53 a focus 8 oxygenation pdf

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OXYGENATION

NURSING FUNDAMENTALS FOCUS VI

OBJECTIVES• List and discuss the major body structures.• Discuss functions responsible for proper

oxygenation• Describe factors that may alter ones O2 balance.• Identify the behaviors indicating negative O2

balance.• Review the common diagnostic tests medically

prescribed in order to determine the clients oxygenation status.

• Explain the major purpose of the tests and therelated nursing responsibilities.

STAGGERING STATISTICS

• Pulmonary Diseases• Lung CA -

• TB –

• Pneumonia –

• Chronic Airflow Limitation (formerly COPD) –

STAGGERING STATISTICS

• Cardiovascular Diseases – # 1 killer• HTN – 65 million• Artheriosclerosis• Arteriosclerosis• Stroke• Hypercholesterolemia

• 107 million - a risk factor for CVD• AMI – 7.5 Million per year, 460,000 die• Americans will pay 393.5 billion in 2005 for

CVD related medical costs

RESPIRATORY SYSTEM

PROCESS OF BREATHING

•Inspiration•Air flows into lungs

•Expiration•Air flows out of lungs

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NORMAL OXYGENATION PROCESS

• Cardiovascular:


• Systemic:

NORMAL OXYGENATIONS PROCESS

INSPIRATION

• Diaphragm and intercostals contact • Thoracic cavity size increases• Volume of lungs increases• Intrapulmonary pressure decreases• Air rushes into the lungs to equalize

pressure

EXPIRATION

•Diaphragm and intercostalsrelax

•Volume of the lungs decreases• Intrapulmonary pressure rises•Air is expelled

GAS EXCHANGE

• Occurs after the alveoli are ventilated• Pressure differences on each side of

the respiratory membranes affect diffusion

• Diffusion of oxygen from the alveoli into the pulmonary blood vessels

• Diffusion of carbon dioxide from pulmonary blood vessels into alveoli

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ADEQUATE O2 BALANCE

• Maintenance of adequate O2 balance Gas Exchange

OXYGEN TRANSPORT

• Transported from the lungs to the tissues

• 97% of oxygen combines with hemoglobin in red blood cells and carried to tissues as oxyhemoglobin

• Remaining oxygen is dissolved and transported in plasma and cells


• Cell environment/ O2 carrying capacity:• O2 Carrying capacity of blood is expressed by:• Red blood cells • Hematocrit• Hemoglobin

CARBON DIOXIDE TRANSPORT

• Must be transported from the tissues to the lungs

• Continually produced in the process of cell metabolism

• 65% is carried inside the red blood cells as bicarbonate

• 30% combines with hemoglobin as carbhemoglobin

• 5% transported in solution in plasma and as carbonic acid

FACTORS THAT INFLUENCE RESPIRATORY FUNCTION

•Age•Environment•Lifestyle•Health status•Medications•Stress

COMMON MANIFESTATIONS OF IMPAIRED RESPIRATORY FUNCTION

•Hypoxia•Altered breathing patterns

•Obstructed or partially obstructed airway

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HYPOXIA

• Condition of insufficient oxygen anywhere in the body

• Rapid pulse• Rapid, shallow respirations and dyspnea• Increased restlessness or lightheadedness• Flaring of nares• Substernal or intercostal retractions• Cyanosis

ABNORMAL RESPIRATORY PATTERNS

• Tachypnea (rapid rate)• Bradypnea (abnormally slow rate)• Apnea (cessation of breathing)• Kussmaul’s breathing• Cheyne-Stokes respirations• Biot’s respirations

ALTERATIONS IN EASE OF BREATHING

•Orthopnea•Dyspnea

OBSTRUCTED OR PARTIALLYOBSTRUCTED AIRWAY

•Partial obstruction• low-pitched snoring during inhalation

•Complete obstruction•extreme inspiratory effort with no chest movement

ADEQUATE O2 BALANCE

• Example of Obstructive Disease Asthma

ADEQUATE O2 BALANCE

• Example of Restrictive Disease Hemothorax

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INADEQUATE O2 BALANCE

• Behaviors of Negative O2 balance • Hypoventilation or hyperventilation• Stridor, audible sounds with respiration, wheezing,

coughing• Hypoxia• Change in mental status• Change vital signs• Cyanosis• Decrease in GI motility• Change in renal function• Hypercapnia

NURSING RESPONSIBILITIES

•• Determine adequacy of cardiopulmonary function:

• Nursing assessment

• HEART

• Respiratory assessment

• PMH

• LIFESTYLE

HEART PROBLEMS

Artheroscleosis = Coronary Artery Disease (CAD)

NURSING MEASURES TO PROMOTE RESPIRATORY FUNCTION

•Ensure a patent airway•Positioning•Encourage deep breathing, coughing

•Ensure adequate hydration


•• Physical Assessment:

• Lung auscultation and breathing pattern

• Abdominal assessment

• Urine output

• Skin and mucous membranes

• Heart sounds

• Circulation

• Edema

• DVT

LUNG SOUNDS• Diminished or absent• Crackles course and fine

• discontinuous course bubbling • fine crackling sound at the middle or end of

inspiration

• Rhonchi• a continuous sonorous sound

• Wheezes• high pitch musical sounds

• Pleural friction rub• grating rubbing, sound

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COMMON TESTS AND NURSING RESPONSIBILITIES

•• Measure adequacy of ventilation and gas exchange

• Complete Blood Count (CBC) phlebotomy

• Arterial Blood Gases (ABG) arterial puncture

• Pulmonary Function Tests preparation by teaching


•• Tests to determine abnormal cell growth or infection in respiratory system:

