Med Surg exam 3
Oxygen
Sputum Collection:
o Should be a morning collection
o 1-2 hours after eating
o Chest PT
o Sterile specimen container
o RT collection
Bronchoscopy: gives visualization of the larynx, trachea, and bronchi, where you are
able to visualize abnormalities.
o Complications: pneumothorax, aspiration, bronchospasm
Arterial Blood Gas (ABG):
o Assess the ability of the lungs to provide O2 and remove CO2
o Assess the ability of the kidneys to reabsorb and excrete bicarbonate ions
Pulmonary Function Test:
o Used for patients with chronic respiratory disorders
o Smokers: can’t smoke 6-8 hours prior
o Inhalers: stop 4-6 hours before
Complications
o Cracks in the oral mucosa
o Oxygen toxicity
o Oxygen-induced hypoventilation
o Combustion
Gero considerations
o Declines begin in middle adulthood
o Decline affects structure and function
o Changes in alveoli reduce surface area
o Alveoli lose elasticity
o Loss of chest wall mobility
o Respiratory dead space increases
o Decreased bronchial and mucous glands
Incentive Spirometer
o Helps expand the lungs to help the pt breathe more deeply and fully
o Prevents post-op pulmonary complications
o Repeat 10 times
Oxygen Therapy
o Medicated- requires an order
o Hypoxia: <92%
o Acute and chronic hypoxemia (PaO2 <65 mmHg, PSPO <92%)
o Pre and post-cardiac or respiratory arrest
o Signs/symptoms of shock
o Low CO
o Metabolic acidosis (HCO3 <18 mmol/L)
, o Recovering from anesthesia
Nasal cannula
o 1-6 liters per min (low flow)- delivers FiO2 at 24-44%
Simple mask
o 6-10 liters per min (low flow)
o A flow rate less than 6 L can result in CO2 buildup
o Flow rate more than 4L should consider hydration
Non-rebreather and partial non-rebreather
o 10-15 liters per min (low flow)- 02 concentration of 60-90%
o A flow rate lower than 6L can result in rebreathing CO2
o One-way valves or reservoir bags
Prevent mixing with room air
Nearly 100% of oxygen is delivered
High flow nasal cannula
o Delivers O2 at 60 liters per minute- FiO2 is 100%
o Fixed performance
Venturi Mask
o Fixed performance: delivers exact concentration of O2- FiO2 is 24-50%
O2 concentration is 4-12 liters per minute
o High flow
o Commonly used for COPD
Pneumonia
o Inflammatory process in the lungs that produces excess fluid, triggered by an
infectious organism or aspiration of an irritant
Bacteria and viral are contagious
Fungal is not contagious
o Hospital-acquired: acquired inside a hospital: pt must have been admitted >48
hours (more resistant to antibiotics)
o Community-acquired: acquired outside of the hospital
o Ventilator-associated: acquired after being placed on mechanical ventilation
(must’ve been intubated >48 hours)
o More prevalent in African Americans
o Assessment
Change in vital signs, sputum, cough, physical assessment, chest x-ray,
and labs
Elderly patients: everything above, including unusual behavior, altered
mental status, dehydration, excessive fatigue, and HF
30-40% are afebrile
Difficult to treat
High mortality rate
o Vaccine
Recommended in ages 19-64 or those with asthma/smoke
Prevents pneumonia by 90%
Oxygen
Sputum Collection:
o Should be a morning collection
o 1-2 hours after eating
o Chest PT
o Sterile specimen container
o RT collection
Bronchoscopy: gives visualization of the larynx, trachea, and bronchi, where you are
able to visualize abnormalities.
o Complications: pneumothorax, aspiration, bronchospasm
Arterial Blood Gas (ABG):
o Assess the ability of the lungs to provide O2 and remove CO2
o Assess the ability of the kidneys to reabsorb and excrete bicarbonate ions
Pulmonary Function Test:
o Used for patients with chronic respiratory disorders
o Smokers: can’t smoke 6-8 hours prior
o Inhalers: stop 4-6 hours before
Complications
o Cracks in the oral mucosa
o Oxygen toxicity
o Oxygen-induced hypoventilation
o Combustion
Gero considerations
o Declines begin in middle adulthood
o Decline affects structure and function
o Changes in alveoli reduce surface area
o Alveoli lose elasticity
o Loss of chest wall mobility
o Respiratory dead space increases
o Decreased bronchial and mucous glands
Incentive Spirometer
o Helps expand the lungs to help the pt breathe more deeply and fully
o Prevents post-op pulmonary complications
o Repeat 10 times
Oxygen Therapy
o Medicated- requires an order
o Hypoxia: <92%
o Acute and chronic hypoxemia (PaO2 <65 mmHg, PSPO <92%)
o Pre and post-cardiac or respiratory arrest
o Signs/symptoms of shock
o Low CO
o Metabolic acidosis (HCO3 <18 mmol/L)
, o Recovering from anesthesia
Nasal cannula
o 1-6 liters per min (low flow)- delivers FiO2 at 24-44%
Simple mask
o 6-10 liters per min (low flow)
o A flow rate less than 6 L can result in CO2 buildup
o Flow rate more than 4L should consider hydration
Non-rebreather and partial non-rebreather
o 10-15 liters per min (low flow)- 02 concentration of 60-90%
o A flow rate lower than 6L can result in rebreathing CO2
o One-way valves or reservoir bags
Prevent mixing with room air
Nearly 100% of oxygen is delivered
High flow nasal cannula
o Delivers O2 at 60 liters per minute- FiO2 is 100%
o Fixed performance
Venturi Mask
o Fixed performance: delivers exact concentration of O2- FiO2 is 24-50%
O2 concentration is 4-12 liters per minute
o High flow
o Commonly used for COPD
Pneumonia
o Inflammatory process in the lungs that produces excess fluid, triggered by an
infectious organism or aspiration of an irritant
Bacteria and viral are contagious
Fungal is not contagious
o Hospital-acquired: acquired inside a hospital: pt must have been admitted >48
hours (more resistant to antibiotics)
o Community-acquired: acquired outside of the hospital
o Ventilator-associated: acquired after being placed on mechanical ventilation
(must’ve been intubated >48 hours)
o More prevalent in African Americans
o Assessment
Change in vital signs, sputum, cough, physical assessment, chest x-ray,
and labs
Elderly patients: everything above, including unusual behavior, altered
mental status, dehydration, excessive fatigue, and HF
30-40% are afebrile
Difficult to treat
High mortality rate
o Vaccine
Recommended in ages 19-64 or those with asthma/smoke
Prevents pneumonia by 90%
