1
NR224 Fundamentals Final Exam Study Guide
Distribution of Questions:
Main Focus Topics : Oxygenation, Bowel/Nutrition, Medications
Delegation: For all topics, please know what the nurse can and cannot delegate related to
the patient’s care.
Oxygenation
Basic A & P
• Ventilation - the movement of air between the atmosphere and the alveoli of the lungs as we
inhale and exhale
• Diffusion - gas exchange which involves CO2 between the alveoli and the pulmonary capillaries
• Transportation - transport of oxygen from the lungs to the tissues and transport of carbon dioxide
from the tissues to the lungs
Respiratory assessment/Priorities of care/s/s of respiratory abnormalities and
RN Response
• Assessment includes pain, dyspnea, wheezing, respiratory infections, health risks, smoking,
cough, environmental exposures, allergies, and medications used.
• Alterations in Respiratory Functioning
• Hyperventilation - ventilation in excess of that required to eliminate carbon dioxide produced by
cellular metabolism
• Hypoventilaiton - alveolar ventilation inadequate to meet the body’s oxygen demand or to eliminate
sufficient carbon dioxide
• Hypoxia - inadequate tissue oxygenation at the cellular level
• Cyanosis - blue discoloration of the skin and mucous membranes
• Interventions
, 2
• Position the client to allow for maximal chest expansion
• Encourage or assist client with frequent changes in position,every 2 hours
• Encourage deep breathing and coughing
• Encourage ambulation
• Promote comfort so client can tolerate the above activities
• increased fluids
• suctioning
, 3
Delivery systems
• Oxygen is a medication, it must be administered as prescribed.
• The dose or concentration of the oxygen should be continuously monitored
• Humidification is necessary for clients receiving O2 therapy >4L/min
• If you have a client receiving oxygen you must check it when you assess the client
• If client is transported make sure portable tank has enough oxygen in tank
• Initiating the adm of oxygen is considered similar to administering a medication and is not
delegated to UAP
• UAP may reapply the oxygen delivery device
• Nasal Cannula
• Most commonly used oxygen device because of convenience and client comfort
• Delivered oxygen concentration can vary with client breathing pattern
• Nasal passages must be patent for client to receive O2
• Can cause skin breakdown over the ears and in the nares
• Face Mask
• Face Masks cover the client’s nose and mouth
, 4
• To avoid rebreathing CO2 while wearing a mask,a minimum of 5L/min oxygen flow rate is
required
• Exhalation Ports on the sides of the mask allow exhaled carbon dioxide to escape
• Remember to find an appropriate mask size for the client
• Limitations: hard to achieve a proper fit and poor tolerance
• 40-60% when operated at 6-10L
• Most common midrange O2 delivery device
• Minimum of 5L/min O2 required to prevent client from re-breathing exhaled carbon dioxide
• As with cannula, actual delivered O2 concentration varies with breathing pattern
• Face Mask is contraindicated for clients with CO2 retention because it can worsen
• Face Masks with Reservior Bags
• Provide a higher oxygen concentration to the client
• Portion of client’s expired air is directed to the bag
• Its oxygen concentration remains the same as the inspired air
• Partial Rebreather
• Delivers oxygen concentrations of 60-90% at liter flows of 6-10 L per minute
• O2 reservoir bag allows client to rebreathe first third of exhaled air in conjunction with O2
• Do not allow bag to deflate during inspiration to avoid CO2 buildup(increase liter of flow if
needed)
• Non-rebreathing Face Mask with Reservior Bag
• Nonrebreather delivers the highest oxygen concentration possible 95-100% at liter flows of 10-15L/
min
• One-way valves on the mask and between the reservoir bag and mask prevent room air and client’s
exhaled air from entering the bag so only O2 in bag is inspired
• To prevent CO2 buildup,the nonrebreather bag must not deflate
• Used for critically ill clients
• Face Tent
• Face Tents can be used when masks are not tolerated
• Provide 30-50% concentrations of O2 at 4-8L/m
• Keep skin dry
NR224 Fundamentals Final Exam Study Guide
Distribution of Questions:
Main Focus Topics : Oxygenation, Bowel/Nutrition, Medications
Delegation: For all topics, please know what the nurse can and cannot delegate related to
the patient’s care.
