Chapter 39: Oxygenation and Perfusion Flashcards
Respiratory and cardiovascular system
cardiopulmonary system
cardiovascular system
heart and BV
oxygentation
process of providing life sustaining oxygen to body cells
Importance of data nurse collects about cardiopulmonary system
decide if data lead to problem statement, indicate another problem or possible cause of problem
upper airway
nose, pharynx, larynx, and epiglottis
function of Upper airway
warm, humidify and filter inspired air
lower airway
trachea, right and left main bronchi, segmental bronchi and terminal bronchioles
lower airway function
air conduction, muco-ciliary clearance and make pulmonary surfactant
mucus
traps cells, particles and infectious debris
protect underlying tissues from irritation and infection
Cilia
microscopic hairlike projects
propel trapped material and accompanying mucus toward upper airway for coughing removal
role of fluid intake for cilia
makes mucus watery and allows easier removal from LRS
geography of lungs
from diaphragm to apex, above the first rib
lung composition
elastic tissue
alveoli
small air sacs; gas exchange bc thin layer of cells in wall
surfactant
phospholipid; reduces surface tension between moist membranes of alveoli; preventing collapse
pleural fluid
in pleural space btw visceral and parietal pleura; lubricant and adhesive agent that holds lungs in expanded position
pressure in pleural space (intrapleural pressure)
negative pressure (less than Atm)
pulmonary ventilation
movement of air in and out of lungs
respiration
gas exchange between atmosphere air in the alveoli and blood in capillaries
perfusion
process by which oxygenated capillary blood passes through tissues
ventilation
inspiration (inhale)
expiration (exhale)
events of inspiration
- diaphragm contracts and descends
- lengthening of thoracic cavity
- external intercostal muscles contract; lift ribs upward and outward
- sternum pushes forward
- volume increases and pressure decrease => air from atm moves into lungs
events of expiration
- diaphragm relaxes
- ribs move down
- sternum drops back down
- decreased volume and increased pressure => air moves out
factors contributing to airflow in and out of lungs
condition of musculature
compliance of lung tissue
airway resistance
effects of weakened musculature
- may use accessory muscles of abdomen, neck, back
called RETRACTION
conditions causing harder time inflating lungs (less lung compliance)
- emphysema
- changes associated with aging
airway resistance
any process that changes bronchial diameter or width
example airway obstructions
food coin toy liquids (drowning) thickened secretions tissues (tumor) decrease in size of airway passages
Diffusion
movement of gas from high to low concentration
Things that affect diffusion of gas in the lungs
- changes in surface area available
- thickening of the alveolar-capillary membrane
- partial pressure
Atelectasis
incomplete lung expansion or the collapse of the alveoli
prevents pressure changes and the exchange of gas by diffusion
predisposal to Atelectasis
- obstructions of air by foreign bodies or mucus
- airway constriction
- external compression by tumors or enlarged BVs
- immobility
What causes thickening of alveolar-capillary membrane
pneumonia, pulmonary edema
Effect of exercise on perfusion
- greater need for O2
- increase in cardiac output
- increased blood return to lungs
What affects amount of blood in any given area of lung
position of body
What affects perfusion to body’s tissues
- adequate blood supply and proper cardiac functioning
Where is respiratory system in brain
- medulla, above spinal cord
What stimulates medulla of brain
- increased CO2 and H+ ions
- to a lesser degree: decreased oxygen in arterial blood
What stimulates medulla
- chemoreceptors aortic arch and carotid bodies = sensitive to same arterial blood gas levels and blood
- –CAN BECOME DESENSITIZED WITH CHRONIC CONDITIONS
- blood pressure
What increases ventilation during body movements
Proprioceptors in muscles and joints
Stimulation of medulla
increase rate and depth of breathing
Impulse from medulla
goes to spinal cord then to respiratory muscles stimulating contraction
Hypoxia
inadequate amount of oxygen available to cells
symptoms of hypoxia
dyspnea (difficulty breathing), elevated BP with small pulse pressure, increased respiratory and pulse rates, pallor, cyanosis, anxiety, restlessness, confusion, drowsiness
Cause of hypoxia
- hypoventilation
- chronic
effects of hypoxia
- altered thought processes
- headaches
- chest pain
- enlarged heart
- clubbing of fingers and toes
- anorexia
- constipation
- decreased urine output
- decreased libido
- weakness of extremity muscles
- muscle pain
Circulation
