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Study Guide #16 Oxygenation


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Liquid Oxygen
-designed to store the oxygen at a precise and safe temperature and deliver it as a gas through wall outlets in a client's room.
-stored at or below -297 degrees F and requires the use of a small ambulatory tank that is filled from a resevoir in the home
Portable Tank
-easily moved
-weigh more than 10 pounds
-not designed to be carrried
-deliver oxygen for about 5 hours at 2L/min.
Tidal Volume
-amount of air inpires and expired with each breath
-usually set at 8-15 mL/Kg of ideal body weight.
Positive-pressure Ventilation
-assists in reinflation
-delivers positive pressure to inflate the lungs
Noninvasive Ventialation
-maintains positive airway pressure and improves alveolar ventillation without the need for an artificial airway.
-reduces and reverses atelectasis, improves cardiac funtion.
Incentive Spirometry
-assists the client in deep breathing
-most often used following abdominal or thoracis surgery to help reduce the incidnece of post-operative pulmony atelectasis
Oxygen Tent
-a tent has been placed over a bed for the continuous administration of oxygen and mist.
-commonly used in the pediatric setting
-able to provide high concentration of humidified oxygen
Venturi Mask
-can be used to deliver oxygen concentration of 24% to 55% with oxygen flow rates fo 2 to 14 L/min
-cone shaped device with entrainment parts of various sizes at the bas of the mask to permit regulation of FiO2 from 24% to 60%.
-The mask is useful because it delivers a more precise concentration of Oxygen to the client
-clinical sign of hypoxia and manifest as breathlessness
-subjective sensation of difficult or uncomfortable breathing
-an abnormal condition in which the person must use multiple pillow when lying down or must sit with the arms elevated and leaning forward to breathe.
Nasal Cannula
-a simple, comfortable device used for oxygen delivery
-tubing used to deliver oxygen at levels from 1 to 6L/m
-it is used in situations such as cardiac disease, in which a low-flow, small % oxgyen therapy is desireable.
-low levels of arterial oxygen
-decreased oxygen concentration of arterial blood, measured by arteriol oxygen partial pressure (Pa02) values.
-it is sometimes associated with decreased oxgyen content
-an oxgyen defiecienty in body tissues
-a decreased concentration of oxygen in inpired air
-inadequate tissue oxygenation at the cellualar level
-blue discoloration of the skin and mucous membranes caused by the presence of desaturated hemoglobin in cappilaries
-a late sign of hypoxia
A pulse deficit provides information about the heart's ability to adequately perfuse the body. A pulse deficit is:
1. the difference between the radial and apical pulse rates.
2. the digital pressure felt when taking radial and ulnar pulses.
1-an insufficient contractuon of the heart that fails to transmit a pulse wave to the periperal pulse site creates a pulse deficit. to assess a pulse deficit, the nurse and a collegue assesses radial and apical rates ismultaneously and then compare rates. the difference between the Ap and radial pulse rates is the pulse deficit. pulse deficits are frequently associated w/abnormal rhythms.
The nursing assistant reports to the nurse that a client is "feeling funny". the nurse's first action would be:
1. obtain the VS herself.
2. instruct the nurse assistant to retake VS.
3. insturct the nursing assistant to continue
1-careful measurment techniques ensure accurate findings. VS & other physiological measurements are the basis for clinical problem solving. VS assessment is an essential ingredient when nurses & physician collaborate to determine the client's health status.
If a BP cuff is too narrow, or wrapped too loosely, the BP reading will be:
1. falsely low
2. falsely high
3. difficult to hear b/c sounds will be muffled.
4. dependent on the examiner's hearing acuity
2-BP mesurements will not be accurate unless the correct size BP cuff is applied appropriately. If a cuff is too small/tends to come loose, the result is a false high reading.
Client's w/apnea expierience:
1. difficult respirations requiring more effort
2. slowness of breathing followed by rapid breathing
3. cessation of breathing that may be temporary
4. lack of O2 to body tissue and organs
3-respirations cease for several seconds. persistant cessation results in resp. arrest. andy irregular resp. pattern/periods of apnea are symptoms of underlying disease in the adult and must be reported to the physician or nurse in charge.
The nurse obtaind a supine BP reading of 130/64. One hour later, the BP (supine) 134/62, and sitting BP 95/62. The nurse's immediate action is to:
1. assist the client to return to a supine position.
