Chapter 21 Oxygenation Copyright 2009 Wolters Kluwer Health

Oxygenation • Oxygen: measures approximately 21% in the Earth’s atmosphere • Each cell of

Question • Is the following statement true or false? Expiration creates more chest space,

Answer False. Inhalation creates more chest space, causing the pressure within the lungs to

Anatomy and Physiology of Breathing • Inspiration and expiration • Ventilation: movement of air

Anatomy and Physiology of Breathing (cont’d) • External and internal respiration – External respiration

Assessing Oxygenation • Physical assessment – Monitoring the client’s respiratory rate – Observing breathing

Assessing Oxygenation (cont’d) • Arterial blood gases measure: – Partial pressure of oxygen dissolved

Arterial Blood Gases Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Assessing Oxygenation (cont’d) • Pulse oximetry – Composed of a sensor and a microprocessor

Question • Which of the following is used for monitoring the oxygen saturation of

Answer b. Pulse oximetry is a technique for periodically or continuously monitoring the oxygen

Promoting Oxygenation • Positioning: Fowler’s position • Breathing techniques – Deep breathing o Incentive

Diaphragmatic Breathing Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Oxygen Therapy • Oxygen sources – Wall outlet – Portable tanks – Liquid oxygen

Oxygen Therapy (cont’d) • Equipment used in oxygen administration – Flowmeter – Oxygen analyzer

Oxygen Therapy (cont’d) • Common delivery devices (cont’d) – Masks o Simple mask o

Oxygen Therapy (cont’d) • Common delivery devices (cont’d) – Face tent – Tracheostomy collar

Comparison of Oxygen Delivery Devices (Refer to Table 21 -4 in the textbook. )

Oxygen Therapy (cont’d) • Additional delivery devices (cont’d) – Oxygen tent and CPAP mask

Administering Oxygen Safely Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question • Which of the following is a common delivery device for oxygen? a.

Answer b. Nasal cannula is a common delivery device. Flowmeter, oxygen analyzer, and humidifier

Related Oxygenation Techniques • Water-seal chest tube drainage – A technique for evacuating air

Nursing Implications • Nursing diagnoses: hypoxemia or hypoxia – Ineffective breathing pattern – Impaired

Ineffective Breathing Pattern (Refer to Nursing Care Plan 21 -1 in the textbook. )

General Gerontologic Considerations • Reduced gas exchange and efficiency in ventilation; major age-related changes

General Gerontologic Considerations (cont’d) • Diminished cough and gag reflexes, increased use of accessory

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Oxygenation • Oxygen: measures approximately 21% in the Earth’s atmosphere • Each cell of the human body uses oxygen to metabolize nutrients and produce energy • Without oxygen, cell death occurs rapidly Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question • Is the following statement true or false? Expiration creates more chest space, causing the pressure within the lungs to fall below that in the atmosphere. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Anatomy and Physiology of Breathing • Inspiration and expiration • Ventilation: movement of air in and out of lungs; facilitates respiration • Respiration: exchange of oxygen and carbon dioxide Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Anatomy and Physiology of Breathing (cont’d) • External and internal respiration – External respiration takes place at most distal point in airway: between the alveolar-capillary membranes – Internal respiration occurs at the cellular level between hemoglobin and body cells Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Assessing Oxygenation • Physical assessment – Monitoring the client’s respiratory rate – Observing breathing pattern and effort – Checking chest symmetry – Auscultating lung sounds Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Assessing Oxygenation (cont’d) • Arterial blood gases measure: – Partial pressure of oxygen dissolved in plasma – Percentage of hemoglobin saturated with oxygen – The p. H of blood Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Assessing Oxygenation (cont’d) • Pulse oximetry – Composed of a sensor and a microprocessor – Noninvasive, transcutaneous technique for periodically or continuously monitoring the oxygen saturation of blood Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question • Which of the following is used for monitoring the oxygen saturation of blood? a. Arterial blood gases b. Pulse oximetry c. Incentive spirometry d. Oxygen analyzer Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer b. Pulse oximetry is a technique for periodically or continuously monitoring the oxygen saturation of blood. Arterial blood gases monitor the p. H of blood. Incentive spirometry is a technique for deep breathing using a calibrated device. Oxygen analyzer is a device that measures the percentage of delivered oxygen to the client. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Promoting Oxygenation • Positioning: Fowler’s position • Breathing techniques – Deep breathing o Incentive spirometry – Pursed-lip breathing – Diaphragmatic breathing – Nasal strips Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Oxygen Therapy • Oxygen sources – Wall outlet – Portable tanks – Liquid oxygen unit – Oxygen concentrator • Equipment used in oxygen administration Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Oxygen Therapy (cont’d) • Equipment used in oxygen administration – Flowmeter – Oxygen analyzer – Humidifier • Common delivery devices – Nasal cannula Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Oxygen Therapy (cont’d) • Common delivery devices (cont’d) – Masks o Simple mask o Partial rebreather mask o Non-rebreather mask o Venturi mask Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Oxygen Therapy (cont’d) • Common delivery devices (cont’d) – Face tent – Tracheostomy collar – T-piece • Additional delivery devices – Nasal catheter Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Oxygen Therapy (cont’d) • Additional delivery devices (cont’d) – Oxygen tent and CPAP mask – Transtracheal oxygen • Oxygen hazards – Fire potential – Oxygen toxicity Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question • Which of the following is a common delivery device for oxygen? a. Flowmeter b. Nasal cannula c. Oxygen analyzer d. Humidifier Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer b. Nasal cannula is a common delivery device. Flowmeter, oxygen analyzer, and humidifier are equipment used in oxygen administration. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Related Oxygenation Techniques • Water-seal chest tube drainage – A technique for evacuating air or blood from the pleural cavity • Hyperbaric oxygen therapy – Delivery of 100% oxygen at 3 times the normal atmospheric pressure within an airtight chamber Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Nursing Implications • Nursing diagnoses: hypoxemia or hypoxia – Ineffective breathing pattern – Impaired gas exchange – Anxiety – Risk for injury (related to oxygen hazards) Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

General Gerontologic Considerations • Reduced gas exchange and efficiency in ventilation; major age-related changes occur in the respiratory system • Respiratory muscles become weaker and the chest wall becomes stiffer as a result of calcification of the intercostal cartilage Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

General Gerontologic Considerations (cont’d) • Diminished cough and gag reflexes, increased use of accessory muscles for breathing, increased mouth breathing, snoring • Inactive, debilitated, or chronically ill clients or smokers are at a higher risk for respiratory infections and compromised respiratory function Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins