Care Of Clients With Problems In Oxygenation (St. Anthony's College)

ST. ANTHONY’S COLLEGE Nursing Department San Jose, Antique CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION (Part 1/1) CZERWIN S. JUALES,DPA,MAN,RN,CHA Course Instructor Oxygenation RESPIRATORY SYSTEM  PROCESS OF BREATHING Inspiration Air flows...

ST. ANTHONY’S COLLEGE Nursing Department San Jose, Antique CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION (Part 1/1) CZERWIN S. JUALES,DPA,MAN,RN,CHA Course Instructor Oxygenation RESPIRATORY SYSTEM  PROCESS OF BREATHING Inspiration Air flows into lungs Expiration Air flows out of lungs  NORMAL OXYGENATION PROCESS Cardiovascular:  NORMAL OXYGENATION PROCESS Systemic: NORMAL OXYGENATION PROCESS  INSPIRATION Diaphragm and intercostal muscles contract Thoracic cavity size increases Volume of lungs increases Intrapulmonary pressure decreases Air rushes into the lungs to equalize pressure  EXPIRATION Diaphragm and intercostal muscles relax Lung volume decreases Intrapulmonary pressure rises Air is expelled  GAS EXCHANGE Occurs after the alveoli are ventilated Pressure differences (gradient) on each side of the respiratory membranes affect diffusion Alveoli: PO2 100mmHg PCO2 40mmHg Venous blood: PO2 60mmHg PCO2 45mmHg O2 diffusion from alveoli →pulmonary blood vessels CO2 diffusion from pulmonary blood vessels → alveoli  ADEQUATE O2 BALANCE Maintenance of adequate O2 balance Gas Exchange  OXYGEN TRANSPORT Transported from the lungs to the tissues 97% of O2 combines with RBC Hgb → oxyhemoglobin carried to tissues Remaining O2 is dissolved and transported in plasma and cells (PO2)  NORMAL OXYGENATION PROCESS Cell environment / O2 carrying capacity: O2 Carrying capacity of blood is expressed by: Red blood cells (#) Hematocrit % of blood that is RBCs Men 40-54% Women 37-50% Hemoglobin  CARBON DIOXIDE TRANSPORT Must be transported from tissues → lungs Continually produced in the process of cell metabolism - 65% – carried inside RBCs as bicarbonate (HCO3 ) 30% – combines with Hgb → carbhemoglobin 5% – transported in plasma as carbonic acid (H2CO3)  FACTORS THAT INFLUENCE RESPIRATORY FUNCTION Age Environment Lifestyle Health status Medications Stress  COMMON MANIFESTATIONS OF IMPAIRED RESPIRATORY FUNCTION Hypoxia Altered breathing patterns Obstructed or partially obstructed airway  HYPOXIA Condition of insufficient oxygen anywhere in the body Rapid pulse Rapid, shallow respirations and dyspnea Increased restlessness or lightheadedness Flaring of nares Substernal or intercostal retractions Cyanosis  ABNORMAL RESPIRATORY PATTERNS Tachypnea (rapid rate) Bradypnea (abnormally slow rate) Apnea (cessation of breathing) Kussmaul’s breathing Cheyne-Stokes respirations Biot’s respirations  ALTERATIONS IN EASE OF BREATHING Orthopnea Dyspnea  OBSTRUCTED OR PARTIALLY OBSTRUCTED AIRWAY Partial obstruction low-pitched snoring during inhalation Complete obstruction extreme inspiratory effort with no chest movement  ADEQUATE O2 BALANCE Example of Obstructive Disease: Asthma  ADEQUATE O2 BALANCE Example of Restrictive Disease: Hemothorax  INADEQUATE O2 BALANCE Behaviors of Negative O2 balance Hypoventilation or hyperventilation Stridor, audible sounds with respiration, wheezing, coughing Hypoxia Change in mental status Change vital signs Cyanosis Decrease in GI motility Change in renal function Hypercapnia  NURSING RESPONSIBILITIES Determine adequacy of cardiopulmonary function: Nursing assessment HEART Respiratory assessment PMH LIFESTYLE  HEART Have client describe specific location, onset and duration of the problem Explore associated signs and symptoms Ask - activities that worsen or ease the problem Rate the severity of discomfort or incapacity Talk - treatments or interventions used to alleviate the problem and their effectiveness  HEART PROBLEMS Artheroscleosis = Coronary Artery Disease (CAD)  NURSING MEASURES TO PROMOTE RESPIRATORY FUNCTION Ensure a patent airway Positioning Encourage deep breathing, coughing Ensure adequate hydration  NURSING RESPONSIBILITIES Physical Assessment: Lung auscultation and breathing pattern Abdominal assessment Urine output Skin and mucous membranes Heart sounds Circulation Edema DVT  LUNG SOUNDS Diminished or absent Crackles course and fine discontinuous course bubbling fine crackling sound at the middle or end of inspiration Rhonchi a continuous sonorous sound Wheezes high pitch musical sounds Pleural friction rub grating rubbing, sound  COMMON TESTS AND NURSING RESPONSIBILITIES Measure adequacy of ventilation and gas exchange Complete Blood Count (CBC) → phlebotomy Arterial Blood Gases (ABG)→ arterial puncture Pulmonary Function Tests→ preparation by teaching  COMMON TESTS AND NURSING RESPONSIBILITIES Tests to determine abnormal cell growth or infection in respiratory system: Sputum culture growing microorganisms from sputum Throat culture growth of microorganisms from throat material  COMMON TESTS AND NURSING RESPONSIBILITIES Tests to visualize structures