Oxygenation Slideshow PDF

Oxygenation Chapter 41 NURS 300  Objectives 1. Describe the structure and function of the cardiopulmonary system. 2. Explain the interrelationship among ventilation, perfusion, and exchange of respiratory gases. 3. Explain the interrelationship among cardiac output, myocardial...

Oxygenation Chapter 41 NURS 300  Objectives 1. Describe the structure and function of the cardiopulmonary system. 2. Explain the interrelationship among ventilation, perfusion, and exchange of respiratory gases. 3. Explain the interrelationship among cardiac output, myocardial blood flow, and systemic circulation. 4. Explain the relationship of cardiac output, preload, afterload, contractility, and heart rate) to the process of oxygenation, hypoventilation and/or hypoxemia. 5. Explain the relationship between the cardiac conduction system and mechanical dysfunction of the heart. 7. Describe the effect of a patient’s level of health, age, lifestyle, and environment on oxygenation. 8. Identify how to assess for the risk factors affecting a patient’s oxygenation. 9. Identify how clinical judgement in assessment identifies the physical manifestations that occur with alternations in oxygenation. 10. Discuss potential clinical outcomes occurring as a result of disturbances in conduction, altered cardiac output, impaired valvular function, myocardial ischemia and/or impaired tissue perfusion. 11. Develop a plan of care for a patient with altered oxygenation. 12. Explain how clinical judgement is used to identify nursing diagnoses and interventions to promote oxygenation in the health promotion, acute care, and restorative and continuing Scientific Knowledge Base Oxygen is needed to sustain life The cardiac and respiratory systems supply the oxygen demands of the body The cardiovascular system provides the transport mechanisms to distribute oxygen to cells and tissues of the body. The exchange of respiratory gases occur between the environment and the blood Neural & chemical regulators control the rate and depth of respiration in response to changing tissue oxygen demands Respiration Respiration is the exchange of oxygen and carbon dioxide during cellular metabolism TFS.IO damagcandcrease ara whi.ch willworsen surface gasexchan Eriono badgas exchange.nl 2 gPred Respiratory Physiology Gases move into & out of lungs through pressure changes and een the lungs then Intrapleural pressure is negative, less than atmospheric pressure In order for air to flow into the lungs intrapleural pressure becomes more negative creating a pressure gradients between the atmosphere and the alveoli The diaphragm & external intercostal muscles88884 contract Imoveairinandoutoflungs to create negative pleural pressure increases the size of the thorax for inspiration Relaxation of diaphragm & contraction of internal intercostal muscles allow air to escape from lungs  chest wall to open and 89s ventilating Steps in Oxygenation Process of moving gases in Ventilation and out of the lungs Exchange of respiratory Diffusion gases across alveoli capillary membrane Cardiovascular system Perfusion pumping blood to and from the lungs and body Respiratory Terminology effortrequired to expand oppositionto and retract inhalingoxygen and other air flowduring the lungs inhalationand air particles exha.lahbwingofairway ashthmal stimulated by chemical receptors in aorta analyzing oxygenlevel changes Ability of lungs to reffed fff fiff ffedi 01m95 or fractured rib collapse of chemicalproduced in lungs Balloon Activity 1 alveoli from that maintains surfacetension traumapost op of alveoli to keep them andlubricates no g for movement lungs to allow atelectasis and prevent Nasalflaring use of abdominal muscles raising the shoulders from trying to get a deep breath breathe faster to bring in more CO2 sleep and fatigue Respiratory Physiology Perfusion unougenated 0 oxygenatingblood Blood getsdiffused intolungs through alveoli  Respiratory Physiology Normal Lung values are determined by age, gender, and height. pregnancy obesity lungvolumes hffions exhaled after ymmgyh.tn raffn in exercise lung an volume affieten mangs fm Yaking of air removedfrom maximum amount the lungs during forced expiration volume of lung complefting Balloon Activity 2 Respiratory Gas Exchange Diffusion of respiratory gases occurs at the alveolar capillary membrane The thickness of the membrane affects the rate of diffusion Increased thickness of membrane slows diffusion, gases take longer to transfer across membrane slower exchange of respiratory gases, decreased delivery of oxygen to tissues Example: Pulmonary edema, pulmonary infiltrates, or pulmonary effusion have thickened membrane Chronic diseases (emphysema), acute diseases (pneumothorax), and surgical processes (lobectomy) often alters the amount of alveolar capillary