Gas Exchange & Oxygenation Nursing Practice PDF

Concept 19 Gas Exchange Concepts for Nursing Practice, 3rd edition Copyright © 2021, Elsevier Inc. All rights reserved. Lesson 19.1 Gas Exchange 1. Define and describe the concept of gas exchange. 2. Notice risk factors for impaired gas exchange. 3. Recognize when an individual has compromise...

Concept 19 Gas Exchange Concepts for Nursing Practice, 3rd edition Copyright © 2021, Elsevier Inc. All rights reserved. Lesson 19.1 Gas Exchange 1. Define and describe the concept of gas exchange. 2. Notice risk factors for impaired gas exchange. 3. Recognize when an individual has compromised gas exchange. 4. Provide appropriate nursing and collaborative interventions to optimize gas exchange. Copyright © 2021, Elsevier Inc. All rights reserved. 2 Define andLoading… Describe the Concept of Gas exchange Copyright © 2021, Elsevier Inc. All rights reserved. 3 Definition • Gas exchange is the process by which oxygen is transported to cells and carbon dioxide is transported from cells. Copyright © 2021, Elsevier Inc. All rights reserved. 4 Scope of Concept • Spectrum of optimal gas exchange to impaired gas exchange Loading… Copyright © 2021, Elsevier Inc. All rights reserved. 5 Copyright © 2021, Elsevier Inc. All rights reserved. 6 Gas Exchange/Oxygenation 3 systems Resp - * , CV , Neuro Hgb * Disease process Can affect proper gas have low baseline Apt's may - exchange -88% While alveoli breakdown the surface aread , &Brain needs x O2 Sugar to work Optimal Ventilation pt Sitting up + - (high Fowlers or a bit less) Cyanosis , lethargic SpOz<951 * Change) In mental Status Pale HR* (Body tryingto compen) ↑ tripod position RR beMord Usually may S/S of Poor gas exchange - , , , , , . , Review of Respiratory System Anatomy and Physiology • Upper and lower airways • Lungs • Alveoli • Capillaries Copyright © 2021, Elsevier Inc. All rights reserved. 7 Copyright © 2021, Elsevier Inc. All rights reserved. 8 Pathyophysiology Norm • Airways and lungs - - 12.20 breath/Min . Color of Pt Rate , pattern effort , • Ventilation • Movement of air into/out of the lungs • Respiration • Exchange of oxygen/carbon dioxide • Alveolar capillary/capillary cell membrane Copyright © 2021, Elsevier Inc. All rights reserved. 9 Factors That Affect Ventilation fast breaths = ↑ CO2 breaths ↓ Oz • Rate • Depth • Lung compliance Aging • Lung elasticity Aging • Airway resistance Underlining disease process shallow = - - - ↓ O2 , Copyright © 2021, Elsevier Inc. All rights reserved. possibly narrowing of lungs 10 Variations and Context (1 of 2) • Impairment of gas exchange occurs when the diffusion of gases (oxygen and carbon dioxide) becomes impaired because of Loading… • Ineffective ventilation • Reduced capacity for gas transportation (reduced hemoglobin and/or red blood cells) • Inadequate perfusion Copyright © 2021, Elsevier Inc. All rights reserved. 11 Variations and Context (2 of 2) Collaborative Learning #2 • In your learning group, discuss ventilation, transport and perfusion. • How they are different? • How they are similar? • In what ways are they dependent on one another? Copyright © 2021, Elsevier Inc. All rights reserved. 12 Consequences • Mild impairment: • Fatigue • Increase in heart and respiratory rates • More severe impairment: • Respiratory acidosis • Prolonged or severe: • Cellular ischemia and necrosis • Death Copyright © 2021, Elsevier Inc. All rights reserved. 13 Recognize Cues: Risk factors for impaired gas exchange Copyright © 2021, Elsevier Inc. All rights reserved. 14 Risk Factors: Populations at Greatest Risk Collaborative Learning #3 • In your learning group, discuss why the following patient groups are considered the populations at greatest risk: • Infants • Children • Older adults Copyright © 2021, Elsevier Inc. All rights reserved. 