PRELIMS OXYGENATION

HANDOUT#2

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SECTION 1 level 3 Page 1

Assessment

1. Health History
a. Cardinal signs of symptoms of respiratory dysfunction:
-Dyspnea, Orthopnea
-Cough (hacking, brassy, wheezing, productive, nonproductive)
-Increased sputum production (purulent, rusty, bloody, mucoid)
-Angina pectoris
-Wheezing, crackles
-Clubbing of fingers
-hemoptysis
-cyanosis (buccal, peripheral)

b. Risk Factors associated with respiratory diseases
-personal or family hx of lung disease
-smoking (most significant contributing factor in lung disease)
-occupational exposure to allergens, environmental pollutants
-age-related changes in lung capacity and respiratory function
-hx of URTI
-post-op changes resulting in diminished respiratory function

2. Physical Examination
a. Inspection
-general appearance (body size, age, skin quality and color, posture)
-configuration and movement of the thorax during respiration
-characteristics of respiration (rate, rhythm, depth, used muscles)
-presence of cough and characteristics of sputum (clear, purulent, bloody, tenacious)
-note clubbing of fingers (angle of nailbed >160 degrees, distal phalangeal depth > interphalengeal depth)
-softening of nailbeds

b. Palpation
-chest for tender areas, mases on surface
-evaluate chest excursion
-presence of fremitus (vibration)

c. Percussion
-chest sounds (resonant is air-filled lung, dull or flat suggests presence of firm mass)

d. Auscultation
-listen to air movement of lungs (normal vs. adventitious)
-normal, clear lungs: vesicular sounds (low-pitched, rustling sound over most of lung field more prominent on
inspiration)
-normal large airways: bronchial sounds (high-pitched, tubular sounds w/ slight pause between inspiration and
expiration)
-bronchovesicular sounds (combination of vesicular and bronchial): heard anteriorly to the right or left of sternum,
Posteriorly between scapulae, inspiration and expiration equal
-adventitious breath sounds: crackles (fine to coarse), wheezes (sibilant or sonorous), pleural friction rub


3. Laboratory and Diagnostic Tests

a.Radiographic & Scanning
PURPOSE: -to visualize structures
Chest Radiography
Chest Tomography
Lung Scan
Computed Tomography Scan
Position-emission Tomography Scan
Fluoroscopy (for bronchial tubes)

b.Endoscopic Studies
PURPOSE:-invasive, visualize structures, obtain specimen
Bronchoscopy
Esophagoscopy
Mediastinoscopy

c.Thoracentesis
PURPOSE: -needle aspiration of pleural fluid (dx & tx), not for the lungs

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d.Needle Biopsy
PURPOSE:-invasive, tissue analysis of the lung and pleura

e.Pulse Oximetry
PURPOSE-monitoring of oxygen saturation of hemoglobin
-93% to 100% : normal
-93% : respiratory compromise

f.Sputum Culture
PURPOSE-to diagnose pathogens

g.Spirometry
PURPOSE-determine lung volumes, ventilator function, airway resistance, distribution of gases
(Pulmonary Function Test)

h.Skin Tests
PURPOSE-determines causes of airway hypersensitivity in asthmatic clients (prevention)
-determines previous exposure to tuberculosis : Purified Protein Derivative (PPD) Test

i.ABG Analysis
PURPOSE-studies arterial blood gases

Respiratory Acidosis Respiratory Alkalosis Metabolic Acidosis Metabolic Alkalosis
pH Ph < 7.35 Ph > 7.35 Ph < 7.35 Ph > 7.35
Carb PaCO
2
> 45 mmHg PaCO
2
< 45 mmHg HCO
3
< 22 mEq/L HCO
3
> 26 mEq/L
CO
2
= acid CO
2
= acid HCO
3
= base HCO
3
= base
Causes Respiratory failure / arrest
Pulmonary edema
COPD
Pneumonia
Pneumothorax
Atelectasis
Overdose
Aspiration
Hyperventilation
Pain
Anxiety
Hypoxemia
Ventilators
Diabetic ketoacidosis
Starvation (ketoacidosis)
Renal Failure
Diarrhea
Acetylsalicylic Acid Poisoning
Vomiting
NGT
Diuretics
Antacids
Bicarb overdose (IV Tx)

