NCMB312 LEC-PRELIM (Week 3) 1.pdf

NCMB312 | Prelim (AY: 2023-2024) Care of the Clients with Problem in Oxygenation, Fluid & Electrolytes Week 3...

NCMB312 | Prelim (AY: 2023-2024) Care of the Clients with Problem in Oxygenation, Fluid & Electrolytes Week 3 decrease in oxygen, so therefore, the oxygenated DISTURBANCES IN OXYGEN EXCHANGE AND UTILIZATION: blood will go back to the heart, to the left atrium and left OBSTRUCTIVE LUNG DISORDERS ventricle for systemic circulation. Now, perfusion is the Anatomy & Physiology delivery of the oxygenated blood to the tissues and Lungs different organs of the body. The respiratory system is composed of UPPER & LOWER RESPIRATORY » Responsible for the exchange of gases in and out of TRACTS, both is responsible for ventilation. the body Your upper respiratory structures consists of nose, » Right: 3 lobes which serve as passage way for air to passthrough and » Left 2 lobes from the lungs. Your sinuses and nasal passages, One of the predictors of which serve as the resonating or echoing chamber in clinical deterioration in speech. These are your frontal, ethmoid, sphenoid and hospitalized patient are maxillary, which are (the sinuses) the common site of the alterations in infection. respiratory status. It is Next, your pharynx or what we call THROAT, it is a important for us, nurse, tube-like structure that connects the nasal and oral that we need to have an cavities to the larynx which is divided into three majors, expert assessment skills nasal, oral and laryngeal which serves as the must be developed and passageway for the respiratory and digestive tracts used in order to provide TAKE NOTE: Your pharynx serves as the passageway the best care for patients for respiratory and digestive tract. Your tonsil and with acute and chronic adenoids and other lymphatic tissues, encircles the respiratory problems. throat, these structures are important things in the And to better understand these respiratory problems, chain of lymph nodes, which guards the body from understanding of the system is very essential. invasion of foreign bodies or organisms coming from The lungs appear elastic structure enclosed in thoracic the nose and the throat. cage which is an airtight chamber with distensible Larynx is called as a voice box, this is a voice box walls. Each lung is divided into two lobes. The right which is a cartilaginous epithelium-lined organ that lung has 3 lobes – the upper, middle, and lower lobes, connects pharynx and trachea and consist of; epiglottis whereas the left lung consists of 2 lobes – the upper and glottis, thyroid cartilages, cricoid cartilage, and lower lobes). Your lungs is responsible for the arytenoid cartilage and vocal cords and the trachea. exchange of gases in and out of the body, so what is Epiglottis covers the opening to the larynx during that gas exchange, that is involved in delivering oxygen swallowing. through the tissues through the blood stream. It also Glottis is the opening between the vocal cords in involves in expelling waste gases – ito yung carbon the larynx dioxide during expiration, therefore, the respiratory Thyroid cartilage is called the Adam’s apple. system depends on cardiovascular system for Vocal cords: ligaments controlled by muscular perfusion or depends on coronary system or bloodflow movements that produce sounds; located in the lumen of through the pulmonary system. the larynx. Although the major function of the larynx is There is also a dead space – it is a space in the lungs vocalization, it also protects the lower airway from foreign where no exchange of gases is happening. It is substances and facilitates coughing; it is, therefore, important to know, important to determine that this sometimes referred to as the “watchdog of the lungs” dead spaces increases if there is respiratory problems. (Norris, 2019). Also take note that the respiratory systems works Trachea serves as the passage between the together with the cardiovascular system through the Larynx and both the right and left main stem bronchi, which process of perfusion. The respiratory system is enter the lungs through an opening called the hilus. responsible for ventilation and diffusion. Take note: The lower respiratory tract consists of the lungs, which The respiratory is also responsible for ventilation contain the bronchial and alveolar structures needed for and perfusion. gas exchange. Ventilation is a movement of air in and out of the The Bronchi and Bronchioles which are both in airways, whereas the DIFFUSION is a movement of the lobe of the lungs. The