Oxygenation_MAN Lecture

OXYGENATION

Nelia B. Perez RN MSN

PCU – Graduate School of Nursing

Respiratory

I. Review of Respiratory SystemII. Common ManifestationsIII. Diagnostic Tests/ ProceduresIV. Common Pharmacologic AgentsV. Disturbances

a. Restrictive Lung Diseaseb. COPD/ CALc. Pulmonary Vascular Disease

Restrictive:AtelectasisTuberculosisPneumonia

COPD:AsthmaEmphysemaChronic Bronchitis

Pulmonary Vascular Disease:

Cor Pulmonale

Pulmonary Embolism

Hematopoietic

I. Review of the Hematopoietic SystemII. Disturbances

a. Anemiab. Polycythemia Verac. Bleeding Tendencies

- DIC- Hemophilia- Thrombocytopenia

Cardiovascular

I. Review of the Cardiovascular SystemII. Common Diagnostic Tests/ ProceduresIII. Disturbances

a. Infection - Rheumatic Heart Disease

b. Coronary Artery Disease- Atherosclerosis- Arteriosclerosis

- Angina Pectoris

- Myocardial Infarction

IV. Congestive Heart Failure

- Right Sided Heart Failure

- Left Sided Heart Failure

V. Congenital Heart Defects

- Cyanotic Heart Defects

- Acyanotic Heart Defects

RESPIRATORY SYSTEM

Measures That Promotes Adequate Respiratory Functions:

1. Adequate OXYGEN supply from the environment.

2. Deep breathing and coughing exercises.

3. Proper positioning

4. Patent airway (FEMS)

5. Adequate hydration

6. Avoid pollutants, alcohol and smoking.

7. Chest Physiotherapy (CPT)

* Percussion

* Vibration

* Postural Drainage

8. Bronchial Hygiene Measures

* Steam Inhalation

* Suctioning

- Oropharyngeal

- Nasopharyngeal

Things to Remember:SUCTIONING

Assess: AUDIBLE SECRETIONS during respiration

Position:

Conscious: SEMI-FOWLER’s POSITION

Unconscious: LATERAL POSITION

Pressure:

Wall Unit:

Adult: 100-120mmHg

Child: 95-110mmHg

Infant: 50-95mmHg

Portable Unit:

Adult: 10-15mmHg

Child: 5-10mmHg

Infant: 2-5mmHg

Appropriate Size of Catheter:

Adult: Fr. 12-18

Child: Fr. 8-10

Infant: Fr. 5-8

Lubricate Catheter:

Nasopharyngeal: water-soluble lubricant

Oropharyngeal: Sterile water or NSS

• Apply suction during withdrawal of the suction catheter (NEVER during insertion)

• Apply suction for 5 to 10 seconds (maximum of 15 seconds)

• Allow 20-30 seconds interval between each suction and limit suction to 5 minutes in total

• Encourage patient to breathe deeply and to cough between suctions.

• Assess effectiveness of suctioning

9. Incentive Spirometry - done to enhance deep inspiration

10. Administration of supplemental oxygen

Signs of Hypoxemia

1. Increased pulse rate

2. Rapid, shallow respiration

3. Increased restlessness

4. Flaring of nares

5. Substernal or intercostal retractions

6. Cyanosis

OXYGEN SYSTEMS:1. Low-flow Administration Devices

a. Nasal Cannula (24-45% at 2-6LPM)b. Simple Face Mask (40-60% at 5-8LPM)c. Partial Rebreathing Mask

(60-90% at 6-10LPM)d. Non-rebreathing Mask

(95-100% at 6-15LPM)e. Oxygen Tent

2. High flow Administration Devices

a. Venturi Mask

b. Oxygen Hood

c. Incubator / Isolette

Common Manifestations:1. Cough

- the cardinal symptom of respiratory problem

2. Dyspnea- refers to difficulty on breathing

* EXERTIONAL DYSPNEA* PAROXYSMAL NOCTURNAL * ORTHOPNEA

3. Clinical Signs of HypoxiaEARLY SIGNS

Tachycardia

Kussmaul’s Respiration

N/V

Headache

Irritability

Memory loss

Dizziness

LATE SIGNS

Bradycardia

Dyspnea

Decreased Systolic BP

Cough

Increased RBC

Increased Hgb

Clubbing of fingers

4. Clubbing of Fingers

5. Hemoptysis

6. Chestpain

7. Headache

8. Easy fatigability

9. Cyanosis

10. Skin flushing

11. Seizures

12. Altered level of consciousness

Common Pharmacologic Agents1. Adrenergic (Sympathomimetic) Agents

2. Bronchodilators

3. Antibacterial

4. Corticosteroids

5. Antihistamine

6. Mucolytic, Antitussive and Expectorant

Common Procedures/ Tests1. Abdominal Thrust (Heimlich Maneuver)

