Chapter 38 Oxygenation and Perfusion Copyright 2011 Wolters

Oxygenation and Perfusion depend on…. . • The condition of the airway system from

Function of the Airway • Warm, filter, humidify inspired air • Movement of air

Anatomy of the Lungs • Main organs of respiration • Extend from the base

The Organs of the Respiratory Tract Copyright © 2015 Wolters Kluwer • All Rights

Pulmonary Ventilation • Inspiration: the active phase of ventilation – Involves movement of muscles

Process of Ventilation • Inspiration begins when the diaphragm contracts and descends, lengthening the

Gas Exchange (Respiration) • Refers to the intake of oxygen and release of carbon

Transport of Respiratory Gases • Oxygen is carried in the body via plasma and

Cardiovascular System • Vital for exchange of gases • Composed of the heart and

Factors Affecting Cardiopulmonary Functioning and Oxygenation • Developmental considerations • Alterations in health •

Developmental Considerations – Infants are nose-breathers – Children have shorter airways – Older adults

Alterations in Health Factors • Cardiac disease • Vessel disease • Blood clots •

Alterations in Respiratory Function • Hypoxia: inadequate amount of oxygen available to the cells

Alterations in the Cardiovascular System • Dysrhythmia (irregularity) • Myocardial ischemia (meaning low oxygen

Medication factors • Cardiac medications—can control irregularities, improve pump function, control pressures, treat or

Lifestyle Factors • Smoking • Sedentary • Illegal drugs • Dietary choices • Occupational

Nursing Interventions Promoting Adequate Respiratory Functioning • Effective breathing techniques • Effective coughing techniques

Promoting Effective Breathing • Deep breathing • Using incentive spirometry (IS) • Pursed-lip breathing

Promoting Comfort • Positioning • Maintaining adequate fluid intake • Providing humidified air •

Medications • Cough suppressants • Expectorants • Lozenges • Bronchodilators • Antiinflammatories • Antibiotics

Administering Inhaled Medications • Bronchodilators: open narrowed airways. Can be given po, IV, or

Vehicles for Inhaled Meds Copyright © 2015 Wolters Kluwer • All Rights Reserved

Common Oxygen Delivery Systems • Nasal cannula— 1 -6 L/min. Can be humidified. •

Oxygen Masks Copyright © 2015 Wolters Kluwer • All Rights Reserved

Precautions for Oxygen Administration • Avoid open flames in the patient’s room. • Place

Type of Artificial Airways • Oropharyngeal and nasopharyngeal airway-to maintain airway patency and facilitate

Oropharngeal Airway Copyright © 2015 Wolters Kluwer • All Rights Reserved

Endotracheal Tube Copyright © 2015 Wolters Kluwer • All Rights Reserved

Two Types of Tracheostomy Sets: Cuffless and Cuffed (Cuffed allows ventilator) Copyright © 2015

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Oxygenation and Perfusion depend on…. . • The condition of the airway system from nose to alveoli • Properly functioning alveolar system in lungs to facilitate gas exchange • Properly functioning cardiovascular and hematologic systems that carry nutrients and wastes to and from body cells Copyright © 2015 Wolters Kluwer • All Rights Reserved

Anatomy of the Lungs • Main organs of respiration • Extend from the base of the diaphragm to the apex above the first rib • The right lung has three lobes; the left lung has two. • The lungs are composed of elastic tissue (alveoli, surfactant, pleura). Copyright © 2015 Wolters Kluwer • All Rights Reserved

Pulmonary Ventilation • Inspiration: the active phase of ventilation – Involves movement of muscles and the thorax to bring air into the lungs • Expiration: the passive phase of ventilation – Movement of air out of the lungs Copyright © 2015 Wolters Kluwer • All Rights Reserved

Process of Ventilation • Inspiration begins when the diaphragm contracts and descends, lengthening the thoracic cavity. • The external intercostal muscles contract, lifting the ribs upward and outward. • The sternum is pushed forward, enlarging the chest from front to back • The relaxation of these structures results in expiration. Copyright © 2015 Wolters Kluwer • All Rights Reserved

Gas Exchange (Respiration) • Refers to the intake of oxygen and release of carbon dioxide • Made possible by respiration and perfusion • Gas exchange occurs via diffusion at the alveolar level • Alveoli have a single layer membrane that allows the exchange of oxygen and carbon dioxide between the alveolar sacs and the capillaries Copyright © 2015 Wolters Kluwer • All Rights Reserved

Transport of Respiratory Gases • Oxygen is carried in the body via plasma and red blood cells. • Oxygen and carbon dioxide are carried by red blood cells in the form of oxyhemoglobin and carboxyhemoglobin. • Internal respiration occurs between the circulating blood and tissue cells in the body. This is called perfusion. Copyright © 2015 Wolters Kluwer • All Rights Reserved

