Lect19 Oxygenation by xiaopangnv

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									 Stressors that Affect
    Oxygen Needs
NUR101 FALL 2008
K. BURGER, MSEd, MSN, RN, CNE
LECTURE #19


PPP by Sharon Niggemeier RN, MSN
Revised October 2005 by K. Burger
              Oxygenation
• Ventilation- air moves in & out of lungs
• External respiration-exchange of O2 &
  CO2 between alveoli and blood
• Gas Transport- blood transports O2 &
  CO2 to body cells
• Internal respiration- exchange of O2 &
  CO2 between blood and cells.
             Checkpoint


1) T / F The pulmonary artery carries
   oxygenated blood away from the lungs.


                   FALSE
  Factors Affecting Respiration
• Integrity of the airway system
  (ventilation)
• Functioning cardiovascular system
  (perfusion)
• Functioning alveoli (diffusion)
• Functioning medulla & chemoreceptors
       Pulmonary Ventilation
• Inspiration- air flows into lungs
• Expiration-gases flow out of lungs
  According to pressure gradiant – Boyle
• Intrapulmonic or intra-alveolar pressure-
  pressure within alveoli
  (fluctuates: Inspiration 759mm Hg
               Expiration 761mm Hg)
• Intrapleural pressure-pressure within the
  intrapleural space (always negative)
  (756 mm Hg)
• Note: Atmospheric Pressure = 760 mm Hg
 Factors Affecting Ventilation

• Lung elasticity / compliance
 (ability to stretch and recoil)
• Airway obstruction
• Musculature condition
• Neurological controls
              Checkpoint
What is the name of the nerve that supplies
 the diaphragm?
                PHRENIC NERVE
        Alveoli Gas Exchange
• Air reaches alveoli
• Oxygen from alveoli space moves into
  pulmonary capillary (oxygen uptake)
  via diffusion
• Oxygen diffuses across alveoli
  membranes moving from high
  concentration (alveoli) to lower
  concentration (pulmonary capillary)
       Alveoli Gas Exchange
• Surfactant- secreted by alveoli cells,
  keeps surfaces moist and prevents
  atelectasis
• Atelectasis- incomplete lung expansion
  or collapse of alveoli
• Lung Compliance- elasticity of lung
  tissue and flexibility of rib cage
• Lung recoil- ability of lungs to recoil
      Other Factors Affecting
          Gas Exchange


• Surface area
• Thickness of tissue

 Fick’s Law of Diffusion:
 Rate of a diffusion of gas is dependent on surface
 area and thickness of the membrane
              Perfusion
• Transport of O2 & CO2 via
  blood to tissue
• Volume of blood flowing through
  lungs affects amount of oxygen and
  gases exchanged
• Adequate blood supply and
  cardiovascular functioning are needed
• Oxyhemoglobin HbO2 (or SaO2)
             Checkpoint
The majority of CARBON DIOXIDE
molecules are transported in the blood as:
                   ???

                BICARBONATE
                     HCO3
              Perfusion

•   Rate of O2 transport depends on:
•   Cardiac output
•   Activity level
•   CO2 transport
          Neurologic/Chemical
         Controls of Respiration

•   Peripheral Chemoreceptors
•   Central Chemoreceptors
•   Medullary respiratory center
•   Spinal cord
•   Phrenic nerve
•   Diaphragm
Factors Affecting Oxygenation

•   Environment   • Life style
•   Emotions      • Medications
•   Exercise      • Respiratory
•   Health          History
•   Age
           Checkpoint

What is the normal respiratory rate
 of a newborn?

            30-60 breaths/min
Assessing Respiratory Functioning

•   Difficulty breathing?
•   SOB?
•   Chest pain?
•   Coughing? Sputum production?
•   Nocturnal diaphoresis
•   Fatigue
•   Sleep with 2 or more pillows?
Assessing Respiratory Functioning

Respiratory Hx   • Smoking
  includes:      • Lifestyle /
• Allergies        Activity Level
• Medications    • Stressors
• Medical Hx     • Recent exposures
                 • Developmental
                   level
Assessing Respiratory Functioning

• Patient states difficulty breathing: you
  can assess by using PQRST
• P- provokes
• Q- quality
• R- region/radiation
• S- severity scale
• T- timing
Assessing Respiratory Functioning
•   Respiratory Rate:
•   Tachypnea R>24
•   Bradypnea R<10
•   Apnea
•   Respiratory Depth:
•   Deep - diaphragmatic
•   Shallow
Assessing Respiratory Functioning

