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OXYGENATION

NURSING FUNDAMENTALS FOCUS VIII


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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 the related

nursing responsibilities.


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STAGGERING STATISTICS

Pulmonary Diseases Lung CA -

TB

Pneumonia

Chronic Airflow Limitation(formerly COPD)


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STAGGERING STATISTICS

Cardiovascular Diseases # 1 killer HTN 65 million

ArtheriosclerosisArteriosclerosis

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


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RESPIRATORY SYSTEM


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PROCESS OF BREATHING

Inspiration

Air flows into lungsExpiration

Air flows out of lungs


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NORMAL OXYGENATION PROCESS

Cardiovascular:


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Systemic:


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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


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EXPIRATION

Diaphragm and intercostal muscles relax

Lung volume decreases

Intrapulmonary pressure rises

Air is expelled


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GAS EXCHANGE

Occurs after the alveoli are ventilated

Pressure differences (gradient) on each side of therespiratory membranes affect diffusion

Alveoli:

PO2 100mmHg

PCO2 40mmHg

Venous blood:

PO2 60mmHg

PCO2 45mmHg O2 diffusion from alveolipulmonary blood vessels

CO2 diffusion from pulmonary blood vesselsalveoli


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ADEQUATE O2 BALANCE

Maintenance of adequate O2 balanceGas Exchange


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OXYGEN TRANSPORT

Transported from the lungs to the tissues

97% of O2combines with RBC Hgb

oxyhemoglobin carried to tissues Remaining O2is dissolved and transported in

plasma and cells (PO2)


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Cell environment / O2carrying capacity:

O2Carrying capacity of blood is expressed by: Red blood cells (#)

Hematocrit

% of blood that is RBCs

Men 40-54%

Women 37-50%

Hemoglobin


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CARBON DIOXIDE TRANSPORT

Must be transported from tissueslungs

Continually produced in the process of cell

metabolism

65% carried inside RBCs as bicarbonate (HCO3-)

30% combines with Hgbcarbhemoglobin

5% transported in plasma as carbonic acid (H2CO3)


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FACTORS THAT INFLUENCE

RESPIRATORY FUNCTION

Age

Environment

Lifestyle

Health status

Medications

Stress


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COMMON MANIFESTATIONS OF IMPAIRED


Hypoxia

Altered breathing patternsObstructed 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


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ABNORMAL RESPIRATORY PATTERNS

Tachypnea (rapid rate)

Bradypnea (abnormally slow rate)

Apnea (cessation of breathing)

Kussmauls breathing

Cheyne-Stokes respirations Biots respirations


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ALTERATIONS IN EASE OF BREATHING

Orthopnea

Dyspnea


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OBSTRUCTED OR PARTIALLY

OBSTRUCTED AIRWAY

Partial obstruction

low-pitched snoring during inhalation

Complete obstruction extreme inspiratory effort with no chest

movement


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ADEQUATE O2 BALANCE

Example of Obstructive Disease:Asthma


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ADEQUATE O2BALANCE

Example of Restrictive Disease: Hemothorax


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INADEQUATE O2BALANCE

Behaviorsof Negative O2balance 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


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NURSING RESPONSIBILITIES

Determine adequacyof cardiopulmonary function:

Nursing assessment

HEART

Respiratory assessment

PMH

LIFESTYLE

HEART


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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 alleviatethe problem and their effectiveness


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HEART PROBLEMS

Artheroscleosis = Coronary Artery Disease (CAD)

NURSING MEASURES TO PROMOTE


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NURSING MEASURES TO PROMOTE


Ensure a patent airway

Positioning

Encourage deep breathing, coughing

Ensure adequate hydration



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Physical Assessment:

Lung auscultation and breathing pattern

Abdominal assessment

Urine output

Skin and mucous membranes

Heart sounds

Circulation

Edema

DVT

LUNG SOUNDS


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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 adequacyof ventilationand gas exchange