continuous one-way circuit of blood through BV
Atria
upper chambers of heart
Ventricles
lower chambers of heart
Stroke volume
how much blood the left ventricle pumps out with each beat
Cardiac output
hod much blood the left ventricle pumps out in a min
Internal repsiration
exchange of O2 and CO2 between BV and tissues
SA node
top of right atrium
pacemaker
initiates transmission of electrical impulses
AV node
mass of tissue at bottom of right atrium
delay to let atria contract
AV bundle
where impulse is sent after Av node
divides into right and left bundle branches
Purkinje fibers
smaller conduction branches in each ventricle wall
Dysrhythmia
disturbance of the rhythm of the heart
ischemia
decreased oxygen blood supply to the heart caused by insufficient blood supply
Angina
temporary imbalance between amount of O2 needed by the heart and amount delivered to heart muscles
causes chest pain
heart failure
heart unable to pump sufficient blood supply, inadequate perfusion and oxygenation of tissues
Arterial blood gas supply and pH analysis
- determine pressure exerted by oxygen in arterial blood and pH
- measures adequacy of oxygenation, ventilation, and perfusion
Normal results of Arterial blood gas supply and pH analysis
pH: 7.35-7.45 pCO2: 35-45 mm Hg PO2: 80-100 mmHg HCO3: 22-26 mEq/L base excess or deficit: -2-+2 mmol/L
Prep for Arterial blood gas supply and pH analysis
- inform test involves arterial puncture
- use radial, brachial, or femoral artery
- perform Allen test to ensure adequate ulnar flow if using radial artery
Aftercare for Arterial blood gas supply and pH analysis
- record supplemental O2 or respirator settings on specimen info
- specimen on ice and to lab
- apply 5-10 min of pressure
- watch for bleeding
- apply more pressure if taking anticoagulants
Cardiac Biomarkers
- Creatine kinases and isoenzymes are enzymes released bc of injury to tissues, including heart muscle
- Troponin found in skeletal and cardiac muscle fibers and released after injury to heart
- used to monitor cardiac injury and myocardial infarction
- help determine extent and timing of damage
Perp for Cardiac Biomarkers
- review procedures, inform this test can assist in assessing for heart damage
- series of samples will be taken, sample could be taken 3-4 times in 3-4 hour intervals
- inform that specimen collection is about 5-10 min
- address concerns about pain and explain there may be some pain during venipuncture
- no food, fluid, or med restrictions unless noted by HCP
Aftercare for Cardiac Biomarkers
- recognize anxiety
- provide teaching and info regarding test results
- reinforce info given by HCP regarding further testing, treatment, or referral to another HCP
- depending on results, additional testing may be needed to eval or monitor the progression of illness
- eval test results in relation to patient’s symptoms, HC problems and other tests performed
Complete blood count (CBC) preparation
- review proced w pat
- inform this test eval body’s response to illness
- inform the collection = 5-10 min
- address pain concerns and explain some discomfort during venipuncture
- no food, fluid or med restrictions unless HCP says so
Complete blood count (CBC) aftercare
- reinforce info given by HCP regarding further testing, treatment, or referral to another HCP
- depending on results, additional testing may be needed to eval or monitor the progression of illness
- eval test results in relation to patient’s symptoms, HC problems and other tests performed
Cytologic study
microscopic examination of sputum and cells it contains
detect cells that may be malignant, determine organisms causing infection and identify blood or pus in sputum
Cytologic study prep
- collect spcimen (morning b4 breakfast)
- 3 successive days of sputum collection
- 1 teaspoon needed for specimen
- pt deep breath and cough
- sterile container with possible preservative
- close with tight lid
Cytologic aftercare
- label and pack then send to lab
thoracentesis definition
puncturing chest wall and aspirating pleural fluid
used for either diagnostic purposes or to remove build up of fluid
thoracentesis pat position
sitting on chair or edge of bed with legs supported and arms folded, resting on pillow on bedside table
thoracentesis nursing responsobilities
- collecting baseline data
- preparation physically and emotionally
- instruct pt not to cough or breath deeply
- monitor color, pulse, RR, deviation from baseline
- fainting, nausea, vomiting
- send specimen to lab
outcomes wanted for improvement in oxygenation
- restore optimum function related to oxygenation
- alleviate symptoms or side effects of disease or treatment
- prevent complications
Example outcomes for oxygenation
pg. 1500
