Chapter 32 Oxygenation Copyright 2011 Delmar Cengage Learning

Physiology of Oxygenation • Ventilation • Alveolar gas exchange • Oxygen transport and delivery

Factors Affecting Oxygenation • Age • Environment • Lifestyle (continued) Copyright © 2011 Delmar,

Factors Affecting Oxygenation • Disease processes: – – – Obstructive pulmonary disease Restrictive pulmonary

Factors Affecting Oxygenation • Disease processes: – Heart failure – Anemia – Alterations in

Physiological Responses to Reduced Oxygenation • • Increased oxygen extraction Anaerobic metabolism Tissue ischemia

Oxygenation and the Nursing Process • Assessment – Health history • Explore problem –

Oxygenation and the Nursing Process • Assessment – Health history • ADLs • Knowledge

Oxygenation and the Nursing Process • Assessment – Physical examination • • • Observation

Oxygenation and the Nursing Process • Assessment – Diagnostic and laboratory data • •

Oxygenation and the Nursing Process • Diagnosis – Prioritize • Airway • Breathing •

Oxygenation and the Nursing Process • Diagnosis – NANDA statements • • • Ineffective

Oxygenation and the Nursing Process • Diagnosis – Other nursing diagnoses: • • Deficient

Oxygenation and the Nursing Process • Diagnosis – Other nursing diagnoses: • Acute pain

Oxygenation and the Nursing Process • Planning and outcome identification – Collaboration (continued) Copyright

Oxygenation and the Nursing Process • Implementation – – – Airway clearance Breathing patterns

Oxygenation and the Nursing Process • Implementation – Interventions to promote airway clearance •

Oxygenation and the Nursing Process • Implementation – Interventions to improve breathing patterns •

Oxygenation and the Nursing Process • Implementation – Interventions to improve oxygen uptake and

Oxygenation and the Nursing Process • Implementation – Interventions to increase cardiac output and

Oxygenation and the Nursing Process • Implementation – Emergency interventions • Remove airway obstruction

Oxygenation and the Nursing Process • Implementation – Interventions to address associated nursing diagnoses

Oxygenation and the Nursing Process • Implementation – Complementary therapies • Herbs (continued) Copyright

Oxygenation and the Nursing Process • Evaluation – Physical and psychological needs – Revisions

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Physiology of Oxygenation • Ventilation • Alveolar gas exchange • Oxygen transport and delivery – Oxygen transport in blood – Circulation • Cellular respiration Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Factors Affecting Oxygenation • Disease processes: – – – Obstructive pulmonary disease Restrictive pulmonary disease Diffusion defects Ventilation-perfusion mismatching Atherosclerosis (continued) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Physiological Responses to Reduced Oxygenation • • Increased oxygen extraction Anaerobic metabolism Tissue ischemia and cell death Carbon dioxide transport and excretion Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Oxygenation and the Nursing Process • Assessment – Physical examination • • • Observation Rate and rhythm Signs of hypoxia Palpation Percussion Breath sounds (continued) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Oxygenation and the Nursing Process • Assessment – Diagnostic and laboratory data • • • Pulse oximetry Arterial blood gases (ABGs) Sputum collection Chest x-ray CT MRI (continued) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Oxygenation and the Nursing Process • Assessment – Diagnostic and laboratory data • • • Ventilation/perfusion (V/Q) scan Bronchoscopy Thoracentesis Echocardiography Electrocardiography Stress test (continued) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Oxygenation and the Nursing Process • Diagnosis – NANDA statements • • • Ineffective airway clearance Ineffective breathing patterns Impaired gas exchange Decreased cardiac output Ineffective tissue perfusion (continued) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Oxygenation and the Nursing Process • Diagnosis – Other nursing diagnoses: • • Deficient knowledge Activity intolerance Insomnia Imbalanced nutrition (continued) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Oxygenation and the Nursing Process • Implementation – – – Airway clearance Breathing patterns Oxygen uptake and delivery Cardiac output and tissue perfusion Emergency interventions (continued) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Oxygenation and the Nursing Process • Implementation – Interventions to promote airway clearance • • Teach effective coughing Initiate postural drainage and chest physiotherapy Monitor hydration Administer medications (continued) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Oxygenation and the Nursing Process • Implementation – Interventions to promote airway clearance • Monitor environmental and lifestyle conditions • Introduce artificial airways • Suction airway (continued) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Oxygenation and the Nursing Process • Implementation – Interventions to improve breathing patterns • Properly position client • Teach controlled breathing exercises • Introduce chest drainage systems (continued) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Oxygenation and the Nursing Process • Implementation – Interventions to improve oxygen uptake and delivery • Administer oxygen • Administer blood components (continued) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Oxygenation and the Nursing Process • 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) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Oxygenation and the Nursing Process • Implementation – Emergency interventions • Remove airway obstruction • Initiate cardiopulmonary resuscitation (CPR) (continued) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Oxygenation and the Nursing Process • Implementation – Interventions to address associated nursing diagnoses • Explore lifestyle and activity adaptations • Encourage dietary and nutritional modifications • Promote comfort (continued) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.