S/S Sudden:
CR
LOC
Feeling of fullness
Dysrhythmias
Chronic:
Weakness
Dull Headache
Lightheadedness
Unability to concentrate
Numbness
Tingling
Tinnitus
Changes in LOC
(confusion, drowsiness)
h/n/v
Kussmauls respirations
( rate depth)
Dysrhythmias
Tingling
Dizziness
Bradypnea
Hypertonic muscles
Dysrhythmias
Tx DBE
Positioning
Suctioning
O
2
Monitor: VS, ABG, PO
Neuro Assess
Treat cause
Encourage slow breaths
Administer NaCO
3
Monitor: VS, I&O, ABG, Dysr
Seizure Precautions
Restore F&E
Monitor: VS, I&O, ABG, Dysr
Neuro Assess



Health Promotion

1.Preventing Respiratory Infections / Health teaching limits exposure to and occurrence of ARI
(flu, pneumonia)
-avoid exposure to known infected people, large crowds during peak flu season
-good hygiene practices (handwashing, covering mouth & nose when sneezing/coughing, proper tissue disposal
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-high risk people should receive annual flu vaccinations

2. Encouraging Smoking Cessation
-a positive step toward health regardless of the length of time a person has been a smoker
-State-of-Change Theory provides a basis for understanding the process underlying changing an addictive habit:
a. Precontemplation - not thinking about quitting
b. Contemplation - thinking about quitting in the next 6 months
c. Preparation - thinking about quitting in the next 30 days
d. Action - in the process of quitting
e. Maintenance - abstaining from tobacco use for 6 months or more

Relapse is common during smoking cessation attempts. Provide + encouragement, explain it takes more than one attempt to
successfully stop smoking

3.Reducing Allergens / Advocate a pollution-free environment
-reducing allergens that trigger bronchoconstriction and inflammation
-200 occupational asthma triggers, most common: chemical vapors in paper & textile mills, chemical/printing plants,
hair salons
-aspirin sensitivity, cold air, exercise can induce an attack

4. Promoting Proper Breathing
a. Deep Breathing
-helps expand alveoli and promote effective cough
-shallow breathing leads to mucous plugging, atelectasis, hypoxemia, pneumonia

b. Incentive Spirometry
-motivates deep breathing (usually visually), and take increasingly deeper breaths
-indicates how deep a breath the client has taken

c. Monitoring Peak Flow
-uses a peak flow meter (hand-held device that measures highest flow during maximal expiration)
-indicates how rapidly a client can breathe out air
-changes in peak flow measurements reflects changes in airway diameter

5. Promoting Comfort
a. Positioning and Ambulation
-prevents pooling of mucus, decreases risk of bacterial colonization and infection
-help shift respiratory mucus into portions of the airways where it may generate a cough, expectoration easier
-encourage progressive ambulation for clients with dyspnea with exertion

b. Maintaining Adequate Hydration
-to maintain mobility of respiratory mucus
-6 to 8 glasses a day, preferably water [caffeinated bev & alcohol (diuretic f/x), milk products (tend to thicken
secretions
c. Providing humidified air
d. Performing chest physicotherapy
e. Maintaining good nutrition to promote optimal immune function

6. Managing Chest Tubes
-assist with insertion and removal of chest tube
-monitor the patients respiratory status and vital signs
-check the dressing
-maintain the patency and integrity of the drainage system

