0xygen insuffficiency

1,751 views

Published on

Published in: Health & Medicine, Business
0 Comments
7 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
1,751
On SlideShare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
160
Comments
0
Likes
7
Embeds 0
No embeds

No notes for slide

0xygen insuffficiency

  1. 1. SEMINAR ON OXYGEN INSUFFICIENCY
  2. 2. Oxygen is essential to life. All cells in the body require it, some being more sensitive than others. A person whose oxygen needs are meet adequately is not aware of the process of respiration.
  3. 3. The word oxygen comes from the Greek word meaning “acid former “because most mineral acids and carboxylic acids contains oxygen. Oxygenation means the delivery of oxygen to the body’s tissues and cells. It’s necessary to maintain health and life. The term oxygen was first coined by Antoine Lavoisier
  4. 4. THE ONE WHO COINED THE TERM OXYGEN
  5. 5. ANCIENT HINDU CONCEPT OF OXYGEN The presence of lungs had been recognized in ancient Hindu medicine. Both Charaka and Susrata the two famous physicians/ surgeons of the vedic period (500)BC,RECOGNIZED A ‘PRANA VAYU’, I.E LIFE AIR. Charaka mentions the head , the chest, the ears, the tongue, the mouth and the nose as the seat of ‘prana vayu’.Susrata (1000)BC spoke of ‘ prana vayu’ as flowing in the mouth.
  6. 6. CHARAKA SUSRATA
  7. 7. ANCIENT GREEK CONCEPT  In the 4th century BC,ARISTOTLE identified few essential elements – earth ,air, fire and water. The need for air remained well organized ,although its role was not identifiable.
  8. 8. MODERN HISTORY OF OXYGEN  :Paracelsus, a Swiss scientist had suggested in 1541 that air contained a life sustaining substance.  Priestley called oxygen as the deep dephlogisticated air  Thomas beddoes used oxygen for the first time in early 1800 for treatment of medical disorders.
  9. 9. MODERN HISTORY OF OXYGEN PARACELSUS PRIESTLY
  10. 10. THE MAIN ORGANS INVOLVED IN THE PROCESS OF OXYGENATION ARE HEART & LUNGS. RESPIRATORY SYSTEM CAN BE DIVIDED INTO TWO PARTS UPPER RESPIRATORY TRACT LOWER RESPIRATORY TRACT
  11. 11. UPPER RESPIRATORY TRACT
  12. 12. UPPER RESPIRATORY TRACT
  13. 13. ADENOID TONSILS
  14. 14.  Larynx: these voice organ that connects the pharynx and trachea .  the major function of the larynx is the vocalization.  protects the lower respiratory system from foreign substance and facilitates coughing  It consist of the following epiglottis, glottis, cricoids cartilage arytenoid cartilage and vocal cords.
  15. 15.  Glottis: The opening between the vocal cords in the larynx.  Cricoid cartilage : The only complete cartilaginous ring in the larynx. (located below the larynx)  Arytenoid cartilage: These are used in the vocal cord movements with the thyroid cartilage.  Vocal cords: It produces sounds which are located in the lumen of the larynx  Trachea: These are called the wind pipe which is composed of the C shaped rings made of cartilages running down at regular intervals. it serves as a passage between larynx and bronchi.
  16. 16. CARTILAGES
  17. 17. LOWER RESPIRATORY TRACT
  18. 18. LOWER RESPIRATORY TRACT These are paired structures enclosed inside the thoracic cage which is a air tight chamber with distensible walls.  When the capacity of the chest is increased air enters through the trachea (inspiration) because of the lower pressure within and it inflates the lung.  When the chest wall and the diaphragm return to their respiration (expiration) the lungs recoil and force air out.
  19. 19. PHYSIOLOGY OF RESPIRATION Air enters through nose, where it is warmed humidified and filtered Inspired air passes from the nose through pharynx After this air moves to trachea passing through larynx Trachea branches into two bronchi Through bronchi air enters into the lungs and moves through primary bronchi and smaller bronchi
  20. 20. Ending with the terminal bronchioles and then alveoli
  21. 21. Respiratory gas exchange  Respiratory gases are exchanged in the alveoli and the capillaries of the body tissues.  Oxygen is transferred from the lungs to the blood and carbondioxide is transferred from the blood to the alveoli.
  22. 22. At the tissue level, oxygen is transferred from the blood to tissues, and carbon dioxide is transferred from tissues to the blood to return to alveoli and be exhaled.
  23. 23. GAS EXCHANGE
  24. 24. DIFFUSION  Movement of gases from higher concentration to the area of lower concentration.  Alveoli capillary layer enhances the diffusion to take place during the ventilation without any difficult.
