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OXYGENATION
NURSING FUNDAMENTALS FOCUS VIII
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OBJECTIVES
List and discuss the major body structures. Discuss functions responsible for proper oxygenation
Describe factors that may alter ones O2 balance.
Identify the behaviors indicating negative O2 balance. Review the common diagnostic tests medically
prescribed in order to determine the clients
oxygenation status.
Explain the major purpose of the tests and the related
nursing responsibilities.
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STAGGERING STATISTICS
Pulmonary Diseases Lung CA -
TB
Pneumonia
Chronic Airflow Limitation(formerly COPD)
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STAGGERING STATISTICS
Cardiovascular Diseases # 1 killer HTN 65 million
ArtheriosclerosisArteriosclerosis
Stroke
Hypercholesterolemia
107 million - a risk factor for CVD
AMI 7.5 Million per year, 460,000 die
Americans paid 393.5 billion in 2005 for CVD
related medical costs
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RESPIRATORY SYSTEM
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PROCESS OF BREATHING
Inspiration
Air flows into lungsExpiration
Air flows out of lungs
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NORMAL OXYGENATION PROCESS
Cardiovascular:
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NORMAL OXYGENATION PROCESS
Systemic:
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NORMAL OXYGENATION PROCESS
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INSPIRATION
Diaphragm and intercostal muscles contract
Thoracic cavity size increases
Volume of lungs increases Intrapulmonary pressure decreases
Air rushes into the lungs to equalize pressure
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EXPIRATION
Diaphragm and intercostal muscles relax
Lung volume decreases
Intrapulmonary pressure rises
Air is expelled
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GAS EXCHANGE
Occurs after the alveoli are ventilated
Pressure differences (gradient) on each side of therespiratory membranes affect diffusion
Alveoli:
PO2 100mmHg
PCO2 40mmHg
Venous blood:
PO2 60mmHg
PCO2 45mmHg O2 diffusion from alveolipulmonary blood vessels
CO2 diffusion from pulmonary blood vesselsalveoli
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ADEQUATE O2 BALANCE
Maintenance of adequate O2 balanceGas Exchange
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OXYGEN TRANSPORT
Transported from the lungs to the tissues
97% of O2combines with RBC Hgb
oxyhemoglobin carried to tissues Remaining O2is dissolved and transported in
plasma and cells (PO2)
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NORMAL OXYGENATION PROCESS
Cell environment / O2carrying capacity:
O2Carrying capacity of blood is expressed by: Red blood cells (#)
Hematocrit
% of blood that is RBCs
Men 40-54%
Women 37-50%
Hemoglobin
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CARBON DIOXIDE TRANSPORT
Must be transported from tissueslungs
Continually produced in the process of cell
metabolism
65% carried inside RBCs as bicarbonate (HCO3-)
30% combines with Hgbcarbhemoglobin
5% transported in plasma as carbonic acid (H2CO3)
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FACTORS THAT INFLUENCE
RESPIRATORY FUNCTION
Age
Environment
Lifestyle
Health status
Medications
Stress
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COMMON MANIFESTATIONS OF IMPAIRED
RESPIRATORY FUNCTION
Hypoxia
Altered breathing patternsObstructed or partially
obstructed airway
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HYPOXIA
Condition of insufficient oxygen anywhere in the body
Rapid pulse
Rapid, shallow respirations and dyspnea
Increased restlessness or lightheadedness
Flaring of nares
Substernal or intercostal retractions
Cyanosis
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ABNORMAL RESPIRATORY PATTERNS
Tachypnea (rapid rate)
Bradypnea (abnormally slow rate)
Apnea (cessation of breathing)
Kussmauls breathing
Cheyne-Stokes respirations Biots respirations
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ALTERATIONS IN EASE OF BREATHING
Orthopnea
Dyspnea
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OBSTRUCTED OR PARTIALLY
OBSTRUCTED AIRWAY
Partial obstruction
low-pitched snoring during inhalation
Complete obstruction extreme inspiratory effort with no chest
movement
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ADEQUATE O2 BALANCE
Example of Obstructive Disease:Asthma
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ADEQUATE O2BALANCE
Example of Restrictive Disease: Hemothorax
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INADEQUATE O2BALANCE
Behaviorsof Negative O2balance Hypoventilation or hyperventilation
Stridor, audible sounds with respiration,wheezing, coughing
Hypoxia Change in mental status
Change vital signs
Cyanosis Decrease in GI motility
Change in renal function
Hypercapnia
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NURSING RESPONSIBILITIES
Determine adequacyof cardiopulmonary function:
Nursing assessment
HEART
Respiratory assessment
