oxygenation Flashcards
overview of oxygenation
- Respiration
- Upper respiratory tract
- Lungs
- Ventilation
- Diffusion of Oxygen
- Circulation
- Heart
- CO=HRxSV (increase one will increase cardiac output)
- Blood vessels
- Blood
- Transports O2, nutrients, wastes
- Regulation of body temperature, pH
- Prevention of infection (white blood cells) & blood loss (platelets)
- Heart
factors that affect oxygenation - age
- Infant
a. Premature infants incapable of making surfactant
b. Lungs fluid filled in utero, infant takes first breath
c. Lungs fully expand in 2 weeks
d. Airways small in diameter, likely to collapse - Child
a. Diaphragmatic breathing until age 5
b. Limited ability to increase stroke volume - Older adult
a. Lungs
i. Increased chest wall stiffness
ii. Decreased lung volume
iii. V/P mismatch
iv. increased risk of aspiration due to GE reflux
b. Circulation
i. Decrease in maximal HR, SV, RBC production
ii. Increased systolic BP
factors that affect oxygenation - environment
- Altitude, heat, cold can affect respiration & circulation
- Air pollution
- Carbon monoxide
factors that affect oxygenation - lifestyle
- Diet—obesity increases work of breathing, can lead to increased BP
- Cigarette smoking, substance abuse
- Exercise vs sedentary lifestyle
factors that affect oxygenation - stress
- Hyperventilation
- Epinephrine, bronchiole dilatation, increased blood flow
factors that affect oxygenation - health status
- Conditions affecting chest wall movement—pregnancy, obesity
- MS abnormalities—scoliosis, kyphosis
- Trauma—upper abdominal incision, chest wall trauma
- Disease of musculoskeletal system—muscular dystrophy
- Disease of nervous system—SC injury, Myasthenia gravis
- Lung disease
- Heat disease
- Anemia
- Hypertension
- Medications—sedatives, narcotics, stimulants, alcohol
nursing history – subjective: symptoms of hypoxia
- Restlessness & Apprehension –> Altered
Level of Consciousness- do you know where you are? do you know your name? do you know the situation?
- hypoxia = not getting adequate amt of oxygen
symptoms of oxygenation problems
- Cough
- How often? When? What precipitates?
- Productive or nonproductive?
- Color, consistency?
- Dyspnea
- Orthopnea = difficulty breathing, lying flat
nursing history – subjective
- Symptoms
- Fatigue
- Fluid Retention: fluid buildup in their extremities
- Dependent areas
- Pain
- Intermittent (comes and goes) claudication–Aching in Calves
- Chest pain
more nursing history subjective
- Personal Habits
- Smoking—pack year history
- # of packs/day X # of years smoking
- Smoking—pack year history
- Allergy
- Exposure to pollutants,
respiratory disease- home, workplace
- Exercise
- Diet
- Current drug therapy
- History of chronic diseases
physical exam – objective
- Skin
- Cyanosis (seen on lips, toes, extremities. blue on fingertips)
- Edema (pooling of fluid in extremities)
- Nailbeds
- Capillary filling time (<3 seconds)
- Clubbing (fingernails are rounded)
- Neck veins (bulging is bad)
- Chest wall movement
Physical exam – breathing pattern
- Check rate rhythm and depth
- Normal rate for adult 12-20, average 16
physical exam – pulses
- Check rate and rhythm
- Normal rate for adult 60-100, average 80
physical exam – lungs
- Normal—Clear to auscultation (CTA)
- Abnormal
- Crackles: fluid in the lungs
- Rhonchi
- Wheezes
- if you don’t hear a clear blowing sound, then it’s abnormal
physical exam – BP
- Systolic—pressure in arteries with contraction
of ventricles- “top” number—should be < 120
- Diastolic—pressure in arteries during resting
phase of heart- “bottom” number—should be < 80
- Pulse pressure
- Difference between systolic and diastolic
- Orthostatic hypotension: shift position and BP drops. lying to sitting –> BP drops and heart rate increases
diagnostics
- Hemoglobin & hematocrit (H&H)
- Hemoglobin (carries oxygen throughout the body)
- Men 14-18
- Women 12-16
- Hemoglobin (carries oxygen throughout the body)
- Hematocrit (solid part of the blood)
- Men 40-45
- Women 38-43
- Arterial Blood Gases: measure oxygen status in the pts blood
- Electrocardiogram (EKG)
- Should be Normal sinus
rhythm (NSR)
- Should be Normal sinus
- Chest X-ray (CXR)
- Should be clear
pulse oximetry
- Normal >95%
- False elevated with CO
exposure - False low oxygen
saturation with poor
circulation- if fingers are cold, they can be falsely low
nursing diagnostic category: ineffective airway clearance
- Difficulty keeping airway passages clear of secretions
or obstructions (Gulanick & Meyer p. 11-14) - may have secretions in chest but doesn’t have a cough to cough it up
- Ineffective or absent cough***
- Inability to remove airway secretions***
- Abnormal breath sounds: if you have secretions, lungs will sound crackly
- Abnormal respiratory rate, rhythm, depth
nursing diagnostic category: activity intolerance
- Inability to perform physical activity without experiencing symptoms such as shortness of breath or fatigue. (Gulanick & Meyer p.8)
- bc I have an issue w/ my lungs it makes it hard for me to do activities
- Defining characteristics (supportive data) are about altered physiologic response to activity
- VS should return to normal within 3 minutes of activity
nursing diagnostic category: impaired breathing
- Difficulty passing air
through airway passages during inhalation and/or exhalation (Gulanick & Meyer p. 25) - pt is not able to breath properly
- pt with asthma
- pt who is hyperventilating
- air can’t flow freely back and forth
- not enough oxygenation
nursing diagnostic category: impaired gas exchange
- A change in the ability to adequately exchange oxygen and carbon dioxide in the lungs which may alter the body’s acid-base balance (Gulanick & Meyer p. 58)
- Not enough O2 or too much CO2 in blood
- Blood gases or pulse oximetry
interventions/implementation TCDB q2 hours
- turn, cough, deep breathing
interventions/implementation deep breathing
- Incentive Spirometry: helps open up alveoli and then you’ll be able to cough and do some deep breathing than can help excel those situations
- Treats atelectasis
- Usually done 5-6x q 1-2h
interventions/implementation chest physiotherapy
- requires MD order in many situations