Review Oxygen - a clear, odorless gas about 21% of the air we breathe a. parietal pleura - lines the thorax and surface of the diaphragm Respiration - the process of gas exchange between individual and environment b. visceral pleura - covers the external surface of the You removed a message Process of Respiration involves several components: You removed a message 1. Pulmonary ventilation/ breathing PROCESS OF OXYGENATION 2. Alveolar - capillary gas exchange *Inhalation 3. Transport of oxygen from the lungs *Exhalation - collapse of lungs; expel the gas in form of CO2 4. Movement of O2 and CO2 between the systemic capillaries and the tissues Pathophysiology 1. Ventilation Gas exchange - function of the respiratory system - movement of air into and out of the lungs - the major inspiratory muscle of respiration is the diaphragm *Oxygen from inspired air diffuses from alveoli in the lungs into the blood. *Adequate ventilation depends on several factors: *Carbon dioxide produces during cell metabolism diffuses. a. clear airways 1. Upper Respiratory Tract b. an intact central nervous system and respiratory center - Mouth c. an intact thoracic cavity capable of expanding and contracting - Pharynx d. adequate primary compliance and recoil - Larynx Control of Breathing 2. Lower Respiratory Tract *Breathing is regulated by the rhythmicity center in the medulla oblongata and - Bronchi pons in the brain stem. - Bronchioles *Medulla oblongata increase rate and depth of breathing - Alveoli 2. Alveolar Gas Exchange - covered with surfactant that prevents alveoli from collapsing - after the alveoli are ventilated, diffusion of O2 and CO2 *Air enters the hose, were it is warmed, humidifies and filtered. *Large particles Diffusion - movement of gases or other particles from an area of Physiology Oxygen is transferred from the lungs to the blood and - The sneeze reflex is initiated by irritants in nasal passages. CO2 - Inspired air passes from the nose through the pharynx. a. nasopharynx - for air 3. Oxygen Transport and Delivery b. oropharynx - for food - oxygen needs to be transported Normally, most of the oxygen (97%) combines loosely with hemoglobin in the red The larynx is a cartilaginous structure that can be identified externally at Adam's blood cells and is carried to the tissues as oxyhemoglobin. apple. During swallowing, the inlet to the larynx (epiglottis) closes Factors that affect the rate of O2 transport from the lung to the tissues: Below the larynx, the trachea leads to the right and left main bronchi. a. cardiac output – pathologic condition that would diminish the amount of O2 in These foreign particles are then swept upward toward the larynx and throat by cilia. the tissues b. number of erythrocytes and blood hematocrit Cough reflex is triggered by irritants in the larynx, trachea or bronchi. c. exercise – has direct influence The respiratory zones: a. respiratory bronchioles Average of 5 million per cubic ml has erythrocytes for men and 4.5 million for b. alveolar ducts women. c. alveoli Hematocrit – 45% to 50 % (men) and 37% to 57% (women)
DINGCONG, PHOEBE JOY M. BSN 1 – A FUNDAMENTALS OF NURSING
2. Person assume sitting position, often leaning forward Factors that influence the capacity of the blood to carry oxygen: Signs and Symptoms (Chronic Hypoxia): a. amount of dissolves oxygen in the plasma 1. Fatigue and is lethargic b. amount of hemoglobin 2. Clubbing of fingers and toes c. tendency of hemoglobin to bind with oxygen Hypoventilation – inadequate alveolar ventilation, may be caused by either slow or shallow breathing or both (e.g. atelectasis) FACTORS AFFECTING RESPIRATORY Hypercarbia/ Hypercapnia – increased levels of CO2 in the blood a. Health Status Hypoxemia – low levels of oxygen - in the healthy person, the respiratory system can provide sufficient O2 to Cyanosis – bluish discoloration of the skin, nail beds and mucous meet the body’s needs Cyanosis requires these 2 conditions: b. Age 1. The blood must contain about 5g or more of - at birth, the fluid-filled lungs drain and the neonate takes a first breath. unoxygenated hemoglobin per 100 ml of blood. The lungs gradually expand with each subsequent breath, reaching full inflation by 2 2. Surface