respiratory bronchioles will then substance from an area of higher concentration to lead to the alveolar ducts and sucks and then the alveoli lower concentration where in the O2 and CO2 wherein, in the alveoli itself the O2 and CO2 exchange exchange. Take note: Your venous blood or your takes place. venous circulation wherein carrying deoxygenated blood toward the pulmonary circulation and your arterial blood or the arterial circulation carrying oxygenated blood towards the systemic circulation. So paano nangyayari yung diffusion, this happens when there is a higher to lower concentration. One of the example of this is GAS EXCHANGE, wherein the venous blood/deoxygenated blood from a high and CO2, CO2 to lungs for lungs to expel out of the body. Whereas the alveoli which is carrying oxygen or full of oxygen in the blood, will reoxygenate the blood. The hemoglobin will Page 15 of 24 NCMB312 LEC: Mr. Ceasar Ordanza JR, RN, MSN-Teacher Document by: @ranzscmllas  NCMB312 | Prelim (AY: 2023-2024) Care of the Clients with Problem in Oxygenation, Fluid & Electrolytes To help determine respiratory conditions, Assessment A decrease may be found said to be a neuromuscular and diagnostic test are anticipated. diseases, may generalized fatigue, atelectasis, pulmonary Assessment and Diagnostics edema or COPD and obesity. Pulmonary Function Test INSPIRATORY CAPACITY is the maximum volume of air inhaled after normal expiration. So it is equal to the Measure lung volumes, ventilator function, and total volume (TV) + inspiratory Reserve volume (IRV) = mechanics of breathing, diffusion, and gas 3,500 mL. If decrease may indicate restrictive disease as exchange well as obesity AKA as PFT – routinely used in patients with chronic FUNCTIONAL RESIDUA CAPACITY is the volume respiratory disorders. They are performed to assess of air remaining in the lungs after a normal expiration, it is respiratory function and to determine the extent of equals to Expiratory Reserve Volume (ERV) + Residual dysfunction. The measurement of the PFT, this could be Volume (RV) = Total Normal value of 2,300mL, if increased your mechanic of breathing. This is viewed in term of lung- may indicate patient having COPD, if decreased the client volume and lung capacities. Your lung volume categories may indicate (ARDS) Acutes Respiratory Distress are your tidal volume(TV), your inspiratory reserve Syndrome or obesity. volume(IRV), expiratory reserve volume (ERV) and residual TOTAL LUNG CAPACITY is a volume of air in the volume(RB. The PFT also measures ventilator function or lungs after maximum inspiration, equals to total volume ventilatory function, on how they inspired air should be (TV) + IRV + ERV + RV = Total Value of 5,800mL. Once carried to the gas exchanging areas of the lungs through decrease, may indicate a presence of destructive diseases the bronchioles, also PFT measures diffusion in the lungs, such as Atelectasis and Pneumonia. If increase, the patient measure how the oxygen passes into the blood from the may have COPD. lungs, and ofcourse the gas exchange. If a patient is diagnosed with respiratory distressed, PFT is continually Sputum Analysis/Culture used and is useful in a course of treatmet in able to evaluate the response of patient to therapy. Checks the causative agent for infectious lung disease Arterial Blood Gas Analysis STERILE container is used for culture Identify pathogenic organisms or presence of infections, Check respiratory function in terms of oxygenating and to determine whether malignant cells are present. Also the blood and maintaining acid-base balance. assess hypersensitivity state or if there is any reactions of ABG Studies - assessing the ability of the lungs to provide allergic because of increase eosinophils, remember that adequate oxygen and remove carbon dioxide, which eosinophil is type of WBC, mataas po ang eosinophil if reflects ventilation, and the ability of the kidneys to reabsorb there is allergic reaction. Periodic sputum examinations or excrete bicarbonate ions to maintain normal body pH, may be necessary for patients receiving antibiotics, which reflects metabolic states of our body to maintaining corticosteroids, and immunosuppressive medications for acid-base balance. ABG levels are obtained through an prolonged periods therefore patients who are taking arterial puncture at the radial, brachial, or femoral artery or immunosuppressive medications has decreased immune through an indwelling arterial catheter. Pain (related to system, therefore, at risk in developing infectionsbecause nerve injury