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Oxygenation Chapter 50
Fundamentals (NUR155)
Galen College of Nursing
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Oxygenation Chapter 50
Factors affect respiratory function
Age o In infants’ lungs gradually inflate and by 2 weeks reach full inflation o Older adults have compromised changes due to infection, physical or emotional stress, surgery, anesthesia and other procedures. These changes include: Chest wall and airway become more rigid and less elastic The amount of exchanged air is decreased The cough reflex and cilia action are decreased, can cause patient to aspirate Mucous membranes become drier and more fragile Decrease in muscle strength and endurance occur If osteoporosis is present, inadequate lung expansion may be compromised A decrease in efficiency of the immune system occurs, more at risk for pneumonia 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. (GERD) Environment o Altitude (the higher you go the lower the oxygen levels), heat, cold, and air pollution affect oxygenation. o Secondhand tobacco smoke Lifestyle o Physical exercise or activity increases the rate and depth of respirations and hence the supply of oxygen in the body. Sedentary people by contrast, lack the alveolar expansion and deep-breathing patters of people with regular activity and are less able to respond effectively to respiratory stressors. o If a person is active, they are not at risk from fluids pooling. Health status
o In the healthy person the respiratory system can provide sufficient oxygen to meet the body’s needs. Diseases of the respiratory system however can adversely affect the oxygenation of the blood. Medications o A variety of medication can decrease the rate and depth of respirations. The most common medication having this effect are the benzodiazepine, sedative-hypnotics and antianxiety drugs as well as opioids/narcotics. They make the breathing more shallow and less frequent. o Patients that are older are unable to metabolize the medications. Can have higher adverse effects. Stress o When stress and stressors are encountered, both psychological and physiological responses can affect oxygenation. Some people may hyperventilate in response to stress. When this occurs, arterial PO rises and PCO2 falls. The person may experience light-headedness and numbness and tingling of the fingers, toes and around the mouth as a result.
Alteration in respiratory function
Patency (open airway) Movement of air in and out of lungs Diffusion of oxygen and carbon dioxide between alveoli and pulmonary capillaries Transport of oxygen and carbon dioxide via the blood to and from the tissue cells
Conditions affecting airway
Obstructions (complete or partial) o Upper airway In the nose, pharynx, or larynx Can occur when a foreign object such as food is present, when the tongue falls back into the oropharynx when a person in unconscious, or when secretion collects in the passageways. Respiration sounds gurgly or bubbly as the air attempts to pass through the secretions Low pitch, rhonci
Orthopnea o The inability to breathe easily unless sitting upright or standing. Dyspnea o Difficulty breathing of the feeling of being short of bread (SOB). It may occur with carrying levels of exertion or at rest. o A person with CFH (congestive heart failure) can have dyspnea at rest or at rest Hyperventilation o Kussmaul’s breathing A type of hyperventilation by which the body attempts to compensate for increased metabolic acids by blowing off acid in the form of CO2. Hyperventilation can also occur in response to stress or anxiety. Related to high blood sugar o Irregular breathing – Cheyne-stokes Marked by rhythmic waxing and waning of respirations from very deep to very shallow with short period of apnea commonly caused by chronic disease, increased intracranial pressure or drug overdose. Biot’s respirations Shallow breaths interrupted by apnea; may be seen in clients with CNS disorders.
Conditions affecting diffusion
Hypoxemia – reduced oxygen levels in the blood o May be caused by conditions that impair diffusion at the alveolar- capillary level such as pulmonary edema or atelectasis (collapse alveoli) or by low hemoglobin levels Hypoxia – insufficient oxygen anywhere in the body, causing cellular injury of death. o Clinical manifestations : o Rapid pulse o Rapid shallow respirations and dyspnea o Increased restlessness of light headedness o Flaring of the nares
o Substernal or intercostal retractions o cyanosis Cyanosis – bluish discoloration of the skin, mail beds and mucous membranes due to reduce hemoglobin-oxygen saturation may be present in hypoxemia or hypoxia Chronic hypoxemia – client often appears fatigued and lethargic o Finger and toenails may be clubbed from long term deprivation of oxygen
Conditions affecting transport (page 1248)
Decreased cardiac output affects transport co2 and 02 o CHF congestive heart failure o Hypovolemia (decreased fluid to pump) When CO is decreased o Tissue oxygenation is affected o The body’s ability to compensate for hypoxemia is affected
Artificial Airways – are inserted to maintain a patient air passage for client whose airways have become of may become obstructed.