membrane surface area from destroyed alveolf IEA Balloon Activity # 3 collapsed removingpart of the lung yid ngm  so decreasing the surface plethral harder area of a lung Respiratory Gas Exchange space around the lungs Oxygen Transport The Oxygen-transport system consists of the lungs and cardiovascular system Delivery depends on the amount of blood entering lungs ventilation, Blood flow to the lungs and tissues perfusion, rate of diffusion, & oxygen-carrying capacity. Carbon Dioxide Transport transports Carbon Dioxide gets transported back EfftenHemoglobin to the lungs to be exhaled anathenters 8498089  they Tofoxygenhemoglobin fatigue Regulation of Respiration T.IE hIfeth'in rate In myth8hr01respiratory Cardiovascular Physiology Right ventricle pumps deoxygenated blood through lungs (pulmonary circulation) Left ventricle pumps oxygenated blood through the systemic circulation review the valves TPMA Cardiovascular Physiology PRL PRL 2 atria & 2 ventricles Stroke volume Starling’s Law Eating stuffedtetheanInsects Unidirectional blood flow Mitral & Tricuspid closure S1 Aortic and pulmonary valve S2 murmur issueswithheart rheates Arteries deliver nutrients and O2 to tissues Veins remove waste from tissues Supply myocardium with nutrients and remove waste Coronary arteries fill during diastole suppliestheheart with the nhhehfshangnym.fr  Heartattack Blood Flow Regulation re's out puts 4 62 of blood 9THfeb Balloon Activity # 4 home nkHngs fresistffan  g before ejection Conduction System The rhythmic relaxation and contraction of the atria and ventricles depend on the continuous and organized transmission of electrical impulses. The cardiac conduction system generates & transmits these impulses Impulse pathway: 04h8Restate ○ Sinoatrial (SA) node- pacemaker ○ Atrioventricular (AV) node- mediator EII.FI Bundle of His- distributes to ventricles ie ○ ○ Purkinje fibers- ventricular contraction intfi contraction tobothsides of the heart form theventricles 8781088 An electrocardiogram (ECG) reflects the electrical conduction system of the heart monitors electrical impulses of the heart changes in lines affects the changes in the mythum of the heart Factors Affecting Oxygenation to bindto fatigueincreasedabdhf.fmkhetafssnefffdfebin globinwhichfails to poisoning If afehdofyfenhe.no udme oxygenbeingbroughtinto the circulatingb1o lungs friskythenfangsandbody Factors affecting oxygenation continued COPD Balloon Activity # 5 Alterations in Respiratory Functioning Yessiaforyrate decrease in respiratory destefano oxygen platesignofhypoxia fifth fifth.jp Alterations in Cardiac Functioning Disturbances in Conduction- (dysrhythmias) caused by electrical impulses that do not originate from the SA node AFibAntricularventrocardia Altered Cardiac Output- insufficient volume is ejected into systemic and pulmonary circulation FILES8 4 bloodgoes keying Alterations in Cardiac Functioning Impaired Valvular function Stenosis hardening or stiffening of the heart valves Regurgitation value does not close leakage back into the lung Myocardial Ischemia- blood to the myocardium (heart muscle) from the coronary arteries does not meet myocardial oxygen needs Patientscanfeelradiatingpain Angina imbalancebetweenoxygensupply and demand0 Myocardial Infarction (MI) /or/ acute ch.esahiYent coronary syndrome (ACS) death due to lack of oxygen the comes anddoesn't goes heart death and cloggedarteries last as  g Developmental factors Risk for upper respiratory infections and Infants & Toddlers nasal congestion. fffferingeatgeimmunesystemsandexposure School-aged children & Risk for respiratory infections & secondhand adolescents smoke. Danger of starting cigarette smoking 9110 smokersstartbefore18 Exposed to many cardiopulmonary risks: Young & middle-aged adults smoking, unhealthy diet, stress, usage of meds not as intended and illegal substances Calcification of valves,SA node & costal Older adults cartilage. Osteoporosis, Enlargement of alveoli, trachea & bronchi. Decreased ciia Lifestyle Risk Factors blood pressure dblood flow to theheart and lungs Environmental Factors Aspiration and the person with IDD Aspiration in people with IDD is more common than the general population. Sometimes it is obvious, Turnswallow like when people cough when eating, but sometimes it is silent (the patient will not show the typical signs and symptoms). How to identify it? Who is at risk? Coughing when eating or drinking? Eat too fast or over-fill their mouths Recurrent episodes of pneumonia? Diagnosed with swallowing disorders Silent aspiration is when oral or gastric People with feeding tubes contents move into the respiratory system Those with GERD without causing a cough or gag reflex. This People who can’t tuck their chin to swallow can. Occur in people with People who have seizures neurodevelopmental