Oxygenation Flashcards
what is needed within the PROCESS OF OXYGENATION?
- needs EFFECTIVE GAS EXCHANGE
(from the lungs)
**includes the EXCHANGE BETWEEN OXYGEN & CO2 - needs EFFECTIVE PUMPING
(from the heart)
definition of VENTILATION
movement of gases INTO AND OUT of the LUNGS
- the process of INHALATION & EXHALATION
- the SIMPLE ACT OF BREATHING
definition of DIFFUSION
the process for EXCHANGE OF RESPIRATORY GASES in the ALVEOLI (LUNGS) & CAPILLARIES (BODY TISSUE)
definition of RESPIRATION
- the EXCHANGE OF OXYGEN & CO2 during cellular metabolism
- is NOT THE ACT OF AIR MOVING IN AND OUT OF LUNGS
- this is VENTILATION
what are the PHYSIOLOGICAL FACTORS THAT AFFECT OXYGENATION?
- having DECREASED OXYGEN-CARRYING CAPACITY
- HYPOVOLEMIA
- DECREASED INSPIRED OXYGEN CONCENTRATION
- INCREASED METABOLIC RATE
how can a patient have DECREASED OXYGEN-CARRYING CAPACITY?
- the blood carries oxygen through HEMOGLOBIN
- ex. ANEMIA -»_space;LOW RBC/LOW HEMOGLOBIN»_space; initiates a DECREASED OXYGEN-CARRYING CAPACITY
describe INCREASED METABOLIC RATE
- needing an INCREASED METABOLIC RATE CAN AFFECT OXYGENATION
- ex. EXERCISE & PREGNANCY
- the necessity of greater resp. rate & a growing fetus
= all these factors that INCREASE OXYGEN DEMAND
how can a patient have DECREASED INSPIRED OXYGEN CONCENTRATION?
- want to look HOW MUCH AIR YOU ARE BREATHING FROM THE OUTSIDE
ex.
- UPPER/LOWER AIRWAY OBSTRUCTIONS
- HIGH ALTITUDES (have a decreased environmental O2)
- HYPOVENTILATION (respiratory rate is less than 12)
- having respiratory diseases or allergies (ex. ASTHMA or ALLERGIES–can be treated with steroids)
definition of HYPOVOLEMIA
where the body has very LOW VOLUME OF FLUIDS OR BLOOD
- often caused by either DEHYDRATION or LOSS OF BLOOD
definition of CARDIAC AFTERLOAD
- having a HIGHER DIASTOLIC BLOOD PRESSURE
- greater DIFFICULTY in PUMPING BLOOD or OVERWORKING THE HEART
- have LOWER EJECTION OF THE VENTRICLES
- necessity of MORE WORK THE HEART MUST DO
what are the CONDITIONS THAT AFFECT CHEST WALL MOVEMENT? (7)
- PREGNANCY
growing fetus - OBESITY
reduced lung volumes/excess fat - greater pressure - MUSCULOSKELETAL ABNORMALITIES
inadequate o2 delivery ex. pectus excavatum or scoliosis - TRAUMA
abdominal surgeries/surgical incisions - NEUROMUSCULAR DISEASES
lung or heart dystrophy - CNS ALTERATIONS
mysathenia gravis or lupus - INFLUENCES OF CHRONIC LUNG DISEASE
COPD or cystic fibrosis
hypoventilation
occurs when ALVEOLAR VENTILATION is INADEQUATE to meet the oxygen demand of the body or ELIMINATE SUFFICIENT CARBON DIOXIDE
- where we have LESS THAN 12 RESPIRATIONS
- pt can also be on NARCOTICS
hyperventilation
state of ventilation in which the lungs REMOVE CO2 faster than it is produced by CELLULAR METABOLISM
- build up of CO2; MORE THAN 20 RESPIRATIONS
ex. infections/fevers **increases metabolic demands – needs more oxygen
ex. cold weather
ex. exercising
ex. pain levels
hypoxia
INADEQUATE TISSUE OXYGENATION at the cellular level
difference between HYPOXIA and HYPOXEMIA
HYPOXIA
where we have LOW OXYGEN LEVELS in the body’s tissues
HYPOXEMIA
where we have LOW OXYGEN LEVELS in the body’s blood
what are some ALTERATIONS THAT CAN OCCUR IN CARDIAC FUNCTIONING?
- disturbances in CONDUCTION
- altered CARDIAC OUTPUT
(left or right-sided heart failures) - IMPAIRED VALVULAR FUNCTION
- MYOCARDIAL ISCHEMIA
- ANGINA (chest pain)
- MYOCARDIAL INFARCTION
(death of the heart muscle cells)
what are the DEVELOPMENTAL FACTORS THAT INFLUENCE OXYGENATION
INFANTS:
- protective function of maternal antibodies
- more at risk for URIs and airway obstruction
SCHOOL-AGE CHILDREN:
- unhealthy diets or stress, smoking, lack of exercise
- important for establishment of good habits
OLDER ADULTS:
- - calcification of heart valves
- increased left ventricular wall thickness
- impaired SA nodes
what are some LIFESTYLE FACTORS THAT INFLUENCE OXYGENATION?
