Oxygenation NRSB 311 Fall 2016 Objectives Oxygenation 1
Oxygenation, NRSB 311 Fall 2016
Objectives: Oxygenation: • 1) Summarize the physiological processes of the respiratory system. • 2) Identify factors affecting oxygenation and nursing interventions. • 3) Identify common lab (oxygen sat) and diagnostic tests for oxygenation issues. • 4) Identify medications commonly used for oxygenation issues (bronchodilators -albuterol, corticosteroids, mucolytics-Acetylcysteine, expectorants-guaifenesin). • 5) Apply the nursing process to the care of a patient with oxygenation issues. • 6) Know terminology • 7) Know NANDA: Ineffective airway clearance, Ineffective breathing pattern, Impaired gas exchange
Scientific Knowledge Base • Oxygen is needed to sustain life. • Blood is oxygenated through the mechanisms of ventilation, perfusion, and transport of respiratory gases. • Neural and chemical regulators control the rate and depth of respiration in response to changing tissue oxygen demands. • The cardiovascular system provides the transport mechanisms to distribute oxygen to cells and tissues of the body. Copyright © 2017, Elsevier Inc. All Rights Reserved. 3
Respiratory Physiology • The exchange of respiratory gases occurs between the environment and the blood. • Respiration is the exchange of oxygen and carbon dioxide during cellular metabolism. • The airways of the lung transfer oxygen from the atmosphere to the alveoli, where the oxygen is exchanged for carbon dioxide. • Through the alveolar capillary membrane, oxygen transfers to the blood, and carbon dioxide transfers from the blood to the alveoli. Copyright © 2017, Elsevier Inc. All Rights Reserved. 4
Structure and Function • Gases move into and out of the lungs through pressure changes. • The diaphragm and external intercostal muscles contract to create a negative pleural pressure and increase the size of the thorax for inspiration. Copyright © 2017, Elsevier Inc. All Rights Reserved. 5
Structure and Function (Cont. ) Ventilation Perfusion Diffusion The process of moving gases into and out of the lungs The ability of the cardiovascular system to pump oxygenated blood to the tissues and return deoxygenated blood to the lungs Exchange of respiratory gases in the alveoli and capillaries Copyright © 2017, Elsevier Inc. All Rights Reserved. 6
Structure and Function (Cont. ) • Respiratory gas exchange • Diffusion is the process for the exchange of respiratory gases in the alveoli of the lungs and the capillaries of the body tissues Copyright © 2017, Elsevier Inc. All Rights Reserved. 7
Factors Affecting Oxygenation • Physiological factors • Conditions affecting chest wall movement • Influences of chronic diseases Copyright © 2017, Elsevier Inc. All Rights Reserved. 9
Alterations in Respiratory Functioning Hypoventilation: Hyperventilation: Hypoxia: Cyanosis”
Relevant Patient History • Family and personal data • Smoking (pack-years) • Drug use • Allergies • Travel, geographic area of residence • Nutritional status 11
Physical Assessment • Inspection • Palpation • Percussion • Auscultation
Assessment: Data Pain Fatigue Dyspnea Cough Wheezing Smoking Respiratory infection Allergies Health risks Medications Copyright © 2017, Elsevier Inc. All Rights Reserved. 13
Laboratory Tests • Blood • Sputum • Standard chest x-rays, digital chest radiography, CT • Ventilation and perfusion scan • Pulse oximetry (noninvasive) 14
Maintenance and Promotion of Lung Expansion • Ambulation • Positioning • Reduces pulmonary stasis, maintains ventilation and oxygenation • Incentive spirometry • Encourages voluntary deep breathing Copyright © 2017, Elsevier Inc. All Rights Reserved. 15
Oxygen therapy • Oxygen: It is considered a medication and as such a medical order is needed before a nurse can administer • Action: Oxygen is used to maintain cellular oxygenation it used to treat many acute and chronic respiratory problems • Desired therapeutic effect: The minimum amount needs to maintain an Sat O 2 of 95 -100% acceptable level may range form 91 -100%
Oxygenation: And medication • Albuterol • Corticosteroids • Oxygen theapy • Mucolytics-Acetylcysteine, Expectorants-guaifenesin
Asthma • Asthma is a disease of the lungs with acute exacerbations caused by chronic inflammation of the airways most often caused by allergies. This inflammation results in airway swelling, bronchospasm occurs in the smooth muscle of the bronchi and bronchioles; secretion increase in viscosity and elastic recoil decreases. These changes result in a reduction of the diameter of the airways, making breathing more difficult. • Asthma: Common signs and symptoms of asthma include: Coughing from asthma often is worse at night or early in the morning, making it hard to sleep. Wheezing is a whistling or squeaky sound that occurs when you breathe (exhale). Chest tightness- may feel like somebody sitting on your chest.
Mrs. T • Mrs T. is a 25 year-old, nursing student, that presents at the emergency room complaining of shortness of breath upon walking half a mile, a productive cough, wheezing on expiration, mildly restless and anxious. Upon assessment the nurse notice that Mrs T. ’s lips are slightly blue and she is having difficulty talking. RR= 24, HR= 105, BP= 140/90, T= 100 F, and Sat O 2 = 90% • Upon further assessment, the nurse notices labored respiratory effort, and mouth breathing (hungry for air). • Mrs. T has been a smoker for 7 years and has a history of Asthma and seasonal allergies since childhood. • What are the priority assessments for Mrs. T?
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