• Sputum culture• growing microorganisms from sputum

• Throat culture • growth of microorganisms from throat material


•• Tests to visualize structures of respiratory system:

• Bronchoscopy

• Chest radiographs

CHEST XRAY

Adenocarcinoma


• Thoracentesis: Thorancentesis


• Medications• Incentive spirometry• Chest PT• Postural drainage • Oxygen therapy• Artificial airways• Airway suctioning• Chest tubes

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BASIC NURSING INTERVENTIONS

• Airway Maintenance:

• Facilitate effective coughing• Suctioning airways• Liquefying and mobilizing sputum


• Maintenance and promotion of proper lung expansion:

Re-expanding collapsed lungs- Closed Chest Tube Drainage

CHEST TUBES


• Improving Activity Tolerance:• Determine etiology• Assess appropriateness of activity level• When appropriate gradually increase activity• Ensure the client changes position slowly• Observe for symptoms of intolerance• Syncope with activity

• refer to MD• Perform ROM exercises with activity intolerance or

is immobile


• Mobilization of Pulmonary Secretions

• Auscultate breath sounds, monitor respiratory patterns, monitor ABG’s

• Position client to optimize respiration• Pulmonary toileting• Incentive spirometry• Suctioning

INCENTIVE SPIROMETRY

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• Mobilization of Pulmonary Secretions• Encourage activity and ambulation as tolerated• Encourage increased fluid intake• Chest physiotherapy• O2• Medications as ordered


• O2 Therapy:

• Low flow• High flow• Humidification• Nasal cannula• Simple mask• Nonrebreathing mask• Partial rebreathing


• Effective Breathing Techniques

• Position for maximal respiratory function

• Pursed lip breathing

• Diaphragmatic or abdominal breathing


Stress and anxiety reduction:• Remove pertinent cause of anxiety at that moment

- help client gain control over respiration- reassure client not in immediate danger

• Chronic clients• exacerbations and remissions• goal is to reduce general level of anxiety• learn to control episodes of anxiety to improve quality

of life• desensitization program• guided mastery

ADMINISTRATION OF PRESCRIBED MEDICATIONS

• Expectorants• Mucolytics• Bronchodilators• Cough suppressants• Corticosteroids• Antihistamines• Antibiotics

• Vasoconstrictors

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BASIC NURSING INTERVENTIONS• Physical Exercise health teaching

Activity and rest -- a priority!Activity stimulates respiratory functionRest conserves energy and reduces metabolic demand• MD’s treatment plan

• guidelines for activity • may simply call for activity as tolerate.

• prioritize activities• arrange need items conveniently• Provide emotional support and encouragement

• gradually increase activity

• Simplify daily life• Work at a steady state• Conserve energy

ADEQUATE O2 BALANCE

• Behaviors of Negative O2 balanceCardio Vascular Disease

• Arterial• Venous:• Impaired tissue perfusion

ADEQUATE O2 BALANCE

• Behaviors of Negative O2 balance CV

• Restlessness, dizziness, syncope, bradycardia, decreased urine

• cold and clammy skin, cyanosis, slow capillary refill• Decreased cardiac output


•Tests to determine adequacy of cardiovascular function:

• CBC

• Lipid profile

• Coagulation studies

• EKG/ECG

• Angiography

• Doppler blood flow studies


Cardiovascular• Modify risk factors

• Preventing vasoconstriction

• Diet • Exercise• Co morbidities

• Positioning• Cold temperatures• Nicotine


• Cardiovascular- Prevent complications

• Promoting rest

•Risk DVT•Position changes•Early ambulation•Obstruction removal•Bypass surgery

•Schedule rest periods•Assistance with ADL’s•Monitor Vitals with activity•Place items, i.e. call light, water pitcher, strategically•Quiet environment, decrease stimuli

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Cardiovascular• Positioning to improve

CO

• Avoiding Valsalvamaneuver

- Position semi to high fowlers-> decrease venous return and preload, decease preload-> decreases risk of heart congestion

-• Teach client to avoid

valsalva maneuver- Hold breath while turning or moving inbed-> assist

- Bearing down during BM-> stool softenersand diet


Cardiovascular• Avoid stimulants

• Maintaining fluid balance

•Avoid appetite suppressants, cold meds, coffee, tea, chocolate

•Assess fluid status, monitor I&O, assess breath sounds, JVD, pitting edema in dependent areas, fluid and NA+ restriction, daily Wgt with diuretic therapy, electrolyte monitoring-> MD


Cardiovascular

• Increase O2 supply

• Administer O2

• Educate client NO SMOKING!

• Position to facilitate breathing

ADMINISTRATION OF PRESCRIBED MEDICATIONS

• Anti coagulants

• Vasodilator Medications

• Inotropic Medications

• Anti Dysrhythmics

• Anti hypertensives


• Dietary control

• Assess nutritional status

• Consider a dietician referral to assess nutritional needs related to clients

• Chronicity of CAL and CAD and nutrition


•Weight control

• Evaluate the client’s physiological status in relation to condition

• More than body requirements

• Less than body requirements

Documents

53 a focus 8 oxygenation pdf