Nursing Care for COPD and Pneumonia Patients

Oxygenation-Week 3

• This week's focus is oxygenation in nursing, specifically cardiopulmonary function, and related clinical outcomes.

Class Objectives

• Describe the structure and function of the cardiopulmonary system.
• Describe physiological processes of ventilation, perfusion, and gas exchange.
• Identify clinical outcomes of hyperventilation, hypoventilation, and hypoxia.
• Assess for risk factors affecting client oxygenation.
• Describe nursing interventions.
• Evaluate patient responses to oxygenation therapies.
• Exclude information on nasotracheal suctioning, and sections on cardiovascular physiology or conduction system pages 973-975.

Case Study (Mr. Edwards)

• Mr. Edwards, age 62, is hospitalized with a 6-day history of chest pain and shortness of breath.
• Chest X-ray shows community-acquired right upper lobe pneumonia.
• He coughs with occasional thick, yellow sputum.
• Lying down worsens his shortness of breath.
• A nursing student is assigned to his care.

History

• Alcohol abuse, sedentary lifestyle
• 40-year history of smoking 2 packs per day
• COPD
• Works outside the home but unable to participate due to his health.

Current Vital Signs

• BP 142/84, HR 110, RR 26, O2 Sat 86% on RA
• Chest pain with breathing at 4/10.
• Anxious
• Fatigue with difficulty getting from bed to chair.
• RR increased to 32 during transfer.

Respiratory Physiology

• Oxygen is a fundamental human need. Low oxygen leads to compromised vital functions.
• Gas exchange disturbances often stem from ineffective lung function or heart issues.
• Blood oxygenation depends on ventilation, perfusion, and respiratory gas transport.
• Cardiovascular system delivers oxygen to tissues.
• Oxygenation involves ventilation, perfusion, and diffusion.

Ventilation

• Moving air in and out of lungs (inspiration/exhalation).
• Coordinated muscular and elastic lung/thorax actions.
• Diaphragm is the primary inspiratory muscle, innervated by the phrenic nerve.

Perfusion

• Cardiovascular system's ability to pump oxygenated blood to tissues and return deoxygenated blood to lungs.

Diffusion

• Respiratory gases' movement across concentration gradients.
• Organs and respiration muscles must be intact, with central nervous system regulation of respiratory cycles.

Respiratory Physiology (cont'd.)

• Diffusion occurs across the alveolar capillary membrane.
• Hemoglobin carries 97% of oxygen.
• Venous blood carries carbon dioxide to be exhaled.
• Central nervous system (CNS) regulates respiratory rate, depth, and rhythm.

Cardiovascular Physiology

• Myocardial pump: ventricles move blood during systole. Stroke volume is the ejected volume.
• Myocardial blood flow involves valves for one-way blood movement.
• Coronary arteries supply the heart during diastole.
• Left coronary artery receives most blood supply.
• Systemic circulation: arteries deliver oxygen and nutrients, veins carry waste. The cardiac output is the amount of blood ejected from the left ventricle per minute.

Factors Affecting Oxygenation

• Physiological factors (e.g., respiratory or cardiac issues, reduced oxygen-carrying capacity).

• Hypovolemia is one cause of reduced oxygenation, linked to shock, dehydration, fluid loss.

• Other physiological factors: decreased inspired oxygen concentration due to airway blockages, high elevation, or opioid use, and increased metabolic demands (pregnancy, wound healing, exercise).

• Developmental stage

• Lifestlye factors

• Environmental factors

Assessment

• Nursing history, health risks
• Pain, fatigue, dyspnea, cough
• Environmental/occupational factors (smoking, infections, etc.)
• Physical exam: inspection, palpation, percussion, auscultation of heart and lungs
• Cardiovascular and respiratory function tests (Holter monitor, ECG, ABGs, pulmonary function tests, etc.).

Interventions

• Health promotion (vaccinations, healthy lifestyle, environmental factors considerations).
• Acute care (dyspnea management - oxygen therapy, steroids, bronchodilators; airway maintenance -- suctioning, positioning, and humidification; nebulization, positive expiratory pressure (PEP), artificial airways -tracheostomy)
• Restorative and continuing care (rehabilitation, exercises).

Evaluation

• Patient outcomes are compared to expected progress.
• Oxygenation status is continually assessed.
• Evaluate symptoms such as breathlessness.
• Assess intervention effectiveness.

Safety Guidelines

• Establish patient baseline vital signs.
• Limit catheter introductions in suctioning procedures.
• Use caution with head injuries during suctioning.
• Review suction procedures.

Additional Information

• Complete Blood Count (CBC) results (WBC, RBC, hemoglobin, hematocrit, platelets, etc.).
• Basic Metabolic Panel (BMP) results (sodium, potassium, chloride, bicarbonate, BUN, creatinine, glucose).
• Chest X-ray results (consolidation, consistency with bacterial pneumonia)
• Sputum culture (organism identification and antibiotic sensitivities)

Medications

• List of medications (Ceftriaxone, Flovent, Albuterol, Tylenol)

Critical Thinking

• Cardiopulmonary physiology knowledge guides assessment approaches.
• Critical thinking ensures logical patient care.
• Professional standards guide patient care.

Additional Clinical Items

• Revisit Mr. Edwards
• Review paperwork from clinical packet.
• How would you address Mr. Edward's case study?
• Action plan
• How/Why would you know if the action plan is working?
• See page 989-990
• Concept map of relevant nursing diagnoses.