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53 a focus 8 oxygenation pdf
- 1. 10/6/2010 NURSING FUNDAMENTALS STAGGERING STATISTICS FOCUS VI OXYGENATION • Cardiovascular Diseases – # 1 killer • HTN – 65 million • Artheriosclerosis • Arteriosclerosis • Stroke • Hypercholesterolemia • 107 million - a risk factor for CVD • AMI – 7.5 Million per year, 460,000 die • Americans will pay 393.5 billion in 2005 for CVD related medical costs OBJECTIVES RESPIRATORY SYSTEM • 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 clients oxygenation status. • Explain the major purpose of the tests and the related nursing responsibilities. STAGGERING STATISTICS PROCESS OF BREATHING • Pulmonary Diseases • Lung CA - •Inspiration •Air flows into lungs • TB – •Expiration • Pneumonia – •Air flows out of lungs • Chronic Airflow Limitation (formerly COPD) – 1
- 2. 10/6/2010 NORMAL OXYGENATIONPROCESS INSPIRATION • Cardiovascular: • Diaphragm and intercostals contact • Thoracic cavity size increases • Volume of lungs increases • Intrapulmonary pressure decreases • Air rushes into the lungs to equalize pressure NORMAL OXYGENATION PROCESS EXPIRATION • Systemic: • Diaphragm and intercostals relax • Volume of the lungs decreases • Intrapulmonary pressure rises • Air is expelled NORMAL OXYGENATIONS PROCESS GAS EXCHANGE • Occurs after the alveoli are ventilated • Pressure differences on each side of the respiratory membranes affect diffusion • Diffusion of oxygen from the alveoli into the pulmonary blood vessels • Diffusion of carbon dioxide from pulmonary blood vessels into alveoli 2
- 3. 10/6/2010 ADEQUATE O2 BALANCE CARBON DIOXIDE TRANSPORT • Maintenance of adequate O2 balance Gas Exchange • Must be transported from the tissues to the lungs • Continually produced in the process of cell metabolism • 65% is carried inside the red blood cells as bicarbonate • 30% combines with hemoglobin as carbhemoglobin • 5% transported in solution in plasma and as carbonic acid FACTORS THAT INFLUENCE OXYGEN TRANSPORT RESPIRATORY FUNCTION • Transported from the lungs to the •Age tissues • 97% of oxygen combines with •Environment hemoglobin in red blood cells and •Lifestyle carried to tissues as oxyhemoglobin •Health status • Remaining oxygen is dissolved and transported in plasma and cells •Medications •Stress COMMON MANIFESTATIONS OF NORMAL OXYGENATION PROCESS IMPAIRED RESPIRATORY FUNCTION • Cell environment/ O2 carrying capacity: •Hypoxia • O2 Carrying capacity of blood is expressed by: •Altered breathing • Red blood cells • Hematocrit patterns • Hemoglobin •Obstructed or partially obstructed airway 3
- 4. 10/6/2010 OBSTRUCTED OR PARTIALLY HYPOXIA OBSTRUCTED AIRWAY • Condition of insufficient oxygen anywhere in the body •Partial obstruction • Rapid pulse •low-pitched snoring during • Rapid, shallow respirations and dyspnea inhalation • Increased restlessness or lightheadedness • Flaring of nares •Complete obstruction • Substernal or intercostal retractions •extreme inspiratory effort with • Cyanosis no chest movement ABNORMAL RESPIRATORY PATTERNS ADEQUATE O2 BALANCE • Tachypnea (rapid rate) • Example of Obstructive Disease Asthma • Bradypnea (abnormally slow rate) • Apnea (cessation of breathing) • Kussmaul’s breathing • Cheyne-Stokes respirations • Biot’s respirations ALTERATIONS IN EASE OF BREATHING ADEQUATE O2 BALANCE • Example of Restrictive Disease Hemothorax •Orthopnea •Dyspnea 4
- 5. 10/6/2010 NURSING MEASURES TO PROMOTE INADEQUATE O2 BALANCE RESPIRATORY FUNCTION • Behaviors of Negative O2 balance •Ensure a patent airway • Hypoventilation or hyperventilation • Stridor, audible sounds with respiration, wheezing, coughing •Positioning • Hypoxia • Change in mental status •Encourage deep breathing, • Change vital signs • Cyanosis coughing • Decrease in GI motility • Change in renal function •Ensure adequate hydration • Hypercapnia NURSING RESPONSIBILITIES NURSING RESPONSIBILITIES • Physical Assessment: • • • Determine adequacy of cardiopulmonary function: • Lung auscultation and breathing pattern • Nursing assessment • Abdominal assessment • HEART • Urine output • Respiratory assessment • Skin and mucous membranes • PMH • Heart sounds • LIFESTYLE • Circulation • Edema • DVT LUNG SOUNDS HEART PROBLEMS • 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 Artheroscleosis = Coronary Artery Disease (CAD) • Pleural friction rub • grating rubbing, sound 5
- 6. 10/6/2010 COMMON TESTS AND NURSING RESPONSIBILITIES CHEST XRAY • • Measure adequacy of ventilation and gas exchange • Complete Blood Count (CBC) phlebotomy • Arterial Blood Gases (ABG) arterial puncture • Pulmonary Function Tests preparation by teaching Adenocarcinoma COMMON TESTS AND NURSING COMMON TESTS AND NURSING RESPONSIBILITIES RESPONSIBILITIES Thorancentesis • •Tests to determine abnormal cell growth or • Thoracentesis: infection in respiratory system: • Sputum culture • growing microorganisms from sputum • Throat culture • growth of microorganisms from throat material COMMON TESTS AND NURSING RESPONSIBILITIES NURSING RESPONSIBILITIES • •Tests to visualize structures of respiratory system: • Medications • Incentive spirometry • Bronchoscopy • Chest PT • Chest radiographs • Postural drainage • Oxygen therapy • Artificial airways • Airway suctioning • Chest tubes 6
