Oxygenation Flashcards
oxygenation concept
mechanism that facilitates (or impairs) the body’s ability to supply O2 to cells of the body
function of respiratory system (oxygenation)
bring in atmospheric air….transport to respiratory tract…into the alveoli…O2 diffuses into capillaries….carried by blood to all cells of the body
function of the respiratory system in achieved through…
respiration (processes of inspiration and expiration)
O2 is brought to alveoli with is then…
exchanged for CO2 and then expelled from the body
ventilation
actual exchange of O2 & CO2
acid-base balance
respiratory acidosis
increase CO2—> vasodilation—>increase ICP and pulse
ICP
intracranial pressure
nursing implications of acid-base balance
- c/o headache
- irritability
- decrease LOC
- flushed skin
- important to chest trauma, aspiration, pneumonia, OD
- be alert with problems r/t airway clearance, limited ambulation, anxiety, or signs/symptoms of decrease O2
cellular regulation
-anemias (blood loss, G6PD, aplastic)
decrease in O2—>increase in systemic workload and shunts blood from periphery to vital organs
- be alert to S/Sx of fatigue, palor, jaundice, tachycardia
- anticipate need for vitamin supplements, blood transfusions, dietary changes,
- consider activity tolerance
cognition
decrease O2 to brain —> changes in cognition
- assess mentation
- rule out acute brain trauma before considering other causes
comfort
pain from ischemic events
- cerebral
- cardiac
- shock states
- pulmonary
decrease in O2 to tissues —> manifestations of pain
- assess for high pulse, respirations, BP, restlessness, anxiety, diaphoresis, client reporting discomfort
- anticipate need for additional assessments, medications for pain relief, diversional therapies
diaphoresis
sweating
perfusion
decrease tissue perfusion —> O2 deficit to organs
- assess pulses, nail beds, color, body position for comfort, orientation
- administer oxygen
- anticipate need for pharmacotherapy to improve CO surgery to correct defect
- monitor arterial blood gases
assessment interview (respiratory)
- current respiratory problems
- hx of respiratory dz
- lifestyle
- presence of cough
- description of sputum
- presence of chest pain
- presence of risk factors
- med hx
sputum
mix of saliva and mucus coughed up from respiratory tract
types of respiratory assessments
- nasal assessment
- respiratory assessment
- thoracic cavity inspection
- muscles of breathing
- thoracic wall
nasal assessment
- midline & symmetrical
- nares mucosa is pink and moist
- no drainage
respiratory assessment
- regular
- depth
- effort
thoracic cavity inspection
-AP diameter is 1/2 the transverse diameter
muscles of breathing
- chest wall gently rises & falls
- neck muscles are relaxed
- inspect intercostal muscles
thoracic wall
-symmetrical hand placement shows symmetrical movement of the hands
types of breath sounds
- vesicular
- bronchovesicular
- bronchial
normal vesicular breath sounds
- “gently sighing” sounds
- air moving through smaller airways (alveoli and bronchioles)
normal bronchovesicular breath sounds
-moderate pitched “blowing” sounds as air moves through larger airways (bronchi)
normal bronchial breath sounds
-high-pitched, loud, “harsh” sounds as air moves through the trachea
color of skin, nail beds, and mucous membranes
- normal
- dusky hue
- cyanosis
normal color (skin/nail beds/MM)
pink color - well oxygenated blood
dusky hue (skin/nail beds/MM)
poorly oxygenated blood
cyanosis (skin/nail beds/MM)
bluish discoloration=severe O2 deprivation
diagnostic tests
- chest radiograph
- CT, MRI
- Arterial blood gas
- pulmonary function tests
- bronchoscopy
- thoracentesis
- sputum specimen
chest radiograph
to see fluid, air, or masses
CT, MRI
more detail
Arterial blood gas
provides direct indication of O2 & CO2 exchange and acid-base balance
pulmonary function tests
info about ventilation airflow, lung volumes, lung capacity, diffusion of gas
bronchoscopy
direct visualization of the lungs via bronchoscope
thoracentesis
drain excessive pleural fluid and the fluid is analyzed
sputum specimen
- collect in AM
- identify microbes, inflammation, immunoglobulins
- culture for ab choice
Non-modifiable risk factors
- genetic effect of hemoglobin and hematocrit
- women have lower concentrations of hemoglobin & hematocrit
- low hemoglobin/hematocrit = anemia —> low O2 carrying capacity
prevention for risk factors
-management of environmental air quality (less smoking in population, workplace, smog…)
-vaccination:
older adults: influenza and pneumonia
children: pertussis
Modifiable risk factors
- HTN
- Atherosclerosis
- obesity
- type 2 diabetes
- smoking
- stress
- anxiety
Independent interventions used to improve respiratory function
- positioning
- encourage smoking cessation
- monitor activity tolerance/ADLs
- promoting secretion clearance
- deep breathing and coughing
- breathing exercises
- turning
- slow diaphragmatic breathing
- forceful exhalation
semi-fowlers
30-45 degrees
-tube feeds = decrease aspiration
fowler’s
45-60 degrees
-increase comfort during eating
high fowler’s
80-90 degrees
-feeding, breathing treatment
orthopneic
head and arms over bed table to facilitate lung expanision
commonly employed breathing exercise
abdominal (diaphragmatic) and pursed lip breathing
collaborative interventions used to improve respiratory function
- improving nutrition
- pharmacologic therapy
- oxygen therapy
pharmacologic therapy meds
- bronchodilator
- anti-inflammatory
- expectorants
nasal cannula
-oxygen therapy
- does NOT provide exact concentration
- cheap
- do NOT use with more than 6L/min
- better tolerated by patients
- check q8hrs for flow, patency, trauma to ears and nose
- need humidifier if >2L/min to prevent drying of nose or mouth
room air is…
~21%
1L/min
~24%
2L/min
~28%
3L/min
~32%
4L/min
~36%
5L/min
~40%
6L/min
~44%
simple face mask
- provides O2 at 5-8L/min
- gives 30-60% O2
partial rebreather mask
- delivers O2 from 60-95% at liter flows of 6-10 L/min
- O2 reservoir bag holds first 1/3 of exhaled air
- must not totally deflate during inspiration to avoid CO2 build up
non-rebreather mask
- delivers highest O2 concentration possible with mask
- 95%-100% at liter flows of 10-15 L/min
- one way valve prevents intake of room air
- no expired air in bag
- bag must not totally deflate during inspiration to prevent CO2 build up
venturi mask
- high flow system
- delivers 02 concentrations varying from 24% to 40% to 60% at liter flows at 4-12 L/min
- color-coded jet adapters correspond to precise O2 concentration & liter flow
- can administer low, constant O2 concentrations to patients with COPD
techniques to mobilize secretions:
-often done by Respiratory therapists or techs
- chest physiotherapy
- postural drainage
- chest percussion (CPT)
- vibration
- suctioning
incentive spirometer
- device that stimulates the patient to achieve maximum voluntary lung expansion
- prevents atelectasis (lung collapse)
- inhale, pause, exhale
- pt encouraged to cough and expectorate any secretions loosened by deep breathing
- patient should perform 10x per hour while awake
pulse oximetry
- noninvasive procedure that helps measure client’s arterial O2 saturation to detect hypoxemia
- sensor on finger, ear lobe, nose, or forehead
- normal=95%-100%;