Oropharyngeal It stimulates the gag reflex and are only used for clients with altered levels of consciousness To insert: Place the client in supine of semi fowler position Apply clean gloves Hold the lubricated airway by the outer flange, with the distal end pointing up or curved upward Open the client’s couth and insert the airway along the top of the tongue When the distal end of the airway reached the soft palate at the back of the mouth, rotate the airway 180 degrees down and slip it pas the uvula into the oral pharynx If not contraindicated, place the client in a side laying position with the head tuned to the side to allow secretions to drain out of the mouth The oropharynx may be suctioned as needed by inserting the suction catheter alongside the airway
o Breath sounds o AP diameter o Color of skin o Thorax, oval or barrel chest Review of relevant diagnostic data o Sputum cultures o Bronchoscopy (visualization of airways) o ABG’s (arterial blood gases) *complete blood count o CXR, MRI, Pulmonary function test, TB screening
Nanda oxygenation problems
Ineffective airway clearance Ineffective breathing pattern Impaired gas exchange Activity intolerance o Anxiety o Fatigue o Powerlessness o Insomnia o Social isolation
Planning (GOALS)
Overall goals: o Maintain a patient airway, clear secretions, foreign bodies o Improve comfort & ease of breathing o Maintain/improve pulmonary ventilation & oxygenation o Improve the ability to participate in physical activities o Prevent risk associated with O2 therapy
Implementing
Promote ventilation/oxygenation Deep breathing and coughing Hydration – fluids/humidifiers Medications Incentive spirometry Postural drainage (and chest physiotherapy)
Oxygen therapy – doctor specifies concentration, method of delivery, liter flow per minute
Let’s compare
Incentive spirometer o Improves pulmonary ventilation o Counteracts the effect of anesthesia or hypoventilation o Loosens respiratory secretions o Facilitates respiratory gaseous exchange o Expands collapsed alveoli Postural Drainage o Facilitates drainage of secretions via gravity o Decreases bacterial growth and infections o Decreases atelectasis
Incentive spirometer
___ pulmonary ventilation.
Incentive spirometer the effects of anesthesia or hypoventilation
___ respiratory secretions
___ respiratory gaseous exchange
___ collapse alveoli postural drainage
___ drainage of secretions via gravity
___ bacterial growth and infections decreases ___
Safe oxygen use
Educate No smoking while on oxygen, ever...... ever.. even once. Check electrical equipment used near oxygen Avoid potential sources of static Review box 50-2 on page 1259
In the hospital setting, we tell clients they must not smoke when using oxygen... should not even go outside! They need the oxygen!
Patients with COPD can have 2 liters of oxygen max Respiratory Medications Expectorants o Help “break up” mucus, making more liquid and easier to expectorate. Guaifenesin is a common expectorant found in many prescriptions and non-prescription cough syrups. When frequent or prolong coughing interrupts sleep, a cough suppressant such as codeine may be prescribed. Bronchodilators o Anti-inflammatory drugs, expectorants, and cough suppressants are some medications that may be used to create respiratory problems. Bronchodilators, including sympathomimetic drugs and xanthine, 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 any systemic side effects. Glucocorticosteroids o They can be given orally, intravenously or by inhaler. They work by decreasing the edema and inflammation in the airways and allowing a better air exchange. If both bronchodilators and anti- inflammatory drugs are ordered by inhaler, the client should be instructed to use the bronchodilator inhaler first and then the anti- inflammatory inhaler. Leukotriene modifiers
Our bodies secrete leukotriene when we have seasonal allergies. The leukotriene cause bronchoconstriction and edema. o These medications suppress the effects of leukotrienes on the smooth muscle of the respiratory tract. Leukotrienes cause bronchoconstriction, mucous production, edema od the respiratory tract.
Oxygenation Chapter 50
Course: Fundamentals (NUR155)
University: Galen College of Nursing
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