Oxygenation

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Oxygenation

  1. 1. Chapter 39 Oxygenation
  2. 2. Cardiovascular Physiology <ul><li>Structure and function </li></ul><ul><ul><li>Myocardial pump </li></ul></ul><ul><ul><li>Myocardial blood flow </li></ul></ul><ul><ul><li>Coronary artery circulation </li></ul></ul><ul><ul><li>Systemic circulation </li></ul></ul><ul><ul><li>Blood flow regulation: cardiac output, preload, afterload, contractility </li></ul></ul><ul><ul><li>Conduction system </li></ul></ul>
  3. 3. Respiratory Physiology <ul><li>Structure and function (cont'd) </li></ul><ul><ul><li>Breathing: inspiration, expiration </li></ul></ul><ul><ul><li>Lung volumes and capacities </li></ul></ul><ul><ul><li>Pulmonary circulation </li></ul></ul><ul><ul><li>Respiratory gas exchange: oxygen, carbon dioxide </li></ul></ul><ul><ul><li>Regulation of respiration </li></ul></ul>
  4. 4. Factors Affecting Oxygenation <ul><li>Physiological factors: cardiac </li></ul><ul><ul><li>Conduction disturbances </li></ul></ul><ul><ul><li>Impaired valvular function </li></ul></ul><ul><ul><li>Myocardial hypoxia </li></ul></ul><ul><ul><li>Cardiomyopathic conditions </li></ul></ul><ul><ul><li>Peripheral tissue hypoxia </li></ul></ul>
  5. 5. Factors Affecting Oxygenation (cont'd) <ul><li>Physiological factors: respiratory </li></ul><ul><ul><li>Hyperventilation </li></ul></ul><ul><ul><li>Hypoventilation </li></ul></ul><ul><ul><li>Hypoxia </li></ul></ul>
  6. 6. Factors Affecting Oxygenation (cont'd) <ul><li>Additional physiological factors </li></ul><ul><ul><li>Decreased oxygen-carrying capacity </li></ul></ul><ul><ul><li>Decreased inspired oxygen concentration </li></ul></ul><ul><ul><li>Hypovolemia </li></ul></ul><ul><ul><li>Increased metabolic rate </li></ul></ul><ul><ul><li>Conditions affecting chest wall movement </li></ul></ul>
  7. 7. Factors Affecting Oxygenation (cont'd) <ul><li>Additional physiological factors </li></ul><ul><ul><li>Musculoskeletal abnormalities </li></ul></ul><ul><ul><li>Trauma </li></ul></ul><ul><ul><li>Neuromuscular diseases </li></ul></ul><ul><ul><li>Central nervous system alterations </li></ul></ul><ul><ul><li>Chronic disease </li></ul></ul>
  8. 8. Alterations in Cardiac Functioning <ul><li>Conduction disturbances </li></ul><ul><ul><li>– Atrial and ventricular dysrhythmias </li></ul></ul><ul><li>Altered cardiac output </li></ul><ul><ul><li>– Heart failure </li></ul></ul><ul><li>Impaired valvular function </li></ul><ul><li>Myocardial ischemia </li></ul><ul><ul><li>– Angina, MI, acute coronary syndrome </li></ul></ul>
  9. 9. Alterations in Respiratory Functioning <ul><li>Hyperventilation </li></ul><ul><li>Hypoventilation </li></ul><ul><li>Hypoxia </li></ul>
  10. 10. Developmental Factors <ul><li>Infants and toddlers </li></ul><ul><li>School-age children and adolescents </li></ul><ul><li>Young and middle adults </li></ul><ul><li>Older adults </li></ul>
  11. 11. Lifestyle Factors <ul><li>Nutrition </li></ul><ul><li>Exercise </li></ul><ul><li>Smoking </li></ul><ul><li>Substance abuse </li></ul><ul><li>Stress </li></ul>
  12. 12. Environmental Factors <ul><li>Residence location </li></ul><ul><li>Occupation </li></ul>
  13. 13. Nursing History <ul><li>Fatigue </li></ul><ul><li>Dyspnea </li></ul><ul><li>Cough </li></ul><ul><li>Wheezing </li></ul><ul><li>Pain </li></ul><ul><li>Environmental or geographical exposures </li></ul>
  14. 14. Nursing History (cont'd) <ul><li>Respiratory infections </li></ul><ul><li>Health risks </li></ul><ul><li>Medications </li></ul>
  15. 15. Assessment of Oxygenation <ul><li>Physical examination </li></ul><ul><ul><li>Inspection </li></ul></ul><ul><ul><li>Palpation </li></ul></ul><ul><ul><li>Percussion </li></ul></ul><ul><ul><li>Auscultation </li></ul></ul>
