Oxygenation

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Oxygenation

  1. 1. OxyGeNati0n... Lecture by: Ms. Shenell A. Delfin, RN
  2. 2. PHYSIOLOGY OF THE RESPIRATORY SYSTEM <ul><li>Organs of the Respiratory System </li></ul><ul><li>A. Bronchial Tree. </li></ul><ul><li>1. Trachea divides below the carina into the right and left main stem bronchi, which extend into the lungs. </li></ul><ul><li>2. The right main stem bronchus is shorter, wider, and straighter than the left; therefore foreign objects are more likely to enter the right side. </li></ul><ul><li>3. Lobar bronchi: three in the right lung and two in the left lung; lobar bronchi subdivide several more times to form segmental and sub-segmental bronchi. </li></ul><ul><li>4. Bronchioles: branching from the sub-segmental bronchi; no cartilage in the walls. Bronchioles branch into the terminal bronchioles; no mucus glands or cilia. </li></ul>
  3. 4. PHYSIOLOGY OF THE RESPIRATORY SYSTEM <ul><li>B. Lungs (organs of respiration). </li></ul><ul><li>1. Lungs are located within the thoracic cavity </li></ul><ul><li>2. Pleura: the transparent serous membrane around the </li></ul><ul><li>lung. </li></ul><ul><li>a. Each lung is sealed within its own compartment by the pleura. </li></ul><ul><li>b. Visceral pleura: adheres to the surface of the lung. </li></ul><ul><li>c. Parietal pleura: covers the inner wall of the chest. </li></ul><ul><li>d. Pleural cavity: potential space between the visceral and parietal pleura membrane; normally pleural layers are in close contact. </li></ul>
  4. 6. PHYSIOLOGY OF THE RESPIRATORY SYSTEM <ul><li>3. Lungs. </li></ul><ul><li>a. Divided into lobes. </li></ul><ul><li>(1) Right lung: three lobes. </li></ul><ul><li>(2) Left lung: two lobes. </li></ul><ul><li>b. Each terminal bronchiole branches into respiratory bronchioles. </li></ul><ul><li>c. The alveolar ducts are located at the end of the respiratory bronchioles. </li></ul><ul><li>d. Alveoli: area of gas exchange; diffusion of oxygen (O2) and carbon dioxide (CO2) between the blood and the lungs occurs across the alveolar membrane. </li></ul><ul><li>e. Surfactant is produced in the alveoli; primary function is to reduce surface tension, which facilitates alveolar expansion and decreases tendency of alveoli to collapse. </li></ul>
  5. 7. Alveoli A scanning electron micrograph reveals the tiny sacs known as alveoli within a section of human lung tissue. Human beings have a thin layer of about 700 million alveoli within their lungs. This layer is crucial in the process called respiration, exchanging oxygen and carbon dioxide with the surrounding blood capillaries.
  6. 8. PHYSIOLOGY OF THE RESPIRATORY SYSTEM <ul><li>4.Premature infants frequently have inadequate production of surfactant. </li></ul><ul><li>5. Blood supply to the lungs. </li></ul><ul><li>a.Pulmonary arteries to pulmonary capillaries to alveoli, where exchange of gas occurs. </li></ul><ul><li>b.Bronchial arteries supply the nutrients to the lung tissue and do not participate in gas exchange. </li></ul>
  7. 9. <ul><li>Role of Pulmonary Surfactant </li></ul><ul><li>Surfactant decreases surface tension which: </li></ul><ul><ul><li>increases pulmonary compliance (reducing the effort needed to expand the lungs) </li></ul></ul><ul><ul><li>reduces tendency for alveoli to collapse </li></ul></ul>Role of Pulmonary Surfactant Surfactant decreases surface tension which: -increases pulmonary compliance (reducing the effort needed to expand the lungs) -reduces tendency for alveoli to collapse
  8. 10. Physiology of Respiration <ul><li>* External respiration is a process by which gas is exchanged between the circulating blood and the inhaled air. </li></ul><ul><li>A. Atmospheric pressure: that pressure exerted on all body parts by surrounding air. </li></ul><ul><li>B. Intrathoracic pressure: the pressure within the pleural cavity. </li></ul>
  9. 11. <ul><li>C. Gases flow from an area of high pressure to an area of low pressure; pressure below atmospheric pressure is designated as negative pressure. </li></ul><ul><li>D. Inspiration. </li></ul><ul><li>1. Stimulus to the diaphragm and the intercostal muscles by way of the central nervous system. </li></ul><ul><li>2. Diaphragm moves down, and intercostal muscles move outward, thereby increasing the capacity of the thoracic cavity and decreasing intrathoracic pressure to below atmospheric pressure. </li></ul><ul><li>3. Through the airways, the lungs are open to atmospheric pressure; air will flow into the lungs to equalize intrathoracic pressure with atmospheric pressure. </li></ul>
