#2 Unit 5 Alteration in Oxygenation and Perfusion LT (1).pptx

Unit 5 Alteration in Oxygenation & Perfusion Lynnette Lynnette Taylor Taylor MSN/Ed, MSN/Ed, RN RN Ventura Ventura College College School School of of Nursing Nursing Alterations in Oxygenation Hypoxemi a& Hypoxia Hypoxemia—when amount of O2 in arterial blood falls below normal (normal PaO2 80-100 m...

Unit 5 Alteration in Oxygenation & Perfusion Lynnette Lynnette Taylor Taylor MSN/Ed, MSN/Ed, RN RN Ventura Ventura College College School School of of Nursing Nursing Alterations in Oxygenation Hypoxemi a& Hypoxia Hypoxemia—when amount of O2 in arterial blood falls below normal (normal PaO2 80-100 mm Hg) Hypoxia –the signs and symptoms of inadequate oxygenation —not measured by a lab value Clinical Manifestations of Hypoxemia Respirat ory CNS CV Other Atelectasis Collapsed, airless alveoli Foreign bodies, mucus, airway constriction, tumors, immobility Clinical manifestations: Diminished/absent breath sounds Common in bedridden and post-op abdominal/thoracic surgery Atelectasis Treatment Deep inspiration is necessary Coughing, deep-breathing exercises Early mobility Incentive spirometry 10x/h while awake (WA) PNEUMONIA Pneumonia Risk Factors Abdominal/thoracic surgery >65 yo 48 hrs after admission/intuba tion Aspiration PNA Clinical Manifestatio ns of PNA Cough—productive and nonproductive Fever, chills Dyspnea, tachypnea Pleuritic chest pain Sputum—green, yellow, rustcolored Confusion/stupor/hypothermia in older adult Fine/course crackles, increased fremitus Diagnostic Studies for PNA CXR Sputum gram stain, c/s Pulse ox; ABG CBC w/ differential Chemistries Blood c/s Nursing Assessment for PNA Subjecti ve data Objectiv e data Nursing Implementat ion Health promotion— pneumococcal vaccines Balance activity/rest IV antibiotic (abx) therapy Resp tx, O2 administration, suction, SaO2 Positioning/ambulating Aspiration precautions Nutrition: HYDRATION 3L/d PNA Case Study D.T. is an 88-year-old woman who lives alone. She has been feeling weaker over past 2 days. Last night became confused and disoriented. Her housekeeper notified her daughter, who brought D.T. to the clinic. PNA Case Study She complains of coughing over the past 3 days. She has a history of mild heart failure that is treated medically but has no other significant health disorders. She last saw her health care provider 4 months ago. PNA Case Study What are D.T.’s risk factors for pneumonia? What type of pneumonia is D.T. likely exhibiting? PNA Case Study What clinical manifestations of pneumonia is D.T. displaying? For what other clinical manifestations would you assess D.T. ? What diagnostic tests would you expect the nurse practitioner in the clinic to order? D.T.’s chest x-ray reveals consolidation in her left lower lobe, consistent with pneumonia. Her WBC 17 is with increased bands. Sputum Gram stain shows grampositive diplococci and many WBCs. PNA Case Study Her electrolytes and BNP are within normal limits. Because of her age and altered mentation, the health care provider admits her to the hospital for treatment. PNA Case Study 1 On admission, D.T. has bronchial breath sounds with dullness of the left lower lobe and egophony. 2 Her O2 saturation is 87%. 3 What is your priority of care for D.T.? PNA Case Study She has been switched from IV antibiotics to oral antibiotics and is ready for discharge. What important teaching should you provide to the patient and family? CORONARY OBSTRUCTIVE PULMONARY DISEASE COPD COPD Description Inability to expire air Systemic disease as a result of chronic inflammation Often coexists with cardiovascular diseases COPD Risk Factors Cigarette smoking (>40, 10+ pack years) Occupational chemicals, dust Air pollution Severe recurring respiratory infections α1-antitrypsin deficiency Aging Chronic inflammati on Leads to Mucus hypersecreti on Pulmonar y vascular changes Lung parenchy ma Dysfunctio n of cilia Pulmonar y HTN Pulmonar y blood vessels Hyperinflatio n of lungs Cor pulmonal e Airways COPD Pathophysi ology Common characteris tics Gas exchange abnormalit ies Clubbing Diagnosis confirmed by spirometry FEV1/FVC ratio 90% during rest, sleep, exertion PaO2 > 60 mm Hg COPD O2 Therapy Long-term O2 improves survival COPD Teaching Pursed Lip Breathing (PLB) Prolongs exhalation and prevents bronchiolar collapse and air trapping Teach patients to use “just enough” positive pressure Diaphragmatic breathing Achieves maximum inhalation Slows RR COPD Nutrition Rest/exercise Supplemental O2 High-calorie, highprotein diet Eat 5-6 small meals to avoid bloating Avoid foods that require a great deal of chewing and gas-forming foods CORONARY ARTERY DISEASE (CAD) Coronary Artery Disease Etiology and Pathophysiology Atherosclerosis major cause of CAD Begins as soft deposits of fat that harden with age Endothelial injury and inflammation play a major role in development Nonmodifiable Risk Factors for CAD Age Gender Ethnicity Family history Genetic predisposition Major Modifiable Risk Factors for CAD Elevated serum lipids Hypertension Inhaled tobacco use Physical inactivity Obesity Nursing Implementation for CAD