PMH
LIFESTYLE
HEART
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HEART
Have client describe specific location, onset and duration of the problem
Explore associated signs and symptoms
Ask - activities that worsen or ease the problem
Rate the severity of discomfort or incapacity
Talk - treatments or interventions used to alleviatethe problem and their effectiveness
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HEART PROBLEMS
Artheroscleosis = Coronary Artery Disease (CAD)
NURSING MEASURES TO PROMOTE
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NURSING MEASURES TO PROMOTE
RESPIRATORY FUNCTION
Ensure a patent airway
Positioning
Encourage deep breathing, coughing
Ensure adequate hydration
NURSING RESPONSIBILITIES
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NURSING RESPONSIBILITIES
Physical Assessment:
Lung auscultation and breathing pattern
Abdominal assessment
Urine output
Skin and mucous membranes
Heart sounds
Circulation
Edema
DVT
LUNG SOUNDS
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LUNG SOUNDS
Diminished or absent
Crackles course and fine
discontinuous course bubbling
fine crackling sound at the middle or end of inspiration
Rhonchi
a continuous sonorous sound
Wheezes
high pitch musical sounds
Pleural friction rub
grating rubbing, sound
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COMMON TESTS AND NURSING RESPONSIBILITIES
Measure adequacyof ventilationand gas exchange
Complete Blood Count (CBC) phlebotomy
Arterial Blood Gases (ABG)arterial puncture
Pulmonary Function Testspreparation by teaching
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COMMON TESTS AND NURSING RESPONSIBILITIES
Tests to determine abnormal cell growthorinfectionin respiratory system:
Sputum culture growing microorganisms from sputum
Throat culture
growth of microorganisms from throat material
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COMMON TESTS AND NURSING RESPONSIBILITIES
Tests to visualize structuresof
respiratory system: Bronchoscopy
Chest radiographs
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CHEST XRAY
Adenocarcinoma
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COMMON TESTS AND NURSING RESPONSIBILITIES
Thorancentesis
NURSING RESPONSIBILITIES
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NURSING RESPONSIBILITIES
Medications
Incentive spirometry
Chest PT
Postural drainage
Oxygen therapy
Artificial airways
Airway suctioning
Chest tubes
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BASIC NURSING INTERVENTIONS
Airway Maintenance:
Facilitate effective coughing
Suctioning airways Liquefying and mobilizing sputum
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BASIC NURSING INTERVENTIONS
Maintenance and promotion of proper lungexpansion:
Re-expanding collapsed lungs
- Closed Chest Tube Drainage
CHEST TUBES
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CHEST TUBES
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BASIC NURSING INTERVENTIONS
Improving Activity Tolerance: Determine etiology
Assess appropriateness of activity level
When appropriate gradually increase activity
Ensure the client changes position slowly
Observe for symptoms of intolerance
Syncope with activity
refer to MD
Perform ROM exercises with activity intolerance if is
immobile
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BASIC NURSING INTERVENTIONS
Mobilization of Pulmonary Secretions
Auscultate breath sounds, monitor respiratory
patterns, monitor ABGs Position client to optimize respiration
Pulmonary toileting
Incentive spirometry Suctioning
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INCENTIVE SPIROMETRY
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BASIC NURSING INTERVENTIONS
Mobilization of Pulmonary Secretions Encourage activity and ambulation as tolerated
Encourage increased fluid intake
Chest physiotherapy
O2
Medications as ordered
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BASIC NURSING INTERVENTIONS
O2 Therapy:
Low flow
High flow
Humidification Nasal cannula
Simple mask
Nonrebreathing mask
Partial rebreathing
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BASIC NURSING INTERVENTIONS
Effective Breathing Techniques
Position for maximal respiratory function
Pursed lip breathing
Diaphragmatic or abdominal breathing
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BASIC NURSING INTERVENTIONS
Stress and anxiety reduction: Remove pertinent cause of anxiety at that moment
- help client gain control over respiration- reassure client not in immediate danger
Chronic clients exacerbations and remissions goal is to reduce general level of anxiety learn to control episodes of anxiety to improve quality
of life desensitization program
guided mastery
S O O
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ADMINISTRATION OFPRESCRIBED MEDICATIONS
Expectorants
Mucolytics
Bronchodilators
Cough suppressants
Corticosteroids
Antihistamines
Antibiotics
Vasoconstrictors
BASIC NURSING INTERVENTIONS
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BASIC NURSING INTERVENTIONS
Physical Exercise health teaching
Activity and rest -- a priority!