Complete Blood Count (CBC) phlebotomy

Arterial Blood Gases (ABG)arterial puncture

Pulmonary Function Testspreparation by teaching


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Tests to determine abnormal cell growthorinfectionin respiratory system:

Sputum culture growing microorganisms from sputum

Throat culture

growth of microorganisms from throat material


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Tests to visualize structuresof

respiratory system: Bronchoscopy

Chest radiographs


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CHEST XRAY

Adenocarcinoma


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Thorancentesis



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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


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Maintenance and promotion of proper lungexpansion:

Re-expanding collapsed lungs

- Closed Chest Tube Drainage

CHEST TUBES


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CHEST TUBES


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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


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Mobilization of Pulmonary Secretions

Auscultate breath sounds, monitor respiratory

patterns, monitor ABGs Position client to optimize respiration

Pulmonary toileting

Incentive spirometry Suctioning


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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


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O2 Therapy:

Low flow

High flow

Humidification Nasal cannula

Simple mask

Nonrebreathing mask

Partial rebreathing


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Effective Breathing Techniques

Position for maximal respiratory function

Pursed lip breathing

Diaphragmatic or abdominal breathing


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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

S O O


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ADMINISTRATION OFPRESCRIBED MEDICATIONS

Expectorants

Mucolytics

Bronchodilators

Cough suppressants

Corticosteroids

Antihistamines

Antibiotics

Vasoconstrictors



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Physical Exercise health teaching

Activity and rest -- a priority!

Activity stimulates respiratory function

Rest conserves energy and reduces metabolic demand

MDs 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


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ADEQUATE O2 BALANCE

Behaviorsof Negative O2 balance

Cardio Vascular Disease

Arterial

Venous:

Impaired tissue perfusion

ADEQUATE O2 BALANCE


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ADEQUATE O2 BALANCE

Behaviorsof Negative O2 balance CV

Restlessness, dizziness, syncope, bradycardia,

decreased urine cold and clammy skin, cyanosis, slow capillary refill

Decreased cardiac output



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Tests to determine adequacy of cardiovascular function:

CBC

Lipid profile

Coagulation studies

EKG/ECG

Angiography

Doppler blood flow studies


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Cardiovascular Modify risk factors

Preventing vasoconstriction

Diet Exercise Co morbidities

Positioning

Cold temperatures Nicotine



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Cardiovascular- Prevent complications

Promoting rest

Risk DVTPosition changesEarly ambulationObstruction removalBypass surgery

Schedule rest periodsAssistance with ADLsMonitor Vitals with activityPlace items, i.e. call light,water pitcher, strategicallyQuiet environment,decrease stimuli


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Cardiovascular Positioning to improve

CO

Avoiding Valsalva

maneuver

- Position semi to highfowlers-> decrease venousreturn and preload, deceasepreload-> decreases risk ofheart congestion

- Teach client to avoid

valsalva maneuver- Hold breath while

turning or moving inbed-> assist- Bearing down during

BM-> stool softenersand diet


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CardiovascularAvoid stimulants

Maintaining fluidbalance

Avoid appetite suppressants, coldmeds, coffee, tea, chocolate

Assess fluid status, monitor I&O,assess breath sounds, JVD, pittingedema in dependent areas, fluid

and NA+ restriction, daily Wgt withdiuretic therapy, electrolytemonitoring-> MD


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Cardiovascular

Increase O2 supply

Administer O2

Educate clientNO SMOKING!

Position to facilitatebreathing

ADMINISTRATION OF PRESCRIBED


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MEDICATIONS

Anti coagulants

Vasodilator Medications

Inotropic Medications

Anti Dysrhythmics

Anti hypertensives


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Dietary control

Assess nutritional status

Consider a dietician referral to assess

nutritional needs related to clients

Chronicity of CAL and CAD and nutrition


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Weight control

Evaluate the clients physiological status in relation

to condition

More than body requirements

Less than body requirements

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