Karla Vallejo

Professor Reilly.
Fundamentals of Nursing

Case Study: Oxygenation

Mix and Match

1. Atelectasis- Collapse of lung tissue in the distal part of the lung

2. Chronic bronchitis- An inflammation of the larger airways, increased production of
mucus, and chronic cough
3. Emphysema- An enlargement of small air sacs on the distal end of terminal bronchioles
4. Asthma- A reaction of airways to stimulation by irritants, allergens, pollutants, or cold
air through constriction and spasms
5. Pneumonia- An infection in the lungs

Complete the following:

6. Normal heart rate is 60-100 beats per minute.

7. Identify cardiovascular alterations that can influence oxygenation.
 Interruption of blood flow to the myocardium can result from narrowing of the
arteries by atherosclerosis, spasm, or congenital malformations.
 Blood clot formation in the coronary arteries may totally block blood flow and
cause a myocardial infarction
 Interrupted electrical impulses, or electrolyte disturbances can also result from
decreased blood flow to the heart
 Cardiac failure results from contractility and reduces the ability of the heart to
meet the needs of the body tissues
8. Cause of these disorders:
a. Emphysema- Lung proteases collapse the walls of the bronchioles and alveolar air
sacs. When the walls collapse, the bronchioles and alveoli transform from small,
elastic structures with great air-exchanging surface area into fewer, larger, inelastic
areas with little surface area. Air gets trapped in these structures, especially during
forced expiration. (ex: coughing) The air stagnates and cannot supply oxygen to the
capillaries. Centrilobular emphysema affects the bronchioles, while panlobular
emphysema is more severe in the alveoli. Can be causes my smoking cigarettes and
exposure to pollution.
b. Pneumonia- An infection of the lungs caused by a bacterium called Streptococcus
pneumoniae.
c. Atelectasis- Results from blockage or collapse of the air passages in at least one lobe
of the lungs.
9. How do scoliosis and kyphosis affect respirations?
Over time kyphoscoliosis (scoliosis and kyphosis) compromises the respiratory system,
resulting in hypoventilation, retention of carbon dioxide, and shortness of breath.
10. Identify 5 questions that should be ask to the patient in regards to the
cardiopulmonary function.
1. Are you having chest pain? If so, rate it on a scale of 0 to 10.
 2. How long have you had the pain?
3. How much do you exercise?
4. Have you had a recent weight gain?
5. Have you had changes in skin texture, color, or temperature?
11. For the physical assessment, which areas will the nurse focus on to determine
oxygenation status?
The nurse will focus on the hands and toes to make sure that the capillary refill is less
than 2 seconds, and inspection of the skin for cyanosis. Auscultating of the lungs for
normal breath sounds or adventitious breath sounds that are made when the airway is
constricted or diseases. Evaluation of the shape of the chest; a barrel shaped chest may
indicate air trapping which can be accompanied by COPD.
12. Define the following.
a. Cyanosis- A bluish discoloration of the skin related to deoxygenation of hemoglobin,
a decreased oxygen saturation level, and a feeling of distress.
b. Hemoptysis- The presence of blood in the sputum.
c. Hypercapnia- An abnormally high level of carbon dioxide in the blood. (>45 mm
Hg)
d. Arrhythmia- Abnormal rhythms of the heart.
e. Necrosis- The death of cells in living tissues.
f. Hypoxemia- Low levels of oxygen in the blood.
13. For the patient with emphysema:
a. The results of the forced vital capacity (FVC), forced expiratory volume (FEV1), and
forced expiratory flow (FEF) are expected to be lower than normal.
b. The results of the residual volume (RV) and functional residual capacity (FRC) are
expected to be higher than normal.
14. For the patient with heart failure:
a. Hemoglobin levels may be decreased.
b. Potassium levels may be increased.
15. What abnormalities can be found with a chest radiograph?
Abnormal findings include rib fractures, tumors, pneumothorax (air in the pleural cavity),
pneumonia, pericardial effusion (fluid around the heart), pleural effusion (excessive fluid
accumulation in the pleural cavity), an enlarged heart, and atelectasis.
16. What concerns does the nurse have for the patient undergoing a cardiac
catheterization?
The should monitor and assess for complications such as allergy to the contrast medium,
arrhythmias, blood clots, and bleeding at the catheter insertion site, and obtain frequent
vital signs.
17. Identify at least three nursing diagnoses related to oxygenation.
1. Impaired Gas Exchange related to destruction of alveolar walls as evidenced by thick
sputum, rhonchi in the lung fields, and prolonged coughing incidents