Activity stimulates respiratory function
Rest conserves energy and reduces metabolic demand
MDs treatment plan
guidelines for activity
may simply call for activity as tolerate.
prioritize activities
arrange need items conveniently
Provide emotional support and encouragement gradually increase activity
Simplify daily life
Work at a steady state
Conserve energy
ADEQUATE O2 BALANCE
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ADEQUATE O2 BALANCE
Behaviorsof Negative O2 balance
Cardio Vascular Disease
Arterial
Venous:
Impaired tissue perfusion
ADEQUATE O2 BALANCE
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ADEQUATE O2 BALANCE
Behaviorsof Negative O2 balance CV
Restlessness, dizziness, syncope, bradycardia,
decreased urine cold and clammy skin, cyanosis, slow capillary refill
Decreased cardiac output
COMMON TESTS AND NURSING RESPONSIBILITIES
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COMMON TESTS AND NURSING RESPONSIBILITIES
Tests to determine adequacy of cardiovascular function:
CBC
Lipid profile
Coagulation studies
EKG/ECG
Angiography
Doppler blood flow studies
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BASIC NURSING INTERVENTIONS
Cardiovascular Modify risk factors
Preventing vasoconstriction
Diet Exercise Co morbidities
Positioning
Cold temperatures Nicotine
BASIC NURSING INTERVENTIONS
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BASIC NURSING INTERVENTIONS
Cardiovascular- Prevent complications
Promoting rest
Risk DVTPosition changesEarly ambulationObstruction removalBypass surgery
Schedule rest periodsAssistance with ADLsMonitor Vitals with activityPlace items, i.e. call light,water pitcher, strategicallyQuiet environment,decrease stimuli
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BASIC NURSING INTERVENTIONS
Cardiovascular Positioning to improve
CO
Avoiding Valsalva
maneuver
- Position semi to highfowlers-> decrease venousreturn and preload, deceasepreload-> decreases risk ofheart congestion
- Teach client to avoid
valsalva maneuver- Hold breath while
turning or moving inbed-> assist- Bearing down during
BM-> stool softenersand diet
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BASIC NURSING INTERVENTIONS
CardiovascularAvoid stimulants
Maintaining fluidbalance
Avoid appetite suppressants, coldmeds, coffee, tea, chocolate
Assess fluid status, monitor I&O,assess breath sounds, JVD, pittingedema in dependent areas, fluid
and NA+ restriction, daily Wgt withdiuretic therapy, electrolytemonitoring-> MD
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BASIC NURSING INTERVENTIONS
Cardiovascular
Increase O2 supply
Administer O2
Educate clientNO SMOKING!
Position to facilitatebreathing
ADMINISTRATION OF PRESCRIBED
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MEDICATIONS
Anti coagulants
Vasodilator Medications
Inotropic Medications
Anti Dysrhythmics
Anti hypertensives
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BASIC NURSING INTERVENTIONS
Dietary control
Assess nutritional status
Consider a dietician referral to assess
nutritional needs related to clients
Chronicity of CAL and CAD and nutrition
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BASIC NURSING INTERVENTIONS
Weight control
Evaluate the clients physiological status in relation
to condition
More than body requirements
Less than body requirements