Oxygenation: Ch. 41 PDF

Preview

Summary

Professors: Wendy Butler, Vy Mai, Suzanne Scheller
Textbook: Potter, Patricia A, Anne G. Perry, Amy Hall, and Patricia A. Stockert. (9th Edition).Fundamentals of Nursing, St. Louis: Elsevier Mosby 2017. ISBN 9780323327404...

Description

NURS 3005 Oxygenation Study Guide Exam 2  Scientific knowledge base o Oxygen is needed to sustain life o Both the cardiac and respiratory systems supply the oxygen demands of the body o The exchange of respiratory gasses occurs between the environment and the blood o Reparation: the exchange of oxygen and carbon dioxide during cellular metabolism o Neural and chemical regulators control the rate and depth of respiration in response to changing tissue oxygen demands  Steps in oxygenation o The air enters the mouth/nose and bronchi  Air is then humidified so that the body can take it into the lungs  Cilia filter the air  Mucous traps “gunk” so that it can be expectorated through coughing or suctioning o Ventilation: the process of moving gases into and out of the lungs  Perfusion: the ability of the cardiovascular system to pump oxygenated blood to the tissues and return deoxygenated blood to the lungs  Has to do with the hearts ability to get blood to the lungs  Diffusion: the exchange of respiratory gasses in the alveoli and capillaries  Occurs at the alveolar level  What can affect respirations? o Work of breathing: the effort required to expand and contract the lungs  Compliance: the ability of the lungs to distend/ expand in response to increased intra-alveolar pressure  Ex: trauma or musculoskeletal diseases  Airway-resistance: increase in pressure that occurs as the diameter of the airway decreases from mouth/nose to alveoli  Ex: asthma, bronchitis, & inflammatory disorders o Surfactant: chemical produced in the lungs to maintain the surface tension of the alveoli and keep them from collapsing  Keeps the alveoli patent so that gas exchange can occur o Atelectasis: collapse of the alveoli that prevents the normal exchange of oxygen and carbon dioxide  Post-surgical patients are prone to atelectasis  Respiratory Physiology Inspiration/ Expiration Pulmonary circulation Moves the blood to and from the alveolar capillary Inspiration: the process of inhaling air into the lungs membranes for gas exchange o Active process o Stimulated by chemical receptors in the aorta  Expiration: the process of exhaling air o Passive process Oxygen Transport Carbon dioxide transport Both the cardiac and pulmonary system play a role in Diffuses into red blood cells and is hydrated into oxygen transport. carbonic acid. Lung volumes: Tidal volume: the amount of air exhaled during expiration; normal= 500-600 cc Residual volume: air that is left in the alveoli after a full expiration Force vital capacity: pushing out as much air as possible on expiration Spirometry: measuring the amount of air exhaled 

NURS 3005 









Oxygenation Study Guide

Exam 2

Respiratory gas exchange o Rate of diffusion is affected by the thickness of the alveolar membrane  Ex: emphysema can alter the thickness of this membrane and decrease the diffusion rate o 3 factors affect the oxygen diffusion  Amount of oxygen being taken into the lungs  Perfusion of the lungs (how much blood is reaching the lungs)  Oxygen carrying capacity of the red blood cells  Hemoglobin levels reflect this because hemoglobin carries oxygen and carbon dioxide Regulation of respiration o Neural regulation:  The CNS controls the respiratory rate, depth, and rhythm  Medulla oblongata regulates involuntary breathing  Cerebral cortex regulates voluntary control of respirations o Chemical regulation:  Maintains the rate and depth of respirations based on changes in the blood consentration of oxygen and hydrogen ion concentrations carbon dioxide  These receptors are located in the aorta and carotid sinuses  Chemoreceptors sense changes in the chemical content of the blood and stimulate neural regulators to adjust Muscles near the lungs help expand and contract the lungs to allow breathing o Diaphragm o Intercostal muscles  Retractions of these muscles can occur when taking a deep breath the muscles appear to be “sucked in”  Substernal retraction  Intercostal retraction  Subcostal retraction o Abdominal muscles o Muscles in the neck and collar bone area Goal of ventilation: to have blood levels within normal ranges means that the bodies oxygen demands are being met o Arterial blood gas analysis  PaCO2: 35-45 mmHg  PaO2: 80-100 mmHg o Pulse oximetry: reflects the arterial oxygen saturation  SpO2: above 95% Alterations in Respiratory Functioning:

Hyperventilation: ventilation in excess of that required to eliminate carbon dioxide produced by cellular metabolism.  Pt. often has a tingling sensation due to high CO2 levels in the body Hypoxia: inadequate tissue oxygenation at the cellular level  Hypoxemia: low levels of oxygen in the blood o Hypoxemia leads to hypoxia

Hypoventilation: alveolar ventilation is inadequate to meet the body’s oxygen demands or to eliminate sufficient carbon dioxide  Pt. has low 02 levels Cyanosis: blue discoloration of the skin and mucous membranes  Circumoral cyanosis: cyanosis around the mouth