or noxious stimulation), infection, hematoma, theire immune system is decreased and sputum analysis and hemorrhage are potential complications that may be can detect such infections. associated with obtaining ABGs, that’s the reason why that Sputum samples ideally are obtained early in the morning we apply pressure to the puncture to relieve some before the patient has had anything to eat or drink, because complications. the client can cough out the sputum accumulated overnight. Mechanics of breathing; viewed in terms of lung volume The patient is instructed to clear the nose and the throat and lung capacities, the lung volume is categorized as tidal and rinse the mouth with clean water (mumog lang not volume. TIDAL VOUME is the amount of air inhaled and toothbrush) to decrease contamination of the sputum and exhaled with each breath, normal value: 500mL. not to simply spit saliva into the container, saliva should not INSPIRATORY RESERVED VOLUME, this is the maximum be collected. Rather, after taking a few deep breaths, the volume of air that can be inhaled after a normal inhalation, patient coughs deeply and expectorates sputum from the normal value: 3,000mL. lungs into a sterile container. You’re going to give EXPIRATORY RESERVED VOLUME, the maximum instructions to the patient to inhale 3 breathing the 1st and volume of air that can be exhaled possibly after a normal 2nd one is a normal inhale-exhale breathing, but at the 3rd exhalation. The normal value is 1,100mL. This decrease if part instruct the client to exert effort in order to collect good there is a restrictive condition, example, obesity, ascites and sputum sample. pungency. If the patient cannot expel an adequate sputum sample RESIDUAL VOLUME, amount of air remaining in the lungs following the above techniques, it should be refer to a MD, after maximum inhalation, may natitira pang volume of air coughing can be induced by administering an aerosolized sa atng baga. The normal value could be 1,200mL. It is only hypertonic solution via a nebulizer, which is the ).9 Sodium increase if there is a presence of obstructive diseases. Chloride – the isotonic solution, in order to aerosolize the Your Lung capacities is evaluated in terms of vital capacity, sputum; imomoist po niya ang ating sputum and also to that is a maximum of volume of air exhaled from the point of induced coughing. Other methods of collecting sputum maximal inspiration. Your vital capacities (VC) is equal to specimens include endotracheal (Suctioning) or the tidal volume + inspiratory reserve volu + Expiratory transtracheal aspiration or bronchoscopic removal; once reserve volume, normal value of 4,600 mL. sputum is obtained, the nurse should label the specimen VC = TV + IRV + ERV + RV Page 16 of 24 NCMB312 LEC: Mr. Ceasar Ordanza JR, RN, MSN-Teacher Document by: @ranzscmllas  NCMB312 | Prelim (AY: 2023-2024) Care of the Clients with Problem in Oxygenation, Fluid & Electrolytes and send it to the laboratory as soon as possible to avoid structures orally. Bronchoscopy permits the clinician to not contamination. only diagnose but also treat various lung problems. Bronchoscopy Bronchoscopy perform in either 2 approaches; Diagnostic DIAGNOSTIC and Therapeutic Approach. In DIAGNOSTIC o Examine tissues and secretions collected BRONCHOSCOPY; used to examine issue and secretion, o Determine location and extent of because bronchoscopes are equipped with bunch biopsy pathologic process instrument which enable to bulk enough tissues for o Determine if a tumor can be resected examination. Also to determine location and extent o Diagnose bleeding sites pathologic process. And also to determine whether the THERAPEUTIC tumor can be resected through surgical resection, also o Remove foreign bodies tracheobronchial Diagnostic Bronchoscopy is used to diagnose bleeding tree sites to find the source of hemoptysis. o Remove secretions from tracheobronchial THERAPEUTIC THERAPY; removal of foreign body from tree when a patient cannot clear dent the tracheobronchial tree or may nalunok na piso si patien expectoration also destroy an excise which can obstruct the airway, we can use this one. lesion that is present within the tissues of Ano-ano yung possible complications of bronchoscopy, the airway. Sent to the lab for diagnostic which include reaction to local anesthetic, wherein there is evaluation an introduction of lidocaine spray to prevent the gag reflex. o Treat post-op atelectasis because patient Infection is one of the complication as well, because you who undergo a general anesthesia may