  10. 14. <ul><li>E. Expiration. </li></ul><ul><li>1. Diaphragm and intercostal muscles relax and return to a resting position; therefore lungs recoil and capacity is decreased. </li></ul><ul><li>2. Air will flow out until intrathoracic pressure is again equal to atmospheric pressure. </li></ul><ul><li>F. Negative pressure is greater during inspiration; therefore air flows easily into the lungs. </li></ul><ul><li>G. Compliance describes how elastic the lungs are or how easily the lungs can be inflated; when compliance is </li></ul><ul><li>decreased, the lungs are more difficult to inflate. </li></ul>
  11. 15. PHYSIOLOGY OF THE RESPIRATORY SYSTEM <ul><li>H. Respiratory volumes. </li></ul><ul><li>1. Tidal volume: amount of air moving in and out of the lungs in one normal breath. Normal = 0.5 L. </li></ul><ul><li>2. Vital capacity: amount of air forcibly exhaled in one breath with a maximum inhalation. Normal = 4.5 L. </li></ul><ul><li>3. Residual volume: air remaining in the lungs at the end of a forced expiration. </li></ul>
  12. 17. . The process of gas exchange. <ul><li>1. Ventilation: the process of moving air between atmosphere and alveoli. </li></ul><ul><li>2. Diffusion. </li></ul><ul><li>a. The process of moving O2 and CO2 across </li></ul><ul><li>alveolar capillary membrane, </li></ul><ul><li>b. Links the processes of ventilation and perfuse </li></ul><ul><li>c. Gas diffuses across the alveolar capillary membrane from an area of high concentration to an area of low concentration. </li></ul><ul><li>d. Factors affecting diffusion: surface area of lung, thickness of the alveolar capillary membrane, characteristics of the gases. </li></ul>
  13. 18. The process of gas exchange. <ul><li>3. Perfusion </li></ul><ul><li>a. The process of linking the blood system to the alveoli. </li></ul><ul><li>b. Dependent on the volume of blood flowing through pulmonary circulation. </li></ul><ul><li>4. Transport. </li></ul><ul><li>a. The process by which O2 is delivered to the tissue by the circulatory system. </li></ul><ul><li>b. Dependent on cardiac output. </li></ul><ul><li>c. O2 is carried either chemically (bound to hemoglobin) or physically (dissolved in plasma). </li></ul>
  14. 19. Oxygen and Carbon Dioxide Transport <ul><li>*Internal respiration is the exchange of gases between the blood and interstitial fluid. The gases are measured by an analysis of arterial blood </li></ul><ul><li>1. Transported as a dissolved gas; Pao2 refers to the partial pressure of O2 in arterial blood. </li></ul><ul><li>2. O2 is primarily transported through hemoglobin; when hemoglobin leaves the pulmonary capillary bed, it is usually 95% to 100% saturated with O2. It may he referred to as the arterial oxygen saturation (Sao2). </li></ul>
  15. 20. Oxygen and Carbon Dioxide Transport <ul><li>3. Oxygenated hemoglobin moves through the arterial system into the cellular capillary bed, where O2, is released from the hemoglobin and made available for cellular metabolism. </li></ul><ul><li>4. Venous blood contains about 75% O2, as it returns to the right side of the heart. </li></ul>
  16. 21. <ul><li>System Assessment </li></ul><ul><li>A. History: </li></ul><ul><li>1. History of childhood and adult illnesses. </li></ul><ul><li>2. Family history. </li></ul><ul><li>3. Status of immunizations. </li></ul><ul><li>a. Tuberculin (TB) skin test (Mantoux test). </li></ul><ul><li>b. Pertussis. </li></ul><ul><li>c. Polio. </li></ul><ul><li>d. Pneumococcal pneumonia vaccine (Pneumovax). </li></ul>
  17. 22. System Assessment <ul><li>4. Medication. </li></ul><ul><li>5. Occupational environment. </li></ul><ul><li>6. Habits </li></ul><ul><li>a. Smoking. </li></ul><ul><li>b. Alcohol intake. </li></ul>
  18. 23. <ul><li>B. Physical assessment. </li></ul><ul><li>1. Initially observe client’s resting position </li></ul><ul><li>a. Appearance: comfortable or distressed? </li></ul><ul><li>b. Assess client in the sitting position, if possible. </li></ul><ul><li>c. Any dyspnea or respiratory discomfort? </li></ul>