Physical fitness Smoking cessation Nutrition ASA Gerontologic Consideratio ns CAD Modify guidelines for physical activity Most likely to change lifestyle after being hospitalized or symptomatic Hypertension Case Study C.S. is a 40-year-old male who attends a community health screening. He states that he has not seen a health care provider in a “really long time.” He is a truck driver who eats mainly fast food He smokes a pack of cigarettes a day “just for something to do during the long hours of driving and to keep me calm.” C.S. is 5 ft., 9 in tall and weighs 230 lb. What risks factors for hypertension does C.S. have? HTN Case Study His BP is 182/104, heart rate 90, respirations 24, and temperature 97.0°F HTN Case Study What clinical manifestatio ns of hypertension would you assess for in C.S.? “Silent killer” HTN Clinical Manifestati ons Symptoms of severe hypertension Fatigue Dizziness Palpitations Angina Dyspnea HTN Case Study What complicati ons will you assess C.S. for? Hypertension Complications Target organ diseases occur most frequently in Heart Brain Peripheral vascular disease Kidney Eyes HTN Case Study C.S. is referred to his health care provider to follow up on his high blood pressure screening. What diagnostic studies might you expect the health care provider to order for C.S.? Measurement of BP Urinalysis BUN and creatinine; creatinine clearance Serum electrolytes, glucose Serum lipid profile Uric acid levels ECG; Echocardiogram Hypertensio n Diagnostic Studies C.S.’s BP is monitored for several visits and remains elevated. HTN Case Study His serum cholesterol, BUN, and creatinine levels are elevated. His creatinine clearance (glomerular filtration rate) is below normal, demonstrating renal insufficiency. What type of lifestyle modifications would you recommend for C.S. to control his BP? HTN Case Study What could you do to increase C.S.’s compliance with his medication and lifestyle changes? Individualize plan Active patient participation HTN Nursing Implementation Select affordable drugs Involve caregivers Combination drugs Patient teaching Most common nutritional disorder in the world Iron-Deficiency Anemia Most susceptible Very young Poor diet Women in reproductive years Copyright © 2020 by Elsevier, Inc. All rights reserved. 52 IronDeficiency Anemia Etiology Inadequate dietary intake Normally dietary intake is enough Need more with menstruation, pregnancy Malabsorption Iron absorption occurs in the duodenum Diseases or surgery that alter, destroy, or remove absorption surface of this area of intestine cause anemia 53 Copyright © 2020 by Elsevier, Inc. All rights reserved. IronDeficiency Anemia Etiology Blood loss Major cause of iron deficiency in adults Chronic blood loss most commonly through GI and GU systems Bleeding often not apparent May take time to identify Postmenopausal bleeding, chronic kidney disease, and dialysis may contribute 54 Copyright © 2020 by Elsevier, Inc. All rights reserved. Iron-Deficiency Anemia Clinical Manifestations General manifestations of anemia Pallor is most common Glossitis is second Inflammation of tongue Cheilitis is also found Inflammation of lips Copyright © 2020 by Elsevier, Inc. All rights reserved. 55 IronDeficiency Anemia Diagnostic Studies Laboratory findings Hgb, Hct, MCV, MCH, MCHC, reticulocytes, serum iron, TIBC, bilirubin, platelets Stool occult blood test Endoscopy and colonoscopy Bone marrow biopsy 56 Copyright © 2020 by Elsevier, Inc. All rights reserved. Iron-Deficiency Anemia Interprofession al and Nursing Management Goal Treat underlying problem causing loss, reduced intake or poor absorption of iron Replace iron Nutritional therapy Oral iron supplements Transfusion of packed RBCs Copyright © 2020 by Elsevier, Inc. All rights reserved. 57 Iron-Deficiency Anemia Drug Therapy Oral iron Inexpensive Convenient Factors to consider Enteric-coated or sustainedrelease capsules are counterproductive Daily dose is 150 to 200 mg 58 Iron-Deficiency Anemia Drug Therapy Oral iron Factors to consider Best absorbed in an acidic environment Undiluted liquid iron may stain teeth Should be diluted and drank through a straw Side effects Heartburn, constipation, diarrhea Copyright © 2020 by Elsevier, Inc. All rights reserved. 59 Iron-Deficiency Anemia Drug Therapy Parenteral iron Indicated for malabsorption, oral iron intolerance, need for iron beyond normal limits, poor patient compliance Can be given IM or IV IM may stain skin Z-track 60 Iron-Deficiency Anemia Nursing and Interprofessional Management 1 Reassess Hgb and RBC count to evaluate response to therapy 2 Emphasize adherence to dietary and drug therapy Need to take supplement for 2 to 3 months after Hgb returns to normal Monitor for liver problems with lifelong therapy 61 References Lewis, S. L., Bucher, L., Heitkemper, M., Harding, M. M., Kwong, J., & Roberts, D. (2020). Medical surgical nursing: Assessment and management of clinical problems (10th ed.). St. Louis, MO: Mosby. Taylor, C., Lillis, C., Lynn, P., & LeMone, P. (2019). Fundamentals of nursing: The art and science of personcentered care (8th ed.). Philadelphia, PA: Wolters Kluwer.