•   Respiratory Rhythm:
•   Regular – “even and symmetrical”
•   Cheyne-Stokes
•   Kussmauls
•   Biot’s (ataxic – without rhythm)
•   Apneustic breathing (gasping)
Assessing Respiratory Functioning
• Respiratory Quality:
•   No difficulty- Eupneic/ Unlabored
•   Dyspnea
•   Orthopnea
•   Retractions
•   Use of accessory muscles
• Auscultation:
• Vesicular
• Bronchial
• Bronchovesicular
Assessing Respiratory Functioning
                    Adventitious
Cough:                Sounds:
• Nonproductive     • Crackles:
• Productive         fine,medium,coarse

• Sputum            • Wheeze:
                     sibilant,sonorous
• Hemoptysis
                    • Stridor
                    • Stertor
    Breath sounds
                    • Pleural friction rub
 Respiratory Assessment Review
• Oxygen delivery method correctly applied
• Obtain a pulse oximetry reading (norm is
  >95%)
• Check Vital Signs ?T ?P ?R
• Auscultate the pt’s lungs
• Note changes in skin and mucosa color
• Assess capillary refill
            Checkpoint
• What are some other elements of a
  respiratory assessment not yet
  mentioned?
             Neurological state
                    Color
                Nail clubbing
         AP vs Transverse Diameter
               Barrel Chest?
Assessing Respiratory Functioning
• Diagnostic tests:
• Sputum
• Nose/throat cultures
• CBC (complete blood count)
• ABG (arterial blood gases)
• CXR (chest x ray)
• PFT (pulmonary function tests)
• Pulse Oximetry
  http://www.oximeter.org/pulseox/principles.htm
• Other: Scopes, CT, MRI, PET
Alterations:Respiratory Functioning
  •   Hypoxia            • Obstructed
  •   Hypoxemia            airway
  •   Hyperventilation   • Foreign body
  •   Hypercapnia          obstruction
                           (FBO)
         Nursing Interventions
             Independent
•   Airway maintenance
•   Positioning
•   Deep breathing & coughing
•   Pursed-lip breathing
•   Abdominal/diaphragmatic breathing
•   Hydration
•   Teaching of health habits
        Nursing Interventions
       Collaborative/Dependent
•   Incentive spirometry
•   Percussion/postural drainage
•   Suctioning
•   Oxygen therapy
•   Medications
        Nursing Interventions
       Collaborative/Dependent
•   Oxygen Therapy
•   Indications
•   Sources- wall outlet or portable tank
•   Monitor pulse oximetry
•   Methods- cannula, mask, venturi
    mask, tent/isolette,BiPAP, CPAP
Administering Oxygen Therapy
•   Flow rate
•   Humidification
•   Hydration
•   Positioning
•   Safety precautions
•   Document
•   MD order required
Oxygen Safety Precautions
• Signs: “No smoking. Oxygen in use.”
• Remove matches, lighters and cigarettes.
• Remove and store electrical equipment to
  avoid sparks. Ground electrical equipment.
• Avoid materials that generate static
  electricity
• Avoid use of volatile, flammable materials,
  such as alcohol.
• Know location & use of fire extinguishers
  & alarms.
        Nursing Interventions
•   Medications
•   Nebulizer Tx
•   Cough suppressants
•   Mucolytic: expectorants
•   Bronchodilators
•   Corticosteroids
          Documentation
        Routine Nurses Note
•   Date          • Rhythm
•   Time          • Breath sounds
•   LOC             (auscultated)
•   Rate          • Quality
•   Depth         • Color
             Nursing Diagnosis
•   Ineffective airway clearance
•   Risk for aspiration
•   Ineffective breathing pattern
•   Impaired gas exchange
•   Risk for suffocation
•   Ineffective tissue perfusion; cardiopulmonary
•   Impaired spontaneous ventilation
•   Dysfunctional ventilatory weaning response
               Checkpoint
Select a priority nursing diagnosis for the
  following scenario:
88 y.o. female with pneumonia who has a
  non-productive cough, R= 24, course
  crackles upon auscultation. She is weak,
  undernourished and fatigued.

            Ineffective airway clearance
              Checkpoint
Select a priority nursing diagnosis for the
  following scenario:
A patient with hx of emphysema with
  decreased PO2, increased CO2 levels who
  is dyspneic and restless.

             Impaired Gas Exchange
              Checkpoint
Select a priority nursing diagnosis for the
  following scenario:
A patient admitted to the ER post MVA with
  notable blood loss, BP= 80/50, P=120,
  R=22
          Ineffective Tissue Perfusion;
               Cardiopulmonary
    Summary: Oxygenation
• Oxygenation based on
  ventilation/perfusion/diffusion of
  oxygen
• Various factors effect oxygenation
• Assessment includes respiratory Hx,
  clinical exam, diagnostic tests
• Interventions include airway
  maintenance /proper breathing/ oxygen
  therapy/meds

								
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