NURS 3000 Module 10 Oxygenation and Circulation Needs PDF

NURS 3000 - Professional Nursing Oxygenation and Circulation Needs Oxygenation and Circulation Needs Harding University - Active Learning Guide, Module 10 Name: Sean Whitfield Instructions Complete the module active learning guide as you work through the module content. Take notes, answer the questi...

NURS 3000 - Professional Nursing Oxygenation and Circulation Needs Oxygenation and Circulation Needs Harding University - Active Learning Guide, Module 10 Name: Sean Whitfield Instructions Complete the module active learning guide as you work through the module content. Take notes, answer the questions on the guide, and respond to any case studies and client scenarios. All of these activities will assist in your preparation for exams, help you plan and implement care in the clinical setting, and facilitate your development as a Christian nurse servant. You will submit your completed guide to the instructor at the end of the week. The completed learning guide will be worth a maximum of 10 points. If you have questions or are unsure about your answers; or you may email your instructor for clarification. Note: The Active Learning Guide provides a general outline of topics covered in this module; it is not all inclusive of all information needed for the exam. You are responsible for all content in readings and activities throughout the module. I. Oxygenation: Chapter 49 1. Name the four components of Respiration: ◦ Ventilation or breathing, the movement of air in and out of the lungs as we inhale and exhale. ◦ Alveolar-capillary gas exchange, which involves the diffusion of oxygen and carbon dioxide between the alveoli and the pulmonary capillaries. ◦ Transport of oxygen and carbon dioxide between the tissues and the lungs. ◦ Movement of oxygen and carbon dioxide between the systemic capillaries and the tissues. 2. Review the structure of the Respiratory System Figure 49.1 NURS 3000 - Professional Nursing Oxygenation and Circulation Needs 3. Pulmonary Ventilation: The first process of the respiratory system, ventilation of the lungs, is accomplished through the act of breathing: inspiration (inhalation) as air flows into the lungs, and expiration (exhalation) as air moves out of the lungs. Depends on: ◦ Clear airways ◦ An intact central nervous system (CNS) and respiratory center (medulla and pons in the brainstem) ◦ An intact thoracic cavity capable of expanding and contracting ◦ Adequate pulmonary compliance and recoil. Lung compliance: the expansibility or stretchability of lung tissue, plays a significant role in the ease of ventilation. Lung Recoil: In contrast to lung compliance is lung recoil, the continual tendency of the lungs to collapse away from the chest wall. Surfactant plays what important role? a lipoprotein produced by specialized alveolar cells, reduces the surface tension of alveolar fluid. Without surfactant, lung expansion is exceedingly difficult and the lungs collapse. 4. What role does hemoglobin play in the transport of oxygen and carbon dioxide? Normally most of the oxygen (97%) combines loosely with hemoglobin (oxygen-carrying red pigment) in the red blood cells (RBCs) and is carried to the tissues as oxyhemoglobin (the compound of oxygen and hemoglobin). 5. Where is the body’s respiratory center located? The body’s “respiratory center” is actually a number of groups of neurons located in the medulla oblongata and pons of the brain. 6. In clients with emphysema/COPD, what is their main stimulus to breathe? However, in clients with certain chronic lung ailments such as emphysema, oxygen concentrations, not carbon dioxide concentrations, play a major role in regulating respiration. For some clients, decreased oxygen concentrations are the main stimuli for respiration because the chronically elevated carbon dioxide levels that occur with emphysema “desensitize” the central chemoreceptors. This is sometimes called the hypoxic drive. Why is this important to keep in mind when administering supplemental oxygen to these clients? Increasing the concentration of oxygen depresses the respiratory rate. Thus, oxygen must be administered cautiously to these clients and often at low flow rates. Clinical Alert: Oxygen is considered a drug, which means what? Oxygen is considered a drug and must be carefully prescribed based on individual client conditions. NURS 3000 - Professional Nursing Oxygenation and Circulation Needs 7. Factors affecting respiratory function: What are some of the specific changes with the aging process which affect the respiratory system? Chest wall and airways become more rigid and less elastic. The amount of exchanged air is decreased. The cough reflex and cilia action are decreased. Mucous membranes become drier and more fragile. Decreases in muscle strength and endurance occur. If osteoporosis is present, adequate lung expansion may be compromised. A decrease in efficiency of the immune system occurs. Gastroesophageal reflux disease is more common in older adults and increases the risk of aspiration. The aspiration of stomach contents into the lungs often causes bronchospasm by setting up an inflammatory response. 