NURS 3005

Oxygenation Study Guide

Type of factor

Factors influencing oxygenation Causes Decreased oxygen-carrying capacity Hypovolemia Decreased inspired oxygen concentration Increased metabolic rate

Physiological factors Conditions affecting chest wall movement

Influences of chronic diseases Infants and toddlers

Developmental factors

School-aged children and adolescents Young and middle aged adults Older adults Nutrition

Lifestyle factors

Exercise Smoking

Lifestyle Risk Factors

Substance abuse Stress

Urban areas

Workplace risks Environmental Factors

Exam 2

Examples Anemia – low RBC= low hemoglobin Blood loss or blood clots Air inspired at high altitudes Hyperthyroidism, wound healing, pregnancy, fever, sepsis Pregnancy, obesity, neuromuscular diseases, musculoskeletal abnormalities, trauma, CNS alterations COPD or emphysema Respiratory arrest occurs more easily than it does in adults Potential for smoking in adolescents Lack of exercise, unhealthy diet Atherosclerosis can affect oxygenation, reduced cilia function Ideal diet is:  Rich in fiber  Whole grains  Fresh fruits and vegetables  Nuts  Antioxidants  Lean meats  Omega-3 fatty acids Recommended 30-60 minutes’ daily  Associated with: o Heart disease o COPD o Lung cancer (10x higher in smokers than non-smokers) Excessive use of alcohol & other drugs impairs tissue oxygenation A continuous state of stress increases the metabolic rate, thus increasing the oxygen demands of the body Incidence of pulmonary disease is higher in urban areas than in rural areas Increased risk for some diseases with certain workplaces:  Coccidodomycosis: affects farmers  Asbestosis: restrictive lung disease

NURS 3005 

Oxygenation Study Guide

Exam 2

Common respiratory conditions: o Pneumonia: an infection at the alveolar level  S&S:  Crackles hear in the lungs o Emphysema: thickening of the alveolar membrane causes air trapping on expiration  Associated with COPD and a history of smoking  A restrictive disease  S&S:  Elevated CO2 levels  Hypoxic drive: the body is stimulated by low oxygen levels to breath instead of by carbon dioxide o This means that emphysema patients should not be put on high flow oxygen because it will eliminate their drive to breath o Pneumothorax: air escapes the lungs and gets between the muscles of the chest wall and the lung itself  This will lead to a collapsed lung o Pleural effusion: fluid gets trapped in the pleura o Pulmonary embolism: a blood clot gets lodged in the capillaries of the lung

Cardiovascular system: 

Physiology

Myocardial pump: Starling’s law: as the myocardium stretches the strength of the subsequent contraction increases Coronary artery circulation: the coronary arteries supply the myocardium with nutrients and remove wastes  Stems off of the aorta

Myocardial blood flow: Unidirectional flow is ensured by 4 valves:  S1: mitral and tricuspid valves close  S2: aortic and pulmonic valves close Systemic Circulation: arteries and veins deliver nutrients and oxygen to the tissues and removes wastes

Blood Flow Regulation Stroke volume: the amount of blood ejected from the left Cardiac output: the amount of blood ejected from the left ventricle with each heart beat ventricle each minute  Any type of hemorrhage will affect this Cardiac output (CO)= stroke volume (SV) x Heart rate (HR) Preload: stretch of the ventricle as blood enters Afterload: resistance to left ventricle ejection

NURS 3005

Oxygenation Study Guide

Exam 2

Conduction System Autonomic nervous system influences the rate of Sympathetic nervous system: increases the rate of impulse generation and the speed of conduction impulse generation and impulse transmission and pathways. innervates all parts of the atria and ventricles Parasympathetic system: decreases the rate and Conduction system: originates with the SA node innervates atria, ventricles, and the SA and AV nodes (pacemaker) and is transmitted to the AV node  bundle of Hiss  purkenje fibers An EKG reflects the electrical conduction system of the heart  P wave= atrial contraction o P-R interval is usually .12-.2 seconds  QRS complex= ventricular contraction o Normal = 0.06-0.12 seconds  ST interval= ventricular relaxing Alterations in cardiac function Altered Cardiac output: Disturbances in Conduction: Dysrhythmias are caused by electrical impulses that do Insufficient volume is ejected into the systemic and not originate from the SA node pulmonary circulation  A result of Right or Left sided heart failure  Right sided CHF affects the pulmonary system o Affects the respiratory rate and perfusion of the lungs Impaired valvar function: Myocardial ischemia: Acquired or congenital disorder of a cardiac valve by Coronary artery flow to the myocardium insufficient to stenosis or regurgitation. meet myocardial oxygen demands  Stenosis= hardening  Results in angina  Can lead to myocardial infarction  Can lead to acute coronary syndrome (ACS)