disorders who may have Individuals on multiple medications abnormal reflexes and responses to stimuli Those who have higher respiratory rates Loss of ability to breathe or labored breathing after eating could be a sign Drop in blood oxygen saturation while eating. Main test to determine aspiration is the modified barium swallow. Escude, 2019 Aspiration and the person with IDD Prevention Proper positioning when eating including alignment of the body and neck slightly flexed When nurses are assisting others to eat, they can seldom tell when the head slides into extension sufficient to open the airway. This can be as little as 5-10 degrees past neutral. A flat hand placed on the back of the neck will indicate good swallowing position. When only a portion of the hand can fit here, the problem is usually that the hips have slipped down in the chair. Evaluation by speech pathologist to give recommendations on assistive devices and feeding techniques Thickening liquids and changes in food texture and size Feeding tubes: when the risk of oral eating is too great Escude, 2019 Nursing History Chest pain Immediate and thorough evaluation of location, duration, radiation, & frequency. Other symptoms associated with it. Fatigue Loss of endurance. Often an early sign of a worsening of a chronic cardiopulmonary alteration. Dyspnea Shortness of breath. Is associated with hypoxia. It is a subjective sensation of difficult or uncomfortable breathing. Associated with exaggerated respiratory effort. Use of accessory muscles may be noted. Orthopnea. Cough Is a protective reflex to clear the trachea, bronchi and lungs of irritants and secretions. Patients with chronic cough tend to deny, underestimate, or minimize their coughing because they are used to it and unaware of its frequency. Is it nonproductive or productive? Wheezing High pitched musical sound caused by movement of air through a narrowed airway. Associated with bronchitis, asthma or pneumonia. Smoking Ask about history of smoking including the number of years smoked and the number of packs per day smoked. Inquire about secondhand smoke exposure. Respiratory infection Obtain information about pt’s frequency and duration of respiratory tract infections, frequency of colds, exposure to TB. Ask if had flu, or pneumonia vaccine or if had PPD test. Determine if at risk for HIV. Allergies Ask specific questions about types of allergens, responses to these allergens, and successful and unsuccessful relief measures Health risks Determine familial risk factors such as history of lung cancer, cardiovascular disease, or a family member with an infectious disease Medications Ask about prescribed medications, over the counter medications, herbal medicines, alternative therapies and illicit drugs Environmental Exposures in the home or travel such as cigarette smoke, CO from faulty or blocked furnace or fireplace, or radon Implementation: Vaccinations Health Promotion Influenza, pneumococcal Gtmonths olderandhighriskadults Healthy lifestyle Eliminating risk factors, eating right, regular exercise Environmental pollutants Secondhand smoke, work chemicals, and pollutants Maintaining the pt’s optimal level of health is important in reducing the number and/or severity of respiratory symptoms. Prevention of respiratory infections is foremost in maintaining optimal health.  Implementation: Acute Care Thiffhiteeasilyremovable over 4L of oxygen Add moisture and medication Mobilizes pulmonary secretions  g Percussion/Vibration Suctioning Used when patients are unable to clear respiratory secretions from the airways by coughing Mouthto pharynx Noseto pharynx Mouth to trachea Nose totrachea Artificial Airways PFEITMAY be on a Higher risk of respiratory infection Maintenance and Promotion of Lung Expansion apnea p g Maintenance and Promotion of Oxygenation Oxygen therapy Goal is to prevent or relieve hypoxia by delivering oxygen at concentrations greater than ambient air (21%). room Safety precautions Oxygen is a highly combustible medical gas & can easily cause a fire in a patient’s room if it contacts a spark from an open flame or electrical equipment. With increasing use of home oxygen therapy, patients & health care professionals need to be aware of the dangers of combustion. Supply of oxygen Tanks or wall-piped system Oxygen Delivery Restoration of Cardiopulmonary Functioning Restorative & Continuing Care Cardiopulmonary rehabilitation Controlled physical exercise; nutrition counseling; relaxation and stress management; medications; oxygen; compliance; systemic hydration Breathing exercises Pursed-lip breathing - deep inspiration and prolonged expiration through pursed lips to prevent alveolar collapse Diaphragmatic breathing - requires the patient to relax intercostal and accessory muscles while taking deep inspirations