of respiratory system: Bronchoscopy Chest radiographs  CHEST XRAY Adenocarcinoma COMMON TESTS AND NURSING RESPONSIBILITIES Thorancentesis  NURSING RESPONSIBILITIES Medications Incentive spirometry Chest PT Postural drainage Oxygen therapy Artificial airways Airway suctioning Chest tubes  BASIC NURSING INTERVENTIONS Airway Maintenance: Facilitate effective coughing Suctioning airways Liquefying and mobilizing sputum  BASIC NURSING INTERVENTIONS Maintenance and promotion of proper lung expansion: Re-expanding collapsed lungs - Closed Chest Tube Drainage CHEST TUBES  BASIC NURSING INTERVENTIONS Improving Activity Tolerance: Determine etiology Assess appropriateness of activity level When appropriate gradually increase activity Ensure the client changes position slowly Observe for symptoms of intolerance Syncope with activity refer to MD Perform ROM exercises with activity intolerance if is immobile  BASIC NURSING INTERVENTIONS Mobilization of Pulmonary Secretions Auscultate breath sounds, monitor respiratory patterns, monitor ABG’s Position client to optimize respiration Pulmonary toileting Incentive spirometry Suctioning INCENTIVE SPIROMETRY  BASIC NURSING INTERVENTIONS Mobilization of Pulmonary Secretions Encourage activity and ambulation as tolerated Encourage increased fluid intake Chest physiotherapy O2 Medications as ordered  BASIC NURSING INTERVENTIONS O2 Therapy: Low flow High flow Humidification Nasal cannula Simple mask Nonrebreathing mask Partial rebreathing  BASIC NURSING INTERVENTIONS Effective Breathing Techniques Position for maximal respiratory function Pursed lip breathing Diaphragmatic or abdominal breathing  BASIC NURSING INTERVENTIONS Stress and anxiety reduction: Remove pertinent cause of anxiety at that moment - help client gain control over respiration - reassure client not in immediate danger Chronic clients exacerbations and remissions goal is to reduce general level of anxiety learn to control episodes of anxiety to improve quality of life desensitization program guided mastery  ADMINISTRATION OF PRESCRIBED MEDICATIONS Expectorants Vasoconstrictors Mucolytics Bronchodilators Cough suppressants Corticosteroids Antihistamines Antibiotics  BASIC NURSING INTERVENTIONS Physical Exercise→ health teaching Activity and rest -- a priority! Activity stimulates respiratory function Rest conserves energy and reduces metabolic demand MD’s treatment plan guidelines for activity may simply call for activity as tolerate. prioritize activities arrange need items conveniently Provide emotional support and encouragement gradually increase activity Simplify daily life Work at a steady state Conserve energy  ADEQUATE O2 BALANCE Behaviors of Negative O2 balance → Cardio Vascular Disease Arterial Venous: Impaired tissue perfusion  ADEQUATE O2 BALANCE Behaviors of Negative O2 balance → CV Restlessness, dizziness, syncope, bradycardia, decreased urine cold and clammy skin, cyanosis, slow capillary refill Decreased cardiac output  COMMON TESTS AND NURSING RESPONSIBILITIES Tests to determine adequacy of cardiovascular function: CBC Lipid profile Coagulation studies EKG/ECG Angiography Doppler blood flow studies  BASIC NURSING INTERVENTIONS Cardiovascular Diet Modify risk factors Exercise Co morbidities Preventing vasoconstriction Positioning Cold temperatures Nicotine  BASIC NURSING INTERVENTIONS Cardiovascular Risk DVT Position changes - Prevent complications Early ambulation Obstruction removal Bypass surgery Promoting rest Schedule rest periods Assistance with ADL’s Monitor Vitals with activity Place items, i.e. call light, water pitcher, strategically Quiet environment, decrease stimuli  BASIC NURSING INTERVENTIONS - Position semi to high Cardiovascular fowlers-> decrease venous Positioning to improve return and preload, decease preload-> decreases risk of CO heart congestion - Teach client to avoid Avoiding Valsalva valsalva maneuver maneuver - Hold breath while turning or moving in bed-> assist - Bearing down during BM-> stool softeners and diet  BASIC NURSING INTERVENTIONS Cardiovascular Avoid appetite suppressants, cold Avoid stimulants meds, coffee, tea, chocolate Maintaining fluid balance Assess fluid status, monitor I&O, assess breath sounds, JVD, pitting edema in dependent areas, fluid and NA+ restriction, daily Wgt with diuretic therapy, electrolyte monitoring-> MD  BASIC NURSING INTERVENTIONS Cardiovascular Administer O2 Educate client Increase O2 supply NO SMOKING! Position to facilitate breathing  ADMINISTRATION OF PRESCRIBED MEDICATIONS Anti coagulants Vasodilator Medications Inotropic Medications Anti Dysrhythmics Anti hypertensives  BASIC NURSING INTERVENTIONS Dietary control Assess nutritional status Consider a dietician referral to assess nutritional needs related to clients Chronicity of CAL and CAD and nutrition  BASIC NURSING INTERVENTIONS Weight control Evaluate the client’s physiological status in relation to condition More than body requirements Less than body requirements