Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Chapter 32 Oxygenation

Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Chapter 32

Oxygenation


Physiology of Oxygenation

• Ventilation

• Alveolar gas exchange

• Oxygen transport and delivery– Oxygen transport in blood

– Circulation

• Cellular respiration


Factors Affecting Oxygenation

• Age

• Environment

• Lifestyle

(continued)



• Disease processes:– Obstructive pulmonary disease

– Restrictive pulmonary disease

– Diffusion defects

– Ventilation-perfusion mismatching

– Atherosclerosis

(continued)



• Disease processes:– Heart failure

– Anemia

– Alterations in oxygen uptake


Physiological Responses to Reduced Oxygenation

• Increased oxygen extraction

• Anaerobic metabolism

• Tissue ischemia and cell death

• Carbon dioxide transport and excretion


Oxygenation and the Nursing Process

• Assessment– Health history

• Explore problem– Duration

– Pattern

• Medical history

(continued)



• Assessment– Health history

• ADLs

• Knowledge

• Coping

(continued)



• Assessment– Physical examination

• Observation

• Rate and rhythm

• Signs of hypoxia

• Palpation

• Percussion

• Breath sounds

(continued)



• Assessment– Diagnostic and laboratory data

• Pulse oximetry

• Arterial blood gases (ABGs)

• Sputum collection

• Chest x-ray

• CT

• MRI

(continued)



• Assessment– Diagnostic and laboratory data

• Ventilation/perfusion (V/Q) scan

• Bronchoscopy

• Thoracentesis

• Echocardiography

• Electrocardiography

• Stress test

(continued)



• Diagnosis– Prioritize

• Airway

• Breathing

• Circulation

(continued)



• Diagnosis– NANDA statements

• Ineffective airway clearance

• Ineffective breathing patterns

• Impaired gas exchange

• Decreased cardiac output

• Ineffective tissue perfusion

(continued)



• Diagnosis– Other nursing diagnoses:

• Deficient knowledge

• Activity intolerance

• Insomnia

• Imbalanced nutrition

(continued)



• Diagnosis– Other nursing diagnoses:

• Acute pain

• Chronic pain

• Anxiety

(continued)



• Planning and outcome identification– Collaboration

(continued)



• Implementation– Airway clearance

– Breathing patterns

– Oxygen uptake and delivery

– Cardiac output and tissue perfusion

– Emergency interventions

(continued)



• Implementation– Interventions to promote airway clearance

• Teach effective coughing

• Initiate postural drainage and chest physiotherapy

• Monitor hydration

• Administer medications

(continued)



• Implementation– Interventions to promote airway clearance

• Monitor environmental and lifestyle conditions

• Introduce artificial airways

• Suction airway

(continued)



• Implementation– Interventions to improve breathing patterns

• Properly position client

• Teach controlled breathing exercises

• Introduce chest drainage systems

(continued)



• Implementation– Interventions to improve oxygen uptake and

delivery• Administer oxygen

• Administer blood components

(continued)



• Implementation– Interventions to increase cardiac output and

tissue perfusion• Manage fluid balance

• Suggest activity restrictions and assistance with ADLs

• Properly position client

• Administer medications

(continued)



• Implementation– Emergency interventions

• Remove airway obstruction

• Initiate cardiopulmonary resuscitation (CPR)

(continued)



• Implementation– Interventions to address associated nursing

diagnoses• Explore lifestyle and activity adaptations

• Encourage dietary and nutritional modifications

• Promote comfort

(continued)



• Implementation– Complementary therapies

• Herbs

(continued)



• Evaluation– Physical and psychological needs

– Revisions to plan of care

Documents

Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Chapter 32 Oxygenation