  25. 25. OXYGEN TRANSPORT AND DELIVERY Oxygen needs to be transported from the lungs to the tissues and carbon dioxide must be transported from the tissue to the lungs. Normally most of the oxygen combines mostly with the hemoglobin in the red blood cells and its carried to tissues as oxyhemoglobin
  26. 26. PULMONARY PERFUSION  Actual blood flow through the pulmonary circulation.
  27. 27. PULMONARY CIRCULATION
  28. 28. VENTILATION  The passage of oxygen from the atmosphere to the Alveoli and the passage of carbon dioxide from the alveoli to the air require an uninterrupted air way.  Anything that interferes with the patency of any part of the respiration tract can interfere with the efficiency of respiration.  Normally the cough is the mechanism by which the respiratory tract is cleared off the foreign materials. Obstruction in the trachea, pharynx, larynx and bronchi can stimulate the cough reflex.
  29. 29. VENTILATION CONT…. Some patients have difficulty in clearing the mucous from the bronchial tree, perhaps because it is painful to cough because of lack of strength or because of unconsciousness At any rate, fluids can accumulate and require nursing intervention for their removal. Continual bed rest and maintaining a prone can contribute to this difficulty by limiting chest expansion and alveolar ventilation
  30. 30. The pumping action of the heart is essential to maintaining oxygen deliver The four chambers of heart fill during diastole and empty during systole. The myocardial fibers have contractile properties that enable them to stretch during filling. In a healthy heart this stretch is proportionally related to the strength of contraction. In the diseased heart, starling's law does not apply because the stretch of the myocardium is beyond the heart’s physiological limits.
  31. 31. .
  32. 32. MYOCARDIAL BLOOD FLOW  To maintain adequate blood flow to the pulmonary and systemic circulation myocardial blood flow must supply sufficient oxygen and nutrients to the myocardium itself.  Blood flow through the heart is unidirectional.  There are four heart valves that ensure this forward blood flow
  33. 33. VENTRICULAR DIASTOLE ATRIOVENTRICULAR VALVES (MITRAL AND TRICUSPID ) OPEN BLOOD FLOW FROM HIGHER PRESSURE ATRIA INTO THE RELAXED VENTRICLES IT REPRESENTS S1 OR THE FIRST HEART SOUND AFTER VENTRICULAR FILLING THE SYSTOLIC PHASE BEGINS
  34. 34. BLOOD FLOWS FROM VENTRICLE INTO THE AORTA & PULMONARY ARTERY CLOSURE OF PULMONIC &AORTIC VALVES REPRESENTS S2 OR THE SECOND HEART SOUND
  35. 35. CORONARY ARTERY CIRCULATION  Blood in the atria and ventricles does not supply oxygen and nutrients to the myocardium itself.  The coronary circulation is the branch of the systemic circulation that supplies the myocardium with oxygen and nutrients and removes waste.  the coronary arteries fill during ventricular diastole . the right and the left coronary arteries arise from the aorta just above and behind the aortic valve through openings called the coronary ostia.
  36. 36. CONDUCTION SYSTEM  The rhythmic relaxation and contraction of the atria and ventricles depend on continuous, organized transmission of electrical impulses. these impulses are generated and transmitted by way of the cardiac conduction system.  The conduction system originates with the sinoatrial node(SA),the “pacemaker” of the heart
  37. 37. CONDUCTION SYSTEM CONTD… …. Impulses are initiated at the SA node at an intrinsic rate of 60 to 100 beats per minute. The resting adult rate is approximately 75 beats per minute. An electrocardiogram (ECG) reflects the electrical activity of the conduction system.
  38. 38. PRINCIPLES RELEVANT TO OXYGEN 1. 2. 3. 4. 5. 6. Oxygen is essential to life. A person can survive only a few minutes without oxygen. An insufficient supply of oxygen impairs functioning of al body systems. Irreparable brain damage may result from prolonged periods of inadequate oxygen. Cells of the cerebral cortex begin to die as soon as they are deprived of oxygen. Air at sea level containing approximately 20% of oxygen and 0.04% carbon dioxide is sufficient to meet man’s oxygen needs.
  39. 39. 7.Carbon di oxide concentrations between 3 and 10 % increase the rate and depth of respirations. 8.The body’s ability to meet its oxygen needs depends on the adequacy of functioning of the cardiovascular and the respiratory systems. 9.A patent airway is essential to normal respiratory functioning. 10.The respiratory tract is lined with mucus secreting epithelium. 11.Coughing, swallowing and sneezing are mechanisms by which the body attempts to rid itself of foreign materials in the respiratory tract. 12.Difficulty in breathing provokes anxiety.