- 7. 10/6/2010 BASIC NURSINGINTERVENTIONS BASIC NURSING INTERVENTIONS • Improving Activity Tolerance: • Airway Maintenance: • Determine etiology • Facilitate effective coughing • Assess appropriateness of activity level • Suctioning airways • When appropriate gradually increase activity • Liquefying and mobilizing sputum • Ensure the client changes position slowly • Observe for symptoms of intolerance • Syncope with activity • refer to MD • Perform ROM exercises with activity intolerance or is immobile BASIC NURSING INTERVENTIONS BASIC NURSING INTERVENTIONS • Maintenance and promotion of proper lung • Mobilization of Pulmonary Secretions expansion: Re-expanding collapsed lungs • Auscultate breath sounds, monitor respiratory - Closed Chest Tube Drainage patterns, monitor ABG’s • Position client to optimize respiration • Pulmonary toileting • Incentive spirometry • Suctioning CHEST TUBES INCENTIVE SPIROMETRY 7
- 8. 10/6/2010 BASIC NURSING INTERVENTIONS • Effective Breathing Techniques • Position for maximal respiratory function • Pursed lip breathing • Diaphragmatic or abdominal breathing BASIC NURSING INTERVENTIONS BASIC NURSING INTERVENTIONS • Mobilization of Pulmonary Secretions Stress and anxiety reduction: • Encourage activity and ambulation as tolerated • Remove pertinent cause of anxiety at that moment - help client gain control over respiration • Encourage increased fluid intake - reassure client not in immediate danger • Chest physiotherapy • O2 • Chronic clients • exacerbations and remissions • Medications as ordered • goal is to reduce general level of anxiety • learn to control episodes of anxiety to improve quality of life • desensitization program • guided mastery BASIC NURSING INTERVENTIONS ADMINISTRATION OF PRESCRIBED MEDICATIONS • O2 Therapy: • Expectorants • Vasoconstrictors • Low flow • Mucolytics • High flow • Bronchodilators • Humidification • Cough suppressants • Nasal cannula • Corticosteroids • Simple mask • Antihistamines • Nonrebreathing mask • Antibiotics • Partial rebreathing 8
- 9. 10/6/2010 BASIC NURSINGINTERVENTIONS COMMON TESTS AND NURSING RESPONSIBILITIES • Physical Exercise health teaching Activity and rest -- a priority! Tests to determine adequacy of cardiovascular function: • Activity stimulates respiratory function Rest conserves energy and reduces metabolic demand • CBC • MD’s treatment plan • guidelines for activity • Lipid profile • may simply call for activity as tolerate. • prioritize activities • Coagulation studies • arrange need items conveniently • Provide emotional support and encouragement • EKG/ECG • gradually increase activity • Simplify daily life • Angiography • Work at a steady state • Conserve energy • Doppler blood flow studies ADEQUATE O2 BALANCE BASIC NURSING INTERVENTIONS • Behaviors of Negative O2 balance Cardiovascular • Diet • Modify risk factors • Exercise Cardio Vascular Disease • Co morbidities • Preventing vasoconstriction • Arterial • Venous: • Positioning • Impaired tissue perfusion • Cold temperatures • Nicotine ADEQUATE O2 BALANCE BASIC NURSING INTERVENTIONS • Cardiovascular •Risk DVT •Position changes • Behaviors of Negative O2 balance CV - Prevent complications •Early ambulation •Obstruction removal • Restlessness, dizziness, syncope, bradycardia, •Bypass surgery decreased urine • Promoting rest • cold and clammy skin, cyanosis, slow capillary refill •Schedule rest periods • Decreased cardiac output •Assistance with ADL’s •Monitor Vitals with activity •Place items, i.e. call light, water pitcher, strategically •Quiet environment, decrease stimuli 9
- 10. 10/6/2010 ADMINISTRATION OF PRESCRIBED BASIC NURSING INTERVENTIONS MEDICATIONS - Position semi to high Cardiovascular fowlers-> decrease venous • Anti coagulants • Positioning to improve return and preload, decease preload-> decreases risk of CO heart congestion • Vasodilator Medications - • Avoiding Valsalva • Teach client to avoid • Inotropic Medications valsalva maneuver maneuver - Hold breath while turning or moving in bed-> assist • Anti Dysrhythmics - Bearing down during BM-> stool softeners and diet • Anti hypertensives BASIC NURSING BASIC NURSING INTERVENTIONS INTERVENTIONS Cardiovascular •Avoid appetite suppressants, cold • Avoid stimulants meds, coffee, tea, chocolate • Dietary control • Assess nutritional status • Maintaining fluid balance •Assess fluid status, monitor I&O, assess breath sounds, JVD, pitting edema in dependent areas, fluid • Consider a dietician referral to assess and NA+ restriction, daily Wgt with nutritional needs related to clients diuretic therapy, electrolyte monitoring-> MD • Chronicity of CAL and CAD and nutrition BASIC NURSING INTERVENTIONS BASIC NURSING INTERVENTIONS Cardiovascular • Administer O2 • Weight control • Educate client • Increase O2 supply NO SMOKING! • Evaluate the client’s physiological status in relation to condition • Position to facilitate breathing • More than body requirements • Less than body requirements 10