8. Describe different conditions which can alter respiratory function. Terms to understand:          Apnea → is the absence of any breathing. Orthopnea → is the inability to breathe easily unless sitting upright or standing. Hypoxemia → or reduced oxygen levels in the blood, may be caused by conditions that impair diffusion at the alveolar–capillary level such as pulmonary edema or atelectasis (collapsed alveoli) or by low hemoglobin levels. Hypoxia → (insufficient oxygen anywhere in the body) results, potentially causing cellular injury or death. Ischemia → is a lack of blood supply due to obstructed circulation. Infarction → The vessels that supply blood to the heart muscle may become occluded by atherosclerosis or a blood clot, shutting off the blood supply to a portion of the myocardium. When this happens, the tissue becomes necrotic and dies. Anemia → Anemia or anaemia is a blood disorder in which the blood has a reduced ability to carry oxygen. This can be due to a lower than normal number of red blood cells, a reduction in the amount of hemoglobin available for oxygen transport, or abnormalities in hemoglobin that impair its function. Hypoventilation → inadequate alveolar ventilation, may be caused by either slow or shallow breathing, or both. Hypoventilation may occur because of diseases of the respiratory muscles, drugs, or anesthesia. Hyperventilation → This involves increasing the number of breaths the client is receiving. This can be done through the ventilator or using a manual resuscitation bag. 9. Diagnostic studies r/t respiratory function: Diagnostic tests that may be performed to assess oxygenation include sputum and throat culture specimens; blood tests such as arterial blood gases; pulmonary function tests; and visualization procedures such as x-rays, lung scans, laryngoscopy, and bronchoscopy. NURS 3000 - Professional Nursing Oxygenation and Circulation Needs              Pulmonary Function Tests → Pulmonary function tests measure lung volume and capacity. CXR → (Chest X-Ray) CXR reveals an enlarged heart. Sputum Culture Bronchoscopy → Procedure allowing a physician to look at a patient's airways through a thin viewing instrument called a bronchoscope. Bronchoscopy is an endoscopic technique of visualizing the inside of the airways for diagnostic and therapeutic purposes. CT → computerized tomography, or computerized axial tomography (CAT), is a painless, noninvasive x-ray procedure that has the unique capability of distinguishing minor differences in the density of tissues. The CT produces a three-dimensional image of the organ or structure, making it more sensitive than the x-ray machine. MRI → is a noninvasive diagnostic scanning technique in which the client is placed in a magnetic field. Clients with implanted metal devices (e.g., pacemaker, metal hip prosthesis) cannot undergo an MRI because of the strong magnetic field. There is no exposure to radiation. If a contrast media is injected during the procedure, it is not an iodine contrast. Another advantage to the MRI is that it provides a better contrast between normal and abnormal tissue than the CT scan. Ventilation/Perfusion Scan D-Dimer Test → A D-dimer test is a blood test that measures D-dimer, which is a protein fragment that your body makes when a blood clot dissolves in your body. D-dimer is normally undetectable or only detectable at a very low level unless your body is forming and breaking down significant blood clots. Thoracentesis → Normally, only sufficient fluid to lubricate the pleura is present in the pleural cavity. However, excessive fluid can accumulate as a result of injury, infection, or other pathology. In such a case or in the case of pneumothorax, a primary care provider may perform a thoracentesis to remove the excess fluid or air to ease breathing. Thoracentesis is also performed to introduce chemotherapeutic drugs intrapleurally. ABGs → are performed to evaluate a client’s acid–base balance and oxygenation. Arterial blood is used because it provides a more accurate reflection of gas exchange in the pulmonary system than venous blood. Blood gases may be drawn by laboratory technicians, respiratory therapy personnel, or nurses with specialized skills. Because a high-pressure artery is used to obtain blood, it is important to apply pressure to the puncture site for at least 5 minutes after the procedure to reduce the risk of bleeding or bruising. ECG → provides a graphic recording of the heart’s electrical activity. Electrodes placed on the skin transmit the electrical impulses to an oscilloscope or graphic recorder. Echocardiogram → is a noninvasive test that uses ultrasound to visualize structures of the heart and evaluate left ventricular function. Images produced as ultrasound waves are reflected back to a transducer after striking cardiac structures. Stress Test 10. Assessment signs and symptoms of impaired oxygenation: Chapter 29 p. 584-588 Adventitious Breath Sounds: NURS 3000 - Professional Nursing Oxygenation and Circulation Needs Crackles → Air passing through fluid or mucus in any air passage. Gurgles → Air passing through narrowed air passages as a result of secretions, swelling, tumors. Friction rub → Rubbing together of inflamed pleural surfaces. Wheeze → Air passing through a constricted bronchus as a result of secretions, swelling, tumors. 11. Interventions to promote oxygenation: pp. 1287-1289; 1291 Medications: How do these medications promote oxygenation? Bronchodilators → including sympathomimetic drugs and xanthines, reduce bronchospasm, opening tight or congested airways and facilitating ventilation. These drugs may be administered orally or intravenously, but the preferred route is by inhalation to prevent many systemic side effects. Anti-inflammatories → They work by decreasing the edema and inflammation in the airways and allowing a better air exchange. They can be given orally, intravenously, or by inhaler. Expectorants → help “break up” mucus, making it more liquid and easier to expectorate. 