Oxygenation
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Oxygenation

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Oxygenation Oxygenation Presentation Transcript

  • OXYGENATION Prepared by: John Gil B. Ricafort, RN
    • Respiratory
    • Review of Respiratory System
    • Common Manifestations
    • Diagnostic Tests/ Procedures
    • Common Pharmacologic Agents
    • Disturbances
    • a. Restrictive Lung Disease
    • b. COPD/ CAL
    • c. Pulmonary Vascular Disease
    • Restrictive:
    • Atelectasis
    • Tuberculosis
    • Pneumonia
    • COPD:
    • Asthma
    • Emphysema
    • Chronic Bronchitis
    • Pulmonary Vascular Disease:
    • Cor Pulmonale
    • Pulmonary Embolism
    • Hematopoietic
    • Review of the Hematopoietic System
    • Disturbances
    • a. Anemia
    • b. Polycythemia Vera
    • c. Bleeding Tendencies
    • - DIC
    • - Hemophilia
    • - Thrombocytopenia
    • Cardiovascular
    • Review of the Cardiovascular System
    • Common Diagnostic Tests/ Procedures
    • Disturbances
    • a. Infection
    • - Rheumatic Heart Disease
    • b. Coronary Artery Disease
    • - Atherosclerosis
    • - Arteriosclerosis
    • - Angina Pectoris
    • - Myocardial Infarction
    • IV. Congestive Heart Failure
    • - Right Sided Heart Failure
    • - Left Sided Heart Failure
    • V. Congenital Heart Defects
    • - Cyanotic Heart Defects
    • - Acyanotic Heart Defects
  • RESPIRATORY SYSTEM
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  • Measures That Promotes Adequate Respiratory Functions:
    • Adequate OXYGEN supply from the environment.
    • Deep breathing and coughing exercises.
    • Proper positioning
    • Patent airway (FEMS)
    • Adequate hydration
    • Avoid pollutants, alcohol and smoking.
    • 7. Chest Physiotherapy (CPT)
    • * Percussion
    • * Vibration
    • * Postural Drainage
    • 8. Bronchial Hygiene Measures
    • * Steam Inhalation
    • * Suctioning
    • - Oropharyngeal
    • - Nasopharyngeal
  • Things to Remember:SUCTIONING
    • Assess: AUDIBLE SECRETIONS during respiration
    • Position:
    • Conscious: SEMI-FOWLER’s POSITION
    • Unconscious: LATERAL POSITION
    • Pressure:
    • Wall Unit:
    • Adult: 100-120mmHg
    • Child: 95-110mmHg
    • Infant: 50-95mmHg
    • Portable Unit:
    • Adult: 10-15mmHg
    • Child: 5-10mmHg
    • Infant: 2-5mmHg
    • Appropriate Size of Catheter:
    • Adult: Fr. 12-18
    • Child: Fr. 8-10
    • Infant: Fr. 5-8
    • Lubricate Catheter:
    • Nasopharyngeal: water-soluble lubricant
    • Oropharyngeal: Sterile water or NSS
    • Apply suction during withdrawal of the suction catheter (NEVER during insertion)
    • Apply suction for 5 to 10 seconds (maximum of 15 seconds)
    • Allow 20-30 seconds interval between each suction and limit suction to 5 minutes in total
    • Encourage patient to breathe deeply and to cough between suctions.
    • Assess effectiveness of suctioning
  • 9. Incentive Spirometry - done to enhance deep inspiration
  • 10. Administration of supplemental oxygen
    • Signs of Hypoxemia
    • 1. Increased pulse rate
    • 2. Rapid, shallow respiration
    • 3. Increased restlessness
    • 4. Flaring of nares
    • 5. Substernal or intercostal retractions
    • 6. Cyanosis
  • OXYGEN SYSTEMS:
    • Low-flow Administration Devices
    • a. Nasal Cannula (24-45% at 2-6LPM)
    • b. Simple Face Mask (40-60% at 5-8LPM)
    • c. Partial Rebreathing Mask
    • (60-90% at 6-10LPM)
    • d. Non-rebreathing Mask
    • (95-100% at 6-15LPM)
    • e. Oxygen Tent
    • 2. High flow Administration Devices
    • a. Venturi Mask
    • b. Oxygen Hood
    • c. Incubator / Isolette
  • Common Manifestations:
    • 1. Cough
    • - the cardinal symptom of respiratory problem
    • 2. Dyspnea
    • - refers to difficulty on breathing
    • * EXERTIONAL DYSPNEA
    • * PAROXYSMAL NOCTURNAL
    • * ORTHOPNEA
  • 3. Clinical Signs of Hypoxia
    • EARLY SIGNS
    • Tachycardia
    • Kussmaul’s Respiration
    • N/V
    • Headache
    • Irritability
    • Memory loss
    • Dizziness
    • LATE SIGNS
    • Bradycardia
    • Dyspnea
    • Decreased Systolic BP
    • Cough
    • Increased RBC
    • Increased Hgb
    • Clubbing of fingers
  • 4. Clubbing of Fingers
    • 5. Hemoptysis
    • 6. Chestpain
    • 7. Headache
    • 8. Easy fatigability
    • 9. Cyanosis
    • 10. Skin flushing
    • 11. Seizures
    • 12. Altered level of consciousness
  • Common Pharmacologic Agents
    • Adrenergic (Sympathomimetic) Agents
    • Bronchodilators
    • Antibacterial
    • Corticosteroids
    • Antihistamine
    • Mucolytic, Antitussive and Expectorant
  • Common Procedures/ Tests
    • 1. Abdominal Thrust (Heimlich Maneuver)
    • - a short, abrupt pressure against the abdomen, two fingerbreadths above the umbilicus, to raise the intrathoracic pressure.