  40. 40. CAUSES OF OXYGEN INSUFFICIENCY & FACTORS AFFECTING  AT BIRTH  The fluid filled lungs drain first
  41. 41. PHYSIOLOGICAL FACTORS VARIOUS DISEASES AFFECT OXYGENATION INCLUDING RESPIRATORY DISEASE LIKE COPD,PNEUMONIA. CARDIOVASCULAR DISEASE LIKE CONGENITAL CARDIAC ANOMALIES
  42. 42. •Change in ageing affects respiratory system. •Infection, physical or emotional stress
  43. 43. DECREASED OXYGEN CARRYING CAPACITY Anemia and inhalation of toxic substances decreases the oxygen carrying capacity of blood. clients with anemia have complaints of fatigue,decreased activity tolerance and increased breathlessness and pallor and an increased heart rate. .
  44. 44. BEHAVIOURAL FACTORS Whenever stress is there both psychological & physiological changes can affect the respiratory system. Person may experience light headedness,num bness,tingling of the fingers, toes, and around the mouth.
  45. 45. LIFESTYLE FACTORS Physical activity or exercise increase the rate and depth of respiration . Smoking affects the oxygenation status.
  46. 46. ENVIRONMENTAL FACTORS altitude heat, cold and air pollution affect oxygenation. The higher the altitude lowers is the pCo2 a patient breaths. Air pollution causes head ache, chocking and coughing even in healthy people.
  47. 47. MEDICATION Certain medication including sedative , hypnotics(eg.diazepam) and narcotics including morphine can cause respiratory distresses
  48. 48. NURSING MANAGEMENT
  49. 49. ASSESSMENT
  50. 50. PHYSICAL EXAMINATION
  51. 51. Inspection  using inspection techniques the nurse performs the head to     toe observation of the client for the skin and the mucus membrane , colour , general appearance, level of consciousness, breathing pattern and chest wall movement. Inspection includes observation of the nails for clubbing the chest wall movement for retraction paradoxical breathing , asynchronous breathing and the clients breathing pattern clients effort during respiration, when especially distress or flaring of noses, position distress
  52. 52. PALPATION  palpation of the chest provides assessment data's in several areas  allows the nurse to feel for abnormal masses or any lumps in the axilla and the breast tissue.  Palpation of the extremities provides the data about the peripheral circulation, the presence and the quality of the peripheral pulses, skin temp, capillary refill and colour.  Palpation should also include the feet and the legs to assess the presence or absence of peripheral edema palpation of the pulses in the neck and extremities is performed to assess the arterial blood flow
  53. 53. PERCUSSION  It allows the nurse to detect the presence of abnormal fluid or air in the lungs.  It is also used to determine the diaphragmatic excursion it may reveal hyper resonance , dull percussion tone or changes in the density of the lungs and the surrounding tissues
  54. 54. AUSCULTATION  It enables the nurse to identify the normal and abnormal fluid in heart and lung sounds.  Auscultation of the cardio vascular system should include the assessment of normal s1 and s2 sounds, the presence of abnormal s3 and s4 sounds (gallops), and murmurs or rubs.
  55. 55.  Auscultation of lung sounds involves listening for the movement of air throughout all lung fields ; anterior , posterior and lateral.  Adventitious breath sound appears when there is a collapse of the lung segment, fluid in a lung segment or in case of narrowing or any obstruction of the airway.  Auscultation also evaluates the clients response intervention for improving their respiratory status.
  56. 56.     ; ABG helps in the measurement of blood for patients arterial oxygen ; sputum is obtained for analysis to identify the pathogenic organism and to determine malignancy or hypersensitivity which in turn is helpful to determine the causes for oxygen insufficiency. The sputum may also be collected through endotracheal aspiration, bronchoscopal aspiration etc… the specimen are usually collected in the early morning en and carbon dioxide tensions
  57. 57.  To assess the fluids , tumor, foreign bodies and other pathological conditions.  It’s the direct inspection and examination of the larynx ,     trachea and bronchi through a fibrotic flexible bronchoscope. The therapeutic bronchoscope are used to Remove foreign from trachea bronchial tree Remove secretions obstructing the tracheal esophageal tree To destroy and excise tumor .
