Lecture of Oxygenation PDF

LECTURE OF OXYGENATION Upper Respiratory System Function: warms, filters, humidified inspired air Composed Of: - Nose - Pharynx - Larynx - Epiglottis Lower Respiratory System Function: conduction of air, mucociliary clearance, production of surfactant Composed Of: - Trachea...

LECTURE OF OXYGENATION Upper Respiratory System Function: warms, filters, humidified inspired air Composed Of: - Nose - Pharynx - Larynx - Epiglottis Lower Respiratory System Function: conduction of air, mucociliary clearance, production of surfactant Composed Of: - Trachea - Right & Left Bronchi - Terminal Bronchiole Anatomy of the Lungs - The organs of respiration - The right lung has 3 lobes; The left lung has 2 lobes - Are composed of elastic tissue - Alveoli: (small air sacs where gas exchange occurs) - Surfactant: (reduces the surface tension between alveoli, preventing collapsing) - Pleura: serous membrane lining in the lungs (Visceral) & thoracic cavity (Parietal) The Cardiovascular System Composed Of: - Heart - Blood Vessels The heart is a muscle divided into 4 chambers (2 Atria & 2 Ventricle) - The atria receive blood from the veins - The ventricles force blood through the arteries Physiology of the Respiratory & Cardiovascular System - Pulmonary Ventilation: is the movement of air in & out of lungs (during inspiration or (active phase of ventilation), the diaphragm moves down, while expiration or (passive phase of ventilation) the diaphragm moves up - Respiration (gas exchange): involves gas exchange between the atmospheric air in alveoli & the blood in the capillaries (intake of oxygen & release of carbon dioxide) - Perfusion: is the process by which oxygenated capillary blood passes through body tissue (how much & how often gas are exchanged depends on amount of blood a person has) carried by plasma & RBCs Required for Normal functioning of the Respiratory System 1. Ability to transport air to & from the lungs 2. Properly functioning of the Alveolar system - oxygenate venous blood - removes carbon dioxide 3. Properly functioning of Cardiovascular & Hematologic system - carries nutrients & waste to & from body cells Alterations in Respiratory Function 1. Hypoxia: inadequate amount of oxygen available to cells S&S - Cyanosis, Tachycardia, Elevated Blood Pressure, Restlessness, Dyspnea, Pallor, Confusion, Increased respiratory rate  2. Dyspnea: difficulty breathing 3. Hypoventilation: decreased rate or depth of air movement into the lungs Factors Affecting Oxygenation - Level of Health - Developmental - Lifestyle - Meds - Environment - Psychological Health Respiratory Factors - Lung Compliance - Strength of Surrounding Muscles - Thickening of Alveolar-Capillary membrane - Decreased Cardiac Output - Decrease in RBC - Use of accessory muscles Factors Affecting Oxygenation in Older Adult - Tissue and airways become less elastic - Power of muscles is reduced - Diaphragm movies less efficiently - Chest is unable to stretch as much - Airways collapse more easily - Decreased Activity Applying the Nursing Process 1. Assessment includes health history, physical examination, diagnostics & labs - Health History includes medications, lifestyle, ADLs, usual patterns of respiration, fatigue, recent changes Assessment Considerations for the Elderly Patient - Bony landmarks are more pronounced - Kyphosis contributes to learning forward - Tissues & airways are less elastic Physical Examination: Inspection, Auscultation, Palpation, Percussion Inspection - General Appearance - Level of Consciousness - Orientation  - Skin - Mucous membranes Auscultation Normal Breath Sounds Vesicular - Low pitched - Soft sound during expiration - Heard over most of the lungs Bronchial - High pitched - Heard over the trachea Bronchovesicular - Medium pitched during expiration - Heard over the upper anterior chest - Intercostal area Adventitious Lung Sounds Crackles - Intermittent - Occurs when air moves through airways - That contain fluid - Fine, medium, or coarse Wheezes - Continuous - Mainly heard on expiration - Air passes through airways constricted by swelling, secretions, or tumors - Sibilant or Sonorous Palpitation - Skin temperature & color - Masses, edema, or tenderness - Presence of vibrations - Capirafillay refill Diagnostic & Lab - Spirometry: measures ventilation, the movement of air in and out of lungs - Pulse Oximetry: noninvasive technique that measures the peripheral arterial oxyhemoglobin saturation of arterial blood - Arterial Blood Gas (ABG): measurement of Blood pH and arterial gases to evaluate acid-base & oxygenation status - Sputum Collection:  - ECG Electrocardiogram: electrodes attached to the skin can detect these electric currents and transmits them to an instrument that produces a record - IS: - Thoracentesis: removal of fluid from pleural space - PFT (Pulmonary Function Test) 1. Tidal Volume (TV): amount of air inhaled & exhaled during normal breathing 2. Vital Capacity (VC): maximum amount of air that can forcibly be exhaled after maximum inhalation 3. Forced Vital Capacity (FVC): amount if air that can forcibly be exhaled after taking a deep breath 4. Forced Expiratory Volume (FEV): the volume of air that is exchanged during forced breath marked at 1 and 6 seconds intervals 5. Total Lung Capacity (TLC): maximum volume to which the lungs can be expanded with the greatest effort 6. Residual Volume (RV): amount of air left