  19. 24. <ul><li>2. Evaluate vital signs. </li></ul><ul><li>a. Appropriate for age level? </li></ul><ul><li>b. Establish database and compare with previous data. </li></ul><ul><li>c. Assess client's overall response. </li></ul><ul><li>(1) Normal Vital Signs vary greatly from one individual to another. </li></ul><ul><li>(2) A blood pressure of 90/60 mmHg may be normal for one person but may indicate hypotension in another. </li></ul><ul><li>3. Assess upper airway passages and patency of the airway. </li></ul>
  20. 25. <ul><li>4. Inspect the neck for symmetry; check to see if the trachea is in midline and observe for jugular vein distention. </li></ul><ul><li>5. Assess the lungs. </li></ul><ul><li>a. Visually evaluate the chest/thorax. </li></ul><ul><li>(1) Do both sides move equally? </li></ul><ul><li>(2) Observe characteristics of respirations and note whether retractions are present. </li></ul><ul><li>(3) Note chest wall configuration (barrel chest, kyphoscoliosis, etc.). </li></ul>
  21. 26. <ul><li>b. Palpate chest for tenderness, masses, and symmetry of motion. </li></ul><ul><li>c. Auscultate breath sounds; begin at lung apices and end at the bases, comparing each area side to side. Breath sounds should he present and equal bilaterally. </li></ul><ul><li>d. Determine presence of tactile fremitus: When client says &quot;ninety-nine,&quot; there should be equal vibrations palpated bilaterally. Over areas of consolidation, there will be an increase in the vibrations. </li></ul>
  22. 27. <ul><li>Normal Breath sounds: </li></ul><ul><li>Vesicular- soft-low pitched sighing sounds created by moving through bronchioles and alveoli heard over lung periphery. </li></ul><ul><li>Bronchovesicular- moderate intensity “blowing” sound created by air passing through bronchi heard between scapula and lateral sternum. </li></ul><ul><li>Bronchial- High pitched loud “harsh” sound created by air passing through the trachea heard over trachea. </li></ul>
  23. 28. <ul><li>e. Determine presence of adventitious breath sounds (abnormal/extra breath sounds). </li></ul><ul><li>(1) Crackles: usually heard during inspiration and do not clear with cough; occur when airway contains fluid (previously also known as rales). </li></ul><ul><li>(2) Rhonchi: usually heard on expiration and may clear with cough; occur as air moves through fluid-filled passages. </li></ul><ul><li>(3) Wheezes: may be heard during inspiration and/or expiration; are caused by air moving through narrowed passages. </li></ul><ul><li>(4) Pleural friction rub: heard primarily on inspiration over an area of pleural inflammation; may be described as a grating sound. </li></ul>
  24. 29. <ul><li>6. Assess cough reflex and sputum production. </li></ul><ul><li>a. Is cough associated with pain? </li></ul><ul><li>b. What precipitates cough episodes? </li></ul><ul><li>c. Is cough productive or non-productive? </li></ul><ul><li>d. Characteristics of Sputum </li></ul><ul><li>(1)Consistency </li></ul><ul><li>(2)Amount </li></ul><ul><li>(3)Color (should be clear or white) </li></ul><ul><li>c. Presence of Hemoptysis </li></ul><ul><li>(1)Duration </li></ul><ul><li>(2)Amount </li></ul>
  25. 30. <ul><li>7. Assess for and evaluate dyspnea. </li></ul><ul><li>a. Onset of dyspnea </li></ul><ul><li>b. Orthopnea. </li></ul><ul><li>c. Adventitious breath sounds </li></ul><ul><li>d. Noisy expiration </li></ul><ul><li>e. Level of tolerance of activity </li></ul><ul><li>f. Correlate vital signs with dyspnea </li></ul><ul><li>g. Cyanosis (a very late and unreliable sign of hypoxia). </li></ul><ul><li>(1) For dark-skinned clients, assess the areas that are less pigmented (oral cavity, nail beds, lips, palms). </li></ul><ul><li>(2) Dark-skinned clients may exhibit cyanosis in the skin as a gray hue, rather than blue. </li></ul><ul><li>(3) Capillary refill time should be less than 3 seconds. </li></ul>
  26. 31. <ul><li>8. Assess for and evaluate chest pain. </li></ul><ul><li>a. Location of pain </li></ul><ul><li>b. Character of pain. </li></ul><ul><li>c. Pain associated with cough. </li></ul><ul><li>d. Pain either increased or decreased with breathing </li></ul><ul><li>9. Evaluate fingers for clubbing (characteristic in clients with chronic respiratory disorders). </li></ul><ul><li>10. Evaluate pulmonary diagnostics </li></ul><ul><li>a. Hemoglobin and hematocrit (presence of polycythemia or anemia). </li></ul><ul><li>b. Electrolyte imbalances </li></ul><ul><li>c. Arterial blood gases (ABGs). </li></ul>