  58. 58.  a sample of the pleural fluid is obtained by the thoracentesis for both diagnostic and therapeutic purposes.  By, thoracentesis pleural fluid is studied for Grams stain culture and sensitivity, acid fast staining and culture, differential cell count, cytology, pH, specific gravity, total protein .  pulmonary angiography is most commonly used to investigate thrombotic disease of lungs, such as pulmonary emboli and abnormalities of vascular trees.  It involves a rapid injection of a radio opaque agent into the vasculature of the lungs for radiographic study of the pulmonary vessels through femoral vein, or branches of pulmonary artery and images are taken and analyzed
  59. 59.       ; these are used to assess the respiratory functions and to determine the extent of dysfunction. These are used to find the; volume of the air in the lungs speed and ease of air flow via airways strength of the respiratory muscle The PFT is performed by the technician using a spirometer that has a volume collecting device attached to a recorder that demonstrates the volume and time simultaneously.
  60. 60. NURSING MANAGEMENT HEALTH PROMOTION MOBILIZATION OF THE PULMONARY SECRETIONS NEBULIZATION CHEST PHYSIOTHERAPY HUMIDIFICATION POSTURAL DRINAGE
  61. 61.  Hyperventilation- it occurs when rapid and deep breathing results in excess of CO2 (hypocapnia). Causes of hyperventilation include anxiety , infection, shock, hypoxia, drugs (aspirin,amphetamines), diabetes mellitus, or acid base imbalance. A person who is hyperventilating may complain of feeling of lightheaded and tingly.  Hypoventilation- it occurs when the rate and depth of respiration are decreased and CO2 is retained or alveolar ventilation is compromised. Hypoventilation may be related to chronic obstructive pulmonary disease(COPD), general anesthesia, or other conditions that results in decreased respiration
  62. 62. POSTURAL DRINAGE
  63. 63.  CLINICAL PRESCRIPTION OF OXYGEN Oxygen like a drug is used for most of the indications. It is generally used as an additional supplement to the other forms of drug therapy. In many other disease where oxygen deficiency is a major abnormality, oxygen constitutes the mainstay of therapy. Oxygen prescription or delivery was associated with significantly minor errors than those seen with the antibiotics. It is important to consider oxygen as a drug to get the maximum benefit. It is important to have oxygen therapy protocols and education programs especially for the nursing staff.
  64. 64. METHODS OF OXYGEN DELIVERY  Nasal cannula:  It is the most common inexpensive method used to administer oxygen to client.it delivers a relatively low concentration of oxygen (24% to 45%)at flow rate of 2-6 l/mt.  But this is not in use nowadays. In these days nasal prongs are used.  nasal cannula
  65. 65. :  The simple face mask delivers oxygen concentrations from 40% to 60%at flow rate of 5 to 8L/min respectively.  The face mask is sub divided into two types namely REBREATHER MASK NON REBREATHER MASK
  66. 66.  Rebreather mask  In rebreather mask the oxygen the oxygen reservoir bag that is attached allows the client to rebreath the exhaled air in conjunction with oxygen. Thus it increases FiO2(fractional oxygen of inspired air) by recycling expired oxygen. Non rebreather mask  It delivers the highest oxygen concentration possible 95% to 100% by means other than intubations or mechanical, at liter flow of 10 to 15 L/min.
  67. 67. VENTURI MASK  It delivers oxygen concentration varying from 24% to 40% or 50%at flow rate of 4 to 5 lit /min. The venturi mask has wide tubing and colour coded jet adaptors that correspond to a precise oxygen concentration and flow rate
  68. 68. Trans tracheal delivery This is used for oxygen dependent clients. Oxygen is delivered through a small, narrow plastic cannula surgically inserted through the skin directly into trachea.a collar around the neck holds the catheter in place. Advantage-with the method client requires less oxygen (0.5 to 2 L/ min) as 5ml of saline twice or thrice a day.
  69. 69. face tents: it can be used for clients who cannot tolerate masks. these provide 30% to 50% oxygen concentration at a flow rate of 4 to 8 L/ min. nurse should frequently of flow is delivered directly to lungs. The nurse keeps the catheter patent by injecting 1.5 ml of normal saline with it. Moving a cleaning rod in and out and then reinjecting 5ml of saline twice or thrice a day.
