Physical Assessment: Oxygenation chp 37 Flashcards
Oxygenation
- the pulmonary, cardiovascular, musculoskeletal and neurological systems work together to achieve oxygenation
- the musculoskeletal and neurological systems regulate the movement of air into and out of the lungs
- the lungs oxygenate the blood
- the heart circulates the blood throughout the body and back to the lungs
What Systems Work Together to Achieve Oxygenation?
- Pulmonary
- Cardiovascular
- Musculoskeletal
- Neurological
The Musculoskeletal and Neurological Systems do what in Oxygenation?
regulate the movement of air into and out of the lungs
What do the Lungs do?
oxygenate the blood
What does the Heart Do?
circulates the blood throughout the body and back to the lungs
The Pulmonary System
-Airways + Lungs
>Ventilation
>Respiration
Ventilation
movement of air into/out of the lungs
Respiration
- exchange of oxygen/ carbon dioxide
- alveolar capillary/ capillary cell membrane
Normal Respiratory Status: Airway Patency
Airway Patency = open, clear tracheobronchial passages for air exchange Indicators: -ease of breathing -moves sputum out of airway -moves blockage out of airway -respiratory rate WNL -rhythm WNL
Normal Respiratory Status: Gas Exchange
alveolar exchange of carbon dioxide and oxygen to maintain arterial blood gas concentrations Indicators: -cognitive status WNL -ease of breathing WNL -arterial blood gases WNL -pulse oximetry WNL
Abnormal Airway Patency
Indicators:
- anxiety
- fear
- choking
- dyspnea
- cyanosis
- abnormal chest excursion
- tactile fremitus
- adventitious breath sounds
External Factors that Influence Pulmonary Function
the adequacy of ventilation is affected by the rate and depth of respirations, lung compliance and elasticity, and airway resistance
- lifespan + development
- environment (stress + allergies)
- lifestyle (nutrition, exercise, substance abuse)
- medications
- smoking; current use/ history
Factors that Affect Ventilation
- respiratory rate and depth
- lung compliance
- lung elasticity
- airway resistance
Rate (respiratory)
how fast you breathe
Depth (respiratory)
how much your lungs expand to take in air
Lung Compliance
-ease of lung inflation
-lungs normally inflate easily
Reduced by:
>increased lung water (edema)
>loss of surfactant
>conditions that cause elastin fibers in the lungs to be replaced with scar tissue (collagen)
Lung Elasticity
(elastic recoil)
- tendency of elastin fibers to return to their original position away from the chest wall after being stretched (think of stretching a rubber band, then letting go of it)
- alveoli that have been overstretched, as with emphysema, lose their elastic recoil over time
Airway Resistance
resistance to airflow within the airways
-the larger the diameter of the airway, the more easily air moves through it
Most Commonly seen CNS Problems in Adults
- Trauma
- Stroke
Abnormalities that Influence Pulmonary Function
- pulmonary system abnormalities
- pulmonary circulation abnormalities
- central nervous system (CNS) abnormalities
- neuromuscular abnormalities
Abnormal Gas Exchange
Indicators:
- dyspnea at rest
- dyspnea on exertion
- cyanosis
- somnolence (sleepiness)
- ABGs + pulse oximetry abnormal
Assessing Oxygenation Status
- breathing pattern
- respiratory effort
- assessing cough
- pulse oximetry
Respiratory Effort/ Dyspnea
- nasal flaring
- retractions
- grunting
- body positioning to facilitate respirations
- paroxysmal nocturnal dyspnea
- conversational dyspnea
- stridor
Respiratory Effort/ Dyspnea: Retractions
the visible “pulling in” of intercostal, supra-clavicular, and subcostal tissue
-caused by negative pressures generated in the chest to try to increase depth of inhalation
Respiratory Effort/ Dyspnea: Paroxysmal Nocturnal Dyspnea
sudden awakening due to shortness of breath that begins during sleep
-the patient feels panic and extreme dyspnea and must sit upright to ease breathing
Respiratory Effort/ Dyspnea: Conversational Dyspnea
inability to speak complete sentences without stopping to breathe
-the more frequently the patient pauses when speaking, the more severe the dyspnea
Respiratory Effort/ Dyspnea: Stridor
a high-pitched harsh, crowing, inspiratory sound caused by partial obstruction of the larynx or trachea
-can hear it without a stethoscope
Assessing Oxygenation Status: Diagnostic Testing
> Arterial Blood Gases (ABGs)
-PO2, PCO2
> Peak Flow Monitoring
-monitors amount of air that can be exhaled with forcible effort
Interventions for Optimal Oxygenation
Promoting Respiratory Function:
- Immunizations/ prevent URI’s
- Positioning
- Aspiration precautions
- Administering respiratory medications
- Use of a mechanical ventilator
- Use of a chest tube drainage system
- Support smoking cessation
Incentive Spirometer
will enable patient to monitor depth of his breathing (abdominal or chest incisions may require pain meds before use)
- Breathe out normally
- Place mouthpiece in mouth and create a seal with lips
- Breathe in slowly and as deeply as possible through mouthpiece
- Hold your breathe for as long as possible, at least to a slow count of 3
- Remove mouthpiece from mouth + exhale
Interventions for Optimal Oxygenation: Mobilizing Secretions
- Deep breathing and coughing
- OOB as soon as possible after surgery
- Daily OOB to chair orders
- Hydration
Interventions for Optimal Oxygenation: Oxygen Therapy
-cannula
-mask
-humidify inhaled air
>provides oxygen at concentrations greater than the level found in room air
>room air contains only 21% oxygen
>requires medical prescription for dosage and route