  27. 41. Suctioning <ul><li>Suctioning is done (using negative pressure) excessive mucous secretion to maintain patent airway and to collect specimen for diagnostic testing </li></ul><ul><li>Procedure: </li></ul><ul><li>Use appropriate catheter size: F 5-8 for infants, F 8-10 for children and F12-18 for adult. </li></ul><ul><li>Position client in fowlers( for those with intact gag reflex), side lying (for unconscious) to prevent aspiration </li></ul><ul><li>Adult pressure: 50-75 mmhg in infants, 100-120 mmhg in adults </li></ul><ul><li>Preoxygenate client </li></ul><ul><li>Lubricate catheter tip by immersing in cup of saline solution </li></ul><ul><li>Insert catheter through during inspiration (when epiglottis is open) without exerting the suction yet (OPEN PORT) until you feel resistance. </li></ul><ul><li>Retract catheter by 1 cm before exerting suction </li></ul><ul><li>Exert suction by CLOSE PORT, withdrawing catheter in rotating motion within 5-10 seconds only!!!! </li></ul><ul><li>Hyper oxygenate for a full minute between subsequent suctioning. Encourage deep breathing! </li></ul>
  28. 45. NURSING PRIORITY <ul><li>GOAL: To promote adequate respiratory function: </li></ul><ul><li>Adequate O2 supply from the environment. Man requires 21% of O2 from the environment in order to survive. </li></ul><ul><li>Deep breathing and coughing exercises. To promote maximum lung expansion and to loosen mucous secretions. </li></ul><ul><li>Positioning. The semi-fowler’s or high fowlers </li></ul><ul><li>position promotes maximum lung expansion. </li></ul>
  29. 46. NURSING PRIORITY <ul><li>Patent airway. To promote gaseous exchange from the person and the environment. Causes of airway obstruction: mucus secretions, edema of airways, spasms of airways, foreign bodies. Airway obstruction is characterized by N oisy breathing. </li></ul><ul><li>Adequate hydration. To maintain moisture of the mucus membrane lining the respiratory tract. This is necessary to prevent irritation and infection. </li></ul>
  30. 47. NURSING PRIORITY <ul><li>Avoid environmental pollutants, alcohol and smoking. These factors inhibit mucociliary function. </li></ul><ul><li>Chest physiotherapy (CPT)- percussion, vibration, and postural drainage (PVD). These procedures are dependent nursing function. </li></ul><ul><li>Percussion (clapping) is forceful striking of the skin with the cupped hands. </li></ul><ul><li>Vibration is a series of vigorous quivering produced by hands that are placed flat against the clients chest wall. </li></ul>
  31. 48. NURSING PRIORITY <ul><li>Postural drainage is expulsion of secretions various segments by gravity. This involves placing the client in different positions so that the area of the lung congestion will be in vertical position with the bronchus. This facilitates drainage by gravity. </li></ul>
  32. 49. NURSING PRIORITY <ul><li>Steam inhalation </li></ul><ul><li>Purposes: </li></ul><ul><li>To liquefy mucous secretions </li></ul><ul><li>To warm and humidify air </li></ul><ul><li>To relieve edema of airways </li></ul><ul><li>To soothe irritated airways </li></ul><ul><li>To administer medications </li></ul>
  33. 50. NURSING PRIORITY <ul><li>Coughing- single most effective measure to control respiratory secretions upward. </li></ul><ul><li>Deep breathing- expands the alveoli and mobilizes secretions. </li></ul><ul><li>Pursed lip breathing- Allows a gradual decline of pressure hence preventing lung collapse </li></ul>
  34. 51. ALTERED BREATHING PATTERNS <ul><li>Tachypnea- rapid respiratory rate </li></ul><ul><li>Bradypnea- slow respiratory rate </li></ul><ul><li>Apnea- cessation of breathing </li></ul><ul><li>Hyperventilation- excessive amount of air in the lungs. It results from deep, rapid respirations. </li></ul><ul><li>Cheyne-stokes- marked rhythmic waxing and waning of respirations from very deep or very shallow breathing and temporary apnea. </li></ul><ul><li>Biot’s- shallow breathes interrupted by apnea </li></ul>
  35. 52. ALTERED BREATHING PATTERNS <ul><li>Kussmauls – increased rate and depth, seen in metabolic acidosis and renal failure. </li></ul><ul><li>Apneustic- prolonged gasping inspiration followed by a very short, usually inefficient expiration. </li></ul><ul><li>Dypsnea- difficult or labored breathing. </li></ul><ul><li>Orthopnea - inability to breathe except in an upright or sitting position. </li></ul>
  36. 53. Thank you for listening..

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