Oxygenation

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Oxygenation

• Foundations of Nursing
• Chapter 27
• Revisions by
• Anita A. Kovalsky, RN, MNEd
• Original work by
• Sandra Gallagher, RN, MSN

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Cardiopulmonary Physiology
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The Heart and Lungs (contd)
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What Factors Affect Oxygenation?

• Physiological
• Developmental
• Behavioral
• Environmental

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Physiological Factors

• Anemia ? O2 carrying capacity
• Airway obstruction
• High altitude
• Fever

• ? Chest wall motion
• Pregnancy
• Obesity
• Trauma
• CNS alterations
• Pain
• Musculoskeletal Abnormalities
• Post-Surgery

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Developmental Factors

• Prematurity/surfactant
• Infancy/Upper Respiratory infections (URIs)
• Adolescence/exposures
• Middle-Age/diet.exercise, etc.
• Older Adults
• atherosclerotic plaques

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Behavioral Factors

• Nutrition
• Exercise
• Smoking
• Anxiety/Stress
• Substance abuse

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Environmental Factors

• Toxic inhalants
• - Asbestosis
• Pollution
• Allergens
• Pollens

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Hyperventilation Hypoventilation

• Hypoventilation inadequate alveolar ventilation
  to meet O2 demand, or to remove sufficient CO2
• May cause atelectasis
• Possible causes COPD
• Signs Symptoms Box 27-4

• Hyperventilation increase in respiratory rate
  which results in excess amounts of carbon dioxide
  being eliminated
• Possible causes anxiety, fever, chemical
• Signs Symptoms Box 27-3

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Stimulus to Breathe (pg.653)

• What is the stimulus to breath in a client with a
  normally functioning respiratory system?
• What is the stimulus to breath in a client with
  chronically elevated PaCO2 levels? Which clients
  would be in this group? (Hypoxic drive)
• What precautions should the nurse use if a client
  is a PaCO2 retainer?

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Hypoxia

• Tissue oxygenation at the cellular level
• Does this occur in relation to O2 delivery or O2
  utilization?
• What is cyanosis?

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What are the Signs Symptoms of Hypoxia?

• Restlessness
• Altered LOC
• Disorientation
• Dyspnea
• Chest Pain infarction versus ischemia

• ? P-R-BP
• Accessory muscle use
• Pallor
• Cyanosis
• Clubbing

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Nursing Process Assess Pertinent Historical Data

• Fatigue
• Dyspnea
• Cough productive or non-productive?
• Hemoptysis ?
• Hematemesis ?

• Pain
• Environment
• Respiratory infections
• Risk Factors
• Medications

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Nursing Process Assess Physical Assessment Data

• Inspection
• Palpation
• Percussion
• Auscultation
• Altered breathing patterns (see next slide)

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Ventilation/O2 Studies

• Pulmonary Function Tests (PFTs) pp. 842-848
• Arterial Blood Gases (ABGs) pp.216-225
• Pulse Oximetry pp. 848-850

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Lab Diagnostics

• CBC (Hgb Hct) pp.562-570
• Cardiac enzymes (CK-MB) pp. 401-404.
• Troponin pp.939-939
• Electrolytes
• Cholesterol pp. 311-316
• Triglycerides pp. 931-933

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Pulmonary Visualization

• CXR (to right) pp. 289-291
• Bronchoscopy pp. 241-242 (shown below)
• Lung Ventilation- Perfusion Scan
• pp.672-679
• /CT Scan of Lungs pp. 388-391

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More Chest X-Ray Photos
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Diagnosing Abnormal Organisms in the Respiratory
Tract

• Throat Cultures (CS) pp.162-164
• Sputum collection pp. 156-160
• AFB (Acid Fast Bacillus - for Tuberculosis (TB)
  diagnosis) pp. 412-417
• Cytology (for cancer) pp. 431-435
• Skin Testing (PPD for TB diagnosis)
• pp. 939-942
• Thoracentesis pp. 793-797

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Nursing ProcessPlanning Care for the Client
with altered Oxygenation

• ABCs
• Airway patency
• Adequate ventilation
• Circulation
• Vital signs
• Promote Lung Expansion
• Promote Mobilization of secretions
• Review Lab Values

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Nursing ProcessNursing Interventions for
Optimal Oxygenation

• Health Promotion vaccines
• Dependent Nursing Interventions (with physicians
  order)
• Oxygen (O2)Therapy
• Medications

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Oxygen Therapies(Table 27-10 will be reviewed
in NAL)

• Nasal Cannula
• Simple Face Mask
• Venturi Mask

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Nursing ProcessNursing Interventions for
Optimal Oxygenation

• Promoting Lung Expansion
• Positioning
• Coughing and Deep Breathing
• Incentive Spirometry with Physicians Order
  (shown at right)
• Promoting Mobilization of Secretions
• Hydration
• Dependent Nursing Interventions
• Chest PT percussion and viibration
• (Chest Physiotherapy)
• Postural Drainage (next slide)

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Nursing ProcessAdditional Dependent Nursing
Interventions for Optimal Oxygenation

• Airway Maintenance humidification, nebulization
• Suctioning oral, nasotracheal, nasopharyngeal,
• Artificial Airways oral/tracheal
• Ventilators

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Nursing ProcessEvaluation of Care

• Reassess clients oxygenation status after
  interventions
• Ask client to rate breathing on a scale
• Notify MD if clients O2 status impaired
• Revise care plan prn
• Documentation!!!!