intrude the bacteria to through into the airway (pharynx). cause alveoli to deflate, mababa po yan, Common complication as well is you aspiration, where in magdedeflate po ang mga alveolus, there there is risk of vomiting and accumulation of secretions will be a collapse as one of its risk. during the procedure. As well as bronchospasm, wherein § Atelectasis may result to the the airway because spastic, narrowed as a complication of production of secretion and may bronchoscopy. Possible complication also is the hypoxemia, accumulate within the bronchial, where there is low blood oxygen level. A procedure where therefore, if there is unsuccessful involved an introduction of scope into the airway which suctioning, bronchoscopy may causes decrease oxygen supply to the lungs. Next perform to removed those complication will be the pneumothorax, there will be a secretions. presence of air inside the lungs, and the last complication o Excise lesions would be the bleeding and perforation of tissues, because Bronchoscopy is the direct inspection and examination of the of the trauma when the scope is introduced because they larynx, trachea, and bronchi through either a flexible utilized rigid bronchoscope in particular. What is the fiberoptic bronchoscope or a rigid bronchoscope. The NURSING CONSIDERATION? Obtain consent to an adult fiberoptic scope is used more frequently in current practice. that the adult patient would sign the consent, if it is pediatric, the parents will sign the consent. Before the procedure, the nurse should verify that informed consent has been obtained. Food and fluids are withheld for 4 to 8 hours before the test to reduce the risk of aspiration when the cough reflex is blocked by anesthesia. The patient must remove dentures and other oral prostheses. The nurse explains the procedure to the patient to reduce fear and decrease anxiety and then administers preoperative medications (usually atropine and a sedative or opioid) as prescribed to inhibit vagal stimulation (thereby guarding against bradycardia, arrhythmias, and hypotension), [nursing consideration, give a lidocaine to] suppress the cough reflex, sedate the patient, and relieve anxiety. Then therefore, advise the client NPO until gag reflex return, kailangan po wala munang kain, wala munang inom until such time po babalik ang gag reflex ng pasyente, otherwise the patient is at risk of aspiration. Pulse Oximeter Pulse oximetry, or SpO2, is a noninvasive method of continuously monitoring the oxygen saturation of hemoglobin (SaO2). Although pulse oximetry does not replace blood gas analysis, it is an effective tool to monitor for changes in SaO2 and can easily be used in the home and various health care settings. So how does this device read the oxygen saturation in the Endoscopic bronchoscopy permits visualization of bronchial body? There is a censor. A probe or sensor is attached to structures. The bronchoscope is advanced into bronchial the fingertip, forehead, earlobe, or bridge of the nose. The Page 17 of 24 NCMB312 LEC: Mr. Ceasar Ordanza JR, RN, MSN-Teacher Document by: @ranzscmllas  NCMB312 | Prelim (AY: 2023-2024) Care of the Clients with Problem in Oxygenation, Fluid & Electrolytes sensor detects changes in monoxide against oxygen, ibig sabihin, oxygen saturation levels by your pulse oximeter cannot determine a monitoring light signals body with an increase carbon monoxide generated by the oximeter because it only detect oxygen or O2Sat, and reflected by blood therefore immediate test is applicable, sa pulsing through the tissue at mga ganun po, ABG testing should be the probe. Normal SpO2 applicable, if the pt. has dark skin or values are more than 95%. wearing nail polish, which will serve as a Values less than 90% barrier in detecting light signal emmited by indicate that the tissues are the LED, kailangan hindi po natin ilalagay not receiving enough oxygen, directly yung probe. in which case further SPO2Saturation value obtain by pulse evaluation is oximetry by unreliable with patient with cardiac needed. arrest, shoch and other state of low perfusion Advantages of (mababa po ang kanilang blood flow through pulse oximetry the tissues such as the sepsis, peripheral include the ability vascular disease, hypothermia and with to obtain rapid vasoconstriction medication as well) In this results and case, ABG Testing is suggested, pag mataas continuous data na ang amount ng Carbon monoxide, using a bumababa na ang hemoglobin, better perform noninvasive ABG. technique. NORMAL O2 SAT: Limitations of o 95-100% pulse oximetry o