12. How would you teach a client to do pursed-lip breathing? One technique, pursed-lip breathing, may help alleviate dyspnea. The client is taught to breathe in normally through the nose and exhale through pursed lips as if about to whistle, and blow slowly and purposefully, tightening the abdominal muscles to assist with exhalation. Clients may practice by slowly blowing a ping-pong ball across a table or visualizing that they are trying to make a candle flame waver. 13. How would you teach a client to use an incentive spirometer? Hold or place the spirometer in an upright position. A tilted flow-oriented device requires less effort to raise the balls or disks; a volume-oriented device will not function correctly unless upright. Exhale normally. Seal the lips tightly around the mouthpiece. Take in a slow, deep breath to elevate the balls or cylinder, and then hold the breath for 2 seconds initially, increasing to 6 seconds (optimal), to keep the balls or cylinder elevated if possible. For a flow-oriented device, avoid brisk, low-volume breaths that snap the balls to the top of the chamber. Greater lung expansion is achieved with a very slow inspiration than with a brisk, shallow breath, even though it may not elevate the balls or keep them elevated while you hold your breath. Sustained elevation of the balls or cylinder ensures adequate ventilation of the alveoli (lung air sacs). If you have difficulty breathing only through the mouth, a nose clip can be used. Remove the mouthpiece and exhale normally. Cough after the incentive effort. Deep ventilation may loosen secretions, and coughing can facilitate their removal. NURS 3000 - Professional Nursing Oxygenation and Circulation Needs Relax and take several normal breaths before using the spirometer again. Repeat the procedure several times and then 4 or 5 times hourly. Practice increases inspiratory volume, maintains alveolar ventilation, and prevents atelectasis (collapse of the air sacs). Clean the mouthpiece with water and shake it dry. 14. Why is supplemental oxygenation considered a medication? The medical administration of supplemental oxygen is considered to be a process similar to that of administering medications and requires similar nursing actions. What is the maximum flow rate administered via a nasal cannula? It delivers a relatively low concentration of oxygen (24% to 45%) at flow rates of 2 to 6 L/min. Above 6 L/min, the client tends to swallow air and the FiO2 is not increased. Low-flow administration devices include nasal cannulas, face masks, oxygen tents, and transtracheal catheters. With these types of devices, room air is also inhaled along with the supplemental oxygen. As a result, the fraction of inspired oxygen (FiO2) will vary depending on the respiratory rate, tidal volume, and liter flow. What assessments and comfort measures are important to implement when the client is receiving oxygen via a nasal cannula? ◦ Skin and mucous membrane color: Note whether cyanosis is present, presence of mucus, sputum production, and impedance of airflow. ◦ Breathing patterns: Note depth of respirations and presence of tachypnea, bradypnea, or orthopnea. ◦ Chest movements: Note whether there are any intercostal, substernal, suprasternal, supraclavicular, or tracheal retractions during inspiration or expiration. ◦ Chest wall configuration (e.g., kyphosis, unequal chest expansion, barrel chest). ◦ Lung sounds audible by ear and auscultating the chest. ◦ Presence of clinical signs of hypoxemia: tachycardia, tachypnea, restlessness, dyspnea, cyanosis, and confusion. Tachycardia and tachypnea are often early signs. Confusion is a later sign of severe oxygen deprivation. ◦ Presence of clinical signs of hypercarbia (hypercapnia): restlessness, hypertension, headache, lethargy, tremor, or elevated carbon dioxide levels in the blood. ◦ Presence of clinical signs of hyperoxic acute lung injury: tracheal irritation and cough, dyspnea, and decreased pulmonary ventilation. 15. Take notes on Cardiovascular Influences on Respiratory Function, Chapter 50 pp. 1331-1333  Pumping Action/stroke volume Cardiovascular function can be altered by conditions that affect:  The function of the heart as a pump  Blood flow to organs and peripheral tissues  The composition of the blood and its ability to transport oxygen and carbon dioxide. NURS 3000 - Professional Nursing Oxygenation and Circulation Needs      Heart Failure → may develop if the heart is unable to keep up with the body’s need for oxygen and nutrients to the tissues. Heart failure usually occurs because of MI, but it may also result from chronic overwork of the heart, such as in clients with uncontrolled hypertension or extensive arteriosclerosis. In left-sided heart failure, the vessels of the pulmonary system become congested or engorged with blood. This may cause fluid to escape into the alveoli and interfere with gas exchange, a condition known as pulmonary edema. Valvular Function Conditions that Increase Preload  Hypervolemia  Valvular disorders such as mitral regurgitation  Congenital defects such as patent ductus arteriosus Conduction System/ dysrhythmias → Abnormalities of heart rate and rhythm are known as dysrhythmias and can be identified on an electrocardiogram (ECG). Coronary Artery Disease; Systemic Circulation Conditions that Affect Myocardial Function  Myocardial infarction  Cardiomyopathy  Coronary artery disease