nursing interventions related to oxygenation
- promote optimal functioning of cardiopul. systems
- promote comfort
- promote and control coughing
Hoe nurses can intervene to help oxygenation
- suctioning the airway
- meeting resp needs with medications
- providing supplemental oxygen
- managing chest tubes
- using artificial airways
- cleaning obstructed airway
- CPR
How to promote optimal health in those with altered oxygenation
- encourage vaccination
- teach them importance of living in pollution-free environ
- minimize anxiety
- ## promote good nutrition
How to promote healthy lifestyle for better cardiopulmonary function
- healthy diet
- healthy weight
- exercise (150 min a week)
- monitor cholesterol, triglyceride, lipoprotein (HDL), and LDL. BP
- limit alcohol intake and stop smoking
Who is at risk for influenza
young children, pregnant women, people with chronic health conditions like asthma or heart and lung disease, 65+ yrs old
age limit for influenza vaccine
6 months of age and older
Pneumococcal disease
caused by pneumococcus bacteria
types:
- Pneumococcal pneumonia, meningitis, otitis media
long of Pneumococcal disease
- brain damage
- hearing loss
- limb loss
GET VACCINE
how to prevent exposure to environmental triggers
- job change
- use of PPE
- requesting enforcements of anti-pollution laws by governing facilities
- subcontracting jobs
- dust and vacuum
Effects of smoke inhalation
- increases airway resistance
- reduces ciliary action
- increases mucus production
- causes thickening of alveolar-capillary membrane
- causes thickening of bronchial walls to thicken and lose elasticity
Most common cause of COPD
Smoking
Cancer and smoking
increases risk for cancers of:
- oral cavity
- esophagus
- lung
- urinary bladder
- kidneys
smoking and BVs
- narrows BV
- causes coronary heart disease
increase risks for smoking
- stroke
- peripheral vascular disease
- abdominal aortic aneurysm
Good eating habits for good cardiopulm health, and decreased obesity
fruits veggies low-fat dairy products whole grains variety of protein foods reduced sat fats, trans fats, added sugars, sodium
how to promote comfort
- proper positioning
- adequate fluid intake
- humidification of inspired air
- appropriate breathing techniques
Comfortable position for people with dyspnea
-high- Fowler’s
eases use of accessory muscles
Comfortable position for people with acute respiratory distress syndrome
prone position
posterior dependent sections of lungs better ventilated and perfused
daily fluid intake
1.9-2.9 L/ day
When increased fluids are needed
- elevated temp
- people breathing through mouth
- people coughing
- people losing excessive body fluids
When to LIMIT fluid intake
- heart failure
- low sodium levels (1.5L)
Benefits of humidified air
- reduces irritation and infection due to dry air
Use of breathing exercises
patients achieve more efficient and controlled ventilations
decrease work of breathing
correct respiratory deficits
Deep breathing
-overcome hypoventilation
- deep breath to bottom of ribs
- start with deep breaths nasally then expire slowly through mouth
(hourly while awake or four times daily)
Using incentive spirometry
- assists patient to breathe slowly and deeply to sustain max inspiration
- can measure own progress
- optimal gas exchange
- secretions cleared and expectorated
Pursed-lip breathing
- for patients who experience dyspnea and feelings of panic
- slows and prolongs expiration
- good for COPD
- pat sits upright and inhales through nose
- counts to three
- exhales slowly against pursed lips
- tighten ab muscles
- exhales and counts to 7
- walking: 2 steps inhale; 4 steps exhale
Diaphragmatic Breathing positives
- reduces RR
- increase alveolar ventilation
- helps expel as much air as possible during exhalation
breathing of people with COPD
shallow, rapid, exhausting pattern
Steps of Diaphragmatic Breathing
- one hand is one stomach and other on chest
- patient breathes slowly through nose
- breathes out through lips
- allow contraction of ab muscles
- one hand inward and upward on abdomen
- repeat for 1 min
- 2 min rest
coughing
cleansing mechanism
Nonproductive cough
dry cough
Productive cough
produces secretions
respiratory secretion expelled by coughing or clearing throat
sputum
congetion
excessive fluid or secretions in organ or body tissue
thick resp secretions
phlegm
series of events producing cough
- initial irritation
- deep inspiration
- quick, tight closure of glottis together
- forceful contraction of expiratory intercostal muscles
- upward thrust of diaphragm
- air moves from lower to upper Rt
- most effective when pat it sitting upraight with feet flat on floor
Effective coughing
Coughing + deep breathing
Early morning cough
