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oxgenation.pptx
- 2. 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 clientâs oxygenation status. ⢠Explain the major purpose of the tests and the related nursing responsibilities.
- 3. Staggering statistics ⢠Pulmonary Diseases ⢠Lung CA - ⢠TB â ⢠Pneumonia â ⢠Chronic Airflow Limitation (formerly COPD) â
- 4. Staggering statistics â˘Cardiovascular Diseases â # 1 killer ⢠HTN â 65 million ⢠Artheriosclerosis ⢠Arteriosclerosis ⢠Stroke ⢠Hypercholesterolemia ⢠107 million - a risk factor for CVD ⢠AMI â 7.5 Million per year, 460,000 die ⢠Americans paid 393.5 billion in 2005 for CVD related medical costs
- 6. Process of Breathing â˘Inspiration â˘Air flows into lungs â˘Expiration â˘Air flows out of lungs
- 7. Normal Oxygenation Process ⢠Cardiovascular:
- 8. Normal Oxygenation Process ⢠Systemic:
- 10. 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
- 11. Expiration â˘Diaphragm and intercostal muscles relax â˘Lung volume decreases â˘Intrapulmonary pressure rises â˘Air is expelled
- 12. 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 ď pulmonary blood vessels ⢠CO2 diffusion from pulmonary blood vessels ď alveoli
- 13. Adequate O2 Balance ⢠Maintenance of adequate O2 balance Gas Exchange
- 14. Oxygen Transport ⢠Transported from the lungs to the tissues ⢠97% of O2combines with RBC Hgb ď oxyhemoglobin carried to tissues ⢠Remaining O2is dissolved and transported in plasma and cells (PO2)
- 15. Normal Oxygenation Process ⢠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
- 18. Carbon Dioxide Transport ⢠Must be transported from tissues ď lungs ⢠Continually produced in the process of cell metabolism - ⢠65% â carried inside RBCs as bicarbonate (HCO3 ) ⢠30% â combines with Hgb ď carbhemoglobin ⢠5% â transported in plasma as carbonic acid (H2CO3)
- 19. Factors that Influence Respiratory Function â˘Age â˘Environment â˘Lifestyle â˘Health status â˘Medications â˘Stress
- 20. Common Manifestations of Impaired Respiratory Function â˘Hypoxia â˘Altered breathing patterns â˘Obstructed or partially obstructed airway
- 21. 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
- 22. Abnormal Respiratory Patterns â˘Tachypnea (rapid rate) â˘Bradypnea (abnormally slow rate) â˘Apnea (cessation of breathing) â˘Kussmaulâs breathing â˘Cheyne-Stokes respirations â˘Biotâs respirations
- 24. Alterations in Ease of Breathing â˘Orthopnea â˘Dyspnea
- 25. Obstructed or Partially Obstructed Airway â˘Partial obstruction â˘low-pitched snoring during inhalation â˘Complete obstruction â˘extreme inspiratory effort with no chest movement
- 26. ⢠Adequate O2 Balance Example of Obstructive Disease: Asthma
- 27. Adequate O2 Balance Example of Restrictive Disease: Hemothorax â˘
- 29. 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
- 37. Nursing Responsibilities ⢠Determine adequacy of cardiopulmonary function: ⢠Nursing assessment ⢠⢠⢠⢠HEART Respiratory assessment PMH LIFESTYLE
- 38. HEART â˘Have client describe ⢠specific location, onset and duration of the problem â˘Explore associated signs and symptoms â˘Ask - activities that worsen or ease the problem â˘Rate the severity of discomfort or incapacity â˘Talk - treatments or interventions used to alleviate the problem and their effectiveness
- 39. Heart Problems Artheroscleosis = Coronary Artery Disease (CAD)
- 40. Nursing Measures to Promote Respiratory Function â˘Ensure a patent airway â˘Positioning â˘Encourage deep breathing, coughing â˘Ensure adequate hydration
- 41. Nursing Responsibilities ⢠Physical Assessment: ⢠⢠⢠⢠⢠⢠⢠⢠Lung auscultation and breathing pattern Abdominal assessment Urine output Skin and mucous membranes Heart sounds Circulation Edema DVT
- 42. 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
- 43. Common Tests and Nursing Responsibilities â˘Measure adequacy of ventilation and gas exchange ⢠Complete Blood Count (CBC) ď phlebotomy ⢠Arterial Blood Gases (ABG)ď arterial puncture ⢠Pulmonary Function Testsď preparation by teaching
