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Oxygenation

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Oxygenation

  1. 1. OXYGENATION Prepared by: John Gil B. Ricafort, RN
  2. 2. <ul><li>Respiratory </li></ul><ul><li>Review of Respiratory System </li></ul><ul><li>Common Manifestations </li></ul><ul><li>Diagnostic Tests/ Procedures </li></ul><ul><li>Common Pharmacologic Agents </li></ul><ul><li>Disturbances </li></ul><ul><li>a. Restrictive Lung Disease </li></ul><ul><li>b. COPD/ CAL </li></ul><ul><li>c. Pulmonary Vascular Disease </li></ul>
  3. 3. <ul><li>Restrictive: </li></ul><ul><li>Atelectasis </li></ul><ul><li>Tuberculosis </li></ul><ul><li>Pneumonia </li></ul><ul><li>COPD: </li></ul><ul><li>Asthma </li></ul><ul><li>Emphysema </li></ul><ul><li>Chronic Bronchitis </li></ul>
  4. 4. <ul><li>Pulmonary Vascular Disease: </li></ul><ul><li>Cor Pulmonale </li></ul><ul><li>Pulmonary Embolism </li></ul>
  5. 5. <ul><li>Hematopoietic </li></ul><ul><li>Review of the Hematopoietic System </li></ul><ul><li>Disturbances </li></ul><ul><li>a. Anemia </li></ul><ul><li>b. Polycythemia Vera </li></ul><ul><li>c. Bleeding Tendencies </li></ul><ul><li>- DIC </li></ul><ul><li>- Hemophilia </li></ul><ul><li>- Thrombocytopenia </li></ul>
  6. 6. <ul><li>Cardiovascular </li></ul><ul><li>Review of the Cardiovascular System </li></ul><ul><li>Common Diagnostic Tests/ Procedures </li></ul><ul><li>Disturbances </li></ul><ul><li>a. Infection </li></ul><ul><li>- Rheumatic Heart Disease </li></ul><ul><li>b. Coronary Artery Disease </li></ul><ul><li>- Atherosclerosis </li></ul><ul><li>- Arteriosclerosis </li></ul>
  7. 7. <ul><li>- Angina Pectoris </li></ul><ul><li>- Myocardial Infarction </li></ul><ul><li>IV. Congestive Heart Failure </li></ul><ul><li>- Right Sided Heart Failure </li></ul><ul><li>- Left Sided Heart Failure </li></ul><ul><li>V. Congenital Heart Defects </li></ul><ul><li>- Cyanotic Heart Defects </li></ul><ul><li>- Acyanotic Heart Defects </li></ul>
  8. 8. RESPIRATORY SYSTEM
  9. 13. Measures That Promotes Adequate Respiratory Functions: <ul><li>Adequate OXYGEN supply from the environment. </li></ul><ul><li>Deep breathing and coughing exercises. </li></ul><ul><li>Proper positioning </li></ul><ul><li>Patent airway (FEMS) </li></ul><ul><li>Adequate hydration </li></ul><ul><li>Avoid pollutants, alcohol and smoking. </li></ul>
  10. 14. <ul><li>7. Chest Physiotherapy (CPT) </li></ul><ul><li>* Percussion </li></ul><ul><li>* Vibration </li></ul><ul><li>* Postural Drainage </li></ul><ul><li>8. Bronchial Hygiene Measures </li></ul><ul><li>* Steam Inhalation </li></ul><ul><li>* Suctioning </li></ul><ul><li>- Oropharyngeal </li></ul><ul><li>- Nasopharyngeal </li></ul>
  11. 15. Things to Remember:SUCTIONING <ul><li>Assess: AUDIBLE SECRETIONS during respiration </li></ul><ul><li>Position: </li></ul><ul><li>Conscious: SEMI-FOWLER’s POSITION </li></ul><ul><li>Unconscious: LATERAL POSITION </li></ul>
  12. 16. <ul><li>Pressure: </li></ul><ul><li>Wall Unit: </li></ul><ul><li>Adult: 100-120mmHg </li></ul><ul><li>Child: 95-110mmHg </li></ul><ul><li>Infant: 50-95mmHg </li></ul><ul><li>Portable Unit: </li></ul><ul><li>Adult: 10-15mmHg </li></ul><ul><li>Child: 5-10mmHg </li></ul><ul><li>Infant: 2-5mmHg </li></ul>
  13. 17. <ul><li>Appropriate Size of Catheter: </li></ul><ul><li>Adult: Fr. 12-18 </li></ul><ul><li>Child: Fr. 8-10 </li></ul><ul><li>Infant: Fr. 5-8 </li></ul><ul><li>Lubricate Catheter: </li></ul><ul><li>Nasopharyngeal: water-soluble lubricant </li></ul><ul><li>Oropharyngeal: Sterile water or NSS </li></ul>