removes secretions from night
Coughing before meals
improves taste of food and oxygenation
coughing at bedtime
improves sleep
removes buildup of secretions
assisted cough
- ## firm pressure on abdomen below diaphragm in rhythm with exhalation
Involuntary cough
- respiratory tract infections and irritations
- triggered by secretions
- must examine cough to determine best kind of medication
Expectorants
- reduce viscosity of secretions
- can make nonproductive cough productive
- ex Guaifenesin
- fluid intake and air humidfication
Cough supressants
- Codeine (BUT addictive)
- Non-addictive= dextromethorphan
- only for sleep
Lozenges
- relieve mild nonprod cough without congestion
- in mouth until it dissolves
- usually control coughs bc of local anesthetic effects of benzocaine (acts on sensory and motor nerves)
Bad effects of cough meds with high sugar or alcohol
- disturb metabolic balance of pt with diabetes mellitus
- tigger relapse of alcoholics
Bad effects of cough meds with antihistamines
- anticholinergic action
- problems with people with glaucoma or urinary retention in men with enlarged prostate
Bad effects of cough meds
- some bad for hypertension or thyroid/cardiac diseases
- some suppress other bad health effects
Chest physiotherapy
- loosen and mobilize secretions
- percussion, vibrations, postural drainage
- NOT for children with pneumonia, adults with COPD and postoperative care adults
Reason for suctioning of airway
- suctioning pharynx
- maintain patent airway
- remove saliva, blood, pulmonary secretions, vomitus, foreign material
Negative of suctioning airways
- may induce hypoxemia (insuff ox in blood)
- – PREOXYGENATE PATIENT
- irritates mucosa
Prep for suctioning airway
- individualized pain management
- ## oxygen
Complications of suctioning airway
- infection
- cardiac arrhythmias
- hypoxia
- mucosal trauma
- death
PPE for suctioning airways
- gloves
goggles
mask
gown
What to monitor for during suctioning
- color
- HR
- blood
- cyanosis
What to avoid when taking meds used to dilate bronchial airways
caffeine
Inhaled meds given to open narrowed airways
bronchodilators
Inhaled meds given to loosen thick secretions
mucolytic agents
Inhaled meds given to reduce inflammation
corticosteroids
how inhaled meds are given
- dry powder inhaler (DPI)
- nebulizer
- metered-dose inhaler (MDI)
Nebulizer
- disperse fine particles of liquid med into deep passages of resp tract
MDI
deliver controlled dose of med with each compression of canister common mistakes (1506)
DPIs
breath activated
no coordination to activate it and inhale like with MDIs
Med clump if exposed to humidity
Important things to teach about inhaled meds
- overuse= serious side effects and ineffectiveness
- know how to clean nebulizer effectively
- must keep track of dosing with MDI
- must use deep inspirations
- spacer is using corticosteroid inhaler to prevent oral fungal infection
Oxygen prescription
must be prescribed EXCEPT if it is an emergency situation or decreasing O2 saturation or tachypnea
Therapeutic oxygen
- wall outlet or portable cylinder tank
- flow meter attached to wall outlet
- valve regulates O2 flow in meters per minute
- regulator releases O2 safely and at desired rate
- —two gauges
- –one nearest to tank shows pressure or amount of O2 in tank
- —other indicates number number of liters per minute of O2 being released
oxygen concentrators
- concentrate room air to provide the appropriate amount of O2
- can be used with portable tank
oxygen conserving device
- pulse of O2 at beginning of inspiration
Oxygen flow rate
- liters per minute
- determine amount of O2 delivered when using wall outlet or portable cylinders
- depends on pt condition and route of O2
- can analyze air pt is breathing to monitor O2 percentage
What to monitor with supplemental Oxygen
- RR
- pule oximetry
- ABG results
Humidification with suppl oxygen
only at rate higher than 4L/min
safety with O2
1509
Nasal cannula
most common
connect to O2 with flow meter and humidifier
Face masks
- Simple
- —O2 tubing, humidifier, flow meter, vents on both sides
- –used for increased oxygen for less than 24 hrs
- —possible skins breakdown bc pressure and moisture
- —hard to eat and talk
- –NEVER apply with flow rate < 5l/min
- Partial rebreather
- —reservoir bag
- —should only deflate slightly with inspiration
- Nonbreather
- — delivers highest concentration of O2 via mask to spontan. breathing patient
- — cannot rebreathe exhaled air
- —can be used for heliox admin
- Venturi
- –allows mask to deliver most precise amount of O2
- –side ports pull O2 in as tube narrows and pressure drops
- –1511
Liquid O2
-kept in small container refilled with large tank in home
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