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Problems of Oxygenation ***Respiratory*** Scenarios Narcotic Overdose Suppresses or shuts down breathing Needs oxygenation immediately Healthy Student

udent who is Nervous uses the diaphragm, scalene, & intercostal muscles Anxious, needs to take a deep breath ICU Patient Mechanical ventilation Concept of Oxygenation Ventilation Movement of air in & out the lungs (Inspiration/Expiration) Compliance Ease of expansion of the lungs Diffusion Transfer of O2 & CO2 b/w the lungs and the capillary membrane How much air the lungs can hold = volume How fast we can get air in and out of the lungs We can have problems where the lungs are restricted or the airways are obstructed or a mix 1. Restrictive think volume Paralyzed muscles Guillian Barre Syndrome Accumulation of air (pneumothorax), fluid (pleural effusion) Inflammation of lung tissue (pneumonia) 2. Obstructive think airflow We have normal volume but we cannot get the air out as fast as we should Asthma Chronic inflammatory disorder COPD Chronic airflow limitation not fully reversible

Concept of Oxygenation

Concept of Oxygenation Oxyhemoglobin Curve Describes the affinity of hemoglobin for O2 Upper flat portion Signifies what happens in the lungs. Saturation is normal Left shift Blood picks up O2 more readily but delivers O2 less readily to the tissues Causes: Alkalosis (increased pH), hypothermia, & decrease in the PaCO2 Right shift Blood picks up O2 less readily but delivers O2 more readily to the tissues Causes: Acidosis (decreased pH), hyperthermia, increased PaO2

Question A leftward shift of the oxyhemoglobin curve causes blood to pick up O2 less readily causes blood to deliver O2 more readily to the tissues is caused by Alkalosis (increased pH) is caused by hyperthermia Nursing Assessment Dyspnea Pattern of progression with exertion &/or rest Wheezing Musical sounds that can be audible to the pt and nurse Cough Acute/Chronic (>3 weeks in duration) Pattern regular/paroxysmal (sudden periodic onset), weather, talking, certain activities Productive/nonproductive. Respiratory equipment CPAP, home O2, inhalers, nebulizer Cleaning, frequency of use, side effects, demonstrate use Nursing Assessment Smoking most important risk factor for COPD and lung cancer Exposure Travels Exposure to persons with TB Work exposure to irritants & toxins fumes, smoke, and other irritants may provoke wheezing or make asthma worse Exposure to second-hand smoke Immunization influenza (flu) pneumococcal pneumonia (pneumovax) Nursing Assessment Activity intolerance Is activity limited by dyspnea Ability to perform ADLs Type of assistance needed Housing- flight of stairs with/without dyspnea Does a certain position cause relief for the patient? Difficulty sleeping Is there frequent waking? Are there signs of sleep apnea Note that night sweats may be a manifestation of tuberculosis Health Promotion know who should and should not get vaccination Flu Vaccine Risk Factors for flu-related complications: 2 yr or younger, 65 yr or older, pts with diabetes, COPD, pregnancy , and asthma All persons 6months or older may get flu vaccination Fever must subside before a pt receives the flu vaccine Contraindications: Allergies to flu vaccine (eggs), Guillain-Barr Syndrome

Pneumovax 65yr & older Persons 2 64yrs with chronic diseases such as DM, COPD, Cardiovascular disease, immunocompromised state Revaccination - only if it was received 5yrs previously and the individual was less than 65 yr at that time Immunocompromised pts-an initial vaccine and revaccinate every 5 yrs HIV or Transplant patients Pt. education Early immunization Never too late to get the vaccine in December, January, or beyond

Health Promotion read 170-172 on pt. teaching Smoking cessation: Packs per day times # yrs (pg 172, table 12-5) Evidence based brief cessation interventions Assess willingness to quit, assist in quit attempt, and arrange follow-up Five Rs for individual unwilling to quit. Agents Nicotine gum (OTC)-30-min chewing; hold gum between cheek and teeth; avoid food 15 min before or during use Nicotine patch (OTC)- provides steady level of nicotine Teach patients not to smoke if using cessation therapy Clonidine 0.1mg every 6 hours craving Chantix 0.5 mg daily for 3 days, 0.5 mg BID for 4 days, then 1 mg BID Purpose is to wean of nicotine versus stopping cold turkey Support Join a quit-tobacco support group Call an ex-user when craving cigarette Ask for support from family & peers Resources/cessation programs: American Lung Association, American Cancer Society Avoiding relapse Avoid others who smoke Get the mind out of tobacco Consider limiting or stopping alcohol Get rid of the smell of cigarette in the car and at home Withdrawal symptoms: dry mouth, cough, scratchy throat, & irritability