- 44. Common Tests and Nursing Responsibilities â˘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
- 45. Common Tests and Nursing Responsibilities ⢠Tests to visualize structures of respiratory system: ⢠⢠Bronchoscopy Chest radiographs
- 47. Common Tests and Nursing Responsibilities Thorancentesis
- 48. Nursing Responsibilities ⢠Medications ⢠Incentive spirometry ⢠Chest PT ⢠Postural drainage ⢠Oxygen therapy ⢠Artificial airways ⢠Airway suctioning ⢠Chest tubes
- 49. Basic Nursing Interventions ⢠Airway Maintenance: ⢠Facilitate effective coughing ⢠Suctioning airways ⢠Liquefying and mobilizing sputum
- 50. Basic Nursing Interventions ⢠Maintenance and promotion of proper lung expansion: Re-expanding collapsed lungs - Closed Chest Tube Drainage
- 51. Chest Tubes
- 52. Basic Nursing Interventions â˘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
- 53. Basic Nursing Interventions ⢠Mobilization of Pulmonary Secretions ⢠Auscultate breath sounds, monitor respiratory patterns, monitor ABGâs ⢠Position client to optimize respiration ⢠Pulmonary toileting ⢠Incentive spirometry ⢠Suctioning
- 56. Basic Nursing Interventions ⢠Mobilization of Pulmonary Secretions ⢠Encourage activity and ambulation as tolerated ⢠Encourage increased fluid intake ⢠Chest physiotherapy ⢠O2 ⢠Medications as ordered
- 57. Basic Nursing Interventions ⢠O2 Therapy: ⢠Low flow ⢠High flow ⢠Humidification ⢠Nasal cannula ⢠Simple mask ⢠Nonrebreathing mask ⢠Partial rebreathing
- 58. Basic Nursing Interventions ⢠Effective Breathing Techniques ⢠Position for maximal respiratory function ⢠Pursed lip breathing ⢠Diaphragmatic or abdominal breathing
- 59. 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
- 60. Administration of Prescribed Medications ⢠Expectorants ⢠Mucolytics ⢠Bronchodilators ⢠Cough suppressants ⢠Corticosteroids ⢠Antihistamines ⢠Antibiotics ⢠Vasoconstrictors
- 61. Basic Nursing Interventions ⢠Physical Exerciseď health teaching Activity and rest -- a priority! Activity stimulates respiratory function Rest conserves energy and reduces metabolic demand ⢠MDâs 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
- 62. Adequate O2 Balance ⢠Behaviors of Negative O2 balance ď Cardio Vascular Disease ⢠Arterial ⢠⢠Venous: Im paired tissue perfusion
- 63. Adequate O2 Balance ⢠Behaviors of Negative O2 balance ď CV ⢠Restlessness, dizziness, syncope, bradycardia, decreased urine ⢠cold and clammy skin, cyanosis, slow capillary refill ⢠Decreased cardiac output
- 64. Common Tests and Nursing Responsibilities Tesâ˘ts to determine adequacy of cardiovascular function: ⢠CBC ⢠Lipid profile ⢠Coagulation studies ⢠EKG/ECG ⢠Angiography
- 65. Basic Nursing Interventions Cardiovascular ⢠Modify risk factors ⢠Preventing vasoconstriction â˘Diet â˘Exercise â˘Co morbidities â˘Positioning â˘Cold temperatures â˘Nicotine
- 66. Basic Nursing Interventions â˘Cardiovascular - Prevent complications ⢠Promoting rest â˘Risk DVT â˘Position changes â˘Early ambulation â˘Obstruction removal â˘Bypass surgery â˘Schedule rest periods â˘Assistance with ADLâs â˘Monitor Vitals with activity â˘Place items, i.e. call light, water pitcher, strategically â˘Quiet environment, decrease stimuli
- 67. 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
- 68. Basic Nursing Interventions Cardiovascular ⢠Avoid stimulants ⢠Maintaining fluid balance â˘Avoid appetite suppressants, cold meds, coffee, tea, chocolate â˘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
- 69. Basic Nursing Interventions Cardiovascular ⢠Increase O2 supply ⢠Administer O2 ⢠Educate client NO SMOKING! ⢠Position to facilitate breathing
- 70. Administration of Prescribed Medications ⢠Anti coagulants ⢠Vasodilator Medications ⢠Inotropic Medications ⢠Anti Dysrhythmics ⢠Anti hypertensives
- 71. 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
- 72. Basic Nursing Interventions â˘Weight control ⢠Evaluate the clientâs physiological status in relation to condition ⢠More than body requirements ⢠Less than body requirements