  16. 16. Assessment of Oxygenation (cont'd) <ul><li>Diagnostic tests: blood studies </li></ul><ul><ul><li>Complete blood count </li></ul></ul><ul><ul><li>Cardiac enzymes </li></ul></ul><ul><ul><li>Cardiac troponin I </li></ul></ul><ul><ul><li>Serum electrolytes </li></ul></ul><ul><ul><li>Cholesterol </li></ul></ul>
  17. 17. Assessment of Oxygenation (cont'd) <ul><li>Diagnostic tests: cardiac function </li></ul><ul><ul><li>Electrocardiogram (ECG) </li></ul></ul><ul><ul><li>Holter monitor </li></ul></ul><ul><ul><li>Exercise stress test </li></ul></ul><ul><ul><li>Thallium stress test </li></ul></ul><ul><ul><li>Electrophysiological study (EPS) </li></ul></ul><ul><ul><li>Echocardiography </li></ul></ul><ul><ul><li>Scintigraphy </li></ul></ul><ul><ul><li>Cardiac catheterization </li></ul></ul>
  18. 18. Assessment of Oxygenation (cont'd) <ul><li>Diagnostic tests: ventilation studies </li></ul><ul><ul><li>Pulmonary function </li></ul></ul><ul><ul><li>Peak expiratory flow rate (PEFR) </li></ul></ul><ul><ul><li>Arterial blood gases </li></ul></ul><ul><ul><li>Oximetry </li></ul></ul><ul><ul><li>Chest x-ray </li></ul></ul><ul><ul><li>Bronchoscopy </li></ul></ul><ul><ul><li>Lung scan </li></ul></ul>
  19. 19. Assessment of Oxygenation (cont'd) <ul><li>Diagnostic tests: ventilation studies (cont'd) </li></ul><ul><ul><li>Thoracentesis </li></ul></ul><ul><ul><li>Throat cultures </li></ul></ul><ul><ul><li>Sputum specimens </li></ul></ul>
  20. 20. Nursing Diagnoses <ul><li>Ineffective airway clearance </li></ul><ul><li>Ineffective breathing pattern </li></ul><ul><li>Decreased cardiac output </li></ul><ul><li>Impaired gas exchange </li></ul><ul><li>Risk for infection </li></ul><ul><li>Ineffective tissue perfusion </li></ul><ul><li>Impaired spontaneous ventilation </li></ul>
  21. 21. Planning <ul><li>Goals and outcomes </li></ul><ul><ul><li>Client’s lungs are clear on auscultation </li></ul></ul><ul><ul><li>Client coughs productively </li></ul></ul><ul><li>Setting priorities </li></ul><ul><li>Continuity of care </li></ul>
  22. 22. Implementation: Health Promotion <ul><li>Body weight </li></ul><ul><li>Diet </li></ul><ul><li>Exercise </li></ul><ul><li>Stress reduction </li></ul><ul><li>Occupational safety </li></ul><ul><li>Smoke-free </li></ul><ul><li>Regular physical examinations </li></ul>
  23. 23. Implementation: Health Promotion (cont'd) <ul><li>Vaccinations/immunizations </li></ul><ul><ul><li>Influenza </li></ul></ul><ul><ul><li>Pneumonia </li></ul></ul>
  24. 24. Implementation: Acute Care <ul><li>Dyspnea management </li></ul><ul><li>Airway maintenance </li></ul><ul><ul><li>Mobilization of secretions </li></ul></ul><ul><ul><li>Suctioning </li></ul></ul><ul><ul><li>Artificial airways </li></ul></ul>
  25. 25. Implementation: Acute Care (cont'd) <ul><li>Maintenance and promotion of lung expansion </li></ul><ul><ul><li>Positioning </li></ul></ul><ul><ul><li>Incentive spirometry </li></ul></ul><ul><ul><li>Chest tubes </li></ul></ul>
  26. 26. Implementation: Acute Care (cont'd) <ul><li>Maintenance and promotion of oxygenation: oxygen therapy </li></ul><ul><ul><li>Safety precautions </li></ul></ul><ul><ul><li>Oxygen supply </li></ul></ul><ul><ul><li>Methods of oxygen delivery </li></ul></ul><ul><ul><li>Home oxygen therapy </li></ul></ul>
  27. 27. Implementation: Acute Care (cont'd) <ul><li>Restoration of cardiopulmonary functioning — CPR </li></ul>
  28. 28. Implementation: Restorative Care <ul><li>Hydration </li></ul><ul><li>Coughing techniques </li></ul><ul><li>Respiratory muscle training </li></ul><ul><li>Breathing exercises </li></ul>
  29. 29. Evaluation <ul><li>Client care </li></ul><ul><li>Client expectations </li></ul>

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