    • PARTIAL: Noisy respiration, repeated coughing
    • TOTAL: Cessation of breathing, inability to speak
  • 2. Radiographic Scanning Test (X-RAY)
    • 3. Endoscopy (Bronchoscopy)
    • 4. Chest Physiotherapy
    • 5. Suctioning of Airway
    • 6. Tracheostomy care
    • 7. Pulmonary Function Test
    • - Incentive Spirometry
    • *Tidal Volume (500ml)
    • * Residual Volume (1200ml)
    • * Expiratory Reserve Volume (1000-1200ml)
    • * Inspiratory Reserve Volume (3000-3300ml)
  • 8. Pulse Oximetry
    • 9. Sputum Exam
    • 10. Oxygen Therapy
    • 11. Thoracentesis
    • 12. Chest Tube (T-Tube)
    • - to drain air : 2 nd or 3 rd ICS
    • - to drain blood/ fluid: 8 th or 9 th ICS
  • 13. Pulmonary Angiogram
    • TUBERCULOSIS
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    • PNEUMONIA
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    • EMPHYSEMA
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    • BRONCHITIS
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    • ASTHMA
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  • Coronary Artery Diseases (CAD)
    • 1. Atherosclerosis
    • - an abnormal accumulation of lipid, or fatty, substances and fibrous tissues in the vessel wall
    • 2. Arteriosclerosis
    • - refers to hardening of the vessel walls
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  • Risk Factors for CAD
    • Nonmodifiable Risk Factors
    • Family History of CAD
    • Increasing Age
    • Gender
    • Race
    • Modifiable Risk Factors
    • High Blood pressure
    • Cigarette smoking
    • High Blood cholesterol levels
    • Diabetes Mellitus
    • Lack of estrogen in women
    • Physical inactivity
    • Obesity
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  • Controlling Cholesterol
    • Normal Total Serum Cholesterol =
    • 150-240mg/dl
    • HDL = 29-77mg/dl
    • LDL= 60-160mg/dl
    • Triglycerides= 10-190mg/dl
  • Desired levels of LDL?
    • < 160mg/dl for patients with one or no risk factors
    • <130mg/dl for patients with two or more risk factors
    • <100mg/dl for patients with CAD
  • Angina Pectoris
    • Classifications of Angina
    Severe Minimal or Rest IV Marked Walking <2 blocks III Slight Walking >2 blocks II None Prolonged exertion I Limits to Activity Activity Evoking Class
  • Types of Angina Pectoris
    • Stable Angina
    • Unstable Angina
    • Intractable Angina/ Refractory Angina
    • Variant Angina
    • Silent Angina
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  • Myocardial Infarction
    • Cardiac Enzymes
    • CPK
    • Normal: Male: 5-35; Female: 5-25
    • Rises: 4-8 hours
    • Peak: ½ to 1 ½ days
    • Returns to Normal: 3-4 days
    • LDH
    • Normal: 100-190IU/L
    • Rises: 12-24 hours
    • Peak: 2-6 days
    • Trop-T
    • Normal: NEGATIVE
    • Rises: immediate
    • Peak: 4-24 hours
    • Returns to Normal: 1-3 weeks
    • Management:
    • M - morphine SO4 for pain
    • O - Oxygen
    • A – Aspirin/ ACE inhibitors (captopril)
    • N – Nitroglycerin
    • S – streptokinase ( thrombolytics )
    • – should be given in 6 hrs but better if in 3 hrs
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  • Congestive Heart Failure
    • Classifications:
    • CLASSIFICATION I
    • Ordinary physical activity does not cause fatigue, dyspnea, palpitations or chestpain
    • ASYMPTOMATIC
    • PROGNOSIS: Good
    • CLASSIFICATION II
    • Slight limitations on ADL’s
    • Patient reports no symptoms at rest but increased physical activity will cause symptoms
    • PROGNOSIS: Good
    • CLASSIFICATION III
    • Marked limitation on ADL
    • Patient feels comfortable at rest but less than ordinary activity will cause symptoms
    • PROGNOSIS: Fair
    • CLASSIFICATION IV
    • Symptoms of Cardiac insufficiency at rest
    • PROGNOSIS: Poor
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