Oxygenation
Basic A & P
• Ventilation - the movement of air between the atmosphere and the alveoli of the lungs as we
inhale and exhale
• Diffusion - gas exchange which involves CO2 between the alveoli and the pulmonary capillaries
• Transportation - transport of oxygen from the lungs to the tissues and transport of carbon dioxide
from the tissues to the lungs
Respiratory assessment/Priorities of care/s/s of respiratory abnormalities and
RN Response
• Assessment includes pain, dyspnea, wheezing, respiratory infections, health risks, smoking,
cough, environmental exposures, allergies, and medications used.
• Alterations in Respiratory Functioning
• Hyperventilation - ventilation in excess of that required to eliminate carbon dioxide produced by
cellular metabolism
• Hypoventilaiton - alveolar ventilation inadequate to meet the body’s oxygen demand or to eliminate
sufficient carbon dioxide
• Hypoxia - inadequate tissue oxygenation at the cellular level
• Cyanosis - blue discoloration of the skin and mucous membranes
• Interventions
, 2
• Position the client to allow for maximal chest expansion
• Encourage or assist client with frequent changes in position,every 2 hours
• Encourage deep breathing and coughing
• Encourage ambulation
• Promote comfort so client can tolerate the above activities
• increased fluids
• suctioning
, 3
Delivery systems
• Oxygen is a medication, it must be administered as prescribed.
• The dose or concentration of the oxygen should be continuously monitored
• Humidification is necessary for clients receiving O2 therapy >4L/min
• If you have a client receiving oxygen you must check it when you assess the client
• If client is transported make sure portable tank has enough oxygen in tank
• Initiating the adm of oxygen is considered similar to administering a medication and is not
delegated to UAP
• UAP may reapply the oxygen delivery device
• Nasal Cannula
• Most commonly used oxygen device because of convenience and client comfort
• Delivered oxygen concentration can vary with client breathing pattern
• Nasal passages must be patent for client to receive O2
• Can cause skin breakdown over the ears and in the nares
• Face Mask
• Face Masks cover the client’s nose and mouth
, 4
• To avoid rebreathing CO2 while wearing a mask,a minimum of 5L/min oxygen flow rate is
required
• Exhalation Ports on the sides of the mask allow exhaled carbon dioxide to escape
• Remember to find an appropriate mask size for the client
• Limitations: hard to achieve a proper fit and poor tolerance
• 40-60% when operated at 6-10L
• Most common midrange O2 delivery device
• Minimum of 5L/min O2 required to prevent client from re-breathing exhaled carbon dioxide
• As with cannula, actual delivered O2 concentration varies with breathing pattern
• Face Mask is contraindicated for clients with CO2 retention because it can worsen
• Face Masks with Reservior Bags
• Provide a higher oxygen concentration to the client
• Portion of client’s expired air is directed to the bag
• Its oxygen concentration remains the same as the inspired air
• Partial Rebreather
• Delivers oxygen concentrations of 60-90% at liter flows of 6-10 L per minute
• O2 reservoir bag allows client to rebreathe first third of exhaled air in conjunction with O2
• Do not allow bag to deflate during inspiration to avoid CO2 buildup(increase liter of flow if
needed)
• Non-rebreathing Face Mask with Reservior Bag
• Nonrebreather delivers the highest oxygen concentration possible 95-100% at liter flows of 10-15L/
min
• One-way valves on the mask and between the reservoir bag and mask prevent room air and client’s
exhaled air from entering the bag so only O2 in bag is inspired
• To prevent CO2 buildup,the nonrebreather bag must not deflate
• Used for critically ill clients
• Face Tent
• Face Tents can be used when masks are not tolerated
• Provide 30-50% concentrations of O2 at 4-8L/m
• Keep skin dry