in the lung after a full exhalation 7. Peak Expiratory Flow Rate (PERF): measurement of the maximum speed Nursing Diagnoses - Ineffective airway clearance - Ineffective breathing pattern - Impaired gas exchange - Decreased cardiac output - Ineffective tissue perfusion Expected Outcomes The patient will: - Demonstrate improved gas exchanged in lungs as evidenced by absence of cyanosis or chest pain and a pulse oximetry reading > 95% - Relate the causative factors & demonstrate adaptive method of coping - Preserve pulmonary function by maintaining an optimal level of activity - Demonstrate self-care behaviors that provide relief from symptoms and prevent further problems Nursing Interventions for Oxygenation - Promote optimal function - Promote comfort - Meet oxygenation needs with medications - Provide supplemental oxygen Evaluation - Did the patient have improved gas exchange? - Did their pulse oximetry stay above 95%?  - Are they able to perform ADLs? - What else did you want them to achieve? If goal not met, revision of interventions. Oxygen Modalities Nasal Cannula (nasal prongs) - low flow concentrations of O2 - deliver low flow oxygen at 1-6 L/min - deliver high flow oxygen at 10-15 L/min - high flow maximum 60 L/min - can use while eating & performing ADLs - more than 4L can cause drying, dry mucosa, can be dislodge easily Simple Mask - used when increase delivery of oxygen is needed for a short period - delivers low flow oxygen at 5-8 L/min - vents on both sides to allow room air in and CO2 to escape - eating & talking is difficult, anything less than 5 L/min, can cause risk of CO2 retention Non-Rebreather Mask - highest concentration through a mask - delivers low flow oxygen at 10-15 L/min - two one way valves prevent patient from breathing exhaled air - malfunction can cause CO2 buildup Venturi Mask - Most accurate way of delivering O2 via a mask - delivers high flow oxygen at 4-12 L/min - mask with color coded valves - exhaled gas exits through port on valves - valves determine required oxygen to match flow rate - Line, clothing or a pt rolling on the mask can cause oxygen to be delivered at a unsafe concentration (too high or too low) High Flow Oxygen/Positive Airway Pressure 1. Continuous Positive Airway Pressure (CPAP)- provides continuous mild air pressure to keep airways open, it is on one level and works during entire breath & decreases effort needed 2. Bi-Level Positive Airway Pressure (BiPAP)- provides changing levels of air pressure as pt breath in & out, it is on 2 levels and more pressure on inspiration Precautions for Oxygen Administration  - Avoid opens flames - No smoking signs should be placed - Make sure electrical equipment is working - Avoid wearing synthetic fabrics - Avoid using oils in the area Increase Cardiac Output & Tissue Perfusion - manage fluid balance - activity restrictions - assistance with ADL - positioning - administer medications Inhaled Medications - Bronchodilators: dilate the bronchi & bronchioles, decreasing resistance in the airways and increasing airflow to the lungs - Mucolytic Agents: break up & thin mucus & to make it easier to clear from the airways - Corticosteroids: reduce inflammation in the lungs Inhaled Medications Delivery Device - Nebulizer: disperses fine particles of liquid medication into the deeper respiratory tract, stays where absorption occurs - Metered Dose Inhaler (MDI): delivers a controlled dose of medication with each compression of the inhaler, must shake canister & hold upright, may need a spacer, activate canister while inhaling - Dry Powder Inhaler (DPI): breath activated delivery medication, metered dose=measured dose; if its corticosteroids make sure patient rinse with water Cough Medications - Cough Suppressants: used fon nonproductive cough without congestion - Expectorants: facilitates the removal of respiratory tract secretions, pt must congested - Lozenges: relieved mild, non productive cough without congestion Promote Airway Clearance - monitor environmental & lifestyle conditions - introduces artificial airways - suction the airway - teach controlled breathing exercises  - introduce chest drainage systems - chest physiotherapy Facts - patients can help keep their secretions thin by drinking at least 1.5 to 2 L of fluids daily - turning to the prone position on a regular basis promotes improved oxygenation - deep-breathing exercises can be used to overcome hypoventilation. instruct the patient to make each breath deep enough to move the bottom ribs. - an incentive spirometer assists the patient to breathe slowly and deeply and to sustain maximal inspiration - patients who experience dyspnea and feelings of panic can often reduce these symptoms by using pursed-lip breathing. Exhaling through pursed lips creates a smaller opening for air movement, effectively slowing and prolonging expiration. prevent the collapse of small airways - use of diaphragmatic breathing can help to slow down the person’s breathing and help them “catch their breath - diaphragmatic breathing (belly breathing) helps patients to calm down, better control their breathing, and use less energy to breathe. To do this, the patient should sit upright in a comfortable chair or lie on their back on a flat surface or in bed, with the knees bent and a pillow under the knees to support their legs. - the respiratory secretion expelled by coughing or clearing the throat is called sputum.