Cardiovascular System • Vital for exchange of gases • Composed of the heart and the blood vessels • The heart is a cone shaped, muscular pump, divided into four hollow chambers: – Atria receive blood from the veins: superior and inferior vena cava (from body) and the left and right pulmonary veins (from lungs). – Ventricles force blood out of the heart through the arteries: aorta (to body) and the left and right pulmonary arteries (to lungs). Copyright © 2015 Wolters Kluwer • All Rights Reserved

Developmental Considerations – Infants are nose-breathers – Children have shorter airways – Older adults have decreased elasticity in lungs and CV system and skeletal changes that can affect lung performance Copyright © 2015 Wolters Kluwer • All Rights Reserved

Alterations in Health Factors • Cardiac disease • Vessel disease • Blood clots • Pulmonary disease • Skeletal abnormalities • Diabetes • Deconditioning and bedridden • Swallowing difficulties • Depression • Trauma • Infections Copyright © 2015 Wolters Kluwer • All Rights Reserved

Alterations in Respiratory Function • Hypoxia: inadequate amount of oxygen available to the cells • Dyspnea: difficulty breathing • Hypoventilation: decreased rate or depth of air movement into the lungs Copyright © 2015 Wolters Kluwer • All Rights Reserved

Alterations in the Cardiovascular System • Dysrhythmia (irregularity) • Myocardial ischemia (meaning low oxygen and perfusion to the heart muscle) • Angina (pain from severe ischemia) • Myocardial infarction (death of tissue from prolonged ischemia) • Heart failure (damaged pump) Copyright © 2015 Wolters Kluwer • All Rights Reserved

Medication factors • Cardiac medications—can control irregularities, improve pump function, control pressures, treat or prevent pain • Anticoagulants and aspirin • Pulmonary medications—can open airways • Antibiotics—treat infection in the respiratory tract • Narcotics—can slow respiratory rate and decrease air exchange; however morphine is a vasodilator • Herbals Copyright © 2015 Wolters Kluwer • All Rights Reserved

Nursing Interventions Promoting Adequate Respiratory Functioning • Effective breathing techniques • Effective coughing techniques • Suctioning the airway • Meeting oxygenation needs with medications • Smoking cessation • Avoiding environmental triggers Copyright © 2015 Wolters Kluwer • All Rights Reserved

Promoting Comfort • Positioning • Maintaining adequate fluid intake • Providing humidified air • Performing chest physiotherapy • Maintaining good nutrition • Pacing physical activities Copyright © 2015 Wolters Kluwer • All Rights Reserved

Administering Inhaled Medications • Bronchodilators: open narrowed airways. Can be given po, IV, or by inhalation. • Nebulizers: disperse fine particles of liquid medication into the deeper passages of the respiratory tract (breathing treatment to dilate bronchioles) • Meter-dose inhalers: deliver a controlled dose of medication with each compression of the canister. Can be rescue or maintenance. • Dry powder inhalers: breath-activated delivery of medications Copyright © 2015 Wolters Kluwer • All Rights Reserved

Common Oxygen Delivery Systems • Nasal cannula— 1 -6 L/min. Can be humidified. • Venturi mask— 4 -10 L/min. O 2 mixes with room air, CO 2 is expelled. Has large tube attached. Allows for the most accurate delivery of whatever percentage the HCP wants. • Simple mask— 6 -8 L/min. O 2 mixes with room air, CO 2 is expelled • Partial rebreather mask— 8 -11 L/min. Has reservoir bag that traps exhaled CO 2. O 2 mixes with small amount of trapped expelled CO 2 on inspiration. • Nonrebreather mask— 12 L/min. Has reservoir bag that holds oxygen. Highest delivery of O 2. No mixing occurs because CO 2 is exhaled through vents. • Tent—used for peds. Plastic cover bed. Motor keeps air cool and humidified. Side vents allow nsg care. Can cause damp linens and clothing. Copyright © 2015 Wolters Kluwer • All Rights Reserved

Precautions for Oxygen Administration • Avoid open flames in the patient’s room. • Place “no smoking” signs in conspicuous places. • Check to see that electrical equipment in the room is in good working order. • Avoid wearing and using synthetic fabrics (builds up static electricity). • Avoid using oils in the area (oils ignite spontaneously in oxygen). Copyright © 2015 Wolters Kluwer • All Rights Reserved

Type of Artificial Airways • Oropharyngeal and nasopharyngeal airway-to maintain airway patency and facilitate suctioning • Endotracheal tube-to deliver oxygen and medications when patient is unconscious • Tracheostomy tube-inserted directly into the trachea from the outside to maintain airway patency when upper airway is obstructed Copyright © 2015 Wolters Kluwer • All Rights Reserved