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OXYGENATIONNelia B. Perez RN MSNPCU – Graduate School of Nursing
RespiratoryI.     Review of Respiratory SystemII.    Common ManifestationsIII.   Diagnostic Tests/ ProceduresIV.    Common...
Restrictive:  Atelectasis  Tuberculosis  PneumoniaCOPD:  Asthma  Emphysema  Chronic Bronchitis
Pulmonary Vascular Disease: Cor Pulmonale Pulmonary Embolism
HematopoieticI.    Review of the Hematopoietic SystemII.   Disturbances      a. Anemia      b. Polycythemia Vera      c. B...
CardiovascularI.     Review of the Cardiovascular SystemII.    Common Diagnostic Tests/ ProceduresIII.   Disturbances     ...
- Angina Pectoris         - Myocardial InfarctionIV. Congestive Heart Failure         - Right Sided Heart Failure         ...
RESPIRATORY SYSTEM
Measures That Promotes AdequateRespiratory Functions:1.   Adequate OXYGEN supply from the     environment.2.   Deep breath...
7. Chest Physiotherapy (CPT)     * Percussion     * Vibration     * Postural Drainage8. Bronchial Hygiene Measures     * S...
Things to Remember:SUCTIONINGAssess: AUDIBLE SECRETIONS during          respirationPosition:  Conscious: SEMI-FOWLER’s POS...
Pressure:  Wall Unit:     Adult:   100-120mmHg     Child:   95-110mmHg     Infant: 50-95mmHg  Portable Unit:     Adult:   ...
Appropriate Size of Catheter:  Adult: Fr. 12-18  Child: Fr. 8-10  Infant: Fr. 5-8Lubricate Catheter:  Nasopharyngeal: wate...
•   Apply suction during withdrawal of the    suction catheter (NEVER during insertion)•   Apply suction for 5 to 10 secon...
9. Incentive Spirometry      - done to enhance deep inspiration
10. Administration of supplemental oxygenSigns of Hypoxemia   1. Increased pulse rate   2. Rapid, shallow respiration   3....
OXYGEN SYSTEMS:1.   Low-flow Administration Devices     a. Nasal Cannula (24-45% at 2-6LPM)     b. Simple Face Mask (40-60...
2. High flow Administration Devices   a. Venturi Mask   b. Oxygen Hood   c. Incubator / Isolette
Common Manifestations:1. Cough      - the cardinal symptom of respiratory    problem2. Dyspnea      - refers to difficulty...
3. Clinical Signs of HypoxiaEARLY SIGNS              LATE SIGNS    Tachycardia               BradycardiaKussmaul’s Respira...
4. Clubbing of Fingers
5. Hemoptysis6. Chestpain7. Headache8. Easy fatigability9. Cyanosis10. Skin flushing11. Seizures12. Altered level of consc...
Common Pharmacologic Agents1.   Adrenergic (Sympathomimetic) Agents2.   Bronchodilators3.   Antibacterial4.   Corticostero...
Common Procedures/ Tests1. Abdominal Thrust (Heimlich Maneuver)    - a short, abrupt pressure against the    abdomen, two ...
2. Radiographic Scanning Test (X-RAY)
3. Endoscopy (Bronchoscopy)4. Chest Physiotherapy5. Suctioning of Airway6. Tracheostomy care7. Pulmonary Function Test    ...
8. Pulse Oximetry
9. Sputum Exam10. Oxygen Therapy11. Thoracentesis12. Chest Tube (T-Tube)   - to drain air : 2nd or 3rd ICS   - to drain bl...
13. Pulmonary Angiogram
TUBERCULOSIS
PNEUMONIA
EMPHYSEMA
BRONCHITIS
ASTHMA
Coronary Artery Diseases (CAD)1. Atherosclerosis      - an abnormal accumulation of lipid, or    fatty, substances and fib...
Risk Factors for CADNonmodifiable 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 estr...
Controlling CholesterolNormal Total Serum Cholesterol =     150-240mg/dlHDL = 29-77mg/dlLDL= 60-160mg/dlTriglycerides= 10-...
Desired levels of LDL?< 160mg/dl for patients with one or no risk     factors<130mg/dl for patients with two or more risk ...
Angina PectorisClassifications of AnginaClass     Activity Evoking    Limits to Activity  I      Prolonged exertion       ...
Types of Angina Pectoris1.   Stable Angina2.   Unstable Angina3.   Intractable Angina/ Refractory Angina4.   Variant Angin...
Myocardial InfarctionCardiac EnzymesCPK  Normal: Male: 5-35; Female: 5-25  Rises: 4-8 hours  Peak: ½ to 1 ½ days  Returns ...
LDH  Normal: 100-190IU/L  Rises: 12-24 hours  Peak: 2-6 daysTrop-T  Normal: NEGATIVE  Rises: immediate  Peak: 4-24 hours  ...