- NUTRITION
poor diet = more common with chronic lung diseases & resp muscle weakness - HYDRATION
dehydration = decreased BP, decreased HR - EXERCISE
- SMOKING
vasoconstrictor of lungs - SUBSTANCE ABUSE
drugs or way of diet = can depress respirations - STRESS
increases respirations
what are some ENVIRONMENTAL FACTORS THAT CAN INFLUENCE OXYGENATION?
- type of OCCUPATION
- where the person grew up
- current surroundings
what are some aspects to consider during assessment of NURSING HISTORY?
- looking for any health risks
- increase in respirations or pain
- is the patient fatigued?
- any dyspnea?
- any coughing? is it productive or non-productive?
- are they exposed to different environmental exposures
- does the patient smoke?
- any respiratory infections/allergies?
- does the patient take any inhalers?
what part of the PHYSICAL EXAMINATION is part of assessing OXYGENATION?
- INSPECTION
(want to observe skin, LOC, nails - capillary refill, RR) - PALPATION
(pulses, tenderness, edema, temperature) - PERCUSSION
(any volumes, air vs. fluid) - AUSCULTATION
(listening for heart & lung sounds)
skin color
does the patient have PALLOR? CYANOTIC?
NORMAL?
mm
are they PALE/PINK? are they MOIST/DRY?
what are SOME DIAGNOSTIC TESTS that can be done? (6)
- TB
- ECG
- BLOOD WORK (CBC, HEMOGLOBIN/HEMATOCRIT)**can be an issue if Hb is in single digits
- ABG; arterial blood gases - how much gas exchange is occurring + pH values
- PFT; pulmonary fxn test; helps determine baseline of respirations
- SPUTUM; determines TB/bacteria/pneumonia
what are the appropriate NANDAS? (5)
- IMPAIRED CARDIAC OUTPUT
- ACUTE PAIN
- ACTIVITY INTOLERANCE
(dysthymia on exertion) - RISK FOR ACTIVITY INTOLERANCE
- IMPAIRED AIRWAY CLEARANCE
(cystic fibrosis pts.)
what are some techniques for ACUTE CARE?
- can help manage the pt’s DYSPNEA
- use of proper EQUIPMENT and MEDICATIONS and OXYGEN ADMIN **always need an order
*steroids, antibiotics - PROPER POSITIONING of PATIENT
- SUCTIONING
- HUMIDIFICATION
- NEBULIZATION
- proper COUGHING and DB EXERCISES
describe CHEST PHYSIOTHERAPY
- external chest wall manipulation using PERCUSSION, VIBRATION, or HIGH-FREQUENCY CHEST WALL COMPRESSION
- POSTURAL DRAINAGE
- overall helps to LOOSEN ANY DRAINAGE OR MUCUS
why do we use ACUTE CARE?
- want to increase POSITIVE EXPIRATORY PRESSURE (trying to get air behind all the mucus)
- want to maintain LUNG EXPANSION
ex. ambulation
ex. positioning
ex. incentive spirometry
what are some ways for HEALTH PROMOTION of proper OXYGENATION?
- having proper vaccinations
- proper HEALTHY LIFESTYLE; eating right and regular exercise
- awareness of any ENVIRONMENT POLLUTANTS
*secondhand smoke, work chemicals or pollutants
what are the types of SUCTIONING METHODS we have?
- OROPHARYNGEAL & NASOPHARYNGEAL
- OROTRACHEAL & NASOTRACHEAL
- TRACHEAL
what are some tips and factors to be aware of before SUCTIONING A PATIENT?
- always allow the patient to be in an UPRIGHT POSITION
- check their GAG REFLEX
- check O2 STAT; suctioning can LOWER
- check HR; suctioning can INCREASE
- suction in INCREMENTS; 5-10 seconds
- allow for VENTILATION PRIOR; PRE-OXYGENATE UR PATIENT if needed
what are some OXYGEN PRECAUTIONS that we must be aware about?
- make sure we have enough oxygen during transportation
- oxygen is COMBUSTIBLE – NO SMOKING OR OPEN FLAMES
- put EXTENSION TUBING for patients who need to move
what are out METHODS OF OXYGEN DELIVERY?
- NASAL CANNULA
- HIGH FLOW NASAL CANNULA
- OXYGEN MASKS
**4 L NEEDS HUMDIFICATION
**anything > 6 L; need to switch to a MASK OR HIGH FLOW
incentive spirometry
- type of HANDHELD PLASTIC DEVICE
- want to take a DEEP BREATH; allows to EXPAND THE LUNGS
- target goal; around 1000 mL
- want to use it frequently to promote LUNG EXPANSION
what are the TYPES OF BREATHING EXERCISES?
- PURSED LIP BREATHING
- DIAPHRAGMATIC BREATHING
when are patients able to be assisted with HOME OXYGEN THERAPY
typically when the indication of pulse ox is < 88% seen during rest/exertion/exercise