2. obtain a BP in the other arm.
3. rep
1-if orthostatic hypotension is assessed the client is assisted to a lying positon and the physician or nurse in charge is notified. while obtaining orthostatice measurements, the nurse observes for other symptoms of hypotension; such as fainting, weakness, or light-headedness. b/c the skill of orthostatice measurements requires critical thinking and ongoing nursing judgement, this procedure is not delegated to unliscensed assistive personnel.
A nurse is taking VS & notes the client has a strong radial pulse that dimenishes in intesity & has an interruption in rhythm about q4-6 beats. the nurse's immediate action is to:
1. report the findings to a physician
2. measure a 60 se
4-when assessing the pulse, the nurse must consider the variety of factors influeincing the pulse rate. A combination of the factors may cause significant changes. If the nurse detects an abnormal rate while palpatin a peripheral pulse, the next step is to assess the Ap. pulse.
Nursing interventions, such as removing excess blankets formt he client & applying cool cloths to the axilla to decrease body temp. through:
1. conduction
2. convection
3. evaporation
4. radiation
1-conduction is the transfer of heat form one object to another w/direct contact. heat conducts through contact w/solids, liquids & gases. when the warm skin touches a cooler object, heat is lost. conducitno normally accounts for a small amount of heat loss. the nurse increases conductive heat loss when applying an ice pack or bathing a clinet w/cool water.
The basic techniques of which of these are used to determine VS?
1. inspection, palpation & auscultation
2. inspection, blood work, & x-rays
3. rhythm, rate, & open communication
4. psychology, physiology, & nursing sk
1-the basic techniques of inpeciton, palpation, and auscultation are used to determine VS. these skills are simple, but should not be taken for granted. careful measurement techniques ensure accurate findings. VS & other physiological measurements are the basis for clinical problem solving. VS assemssment is an essential ingredient when nurses & physician's collaborate to determine the client's health status.
When the nurse takes the client's radial pulse, he notes dysrhythmia. his most appropriate action is:
1. inform the physician immediately
2. wait 5 minutes & retake the radial pulse.
3. take the pulse Ap. for one full minute.
4. c
3-take the pulse Ap. for one full minute
The nurse is assessing a client who she suspects has the nursing diagnosis hyperthemia to vigorouse exercise in hot weather. in reviewing the data, the nurse knows that the most important sign of heatstroke is:
1. confusion
2. hot, dry skin
2-hot, dry skin
The nurse bathes a client who has a fever w/cool water. the nurse does this to increase heat loss by means of:
1. radiation
2. convection
3. condnesation
4. conduction
The skin plays a role in temperature regulation by:
1. insulating the body
2. constricting blood vessels
3. sensing external temperature variations
4. all above
4-all above
Clients with anemia my c/o:
1. lack of energy
2. increased activity tolerance
3. decreased breathlessness
4. increased activity tolerance
1-anemia, a lower than normal hemoglobin level is a result of decreased hemoglobin produciton, increased RBC destruction, c/o fatigue, decreased activity tolerance and increased breathlessness, as well as pallor (esp. seen in conjuctiva of the eye) and increased heart rate.
The most common toxic inhalant that decreases the oxygen-carrying capacity of blood is:
1. carbon dioxide
2. carbon monoxide
3. nitrogen
4. mustard gas
2-carbon monoxide is the most common toxic inhalent that decreases the oxygen-carrying capacity of blood. the affinity for hemiglobin to bind w/carbon monoxide is greater than 200 times its affinity to bind w/O2, creating a funcitonal anemia b/c of the bonds strenght, carbon monoxide is not easily disassociated from hemoglibin, making the hemoglobin unavailabel for O2 transportation.
Conditinos such as shock and severe dehydration resulting from extracellular fluid loss and reduced circulating blood volume cause:
1. hypovolemia
2. hypervolemia
3. uncontrolled bleeding
4. hypoxia
1-conditions such as shock and severe dehydration resulting from extracellular fluid loss & reduced circulating blood volume cause hypovolemia. w/a significant loss the body tries to adapt by increasing the heart rate and peripheral vasoconstriction to the increase the volume of blood returend to the heart and in turn increasing cardiac output.