2. Acute pain related to damage to the heart muscles, as evidenced by increased
respirations and diaphoresis
3. Anxiety related to difficulty breathing, as evidenced by verbalization of nervousness
about health status and irritability
18. Identify at least two related goal/outcome statements for patient oxygenation.
 Patient will maintain SpO2 at 92% or greater by the end of the shift
  Patient’s lungs will be clear to auscultation within 24 hours.
19. What measures can the nurse implement to promote a patient’s oxygenation?
Placing a dyspneic patient in the semi-Fowler position; aiding airway clearance by
teaching the patient to cough, deep-breath, and use incentive spirometer; and providing
adequate hydration to help thin secretions.
20. Oxygen saturation should be at a minimum of 95%.
21. What is required when oxygen is going to be used by a patient at home?
A patient should be educated on proper use and storage of the oxygen, signs of “No
Smoking” need to be placed in the home, the size and length of the home need to be
measured to determine the placement of oxygen as well as the length of tubing to allow
the patient to go from room to room.
22. For the QSEN competency of Teamwork and Collaboration, what other health team
members will most likely be involved in the care of a patient with an oxygenation
deficit?
Oxygenation problems involve the collaboration of nursing, physicians, respiratory
therapist, speech therapist, and physical therapist.
23. The patient is admitted to the hospital with an exacerbation of his emphysema. The
patient’s wife asks why the oxygen level is “not turned up high” to help her husband
breather better. The nurse responds by explaining to the patient’s spouse:
The medication orders by the primary care provider follow the national hospital inpatient
quality measures and the individual needs of the patient.
24. Indicate safety consideration associated with the oxygen delivery methods pictured:
a. Oxygen delivery by nasal cannula
 Correct application of the nasal cannula
 Encourage the patient to breathe through the nose
 Be sure to follow flow rate guidelines
 Do not administer oxygen through a nasal cannula at greater than 6 L/min
 Consider humidification at all levels, especially at flow rates of 4 L/min and
higher
b. Oxygen delivery by mask
 Always humidify the oxygen delivery mask
 If there is a bag reservoir, ensure it is filled before placing the mask on the patient
 Follow flow rate guidelines
25.
a. Continuous positive airway pressure (CPAP) is used for: Patients with obstructive
sleep apnea, pneumonia, and COPD, and prevent atelectasis.
b. Barriers to CPAP compliance include: Dry nares, skin irritation, claustrophobia,
perceived inability to breathe against air, and the noise of the apparatus.
c. What is the difference between the CPAP and BIPAP? CPAP is used to provide
the same pressure for inhalation and exhalation while BIPAP provides a higher
pressure during inhalation and a lower pressure during exhalation.
26. When would a bag-valve-mark (BVM) or Ambu bag be used? Used to support,
ventilate, and oxygenate a patient who needs ventilatory support.
27. Identify the following for airway insertion and care:
a. Oropharyngeal Airway: Size: 90 mm, measure from the mouth opening to the back of
the jaw; Insertion: Insert the airway while directing the curve of the airway at the roof
 of the mouth, and then rotate the airway 180 degrees after it reaches the back of the
throat; Nursing care: Remove the airway every 4 to 8 hours.
b. Nasopharyngeal Airway: Size: 28 French, measure from the ear tragus to the nostril
plus 1 inch; Insertion: Lubricate the airway, the airway is inserted gently, if resistance
is encountered try the other nostril; Nursing care: Remove the airway every 8 to 24
hours and alternate the nares.
28. What emergency equipment should be in the room of a patient with a
tracheostomy?
The equipment that is needed is and obturator, tracheostomy tube holder, BMV device,
and an extra tracheostomy care kit.
29. Indicate interventions that can be used to promote cardiopulmonary function.
Exercise programs can be used to promote cardio-pulmonary function. Regular exercise
is recommended for these patients to optimize functioning. Cardiac and pulmonary
rehabilitation is also recommended.
30. Identify at least three classifications of medications that are expected to be part of
the treatment for:
a. Pulmonary disease-
 Inhalation therapy bronchodilators increase the diameter of the bronchi,
which decrease wheezing and improved oxygenation
 Anticholinergic agents decrease secretions, which improves airway
clearance and decreases bronchospasms 
 Corticosteroids decrease inflammation, which improves respiratory
function.

