? Cover wound with cleanest material available, resp status is priority over risk for infection

When a chest tube separates from the drainage system what should the nurse do?  Reconnect it immediately to prevent pneumothorax

Why does a trach need suctioning?  It interferes with the ability to cough effectively

What is highest priority assessment for a pt with a crushing chest wound?  Quality of respirations and presence of pulses –

What is the treatment for hypoxia among postop pts, when the pt complains of chest pain and shortness of breath? O2 – supplemental O2 supports the body while the cause of the problem is sought; O2 support is the first therapy in all cases of hypoxia and can be instituted without a physician’s order in an emergency

The primary responsibility of the nurse when caring for a client with a chest tube attached to a 3 chamber underwater seal drainage system would be to?   Maintain the closed system – an airtight system is needed to reestablish negative pressure and reinflate the lung

A pt with a left chest stab wound  should be positioned how? Left side with head elevated – needs to lay on the affected side so they unaffected lung can expand to its fullest potential, elevation of the head facilitates respirations by reducing the pressure of the ab organs on the diaphragm and allowing the diaphragm to descend with gravity

When assessing a stab wound pt the 1^st priority is? quality of depth of respirations, – should evaluate unilateral chest movements that may indicate pneumothorax and tachypnea, which are associated with hypercapnia and acidosis