Fever increases the tissues' need for oxygen, and as a result:
1. carbon dioxide decreases
2. carbon dioxide increases
3. cyanosis occurs
4. there is increase muscle mass
2-fever increases the tissues' need for O2, & as a result, carbon dixide production also increases. if the febrile state persists, the metabolic rate remains high and the body begins to breakdown protein stores, resulting in muscle wasting and decreased muscle mass. Resp. muscle such as the diaphram and intercostal muscles are also wasted.
Left-sided heart failure is an abnormal condition characterized by:
1. impaired functioning of the L ventricle
2. impaired funcitoning of the L atrium
3. lowered cardiac pressures
4. increased cardiac output
1-L-sided heart failure is an abnormal condition characterized by impaired funtioning of the L ventricle d/t the elevated pressures and pulmonary congestion. If L ventricular failure is significatnt, the amount of blood ejected from the L ventricle drops greatly, resulting in decreased cardiac output.
Right-sided heart failure results form:
1. impaired funtioning on the R ventricle
2. impaired functioning of the R atrium
3. severe weight loss
4. lowered pulmonary vascular resistance.
1- R-sided heart failure results from impaired funtioning of the R ventricle, characterized by veous congestion in the systemic circulation. R-sided heart failure more commonly results form pulmonary disease or as a reult of long term L-sided failure.
What is the primary factor in R-sided Failure?
-elevated pulmonary vasular resistance (PVR). as the PVR increases, the R ventricle must generate more work and the O2 demand in the heart increases. as the failure continues, the amount of blood ejected from the R ventricle decreases & blood beginst to "back up" in systemic circulation. Clinically, the client has weight gain, distended neck veins, hepatomegally, and slenomegally, and dependant peripheral edema
Cyanosis, the blue discoloration of the skin and mucous membranes caused by the presence of desaturated hemoglobin in capillaries is a/an:
1. early s/o hypoxia
2. late s/o hypoxia
3. reliable measure of O2 status.
4. non-life threaten
2-late s/o hypoxia. the presence/absence of cyanosis is not a reliable measure of oxygenation status.
A person who starts smoking in adolscence & continues to smoke in middle age:
1. has in incrased risk for cardiopulmonary disease and lung cancer.
2. has an increased risk for obesity & diabetes
3. has an increased risk for stress-
-a person who starts smoking in adolescence & continues to smoke in middle age has an incrased risk for cardiopulmonary disease and lung cancer
A simple & cost effective method for reducing the risks of stasis of pulmonary secreations & decrese chest wall expansion is:
1. O2 humidification
2. chest physiotherapy
3. frequent change of positon
4. antifectives
3-frequent changes of positon are simple & cost effective methods for reducing the risks fo stasis of pulmonary secretions & decrease chest wall expansion
The most effective positon for a client w/cardiopulmonary disease is the:
1. supine position
2. prone position
3. high fowlers
4. 45 degree semi-fowler's
4-the most effective positon for a client w/cardiopulmonar diseases is the 45 degree semi-fowler's position, using gravity to assist in lung expansion & reduce pressure form the abdomen on the diaphram.
Ventilation, perfusion & exchange of gases are the major purposes of:
1. respiration
2. circulation
3. aerobic metabolism
4. anerobic metabolism
Afterload refers to:
1. the amount of blood ejected from the L ventricle each minute
2. the amount of blood ejected from the L ventricle w/each contraction
3. the resistance to L ventricle ejection
4. the amount of blood in the L vent
3-the resistance to L ventricle ejection
The movement of gases into and out of the lungs depends on:
1. a 50% O2 content int he atmospheric air
2. Pressure gradient between the atmosphere & the alveoli
3. use of accessory muscles of respiration during expiration
4. amoun
2-pressure gradient between the atmosphere & the alveoli
The client's ECG shows an abnormal rhythm that slow during inspiration & increases w/expiration. the rate is 70-80 beats/minute. the P-wave, PR interval, and QRS comples are normal. this is referred to as:
1. sinus tachycardia
2. sinus dysr
2-sinus dysrythmia
Mr. Isaac comes to the ER c/o difficulty breathing. An objective finding associated w/his dyspnea might include:
1. statements about a sense of impending doom.
2. c/o SOB
3. feelings of heaviness in the chest
4. use of accessary muscl
4-use of accessary muscles of respiration
The use of chest physiotherapy to mobilze pulmonary secretions involves the use of:
1. hydration
2. percusssion
3. nebulization
4. humidification
Partial assessment of a dyspneic client would not include which of the following?