  14. 18. <ul><li>Apply suction during withdrawal of the suction catheter (NEVER during insertion) </li></ul><ul><li>Apply suction for 5 to 10 seconds (maximum of 15 seconds) </li></ul><ul><li>Allow 20-30 seconds interval between each suction and limit suction to 5 minutes in total </li></ul><ul><li>Encourage patient to breathe deeply and to cough between suctions. </li></ul><ul><li>Assess effectiveness of suctioning </li></ul>
  15. 19. 9. Incentive Spirometry - done to enhance deep inspiration
  16. 20. 10. Administration of supplemental oxygen <ul><li>Signs of Hypoxemia </li></ul><ul><li>1. Increased pulse rate </li></ul><ul><li>2. Rapid, shallow respiration </li></ul><ul><li>3. Increased restlessness </li></ul><ul><li>4. Flaring of nares </li></ul><ul><li>5. Substernal or intercostal retractions </li></ul><ul><li>6. Cyanosis </li></ul>
  17. 21. OXYGEN SYSTEMS: <ul><li>Low-flow Administration Devices </li></ul><ul><li>a. Nasal Cannula (24-45% at 2-6LPM) </li></ul><ul><li>b. Simple Face Mask (40-60% at 5-8LPM) </li></ul><ul><li>c. Partial Rebreathing Mask </li></ul><ul><li>(60-90% at 6-10LPM) </li></ul><ul><li>d. Non-rebreathing Mask </li></ul><ul><li>(95-100% at 6-15LPM) </li></ul><ul><li>e. Oxygen Tent </li></ul>
  18. 22. <ul><li>2. High flow Administration Devices </li></ul><ul><li>a. Venturi Mask </li></ul><ul><li>b. Oxygen Hood </li></ul><ul><li>c. Incubator / Isolette </li></ul>
  19. 23. Common Manifestations: <ul><li>1. Cough </li></ul><ul><li>- the cardinal symptom of respiratory problem </li></ul><ul><li>2. Dyspnea </li></ul><ul><li>- refers to difficulty on breathing </li></ul><ul><li>* EXERTIONAL DYSPNEA </li></ul><ul><li>* PAROXYSMAL NOCTURNAL </li></ul><ul><li>* ORTHOPNEA </li></ul>
  20. 24. 3. Clinical Signs of Hypoxia <ul><li>EARLY SIGNS </li></ul><ul><li>Tachycardia </li></ul><ul><li>Kussmaul’s Respiration </li></ul><ul><li>N/V </li></ul><ul><li>Headache </li></ul><ul><li>Irritability </li></ul><ul><li>Memory loss </li></ul><ul><li>Dizziness </li></ul><ul><li>LATE SIGNS </li></ul><ul><li>Bradycardia </li></ul><ul><li>Dyspnea </li></ul><ul><li>Decreased Systolic BP </li></ul><ul><li>Cough </li></ul><ul><li>Increased RBC </li></ul><ul><li>Increased Hgb </li></ul><ul><li>Clubbing of fingers </li></ul>
  21. 25. 4. Clubbing of Fingers
  22. 26. <ul><li>5. Hemoptysis </li></ul><ul><li>6. Chestpain </li></ul><ul><li>7. Headache </li></ul><ul><li>8. Easy fatigability </li></ul><ul><li>9. Cyanosis </li></ul><ul><li>10. Skin flushing </li></ul><ul><li>11. Seizures </li></ul><ul><li>12. Altered level of consciousness </li></ul>
  23. 27. Common Pharmacologic Agents <ul><li>Adrenergic (Sympathomimetic) Agents </li></ul><ul><li>Bronchodilators </li></ul><ul><li>Antibacterial </li></ul><ul><li>Corticosteroids </li></ul><ul><li>Antihistamine </li></ul><ul><li>Mucolytic, Antitussive and Expectorant </li></ul>
  24. 28. Common Procedures/ Tests <ul><li>1. Abdominal Thrust (Heimlich Maneuver) </li></ul><ul><li>- a short, abrupt pressure against the abdomen, two fingerbreadths above the umbilicus, to raise the intrathoracic pressure. </li></ul><ul><li>PARTIAL: Noisy respiration, repeated coughing </li></ul><ul><li>TOTAL: Cessation of breathing, inability to speak </li></ul>
  25. 29. 2. Radiographic Scanning Test (X-RAY)
  26. 30. <ul><li>3. Endoscopy (Bronchoscopy) </li></ul><ul><li>4. Chest Physiotherapy </li></ul><ul><li>5. Suctioning of Airway </li></ul><ul><li>6. Tracheostomy care </li></ul><ul><li>7. Pulmonary Function Test </li></ul><ul><li>- Incentive Spirometry </li></ul><ul><li>*Tidal Volume (500ml) </li></ul><ul><li>* Residual Volume (1200ml) </li></ul><ul><li>* Expiratory Reserve Volume (1000-1200ml) </li></ul><ul><li>* Inspiratory Reserve Volume (3000-3300ml) </li></ul>
  27. 31. 8. Pulse Oximetry
  28. 32. <ul><li>9. Sputum Exam </li></ul><ul><li>10. Oxygen Therapy </li></ul><ul><li>11. Thoracentesis </li></ul><ul><li>12. Chest Tube (T-Tube) </li></ul><ul><li>- to drain air : 2 nd or 3 rd ICS </li></ul><ul><li>- to drain blood/ fluid: 8 th or 9 th ICS </li></ul>