b. Cardiovascular disease-
 Hypertension treatment with ACE-I
 Beta-Blockers
 Calcium channel blockers
 Vasodilators
31. An unlicensed assistive personnel (UAP) is checking on the patient with a patient
with a nasopharyngeal airway who has oxygen in place and requires frequent
suctioning. What do you tell the UAP to report to you regarding this patient’s
status?
Changes in vitals, respiratory status, or LOC, Pain or discomfort noticed by the patient,
Skin breakdown or open areas on the oral mucosa, and Excessive secretions.
32. The patient who needs nasotracheal suctioning has an excessive amount of
secretions. How does the nurse ventilate this patient before suctioning?
Use a tracheostomy oxygenation mask set for 100% FiO2 for several respiratory cycles.
33. The nurse recognizes that suctioning through the patient’s nares is contraindicated
for the patient who has which of the following?
a. Epistaxis
d. Reactive airways disease
e. An upper neck injury
34. To clear the suction catheter and check that the suction is functioning, the nurse
uses:
The suction control port on the catheter.
 35. Identify the pressures to be set for suction of the following:
a. Tracheostomy: 80 to 120 mm Hg continuous
b. Oropharyngeal: 120 mm Hg continuous
36. Identify the correct sequence for cleaning the tracheostomy once the sterile field and
solutions are prepared.
1. Apply sterile gloves.
2. Clean the inner cannula, if nondisposable.
3. Dip the cotton swab into the sterile normal saline solution.
4. Gently clean the outer area of the tracheostomy from the stoma outward.
5. Pat the outer area of the tracheostomy dry with sterile gauze.
37. For a patient with a chest tube, indicate what the nurse should do for the following:
a. Positioning for a patient with a pneumothorax- The nurse should use the semi-fowler
position
b. Bubbling in the water-seal chamber- Bubbling indicates an air leak, which may be a
sign of a new or persistent pneumothorax. Notify the PCP immediately.
c. Drainage is collecting in the coiled tube- Drain the tube every 15 minutes
d. Assessment of the drainage system should be done at least every 4 hours or per
agency policy.

Multiple Choice Questions

38. C 45. C
39. C 46. D
40. B 47. A
41. D 48. C
42. B 49. C
43. B 50. D
44. A 51. B

Practice situation
You are working with a 72-year-old patient who has had left-sided congestive heart failure
for several years. She is admitted to the hospital with dyspnea and 2+ peripheral edema.
a. What medical treatment do you anticipate for this patient?
The medical treatment would be a diuretic based on the patient’s labs.

b. Which independent nursing actions can you implement to assist the patient to
achieve necessary oxygenation?
Nursing independent actions would be to put the patient in a sitting position, strict intake
& output, restriction of fluid depending on the patient’s office, weighting the patient on a
daily basis, give oxygen as needed depending on the patient’s oxygen saturation.

Review Questions

1. How do the anatomy and physiology of the cardiovascular and respiratory systems
function in relation to ventilation and perfusion?
 The heart is a hollow, cone shaped organ composed of four chambers divided into right
and left sides. The chambers on the top are atria; the lower chambers are ventricles. The
respiratory system is divided into the upper (nose, nasal cavity, sinuses, and pharynx) and
the lower (larynx, trachea, right and left bronchi, bronchioles, alveoli) respiratory tract.
The cardiac and pulmonary systems work together in our body to deliver oxygen to
tissues. An intact respiratory system is necessary to inspire oxygen and deliver it to the
circulatory system. A healthy heart pumps oxygenated blood to tissues through the
vascular system.
2. What are common alterations in structure and function of the cardiovascular and
respiratory and respiratory systems?
Common alterations in the cardiovascular system and respiratory system may decrease
the ability to deliver oxygen to alveoli, absorb oxygen, and expel carbon dioxide.
3. How does the nurse assess the cardiac and respiratory systems?
The nurses assess the cardiac and respiratory systems starting the assessment of
subjective data. Objective data are obtained through vital signs and through inspection,
palpation, and auscultation of the heart, lungs, and peripheral vascular system, noting any
abnormalities. Diagnostic tests, such as blood work, pulmonary function tests, x-rays ,
echocardiograms, electrocardiogram , and cardiac catherization, may be ordered.
4. Which nursing diagnoses are appropriate for patients with problem of decreased
oxygenation?
Nursing diagnoses for the patient with decreased oxygenation are based of the patient’s
specific problem. Major diagnoses include Impaired Gas Exchange, Ineffective Airway
Clearance, Activity Intolerance, Ineffective Breathing Pattern, Ineffective Tissue
Perfusion, and Anxiety.
5. How does the nurse evaluate interventions used to enhance patient oxygenation,
promote safety, and reverse negative effects of decreased oxygenation?
Interventions for patients with decreased oxygenation include oxygen therapy; artificial
airways, including pharyngeal airways; endotracheal airways, and tracheostomies;
postural drainage; and pharmacologic therapy.