1. respiratory risk
2. sputum
3. chest x-ray
4. breathing pattern
4-chest x-ray
2 L/m of O2 via nasal cannula or simple face mask is given to clients w/underlying chronic obstructive lung disease in order to:
1. decrease the risk of O2 toxicity.
2. decrease the risk of carbondioxide retention
3. increase PH level
2-reduce the risk of carbon dioxide retention
Humidification is added to O2 therapy via nasal cannula O2 in order to:
1. prevent drying of the nasal mucosa
2. liquefy pulmonary secretions
3. increase the clients cough
4. improve oxygentation
1-prevent drying of the nasal mucosa
BiPap differs from CPAP in that:
1. positive pressrue is only given during inhalation
2. positive pressure is only given during exhalation
3. it uses negative rpessure during inhalation & exhalation
4. it uses positive pressure du
4-it uses positive pressrue during inhalaiton and exhalation
Your client is on mechanical ventilation. suddenly he develops severe resp. distress, his VS changes, his O2 saturation suddenly decreases and his trachial tube is no longer midline. you suspect a tension pneumothorax. your immediate actions are to:
1-begin manual vintillation and obtain VS and pulse ox. ASAP
Your client has a large amount of pulmonary secretions. over the last hour, you note that the secretions are thicker & the volume has incresed. during the last 30 minutes, the pressure alarm on the mechanical ventillator has triggered repeatedly. wha
3-suction the client's airway
What is PaO2?
-arterial partial pressure -the partial pressure of O2 in arterial blood; arterial O2 concentration, or tension; usually expressed in millimeter of mercury (mmHg)
Face Tent
-alternative to aerosol mask -provides high humidity w/O2 -difficult to keep in place and the FiO2 cannot be controlled
Oxygen Mask
-shaped to fit snugly over the client's mouth and nose and is secured in place with a strap.
Simple Mask
-used for short term O2 therapy -fits loosely & delivers O2 concnetrations from 30% to 60% -mask is contraindicated for clients w/CO2 retention b/c retention can be worsened
-the expectoration of blood that arises from the larynx, trachea, bonchi, or lungs
-the process of adding water to gas -gas flow is exposed to a material saturated with water
-collapse of the alveoli that prevents normal respiratory exchange of oxygen and carbondioxide
-respirations cease for several seconds -persistant cessation results in repiratory arrest
-respirations are labored -increased in depth -increased in rate -<20 breaths/minute -occurs normally during exercise
-rate of breathing is regular, but abnormally rapid (>12 breaths/minute)
-respiratory rate is abnormally low, and depth of ventillation may be depressed. -Hypercarbia may occur -alveolar ventillation is inadequate to meet the body's O2 demand or to eliminate sufficient carbon dioxide
-rate and depthe of respiration increase -hypocarbia may occur -state of ventillation in excess of that required to eliminate the normal venous carbon diaxide produced by cellular metablolism -can be induced by: anxiety, infections, drugs or an acid-based imbalance fever
What are the respiratory rates for a newborn?
30-60 breaths per minute
what are the respiratory rates for an infant (6 months)
30-60 breaths per minute
what are the respiratoy rates for a toddler (2 years)?
25-32 breaths per minute
what are the respiratory rates for a child?
20-30 breaths per minute
what are the respiratory rates for an adlolescent?
16-19 breaths per minutes
what are the respiratory rates for an adult?
12-20 breaths per minute
the % of hemoglobin that is bound with oxygen in the arteries is the % of saturation of hemoglobin (SaO2)
It is usually between 95% and 100%
Rate of breathing is regular but abnormally slow (>12/min)
Systolic BP
the peak of maximum pressure when ejection occurs
Diastolic BP
the minimal pressure exerted against the arterial walls at all times
Pulse Pressure
the difference between systolic and diastolic pressure (i.e. 120/80=40)
Pulse Oximeter
permits the indirect measurement of oxygen saturation
Biot's Respiration
Resp. are abnormally shallow for 2-3 breaths, followed by irregular period of apnea.
Kussmaul's Respiration
Resp. are abnormally deep, regular and increase in rate
Cheyne-Stokes Respiration
Resp. rate and depth irregular, characterized by alternating periods of apnea and hyperventilation. Resp. cycle begins w/slow, shallow breaths that gradually increase to abnormal rate and depth. The pattern reverses, breathing slows, and becomes shallow, climaxing in apnea before resp. resumes.