Question Which of the following conditions is contraindicated in Flu vaccination Obstructive sleep apnea COPD Guillian Barre Syndrome Asthma Question The patient with lung cancer needs to receive influenza vaccine and pneumococcal vaccines. The nurse will administer both vaccines at the same time in the same arm administer both vaccines at the same time in different arms administer the flu vaccine and tell the patient to come back one week later to receive the pneumococcal vaccines administer the pneumococcal vaccines only

Diagnostic Studies Radiology Chest x-ray, CT, MRI Screen, Diagnose, & Evaluation CXR Asthma (obstructive) Asymptomatic pt is normal but obtained as a baseline Acute asthma attack shows hyperinflation & may reveal other complications of asthma such as atelectasis, pnuemothorax COPD CXR not diagnostic early in the disease Pleural effusion (restrictive) CXR will reveal the volume and location of the effusion Deep breathing- Good image Provide support Patient & Family Remove metal b/w neck & waist Post-test Anxiety r/t results Diagnostic Studies CT Pleural effusion CT will reveal the volume and location of the effusion Contrast Evaluate BUN and serum creatinine to assess renal function Hydration before and after contrast. Notify the healthcare provider if any values are critically decreased or increased Patient Education Pt may feel warm & flushed with contrast Pt will lie still on a high table Scanner revolves around the body with humming noise Diagnostic Studies MRI Diagnosis of lesions difficult to assess by CT scan e.g. lung apex & distinguishing vascular from nonvascular structures Contrast not iodine based for MRI not as worried about adverse effects on kidney function It can be done with or without contrast Remove any metal between neck and waist. Jewelry, watches, coins, keys, and credit cards are incompatible with the magnetic resonance imaging procedure. These objects can be attracted by the magnet on the imager or distort the images. Reinforce information given by the health care provider Contraindications Pacemakers , ear implants, heart valve, intrauterine devices, pt with iron pigment in tattoos, implantable cardioveter-defibrilators. A pregnant pt can undergo MRI if the benefits outweigh the risk for the pt and fetus Discuss anxiety r/t test results Loud clicking noise If closed MRI-Claustrophobia/relaxation techniques MRI of the chest takes 30-60 min. Consider sedation for pt they cannot stay still Hydration: Monitor for fluid imbalance. (I&O) Hydrate before & after to excrete contrast

Diagnostic Studies Sputum Studies Culture & sensitivity A culture is done to find out what kind of organism (usually a bacteria) is causing an illness or infection. A sensitivity test checks to see what kind of medicine, such as an antibiotic, will work best to treat the illness or infection. Early morning after mouth care secretions collect during night If unsuccessful obtain specimen by suctioning or aspirating secretions from the trachea Document sputum characteristics and send specimen to lab promptly or refrigerate Obtain specimen before giving first dose of antibiotic. Do not wait for results before starting antibiotic. Results 48-72 hrs Asthma C&S may be obtained to rule out the presence of bacterial infections, if purulent sputum, hx of upper respiratory track infection, fever or an elevated WBC count Pt Education Ask patient to deep breath and expectorate into a sterile container after coughing deeply Place specimen in a biohazard bag and send straight to the lab Gram stain- Guides therapy until C&S results are obtained Diagnostic Studies Pulmonary Function Tests (PFTs) PFTs measure the lungs volumes, capacities, & airflow to find out whether they are normal or abnormal. If abnormal to find out why. Progression & to evaluate response to bronchodilators The best in distinguishing restrictive & obstructive respiratory disorders PFTs can be scheduled before and after using bronchodilators. 6-12 hr before testing to obtain optimal results Explain the procedure Provide rest after the procedure Spirometry Verbal coaching to ensure that pt continues to blow out until exhalation is complete. Home spirometry could be used Peak flow meter Hand held & home use Peak Flow Meter Technique Clear instruction, demonstrations and frequent review of technique To indicator is moved to the lowest end of the numbered scale; if the device has a separate mouth piece, it must now be attached While standing, the patient inhales deeply Place mouthpiece in the pts mouth with lips closed around it The tongue should not be placed in the front hole Patient blows out forcefully and rapidly in a single exhalation Repeat 2 more times If the patient coughs or does not preform the technique correctly, the turn is ignored and repeated Highest number from the 3 attempts is recorded

**PEFR**

Diagnostic Studies

** biggest difference is that Asthma it is intermittent