7. Meeting Respiratory Needs with Medications
a. Cough suppressants, Expectorants, Lozenges
b. Inhaled Medications
Bronchodilators open narrowed airways
Mucolytic agents liquefy or loosen thick secretions
Corticosteroids reduce inflammation in airways
Types of Inhalers
Nebulizers disperse fine particles of medication into deeper passages of respiratory tract where absorption occurs
Metered dose inhalers delivers controlled dose of medication with each compression of the canister
Dry powder inhaler activated by the patients inspiration

8. Administering Cardiopulmonary Resuscitation


PRELIMS OXYGENATION
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Nursing Diagnoses
1. Ineffective Breathing Pattern
-state in which a persons inspiration/expiration pattern does not provide adequate ventilation
2. Ineffective Airway Clearance
-the state in which a person is unable to clear secretions or obstructions from the respiratory tract to maintain a clear
airway
3. Impaired Gas Exchange
-state in which a person experiences an excess or deficit in oxygenation/carbon dioxide elimination at an alveolar-
capillary level


Overview on Respiratory Alterations
Respiratory Dysfunctions
1. Hypoxia-inadequate cellular oxygen
- increased, rapid pulse, rapid, shallow respirations and dyspnea, increased restlessness or lightheadedness,
flaring of the nares, substernal and/or intercostal retractions, cyanosis
2. hypoxemia reduced oxygen tension in arterial blood
- PaO
2
less than 80 mm Hg
3. hypercapnia increased carbon dioxide tension in arterial blood
- PaCO
2
greater than 45 mm Hg
4. hypocapnia decreased carbon dioxide tension in arterial blood
- PaCO
2
less than 35 mm Hg

Respiratory Disorders
1. Pneumonia
-inflammatory process of bronchioles, alveolar space/walls/lobes
-caused by chemical irritants, bacteria, virus, fungi, parasites
2. COPD (chronic airflow limitation)
-group of disorders associated with persistent/recurrent obstruction of airflow (chronic bronchitis, emphysema,
asthma)
3. Occupational Lung Disease (Pneumoconioses)
-nonneoplastic alterations of the lung
-caused by exposure to organic/inorganic dusts, gases in the workplace (silicosis, asbestosis, CWP black lung)
4. Acute Respiratory Failure
-results when exchange of O
2
for CO
2
in the lungs cannot match the rate of O
2
consumption and CO
2
production in
body cells
5. Pulmonary Embolism
-obstruction of one or more pulmonary arteries by thrombus originating from the venous system (right side of heart)
6. Pleural Effusion
-collection of fluid in the pleural space
7. Chest Trauma
-injury to the chest wall or lungs
a.hemothorax (blood in pleural space) penetrating or blunt chest injury
b.tension pneumothorax (air in pleural space) disease or injury (lacerations of the lung, tracheobronchial
tree, esophagus)
c. open pneumothorax (sucking chest wound) penetrating chest injury
8. Acute Respiratory Distress Syndrome (ARDS)
-clinical syndrome characterized by pulmonary edema, progressive in arterial O
2
content
-occurs after serious illness or injury, accumulation of lung fluids (noncardiogenic pulmonary edema)
-caused by aspirations, drug overdose, prolonged inhalation of high concentrations of O
2
, smoke, corrosives, shock,
Systemic infection, trauma (pulmonary contusions, multiple fractures, head injury)
9. Airway Obstruction
-any mechanical impediment of O
2
delivery or absorption in the lungs
-obstruction by aspirated food, foreign objects, laryngospasm/edema due to inflam, injury (blood, teeth, tongue),
anaphylaxis
10. Near-drowning
-pathologic status of a person surviving events that lead to drowning
-asphyxia and aspiration are primary problems
-alcohol ingestions is an important factor in adult drowning deaths
11. Mechanical Ventilation
-maintains ventilation and O
2
delivery for a prolonged period
-indicated during continuous decease in oxygenation, increase in arterial CO
2
, persistent acidosis

PRELIMS OXYGENATION
HANDOUT#2

GreywolfRed
SECTION 1 level 3 Page 5