The process by which energy is propogated through space/matter. the emission of rays in all directtions from a common center. ionizing rays used for diagnotsic or therapeutic purposes.
-the process whereby a state of excitiation affects adjacant portions of a tissue/cell so that the disturbances is transmitted to remote points -occurs in muscle fibers inthe nervous system. -the transfer of electrons, ions, heat or sound waves through a conductor/conducting medium
-the movement of sollutes that occurs during ultrafilltration of a fluid -loss of body heat by means of transfer to the surrounding cooler air
-change from liquid to vapor -loss in volume d/t conversion of a liquid into a vapor
-a device for measuring the movement of a gas/liquid -used esp. in monitoring the use of anesthetic gases.
-a decreased blood volume that may be caused by internal/external bleeding, fluid losses or inadequate fluid intake.
-greater than 100 beats/minute
-less than 60 beats/minute
Left-sided Heart Failure
-abnormal condition charaterized by impaired functioning of the left ventricle d/t elevated pressure and pulmonary congestion
Right-sided Heart Failure
-results from impaired functioning of the right ventricl characterized by venous congestion in the systemic circulation. -more commonly results from pulmonary diseases or as a result of long-term left sided failure
Electrocardiogram (ECG/EKG)
-reflects the electrical activity of the conduction system. -monitors the regulartity and path of the electrical impulse through the conduction system -the normal sequence is normal sinus rhythm (NSR)
S1, or the first heart sound
-during ventricular diastole, the atrioventricular (mitral & tricuspid) valves open & blood flows from the higher pressure atria into the relaxed ventricles -after ventricular filling, the systolic phase begins
S2 or the second heart sound
-during the systolic phase semilunar (arotic & pulmonic) valves open and blood glows fromt he ventricles into the aorta and pulmonary arter. -closure of the aortic and pulmonary valves
Cardiac Output
-the amount of blood ejected from the left ventricle each minute -normal cardiac output is 4 to 6 L/min. in a healthy 1150 lb. adult at rest.
-deviation from th enormal sinus heart rhythm. -may occur as a primary conduction disturbance; as a response to: ischemia, vulvular abnormality, anxiety or drug toxicity--as a reslu of: caffeine, alcohol, or tobacco use, or a complication of acid-base or electolyte impalance.
-the interchange of gases between an organish and the medium in which it lives. -the act of breathing during which the lungs are provided with air through inhaling and the CO2 is removed through exhaling. Normal respiratory exchange of O2 and CO2 in the lungs is impossible unless the pulmonary tissue is adequately perfused with blood.
Oxygen Concentrator
-a device used for home oxygen therapy that removes most of the nitrogen fromt he room air and delivers the oxgyen at a low flow rate
-the movement of gases in and out of the lungs
Non-rebreather Mask
-an oxygenadministration device with one-way valves for inpiration and expiration and a reservoir bag; used to attain high concentrations of oxygen
Nasal Catheter
-a tube inserted into the nose made of plastic, used to inject fluids (oxygen) into the nose
A 7 year old child who is receiving chemotherapy for acute lymphocytic leukemia is about to be discharged from the hospital. Which of the statements made by the child's mother indicates the need for follow-up by the nurse? 1. "I should call the phys
2 "I will have to learn how to take rectal temperatures with a glass thermometer."
Betty has purchased a new electronic BP monitoring device. Which of the following nursing actions will verify the accuracy of the BP monitor? 1. Nothing needs to be done. Electronic BP monitors are extremely accurate. 2. Have Betty take her daughter's BP
3 Take Betty's blood pressure with a manual aneroid sphygmomanometer right after Betty takes her blood pressure with her mother.
A group of clients are enrolled in an exercise class. Which pulse site would be best for monitoring exercise tolerance? 1. femoral 2. brachial 3. anecubital 4. radial
4 Radial
Which of the following should the nurse teach a client who is being discharged from the hospital with home oxygen therapy? 1. The client should not allow people in the home to smoke. 2. The client should be able to attend his son's Boy Scout campfire. 3.
1 The client should not allow people in the home to smoke.
A client using a concentrator oxygen delivery system at home. Which of the following statements when made by the client indicates understanding of client education? 1. If my concentrator does not reach the outlet in my house, I will use an extension cord
3 I need to make sure my breaker box will meet the electrical requirements of the concentrator.

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