  29. 33. 13. Pulmonary Angiogram
  30. 34. <ul><li>TUBERCULOSIS </li></ul>
  31. 37. <ul><li>PNEUMONIA </li></ul>
  32. 42. <ul><li>EMPHYSEMA </li></ul>
  33. 48. <ul><li>BRONCHITIS </li></ul>
  34. 52. <ul><li>ASTHMA </li></ul>
  35. 55. Coronary Artery Diseases (CAD) <ul><li>1. Atherosclerosis </li></ul><ul><li>- an abnormal accumulation of lipid, or fatty, substances and fibrous tissues in the vessel wall </li></ul><ul><li>2. Arteriosclerosis </li></ul><ul><li>- refers to hardening of the vessel walls </li></ul>
  36. 57. Risk Factors for CAD <ul><li>Nonmodifiable Risk Factors </li></ul><ul><li>Family History of CAD </li></ul><ul><li>Increasing Age </li></ul><ul><li>Gender </li></ul><ul><li>Race </li></ul>
  37. 58. <ul><li>Modifiable Risk Factors </li></ul><ul><li>High Blood pressure </li></ul><ul><li>Cigarette smoking </li></ul><ul><li>High Blood cholesterol levels </li></ul><ul><li>Diabetes Mellitus </li></ul><ul><li>Lack of estrogen in women </li></ul><ul><li>Physical inactivity </li></ul><ul><li>Obesity </li></ul>
  38. 61. Controlling Cholesterol <ul><li>Normal Total Serum Cholesterol = </li></ul><ul><li>150-240mg/dl </li></ul><ul><li>HDL = 29-77mg/dl </li></ul><ul><li>LDL= 60-160mg/dl </li></ul><ul><li>Triglycerides= 10-190mg/dl </li></ul>
  39. 62. Desired levels of LDL? <ul><li>< 160mg/dl for patients with one or no risk factors </li></ul><ul><li><130mg/dl for patients with two or more risk factors </li></ul><ul><li><100mg/dl for patients with CAD </li></ul>
  40. 63. Angina Pectoris <ul><li>Classifications of Angina </li></ul>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
  41. 64. Types of Angina Pectoris <ul><li>Stable Angina </li></ul><ul><li>Unstable Angina </li></ul><ul><li>Intractable Angina/ Refractory Angina </li></ul><ul><li>Variant Angina </li></ul><ul><li>Silent Angina </li></ul>
  42. 66. Myocardial Infarction <ul><li>Cardiac Enzymes </li></ul><ul><li>CPK </li></ul><ul><li>Normal: Male: 5-35; Female: 5-25 </li></ul><ul><li>Rises: 4-8 hours </li></ul><ul><li>Peak: ½ to 1 ½ days </li></ul><ul><li>Returns to Normal: 3-4 days </li></ul>
  43. 67. <ul><li>LDH </li></ul><ul><li>Normal: 100-190IU/L </li></ul><ul><li>Rises: 12-24 hours </li></ul><ul><li>Peak: 2-6 days </li></ul><ul><li>Trop-T </li></ul><ul><li>Normal: NEGATIVE </li></ul><ul><li>Rises: immediate </li></ul><ul><li>Peak: 4-24 hours </li></ul><ul><li>Returns to Normal: 1-3 weeks </li></ul>
  44. 68. <ul><li>Management: </li></ul><ul><li>M - morphine SO4 for pain </li></ul><ul><li>O - Oxygen </li></ul><ul><li>A – Aspirin/ ACE inhibitors (captopril) </li></ul><ul><li>N – Nitroglycerin </li></ul><ul><li>S – streptokinase ( thrombolytics ) </li></ul><ul><li>– should be given in 6 hrs but better if in 3 hrs </li></ul>
  45. 71. Congestive Heart Failure <ul><li>Classifications: </li></ul><ul><li>CLASSIFICATION I </li></ul><ul><li>Ordinary physical activity does not cause fatigue, dyspnea, palpitations or chestpain </li></ul><ul><li>ASYMPTOMATIC </li></ul><ul><li>PROGNOSIS: Good </li></ul>
  46. 72. <ul><li>CLASSIFICATION II </li></ul><ul><li>Slight limitations on ADL’s </li></ul><ul><li>Patient reports no symptoms at rest but increased physical activity will cause symptoms </li></ul><ul><li>PROGNOSIS: Good </li></ul>
  47. 73. <ul><li>CLASSIFICATION III </li></ul><ul><li>Marked limitation on ADL </li></ul><ul><li>Patient feels comfortable at rest but less than ordinary activity will cause symptoms </li></ul><ul><li>PROGNOSIS: Fair </li></ul>
  48. 74. <ul><li>CLASSIFICATION IV </li></ul><ul><li>Symptoms of Cardiac insufficiency at rest </li></ul><ul><li>PROGNOSIS: Poor </li></ul>

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