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Oxygenation
Nursing Fundamentals Focus VIII
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 client’s oxygenation status.
• Explain the major purpose of the tests and the related 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 paid 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
Normal Oxygenation Process• Cardiovascular:
Normal Oxygenation Process• Systemic:
Normal Oxygenation Process
Inspiration
• Diaphragm and intercostal muscles contract • Thoracic cavity size increases• Volume of lungs increases• Intrapulmonary pressure decreases• Air rushes into the lungs to equalize pressure
Expiration
• Diaphragm and intercostal muscles relax• Lung volume decreases• Intrapulmonary pressure rises• Air is expelled
Gas Exchange
• Occurs after the alveoli are ventilated• Pressure differences (gradient) on each side of the
respiratory membranes affect diffusion• Alveoli:
• PO2 100mmHg• PCO2 40mmHg
• Venous blood:• PO2 60mmHg• PCO2 45mmHg
• O2 diffusion from alveoli pulmonary blood vessels• CO2 diffusion from pulmonary blood vessels alveoli
Adequate O2 Balance• Maintenance of adequate O2 balance Gas Exchange
Oxygen Transport
• Transported from the lungs to the tissues• 97% of O2 combines with RBC Hgb
oxyhemoglobin carried to tissues • Remaining O2 is dissolved and transported in
plasma and cells (PO2)
Normal Oxygenation Process
• Cell environment / O2 carrying capacity:
• O2 Carrying capacity of blood is expressed by:• Red blood cells (#)• Hematocrit
• % of blood that is RBCs• Men 40-54%• Women 37-50%
• Hemoglobin
Carbon Dioxide Transport
• Must be transported from tissues lungs• Continually produced in the process of cell
metabolism
• 65% – carried inside RBCs as bicarbonate (HCO3-)
• 30% – combines with Hgb carbhemoglobin• 5% – transported in plasma as carbonic acid (H2CO3)
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
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
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•Have client describe
• specific location, onset and duration of the problem
•Explore associated signs and symptoms
•Ask - activities that worsen or ease the problem
•Rate the severity of discomfort or incapacity
•Talk - treatments or interventions used to alleviate the problem and their effectiveness
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
Nursing Responsibilities
• 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
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
Common Tests and Nursing Responsibilities
•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
Common Tests and Nursing Responsibilities
• Tests to visualize structures of respiratory system:
• Bronchoscopy
• Chest radiographs
Chest Xray
Adenocarcinoma
Common Tests and Nursing Responsibilities
Thorancentesis
Nursing Responsibilities
• Medications• Incentive spirometry• Chest PT• Postural drainage • Oxygen therapy• Artificial airways• Airway suctioning• Chest tubes
Basic Nursing Interventions
• Airway Maintenance:
• Facilitate effective coughing• Suctioning airways• Liquefying and mobilizing sputum
Basic Nursing Interventions
• Maintenance and promotion of proper lung expansion:
Re-expanding collapsed lungs- Closed Chest Tube Drainage
Chest Tubes
Basic Nursing Interventions
• 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 if is immobile
Basic Nursing Interventions
• 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
Basic Nursing Interventions
• Mobilization of Pulmonary Secretions• Encourage activity and ambulation as
tolerated• Encourage increased fluid intake• Chest physiotherapy• O2• Medications as ordered
Basic Nursing Interventions
• O2 Therapy:
• Low flow• High flow• Humidification• Nasal cannula• Simple mask• Nonrebreathing mask• Partial rebreathing
Basic Nursing Interventions
• Effective Breathing Techniques
• Position for maximal respiratory function
• Pursed lip breathing
• Diaphragmatic or abdominal breathing
Basic Nursing Interventions
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
Basic Nursing Interventions
• Physical Exercise health teachingActivity 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 balance Cardio 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
Common Tests and Nursing Responsibilities
• Tests to determine adequacy of cardiovascular function:
• CBC
• Lipid profile
• Coagulation studies
• EKG/ECG
• Angiography
• Doppler blood flow studies
Basic Nursing Interventions
Cardiovascular• Modify risk factors
• Preventing vasoconstriction
•Diet •Exercise•Co morbidities
•Positioning•Cold temperatures•Nicotine
Basic Nursing Interventions
• 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
Basic Nursing Interventions
Cardiovascular• Positioning to
improve CO
• Avoiding Valsalva maneuver
- 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
in bed-> assist - Bearing down
during BM-> stool
softeners and diet
Basic Nursing Interventions
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
Basic Nursing Interventions
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
Basic Nursing Interventions
• Dietary control
• Assess nutritional status
• Consider a dietician referral to assess nutritional needs related to clients
• Chronicity of CAL and CAD and nutrition
Basic Nursing Interventions
•Weight control
• Evaluate the client’s physiological status in relation to condition
• More than body requirements
• Less than body requirements