Oxygenation

OxygenationBy Richard Araneta

Oxygenation

0Oxygenation is a basic human need0Breathing is synonymous to life, thus, oxygen is

required to sustain life02 body systems that supply the body’s oxygen

demands0 Cardiovascular system0 Respiratory system

Respiratory System

0The lung transfers O2 from the atmosphere into the alveoli, where the O2 is exchanged for CO2

0The alveoli transfers O2 and CO2 to and from the blood through the alveolar membrane

Pulse Oximetry

0Noninvasive0Estimates arterial blood oxygen susturation (SpO2)

0Normal SpO2 95-100%

0< 70% - life threatening0Detects hypoxemia (low oxygen; more in blood)

before clinical0Sensor, photodetector, pulse oximeter unit

Pulse Oximetry

0Factors that affect accuracy include0 Hemoglobin level0 Circulation0 Activity0 Carbon monoxide poisoning

Respiration

0Processes0 Ventilation0 Diffusion0 Perfusion

Ventilation

0Factors influencing ventilation0 Adequate atmosphere oxygen0 Clear air passages0 Adequate pulmonary compliance and recoil0 Regulation of respiration

Diffusion

0Factors influencing diffusion of gasses0 Thickness of membrane0 Surface area of the membrane0 Diffusion coefficient of gasses0 Pressure gradient on each side of the membrane

Perfusion

0Factors affecting oxygen transport from lungs to the tissues0 Cardiac output0 Number of erythrocytes0 Exercise0 Blood hematocrit

Factors Affecting Oxygenation

0Environment (altitude, heat, cold, air pollution)0Exercise0Emotions (fear, anxiety, anger)0Lifestyles (smoking, occupations, sedentary life, etc)0Health status (anemia [low red blood cells]

respiratory)Narcotics (morphine, demorol, etc)

3 Major Alterations in Respiratory Functions

01. Hypoxia0 Respiratory insufficiency0 Acapnea (absence of CO2 in blood)

0 Hypocarbia0Depressed level of CO2 in the blood

0 Hyperpnea (rapid breathing)0 Hypopnea (slow breathing)

Signs of Hypoxia

0Early/ acute signs0 Restlessness0 Increased pulse rate0 Increased rate and depth of respiration0 Increase in systolic blood pressures

Signs of Hypoxia

0Late/chronic signs0 Decreased pulse rate0 Decreased systolic blood pressure0 Dyspnea0 Fatigue and lethargy0 Cough0 Hemoptysis0 Clubbing of fingers

3 Major Alterations in Respiratory Functions

02. Altered breathing patterns0 Rate0 Volume (hypo or hyper)0 Rhythm (Cheyne Stokes, Kussmaul’s, Apneustic, and

Biat’s)0 Relative case of effort respiration (dyspnea and

orropnea)

3 Major Alterations in Respiratory Functions

03. Obstructive or particularly obstructive airways0 Upper airway, obstruction

0nose, pharynx, larynx, trachea

NANDA Nursing Diagnosis Related to Oxygenation

01. Ineffective airway clearance0 Refers to inability of the individual to clear secretions or

obstruction from the respiratory tract to maintain airway patency0Tracheobrachial infections0Obstructions, secretions

NANDA Nursing Diagnosis Related to Oxygenation

02. Ineffective breathing pattern0 Refers to and individual’s inhalation or exhalation

pattern that inhibits adequate ventilation0Neuromuscular0Pain, anxiety0Decreased energy and fatigue0 Inflammatory process

NANDA Nursing Diagnosis Related to Oxygenation

03. Decreased cardiac output0 State in which the blood pumped by the heart is

sufficiently reduced that it is inadequate to meet the needs of the body

0 Structural alteration0Ventricular – septal rupture, valvular disease

NANDA Nursing Diagnosis Related to Oxygenation

04. Impaired gas exchange0 State in which there is an imbalance between O2 and CO2

elimination at the alveolar capillary membrane gas exchange area0Altered O2 supply

0Altered blood

NANDA Nursing Diagnosis Related to Oxygenation

05. Altered tissue perfusion0 State in which an individual experiences a decrease in

nutrition and oxygenation at the cellular level because of a deficit in capillary blood supply0 Interrupted venous or arterial flow0Hypo/hyper volemia

Measures That Promote Adequate Respiratory Function01. Ensure a patent airway

0 To promote gaseous exchange between client and environment

0 Check for obstructions0Foreign objects, mucus

02. Positioning0 To allow maximum chest expansion0 Fowler’s position0 Encourage frequent changes

Measures That Promote Adequate Respiratory Function03. Deep breathing and coughing exercises

0 To promote lung expansion and loosen secretions0E.g. abdominal breathing (diaphragmatic and pursed lip)

04. Adequate hydration0 Maintain moisture of the respiratory mucus membrane 0 Use of humidifiers/ nebulizers

0Steam/ aerosol/ medimist

Measures That Promote Adequate Respiratory Function05. Chest physiotherapy

0 Percussion0Forceful striking of skin with cupped hands

0 Vibration0Serves of vigorous quivering produced by hands that are

placed flat against clients chest wall; done during exhalation

0 Postural drainage0Drainage by gravity of secretions from various lung

segments

Measures That Promote Adequate Respiratory Function06. Proper suctioning

0 A catheter – for 12-18 mmHg, tip of mouth to earlobe 5 meters suction 5-10 seconds, max is 15 seconds, wall suction 80-120 mmHg

07. Avoid environmental pollutants = smoking

Measures That Promote Adequate Respiratory Function08. Using inflation devices

0 Incentive spirometry – to enhance deep inspiration0 Intermittent positive pressure breathing

0To administer O2 at pressures higher than the atmospheric pressure

09. Administration of supplemental O2

0 Nasal cannula

Nursing Implication

0Since oxygen is colorless, odorless, and tasteless, leakage can’t be detected

0Since oxygen is dry, gas mucus membrane invitation could happen

Nursing Planning, Intervention, and Evaluation in O2 Administration

0Assess s and sx of hypoxemia0Check doctor’s orders0Open source before insertion of device0Regulated accurately0Place a “No Smoking” sign0Avoid use of oil, grease, and alcohol

Nursing Planning, Intervention, and Evaluation in O2 Administration

0Check of electrical device malfunction0Avoid using materials that could generate static

electricity0Humidify O2

0Provide good oro-nasal hygiene0Lubricate with water soluble stuff0Document