15 Individual Risk Factors • Age • Smoking • Presence of chronic medical conditions, such as chronic obstructive pulmonary disease (COPD), cystic fibrosis (CF), heart failure (HF) • Immunosuppression • Reduced state of cognition Copyright © 2021, Elsevier Inc. All rights reserved. • Brain injury 16 Recognize when an individual has compromised gas exchange Copyright © 2021, Elsevier Inc. All rights reserved. 17 Assessment • History • Examination • Past medical history • Vital signs • Family history • Inspection • Current medications • Breathing effort • Lifestyle behaviors • Skin color • Occupation • Thorax • Social environment • Problem-based history • Extremities • Auscultation Copyright © 2021, Elsevier Inc. All rights reserved. 18 Copyright © 2021, Elsevier Inc. All rights reserved. 19 Key Terms Collaborative Learning #1 • In your learning group, discuss the meaning of the listed key terms and each one’s link to the concept definition. • Ischemia • Hypoxia • Anoxia • Hypoxemia Copyright © 2021, Elsevier Inc. All rights reserved. 20 Diagnostic Tests • Laboratory tests • Arterial blood gases, complete blood count, sputum, pathologic analysis • Radiologic studies • Chest x-ray, CT and MRI scans, ventilation/perfusion (V/Q) scan, positron emission tomography (PET) scan • Pulmonary function studies • Endoscopy Copyright © 2021, Elsevier Inc. All rights reserved. 21 Copyright © 2021, Elsevier Inc. All rights reserved. 22 Provide appropriate nursing AND collaborative interventions to optimize GAS EXCHANGE Copyright © 2021, Elsevier Inc. All rights reserved. 23 Clinical Management: Primary Prevention • Infection control • Smoking cessation • Immunizations • Preventing postoperative complications Copyright © 2021, Elsevier Inc. All rights reserved. 24 Clinical Management: Secondary Prevention (Screening) • Mantoux skin test • How is it done? • Who should be screened? • How does this screening test link to gas exchange? Copyright © 2021, Elsevier Inc. All rights reserved. 25 Collaborative Interventions • Smoking cessation • Pharmacotherapy • Oxygen therapy • Airway management and breathing support • Chest physiotherapy • Postural drainage Copyright © 2021, Elsevier Inc. All rights reserved. • Invasive procedures 26 Copyright © 2021, Elsevier Inc. All rights reserved. 27 Medical Management & Nursing Actions • Promoting respiratory function • Prevent healthcare-associated pneumonia • Immunizations/prevent upper respiratory infections (UR Is) ’ • Smoking cessation • Positioning: Maximum lung excursion • Incentive spirometry • Aspiration precautions Copyright © 2021, Elsevier Inc. All rights reserved. 28 Medical Management & Nursing Actions • Mobilizing secretions Loading… • Deep breathing and coughing • Hydration • Chest physiotherapy • Oxygen therapy • Cannula • Mask • Transtracheal catheter Copyright © 2021, Elsevier Inc. All rights reserved. 29 Medical Management & Nursing Actions • Using artificial airways • Oropharyngeal • Nasopharyngeal • Endotracheal tubes • Tracheostomy tubes • Artificial airway patency • Suctioning Copyright © 2021, Elsevier Inc. All rights reserved. 30 Priority Patient Education • Signs & Symptoms to report • Use of inhalers/nebulizers • Oxygen therapy & Safety risks • Balancing activity with rest • Avoid infections • Medications for treatment Copyright © 2021, Elsevier Inc. All rights reserved. 31 Interrelated Concepts (1 of 2) • Acid-Base Balance • Perfusion • Anxiety • Mobility • Fatigue • Nutrition Copyright © 2021, Elsevier Inc. All rights reserved. 32 Interrelated Concepts (2 of 2) Collaborative Learning #5 • In your learning group, develop a list of the four most important concepts interrelated to gas exchange. Defend your answers. Compare lists with those of other learning groups. Copyright © 2021, Elsevier Inc. All rights reserved. 33 Featured Exemplars • Asthma • Chronic obstructive pulmonary disease • Lung cancer • Pneumonia • Anemia • Pulmonary emboli Copyright © 2021, Elsevier Inc. All rights reserved. 34