Management:M - morphine SO4 for painO - OxygenA – Aspirin/ ACE inhibitors (captopril)N – NitroglycerinS – streptokinase ( ...
Congestive Heart FailureClassifications:CLASSIFICATION I  Ordinary physical activity does not cause  fatigue, dyspnea, pal...
CLASSIFICATION II  Slight limitations on ADL’s  Patient reports no symptoms at rest but  increased physical activity will ...
CLASSIFICATION III  Marked limitation on ADL  Patient feels comfortable at rest but less  than ordinary activity will caus...
CLASSIFICATION IV  Symptoms of Cardiac insufficiency at restPROGNOSIS: Poor
Oxygenation_MAN Lecture
Oxygenation_MAN Lecture
Oxygenation_MAN Lecture
Oxygenation_MAN Lecture
Oxygenation_MAN Lecture
Oxygenation_MAN Lecture
Oxygenation_MAN Lecture
Oxygenation_MAN Lecture
Oxygenation_MAN Lecture
Oxygenation_MAN Lecture
Oxygenation_MAN Lecture
Oxygenation_MAN Lecture
Oxygenation_MAN Lecture
Oxygenation_MAN Lecture
Oxygenation_MAN Lecture
Oxygenation_MAN Lecture
Oxygenation_MAN Lecture
Oxygenation_MAN Lecture
Oxygenation_MAN Lecture
Oxygenation_MAN Lecture
Oxygenation_MAN Lecture
Oxygenation_MAN Lecture
Oxygenation_MAN Lecture
Oxygenation_MAN Lecture
Oxygenation_MAN Lecture
Oxygenation_MAN Lecture
Oxygenation_MAN Lecture
Oxygenation_MAN Lecture
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Transcript of "Oxygenation_MAN Lecture"

  1. 1. OXYGENATIONNelia B. Perez RN MSNPCU – Graduate School of Nursing
  2. 2. RespiratoryI. Review of Respiratory SystemII. Common ManifestationsIII. Diagnostic Tests/ ProceduresIV. Common Pharmacologic AgentsV. Disturbances a. Restrictive Lung Disease b. COPD/ CAL c. Pulmonary Vascular Disease
  3. 3. Restrictive: Atelectasis Tuberculosis PneumoniaCOPD: Asthma Emphysema Chronic Bronchitis
  4. 4. Pulmonary Vascular Disease: Cor Pulmonale Pulmonary Embolism
  5. 5. HematopoieticI. Review of the Hematopoietic SystemII. Disturbances a. Anemia b. Polycythemia Vera c. Bleeding Tendencies - DIC - Hemophilia - Thrombocytopenia
  6. 6. CardiovascularI. Review of the Cardiovascular SystemII. Common Diagnostic Tests/ ProceduresIII. Disturbances a. Infection - Rheumatic Heart Disease b. Coronary Artery Disease - Atherosclerosis - Arteriosclerosis
  7. 7. - Angina Pectoris - Myocardial InfarctionIV. Congestive Heart Failure - Right Sided Heart Failure - Left Sided Heart FailureV. Congenital Heart Defects - Cyanotic Heart Defects - Acyanotic Heart Defects
  8. 8. RESPIRATORY SYSTEM
  9. 9. Measures That Promotes AdequateRespiratory Functions:1. Adequate OXYGEN supply from the environment.2. Deep breathing and coughing exercises.3. Proper positioning4. Patent airway (FEMS)5. Adequate hydration6. Avoid pollutants, alcohol and smoking.