  70. 70. VETILATORS  In medicine, mechanical ventilation is a method to mechanically assist or replace spontaneous breathing. This may involve a machine called a ventilator or the breathing may be assisted by a physician, respiratory therapist or other suitable person compressing a bag or set of bellows. There are two main divisions of mechanical ventilation: invasive ventilation and non-invasive ventilation.There are two main modes of mechanical ventilation within the two divisions: positive pressure ventilation, where air (or another gas mix) is pushed into the trachea, and negative pressure ventilation, where air is essentially sucked into the lungs
  71. 71.  OXYGEN CONCENTRTION The exact oxygen concentration being delivered is usually difficult to know for this reason it can best assessed by the flow rate (FiO2) and by the type of mask being used to the patient. The fiO2 required to be delivered based upon the acuteness of illness and the severity of the hypoxemia. One must avoid a high fiO2 for prolonged period to avoid toxicity.  SOURCE OF OXYGEN Compressed gas cylinders continues to be used in hospitals in our country. Piped system with wall outlets from the central sourceis made available in large hospitals. A knowledge about the cylinders, regulators, flow meters and the pressure guage is much important for the nurses for an efficient role
  72. 72. Application and duration  It can be used as a short term measure, for example during an operation or critical illness (often in the setting of an intensive care unit). It may be used at home or in a nursing or rehabilitation institution if patients have chronic illnesses that require long-term ventilatory assistance. Owing[clarification needed] to the anatomy of the human pharynx, larynx, andesophagus and the circumstances for which ventilation is required then additional measures are often required to secure the airway during positive pressure ventilation to allow unimpeded passage of air into the trachea and avoid air passing into the esophagus and stomach. Commonly this is by insertion of a tube into the trachea which provides a clear route for the air. This can be either an endotracheal tube, inserted through the natural openings of mouth or nose or a tracheostomy inserted through an artificial opening in the neck. In other circumstances simple airway maneuvres, an oropharyngeal airway or laryngeal mask airway may be employed. If the patient is able to protect their own airway and non-invasive ventilation or negative-pressure ventilation is used then a airway adjunct may not be needed
  73. 73. Types of ventilators Negative pressure ventilation  This exerts the negative pressure on the external chest; which in turn decreases the intra thoracic pressure during inspiration and allows the air to flow into the lungs., thereby filling its volume. These are mainly used in clients with neuro muscular conditions  Advantage-easy to use and doesn’t require intubation  Disadvantage- unsuitable for patients who require frequent ventilation changes
  74. 74.  METHODS OF OXYGEN DELIVERY Nasal cannula: It is the most common inexpensive method used to administer oxygen to client. it delivers a relatively low concentration of oxygen (24% to 45%)at flow rate of 26 l/mt. But this is not in use nowadays. In these days nasal prongs are used.
  75. 75. Positive pressure ventilation These inflates the lungs by exerting pressure on the airways, forcing the alveoli to expand during inspiration. Expiration occurs passively which further includes cycled ventilatiors, pressure cycled ventilators and volume cycled ventilators
  76. 76. Modes in ventilators  CMV- continous mandatory volume without allowances for spontaneous breathing  ACV- assist control ventilation; where assisted breaths are followed by controlled breaths  IMV- intermittent mandatory ventilation; are those which mixes controlled breath and spontaneous breaths.  PSV- pressure support ventilation; this is where the patient has the complete control over all the aspects of his/her breaths except the pressure limits  HIGH FREQENCY VENTILATION- where mean airway pressure is maintained constantly and hundreds of tiny breaths are delivered /min.  CPAP- continous positive airway pressure; spontaneous ventilation with continous positive airway pressure . this ventilator is adjunct and is used only with spontaneous ventilation. i.e the patient breaths spontaneously through the ventilator at an elevated baseline pressure throughout the breathing cycle.  SIMV-synchorinized intermittent mandatory ventilation; a present a minimum number of breaths are synchronously delivered to the patient but the patient may also take spontaneous breaths of various volume. Note how the inspiratory and expiratory pressure differ between spontaneous and ventilator breaths.  PEEP-positive and expiratory pressure; airway pressure with varying levels of positive and expiratory pressure. Note that at he end of the expiration, the airway is not allowed to return to zero.
  77. 77.  face mask: The simple face mask delivers oxygen concentrations from 40% to 60%at flow rate of 5 to 8L/min respectively. The face mask is sub divided into two types namely: Rebreather mask: In rebreather mask the oxygen the oxygen reservoir bag that is attached allows the client to rebreath the exhaled air in conjunction with oxygen.thus it increases FiO2(fractional oxygen of inspired air) by recycling expired oxygen. Non breather mask: It delivers the highest oxygen concentration possible 95% to 100% by means other than intubations or mechanical, at liter flow of 10 to 15 L/min.
  78. 78. ADVANCE OXYGEN THERAPY
  79. 79. ADVANCE OXYGEN THERAPY
  80. 80. ADVANCE OXYGEN THERAPY
  81. 81.  .Venturi mask: It delivers oxygen concentration varying from 24% to 40% or 50%at flow rate of 4 to 5 lit /min. the venturi mask has wide tubing and colour coded jet adaptors that correspond to a precise oxygen concentration and flow rate.

×