NURS 3005 Assessment

Oxygenation Study Guide Exam 2 The nursing process An in depth history of the pts. normal and present cardiopulmonary function should be taken.  Past impairments in circulatory or respiratory functioning o Chest pain o Dyspnea o Wheezing o Respiratory infection o Health risks o Cough: hemoptysis = coughing up blood o Smoking o Allergies o Medications o Environmental/ geographical exposures o Fatigue: a major sign of the body compensating for decreased oxygenation  Methods that a patient uses to optimize oxygenation  Review of drug, food, and other allergies  Physical examination Inspection: skin and mucous membranes, Palpation: chest, feet, legs, pulses level of consciousness (hypoxia  altered (peripheral pulses x4) Check for tenderness, temp, edema LOC), breathing pattern, chest wall movement Percussion: presence of abnormal fluid or Auscultation: normal and abnormal heart air; diaphragmatic excursion and lung sounds 

Nursing Diagnosis

Laboratory and diagnostic testing Imaging: Blood tests:  Chest x-ray  CBC: tells about hemoglobin and RBC’s  Cardiac catheterization  Cardiac enzymes: evaluate how well the heart is functioning  Serum electrolytes o Potassium is important for the heart due to the cell membrane  Cholesterol  Activity intolerance  Decreased cardiac output  Fatigue  Impaired gas exchange  Impaired spontaneous ventilation  Impaired verbal communication  Ineffective airway clearance  Ineffective breathing pattern  Ineffective health maintenance  Risk for aspiration  Risk for infection  Risk for suffocation

Noninvasive:  TB skin test  Holter monitor: a heart monitor that a pt. wears like a purse  EKG  Thallium stress test  EPS: very invasive  PFT

NURS 3005 Implementation

Maintenance & promotion of lung expansion

Oxygenation Study Guide Exam 2  Risk for imbalanced fluid volume Health promotion:  Vaccinations: influenza and pneumococcal  Healthy lifestyle: advise pt. to eliminate risk factors such as: o Poor nutrition o Smoking o Sedentary life style  Environmental pollutants: second hand smoke, work chemicals, and pollutants  Acute care: o Dyspnea management- interventions depend on severity and underlying cause!  Position pt. in high Fowler’s tripod, administer oxygen, pharmacological agents (bronchodilators, steroids, mucolytic, and anti-anxiety), relaxation techniques o Airway maintenance  Suctioning is used when a pt. cannot expectorate secretions  Artificial airways:  Oral airway: prevents obstruction of the trachea by displacement of the tongue into the oropharynx  Endotracheal and tracheal airways: short term use to ventilate, relieve upper airway obstruction, protect against aspiration, or clear secretions  Tracheostomy: long term assistance, a surgical incision made into the trachea o Mobilization of pulmonary secretions o Hydration: maintain 1500-2000 cc of fluid intake per day o Humidification: when a pt. has oxygen at more than 4L/min o Nebulization o Coughing and deep breathing techniques  Incentive spirometry: used to measure the inspiratory amount (generally used in post-op or bedridden pts.) o Chest physiotherapy (postural drainage): done by respiratory therapy, a percussion technique used to loosen mucous in the lungs  Ambulation  Positioning: reduces pulmonary stasis and maintains ventilation & oxygenation  Incentive spirometry: encourages voluntary deep breathing  Non-invasive ventilation: maintains positive airway pressure and improves alveolar ventilation  Chest tube: a catheter places through the thorax to remove air and fluids from the pleural space, to prevent air from re-entering, or to re-establish intra-pleural and intra-pulmonic pressures o Relieves:  Pneumothorax  Hemothorax  Oxygen therapy: prevents or relieves hypoxia o 2 delivery methods: nasal cannula and oxygen mask o Home oxygen systems:  Indications:  Arterial partial pressure (PaO2) of 55 mmHg or less -OR Arterial oxygen saturation (SaO2) of 88% or less on room air at rest, on exertion, or with exercise

NURS 3005

Evaluation

Restoration of cardiopulmonar y functioning Restorative and continuing care

Safety guidelines

Oxygenation Study Guide Exam 2  Can be administered via N.C. or oxygen mask  T-tube or tracheostomy collar used if patient has a permanent tracheostomy  Home oxygen is beneficial for pts. with chronic cardiopulmonary disease Ask about:  Degree of breathlessness  If distance ambulated w/out fatigue has increased  Rating the breathlessness from 0-10  Which interventions reduce dyspnea  Frequency of cough and sputum production Preform:  Observe respiratory rate before, during, and after any activity  Assess any sputum produced  Auscultate lung sounds for improvement in adventitious sounds 1. A – Airway 2. B – breathing 3. C – Circulation D – defibrillation (AED)  Cardiopulmonary rehabilitation o Controlled physical exercise o Nutrition counseling o Relaxation and stress management o Medications o Oxygen o Compliance o Systemic hydration  Respiratory muscle training  Breathing exercises: o Pursed-lip breathing o Diaphragmatic breathing  Pts. with sudden changes in vital signs, level of consciousness, or behavior are possibly experiencing profound hypoxia  Preform tracheal suctioning before pharyngeal suctioning whenever possible  Use caution when suctioning pts. with a head injury  The routine use of normal saline instillation into the airway before ET and tracheostomy suctioning is not recommended  Check your institutional policy before stripping or milking chest tubes...