  10. 10. 7. Chest Physiotherapy (CPT) * Percussion * Vibration * Postural Drainage8. Bronchial Hygiene Measures * Steam Inhalation * Suctioning - Oropharyngeal - Nasopharyngeal
  11. 11. Things to Remember:SUCTIONINGAssess: AUDIBLE SECRETIONS during respirationPosition: Conscious: SEMI-FOWLER’s POSITION Unconscious: LATERAL POSITION
  12. 12. Pressure: Wall Unit: Adult: 100-120mmHg Child: 95-110mmHg Infant: 50-95mmHg Portable Unit: Adult: 10-15mmHg Child: 5-10mmHg Infant: 2-5mmHg
  13. 13. Appropriate Size of Catheter: Adult: Fr. 12-18 Child: Fr. 8-10 Infant: Fr. 5-8Lubricate Catheter: Nasopharyngeal: water-soluble lubricant Oropharyngeal: Sterile water or NSS
  14. 14. • 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
  15. 15. 9. Incentive Spirometry - done to enhance deep inspiration
  16. 16. 10. Administration of supplemental oxygenSigns of Hypoxemia 1. Increased pulse rate 2. Rapid, shallow respiration 3. Increased restlessness 4. Flaring of nares 5. Substernal or intercostal retractions 6. Cyanosis
  17. 17. OXYGEN SYSTEMS:1. 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
  18. 18. 2. High flow Administration Devices a. Venturi Mask b. Oxygen Hood c. Incubator / Isolette
  19. 19. Common Manifestations:1. Cough - the cardinal symptom of respiratory problem2. Dyspnea - refers to difficulty on breathing * EXERTIONAL DYSPNEA * PAROXYSMAL NOCTURNAL * ORTHOPNEA
  20. 20. 3. Clinical Signs of HypoxiaEARLY SIGNS LATE SIGNS Tachycardia BradycardiaKussmaul’s Respiration Dyspnea N/V Decreased Systolic BP Headache Cough Irritability Increased RBC Memory loss Increased Hgb Dizziness Clubbing of fingers
  21. 21. 4. Clubbing of Fingers
  22. 22. 5. Hemoptysis6. Chestpain7. Headache8. Easy fatigability9. Cyanosis10. Skin flushing11. Seizures12. Altered level of consciousness
  23. 23. Common Pharmacologic Agents1. Adrenergic (Sympathomimetic) Agents2. Bronchodilators3. Antibacterial4. Corticosteroids5. Antihistamine6. Mucolytic, Antitussive and Expectorant
  24. 24. Common Procedures/ Tests1. 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 coughingTOTAL: Cessation of breathing, inability to speak
  25. 25. 2. Radiographic Scanning Test (X-RAY)
  26. 26. 3. Endoscopy (Bronchoscopy)4. Chest Physiotherapy5. Suctioning of Airway6. Tracheostomy care7. Pulmonary Function Test - Incentive Spirometry*Tidal Volume (500ml)* Residual Volume (1200ml)* Expiratory Reserve Volume (1000-1200ml)* Inspiratory Reserve Volume (3000- 3300ml)
  27. 27. 8. Pulse Oximetry
  28. 28. 9. Sputum Exam10. Oxygen Therapy11. Thoracentesis12. Chest Tube (T-Tube) - to drain air : 2nd or 3rd ICS - to drain blood/ fluid: 8th or 9th ICS
  29. 29. 13. Pulmonary Angiogram
  30. 30. TUBERCULOSIS
  31. 31. PNEUMONIA
  32. 32. EMPHYSEMA
  33. 33. BRONCHITIS
  34. 34. ASTHMA
  35. 35. Coronary Artery Diseases (CAD)1. Atherosclerosis - an abnormal accumulation of lipid, or fatty, substances and fibrous tissues in the vessel wall2. Arteriosclerosis - refers to hardening of the vessel walls
  36. 36. Risk Factors for CADNonmodifiable Risk Factors Family History of CAD Increasing Age Gender Race
  37. 37. Modifiable Risk Factors High Blood pressure Cigarette smoking High Blood cholesterol levels Diabetes Mellitus Lack of estrogen in women Physical inactivity Obesity
  38. 38. Controlling CholesterolNormal Total Serum Cholesterol = 150-240mg/dlHDL = 29-77mg/dlLDL= 60-160mg/dlTriglycerides= 10-190mg/dl
  39. 39. 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
  40. 40. Angina PectorisClassifications of AnginaClass Activity Evoking Limits to Activity I Prolonged exertion None II Walking >2 blocks Slight III Walking <2 blocks Marked IV Minimal or Rest Severe
  41. 41. Types of Angina Pectoris1. Stable Angina2. Unstable Angina3. Intractable Angina/ Refractory Angina4. Variant Angina5. Silent Angina
  42. 42. Myocardial InfarctionCardiac EnzymesCPK Normal: Male: 5-35; Female: 5-25 Rises: 4-8 hours Peak: ½ to 1 ½ days Returns to Normal: 3-4 days
  43. 43. LDH Normal: 100-190IU/L Rises: 12-24 hours Peak: 2-6 daysTrop-T Normal: NEGATIVE Rises: immediate Peak: 4-24 hours Returns to Normal: 1-3 weeks
  44. 44. Management:M - morphine SO4 for painO - OxygenA – Aspirin/ ACE inhibitors (captopril)N – NitroglycerinS – streptokinase ( thrombolytics ) – should be given in 6 hrs but better if in 3 hrs
  45. 45. Congestive Heart FailureClassifications:CLASSIFICATION I Ordinary physical activity does not cause fatigue, dyspnea, palpitations or chestpain ASYMPTOMATICPROGNOSIS: Good
  46. 46. CLASSIFICATION II Slight limitations on ADL’s Patient reports no symptoms at rest but increased physical activity will cause symptomsPROGNOSIS: Good
  47. 47. CLASSIFICATION III Marked limitation on ADL Patient feels comfortable at rest but less than ordinary activity will cause symptomsPROGNOSIS: Fair
  48. 48. CLASSIFICATION IV Symptoms of Cardiac insufficiency at restPROGNOSIS: Poor
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