Nursing Care of the client with Alteration in Oxygenation PDF

Nursing Care of the client with: Alteration in Oxygenation Developed by J. Keane & T. Abraham Edited and Presented by Kim Stiles, PhD, RN, CNE, AHN-BC Pop Quiz 1. True or False: The left lung has three lobes and the right lung has two lobes. 2. ______________ delivers unoxygenated blood to the lungs...

Nursing Care of the client with: Alteration in Oxygenation Developed by J. Keane & T. Abraham Edited and Presented by Kim Stiles, PhD, RN, CNE, AHN-BC Pop Quiz 1. True or False: The left lung has three lobes and the right lung has two lobes. 2. ______________ delivers unoxygenated blood to the lungs.* 3. Gas exchange in the lungs occurs in the? 2 Another interesting fact: Did you know that breathing is the only natural Process in our body that we have some “easy” conscious control over? Try this out: Ask you heart to stop beating for 30 seconds. Now hold your breath for 15 seconds… Tell your kidneys to take an hour off from making urine. Yeah, right…. Now take a deep breath, and be grateful you can! Any Nursing Implications here? 3 O2 Journey https://www.youtube.com/watch? v=GVU_zANtroE 4 Why do we breath? Primary purpose is gas exchange The cardiac and respiratory systems supply the oxygen demands of the body. The exchange of respiratory gases occurs between the environment and the blood. Respiration is the exchange of oxygen and carbon dioxide during cellular metabolism 5 Steps in Oxygenation Ventilation Perfusion Diffusion The process of moving gases into and out of the lungs The ability of the cardiovascular system to pump oxygenated blood to the tissues and return deoxygenated blood to the lungs Exchange of respiratory gases in the alveoli and capillaries Pulmonary Anatomy 7 Ventilation, Perfusion, Diffusion Impairment Examples Ventilation Perfusion Ventilation Diffusion Anemia: low RBCs https://www.pinterest.com/pin/274015958560617337/ 8 Structures and Functions of Respiratory System Respiratory Defense Mechanisms – Filtration of air – Mucociliary clearance system – Cough reflex – Reflex bronchoconstriction – Alveolar macrophages Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Neural and Chemical Regulators of Breathing https://www.google.com/search? q=chemoreceptors+involved+in+respiration &biw=1525&bih=729&source=lnms&tbm= isch&sa=X&ved=0CAYQ_AUoAWoVChM Iz-e_ubUyAIVAkiICh1LAA03&dpr=0.9#imgrc= Qk_RFkCrVO6GHM%3A https://www.google.com/search? q=chemical+sensors+to+breath&biw=1280&bih=887&source=lnms&tbm=isch&sa=X&ved=0CAcQ_AUo AmoVChMIv42PpuHiyAIVA6eICh1YrwZD#tbm=isch&q=chemical+sensors+aortic+arch&imgrc=jjcvlc2j 10 swTeBM%3A Nursing Knowledge Base Factors influencing oxygenation: 1) Physiological 2) Developmental 3) Lifestyle 4) Environmental Factors Affecting Oxygenation 1) Physiological factors – Decreased oxygen-carrying capacity – Hypovolemia – Decreased inspired oxygen concentration – Increased metabolic rate Conditions affecting chest wall movement – Pregnancy, obesity, neuromuscular disease, musculoskeletal abnormalities, trauma, CNS alterations Influences of chronic diseases 2. Developmental Factors Older Adults: see Lewis, Table 25.2 13 3. Lifestyle Factors Nutrition Cardioprotective nutrition = Diets rich in fiber; whole grains; fresh fruits and vegetables; nuts; antioxidants; lean meats; and omega-3 fatty acids. Exercise People who exercise for 30 to 60 minutes daily have a lower pulse rate and blood pressure, decreased cholesterol level, increased blood flow, and greater oxygen extraction by working muscles. Lifestyle Risk Factors continued Smoking – Associated with heart disease, COPD, and lung cancer – The risk of lung cancer is 10 times greater for a person who smokes than for a nonsmoker. Substance abuse – Excessive use of alcohol and other drugs impairs tissue oxygenation. Stress – A continuous state of stress or severe anxiety increases the metabolic rate and oxygen demand of the body. = vaping&biw=1708&bih=816&source=lnms&tbm=isch&sa=X&ved=0CAkQ_AUoBGoVChMIrOP0qYzbyAIVAvZjCh0TJAJv&dpr=0.8 4. Environmental Factors The incidence of pulmonary disease is higher in smoggy, urban areas than in rural areas. A patient’s workplace sometimes increases the risk for pulmonary disease. – Coccidioidomycosis- known as valley fever, fungus – Asbestosis – Pneumoconiosis (CWP), commonly known as black lung disease Assessment In-depth history of a patient’s normal and present cardiopulmonary function Past impairments in circulatory or respiratory functioning Methods that a patient uses to optimize oxygenation Review of drug, food, and other allergies Physical examination Laboratory and diagnostic tests Assessment Excursion Percussion Tactile fremitus 18 Normal percussion findings 19 Case Study Chronic Cough Evaluation Subjective Data Has had a dry, hacking cough intermittently for the past 2 or 3 months Not taking any medications Patient Profile C.G. is a 38-year-old male who comes to the health care provider with a “cough that won’t go away.” Objective Data Physical Examination Blood pressure 134/76, pulse 88, temperature 98.4°F, respirations 24 Oxygen saturation 97% on room air Height 5'11", weight 190 lb 20 Case Study Describe the questions you would ask C.G. to specifically evaluate his cough. 21 Why ask about a cough? The reason for the physical and history taking is to find clues as to the cause of the cough: Pathophysiology such as COPD may cause a clear, whitish, or slightly yellow sputum, especially in the morning. Foul odor in the sputum of breath or an increase in temperature with thicker sputum may indicate pneumonia. Blood in the sputum may indicate pneumonia, tuberculosis, lung cancer. 22 Assessment What additional health history information would you obtain from C.G.? What are common causes of a chronic cough? 23 Case Study: Mr. King Assessment- Chart review. Pt admitted yesterday with medical diagnosis of right lower lobe pneumonia What information to do you want to obtain from the chart? What questions do you want to ask? What position should this pt be in? https://www.google.com/search? q=right+lower+lobe+pneumonia&biw=1708&bih=816&source=l nms&tbm=isch&sa=X&ved=0CAYQ_AUoAWoVChMI3sCqp5T byAIVF-djCh1dnAIe&dpr=0.8 24 Quick Survey Observe the patient’s breathing pattern – Rate (normal vs. increased/decreased) – Depth (shallow vs. deep) – Effort (any sign of accessory muscle use, inspect neck) Assess the patient’s color – cyanosis https://www.google.com/search? q=finger+clubbing&biw=1708&bih=816&source=lnms&t bm=isch&sa=X&ved=0CAYQ_AUoAWoVChMI2In7kp3 byAIVUKKICh2nQ0W&dpr=0.8#imgrc=RkSRWauTn7jiNM%3A https://www.google.com/search? q=right+lower+lobe+pneumonia&biw=1708&bih=816&source=lnms&tbm=isch&sa= X&ved=0CAYQ_AUoAWoVChMI3sCqp5TbyAIVFdjCh1dnAIe&dpr=0.8#tbm=isch&q=barrel+chest&imgrc=VIMlC4KeSOu6_M%3A Possible breathing patterns Tachypnea: rapid shallow breathing >24/min Bradypnea: slow regular breathing