Oxygenation, Circulation, and Perfusion.pdf

Important!! RESPIRATORY SYSTEM ● Gas exchange is made possible by: ○ Ventilation = movement of air into and out of the lungs ■ Contraction → inhaling ■ Relaxing → exhaling ■ Factors ● Condition of the musculature ○ Weak muscles = less effective inhalation and exhalation (OLDER ADULTS) ○ Signs of di...

Important!! RESPIRATORY SYSTEM ● Gas exchange is made possible by: ○ Ventilation = movement of air into and out of the lungs ■ Contraction → inhaling ■ Relaxing → exhaling ■ Factors ● Condition of the musculature ○ Weak muscles = less effective inhalation and exhalation (OLDER ADULTS) ○ Signs of difficulty breathing ■ Nasal flaring ■ Retractions ■ Use of accessory muscles ● Compliance of the lung tissue ○ The ability of the lungs to distend or expand ○ Surfactant = decreases surface tension, prevents alveoli from collapsing ○ Conditions that decrease compliance ■ Emphysema and fibrosis ■ Older adults have decreased surfactant ■ Premature babies do not have enough surfactant to breathe on their own ● Airway resistance ○ When the diameter of an airway decreases, the airway resistance increase and limits the amount of oxygen delivered to the alveoli ○ Conditions that increase resistance ■ Asthma ■ Sleep apnea ■ Edema ■ Increased secretions ■ Obstruction ○ May hear wheezing, high pitched sounds, crackling ○ Respiration = exchange of oxygen and carbon dioxide between the atmospheric air in the terminal alveoli and blood in the capillaries ■ Moves from high pressure/concentration to low pressure/concentration ■ Factors influencing diffusion ● Change in surface area ○ Removal of the lung, emphysema ○ Reducing the surface area, reduces diffusion Important!! ● Thickening of the alveolar-capillary membrane (Pneumonia) ● Partial pressure = increased altitude pressure, decreased respiration ■ Atelectasis → collapse of the alveoli; prevents normal gas exchange ● Usually due to hospitalization/post-op complication ● Nursing interventions ○ Deep breathing exercises (incentive spirometer) ○ Ambulation – better circulation ○ Semi-fowler’s position ○ Perfusion = process by which oxygenated capillary blood passes through the body tissues ■ Factors ● Amount of blood flowing through lungs ● Activity level ○ Increased activity → increases demand for O2 → increases perfusion ● Adequate blood supply and proper cardiovascular functioning ● Medulla oblongata regulates respiration ○ Chemoreceptors sense changes in concentration of O2, CO2, and pH ○ Proprioceptors – sensory receptors in the muscles; help increase ventilation ○ What effect would a CNS injury (stroke) have on respirations? ■ Respiratory depression, hypoxia ● ABG normal values for ventilation ○ PaO2 = 80-100 mm Hg ○ PaCO2 = 35-45 mm Hg ○ SpO2 = 95-100%; COPD = 88-92% ● Alterations in respiratory functioning ○ HYPOventilation = decreased respirations; body retains CO2 and can lead to respiratory acidosis ■ Can occur with atelectasis, sedation, and drug overdose ■ S&S: changes in mental status, dysrhythmias, potential cardiac arrest, death ○ HYPERventilation = increased rate/depth of respirations; lungs remove CO2 faster than it is produced and can lead to respiratory alkalosis ■ Can occur with severe anxiety ■ S&S: lightheadedness, loss of consciousness ○ Hypoxia = inadequate tissue oxygenation; life threatening condition; give O2 ASAP ■ S&S: restlessness, decreased LOC, increased HR and RR, cyanosis ■ Causative factors Important!! ● Decreased O2 carrying capacity (anemia, carbon monoxide poisoning) ● Hypovolemia – decreased circulating blood volume (shock, severe dehydration) ● Decreased O2 concentration (airway obstructions, decreased environmental oxygen, hypoventilation) ● Increased metabolic rate (persistent fever) CARDIOVASCULAR SYSTEM ● Cardiac output = stroke volume X heart rate ○ Stroke volume is affected by: ■ Preload – volume of blood in ventricles at the end of diastole ■ Afterload – resistance of left ventricles to pump blood to the body ■ Contractility – strength of the heart’s muscles ○ Regulation of the cardiovascular system ■ Conduction system ● Electrical impulses ○ P wave = atria-depolarization ○ QRS complex = ventricular depolarization ○ T wave = ventricular repolarization ■ Alterations in conduction Rhythm HR SV CO BRADYCARDIA <60bpm ↓ ↓ ↓ TACHYCARDIA >100bpm ↑ ↓ ↓ Important!! ● ● ● ● ATRIAL FIBRILLATION 100-175 bpm ↑ ↓ ↓ VENTRICULAR FIBRILLATION >175 bpm ↑ ↓ ↓ ■ Atrial fibrillation is at risk for blood clots ● Deep vein thrombosis – swelling, erythema, warmth ■ Ventricular fibrillation is deadly Blood flow to the cardiovascular system ○ Myocardial ischemia = decreased blood flow to the heart ■ Stable angina – temporary imbalance; often due to an increase in myocardial oxygen demand ● Often relieved with rest and vasodilators ● Reduce alcohol, no smoking, activity is limited ■ Myocardial infarction – medical emergency; usually due to decrease in O2 blood flow ● Accompanied by chest pain ● Can only be relieved through surgery Heart failure → inability to pump sufficient blood leading to inadequate perfusion and oxygenation of tissues ○ Causes ■ Chronic HTN – heart was to work harder ■ Coronary artery disease ■ Incompetent valves Deep Vein Thrombosis (DVT): blood clots form in the deep veins, usually in the legs ○ Requires IMMEDIATE ATTENTION → can lead to pulmonary embolism ○ Risk factors = impaired circulation, decreased motility, prolonged bed rest, smoking, obesity ○ S&S: unilateral swelling in legs/calf, inflammation, redness, pain, warmth ○ Interventions = ambulate!!!!!, encourage hydration, ROM, compression stockings ○ DO NOT massage the leg Factors affecting cardiopulmonary functioning ○ Level of health ○ Development ■ Infants-adolescents → immature immune system ● At risk for upper respiratory infection ■ Older adults → cardiac output decreases, cannot handle stress ○ Nutrition ○ Exercise Important!! ○ Smoking ○ Substance abuse ○ Stress ○ Environmental factors ● Nursing process ADPIE ○ Assessment ■ Health history ■ Physical assessment ■ Vital signs ■ Diagnostic tests ■ Pulse oximetry monitoring ● Assess the patient FIRST, not the machine ● COPD O2 level 88-92% is NORMAL ○ Diagnoses ■ Ineffective airway clearance ■ Impaired gas exchange ■ Decreased cardiac output ○ Planning ■ Demonstrate improved gas exchange ■ Preserve cardiopulmonary function ■ Demonstrate coping methods and self-care behaviors ○ Implementation ■ Promote healthy lifestyle ■ Maintain good nutrition ■ Adequate hydration ■ Promote lung expansion ● Breathing exercises !! ● Pursed lip breathing = patient breathes in and exhales slowly to release CO2 from the body ○ Recommended for COPD patients ● Incentive spirometer = inhaling deep and slow 10 times every hour ○ Prevents atelectasis and pneumonia ○ Used post-op ■ Promoting and controlling cough ■ Loosen and mobilize secretions ■ Meeting oxygen needs with medication (inhalers) ■ Providing supplemental oxygen ● Humidifier requires an order → DO NOT HOLD IN EMERGENCY Important!! ● In patients with COPD, the administration of excessive oxygen causes them to hypoventilate ○ Can lead to respiratory acidosis ■ Suctioning ■ Thoracentesis (removal of fluid in pleural space) ■ Chest tubes ● Never clamp the tubing ○ Evaluation ■ Ask about improvement ■ Auscultate lung sounds ■ Evaluate pulse oximetry changes ■ Use diagnostic results ● Oxygen delivery devices (O2 flow rates) ○ Ambient Air = 21% ○ Nasal Cannula ■ 1-6L/min 24-44% ■ Can dry mucosa and needs humidification ■ Encourage patient to breathe through their nose ○ Simple face mask ■ 5-8L/min 40-60% ■ Contraindicated for patients who retain CO2, may induce claustrophobia ○ Venturi mask ■ 4-6L/min 24-60% ■ Has flow-control meter on the mask ○ Partial/non-rebreather mask ■ 10-15L/min 80-95% ■ Should never be deflated ● Complete Blood Count Important!! ● Coagulation ● In emergency situations: ○ Maintaining an airway is a priority ○ Administer oxygen ○ Interventions will vary ○ Always have emergency supplies ready ○ Activate appropriate emergency response ● Cardiopulmonary resuscitation ○ Permanent heart, brain, and vital organ damage occurs within 4-6 minutes ○ CPR ■ Maintain circulation ■ Establish airway ■ Initiate breathing ■ Early defibrillation