- a short, abrupt pressure against the abdomen, two fingerbreadths above the umbilicus, to raise the intrathoracic pressure.

PARTIAL: Noisy respiration, repeated coughing

TOTAL: Cessation of breathing, inability to speak

2. Radiographic Scanning Test (X-RAY)

3. Endoscopy (Bronchoscopy)

4. Chest Physiotherapy

5. Suctioning of Airway

6. Tracheostomy care

7. Pulmonary Function Test

- Incentive Spirometry

*Tidal Volume (500ml)

* Residual Volume (1200ml)

* Expiratory Reserve Volume (1000-1200ml)

* Inspiratory Reserve Volume (3000-3300ml)

8. Pulse Oximetry

9. Sputum Exam

10. Oxygen Therapy

11. Thoracentesis

12. Chest Tube (T-Tube)

- to drain air : 2nd or 3rd ICS

- to drain blood/ fluid: 8th or 9th ICS

13. Pulmonary Angiogram

TUBERCULOSIS

PNEUMONIA

EMPHYSEMA

BRONCHITIS

ASTHMA

Coronary Artery Diseases (CAD)1. Atherosclerosis

- an abnormal accumulation of lipid, or fatty, substances and fibrous tissues in the vessel wall

2. Arteriosclerosis

- refers to hardening of the vessel walls

Risk Factors for CADNonmodifiable Risk Factors

Family History of CAD

Increasing Age

Gender

Race

Modifiable Risk Factors

High Blood pressure

Cigarette smoking

High Blood cholesterol levels

Diabetes Mellitus

Lack of estrogen in women

Physical inactivity

Obesity

Controlling CholesterolNormal Total Serum Cholesterol =

150-240mg/dl

HDL = 29-77mg/dl

LDL= 60-160mg/dl

Triglycerides= 10-190mg/dl

Desired levels of LDL?< 160mg/dl for patients with one or no risk

factors

<130mg/dl for patients with two or more risk factors

<100mg/dl for patients with CAD

Angina PectorisClassifications of Angina

Class Activity Evoking Limits to Activity

I Prolonged exertion None

II Walking >2 blocks Slight

III Walking <2 blocks Marked

IV Minimal or Rest Severe

Types of Angina Pectoris1. Stable Angina

2. Unstable Angina

3. Intractable Angina/ Refractory Angina

4. Variant Angina

5. Silent Angina

Myocardial InfarctionCardiac Enzymes

CPK

Normal: Male: 5-35; Female: 5-25

Rises: 4-8 hours

Peak: ½ to 1 ½ days

Returns to Normal: 3-4 days

LDHNormal: 100-190IU/LRises: 12-24 hoursPeak: 2-6 days

Trop-TNormal: NEGATIVERises: immediatePeak: 4-24 hoursReturns to Normal: 1-3 weeks

Management:

M - morphine SO4 for pain

O - Oxygen

A – Aspirin/ ACE inhibitors (captopril)

N – Nitroglycerin

S – streptokinase ( thrombolytics )

– should be given in 6 hrs but better if in 3 hrs

Congestive Heart FailureClassifications:

CLASSIFICATION I

Ordinary physical activity does not cause fatigue, dyspnea, palpitations or chestpain

ASYMPTOMATIC

PROGNOSIS: Good

CLASSIFICATION II

Slight limitations on ADL’s

Patient reports no symptoms at rest but increased physical activity will cause symptoms

PROGNOSIS: Good

CLASSIFICATION III

Marked limitation on ADL

Patient feels comfortable at rest but less than ordinary activity will cause symptoms

PROGNOSIS: Fair

CLASSIFICATION IV

Symptoms of Cardiac insufficiency at rest

PROGNOSIS: Poor