of must be dilated. weeks of age. - older adults are also susceptible to respiratory infection because of Altered Breathing Patterns decreased activity Breathing Pattern c. Environmental and Lifestyle Factors Eupnea – quiet, rhythmic and effortless - clients who are exposed to dust, animal dander, asbestos, or toxic Tachypnea – (rapid rate) breathing is seen with fever, chemicals in the home or workplace are at increased risk for alterations in metabolic acidosis, pain oxygenation. Bradypnea – abnormally slow rate of breathing is seen in d. Disease Processes clients who have taken drugs - oxygenation alterations can often be traced to disease states related to Apnea – is the cessation of breathing alterations in ventilation, alveolar gas exchange Hyperventilation – is an increased movement of air into e. Medications and out of the lungs - a variety of medications can decrease the rate and depth of respirations The rate and depth of respiration increased and more CO2 is eliminated than is produced. Manifestations of Alterations in Respiratory Function One type of hyperventilation that accompanies Cough metabolic acidosis is Kussmaul’s breathing by Sputum Production which the body attempts to compensate. Chest Pain Other abnormal breathing Abnormal Breath Sounds Cheyne-strokes respiration – very deep to very shallow Cyanosis breathing with short periods of apnea Clubbing of Fingers Biot’s (Cluster) respiration – shallow breaths interrupted Alteration in Respiratory Functions by these who have CNS problem It can be altered by: Orthopnea – is the inability to breathe easily unless a. sitting upright/ standing b. Dyspnea – difficulty of breathing or the feeling of being c. the diffusion of oxygen and CO2 between short of breathing (SOB) d. the transport of oxygen via the blood to cells Signs and Symptoms of Dyspnea: 1. Labored breathing Hypoxia – is a condition of insufficient oxygen anywhere in the body from 2. Increased HR the inspired gas to the tissues 3. Cyanosis Signs and Symptoms (Acute Hypoxia): 4. Diaphoresis 1. Person appears anxious, tired and drawn 5. Flaring of Nostrils DINGCONG, PHOEBE JOY M. BSN 1 – A FUNDAMENTALS OF NURSING Obstructed Airway Presence of blood in sputum a. Upper Airway Obstruction – that is in the nose, pharynx/larynx o Hemoptesis – bloody sputum associated with Causes: coughing and has bleeding on the upper Food trapped in the airway. respiratory tract Tongue falls back into the oropharynx on o Hematemesis – vomits or spits blood which is unconscious person. from the gastrointestinal tract Collection of secretions/ mucous and c. Shortness of Breath inflammatory exudates in the passageways. Qualifiers Indications: Onset Partial obstruction – low-pitched snoring sound Nature during inhalation Pattern Complete obstruction – extreme inspiratory Associated Symptoms effort that produces no chest movement Pain b. Lower Airway Obstruction – involves occlusion the passage in Cough the bronchi and lungs Diaphoresis Stridor – a harsh, high-pitched sound may be heard d. Pain during inspiration Qualifiers Adventitious Breath Sounds – abnormal breath sound Location and radiation Nature NURSING PROCESS FOR OXYGENATION Associated Symptoms A. Assessment Dizziness Health History Nausea Data about current and past respiratory problem Diaphoresis How long it has been present and whether it has recently gotten Palpitations worse Check lifestyle of the patient a. Inspection – will begin when the nurse first met with the client Health History related to Oxygenation Physical Examination: a. Cough 1. Inspection – make general notes of the client’s efforts of ventilation, Qualifiers anxious or distressed appearance, flaring of nostrils, position preferences Onset – “Kanus-a gasugod?” and general chest configuration Nature – “Is it dry, moist? Is it productive? or 2. Palpation – common findings related to compromised ventilated include nonproductive?” vocal (tactile) fremitus and displacement of trachea Pattern – “Is it continuous? occasionally?” 3. Percussion – percussion deficits are rated in diaphragmatic excursion; Severity – “Unsa man ka grave imohang ubo?” may reveal hyperresonance, dull percussion tone, or changes in the density Associated Symptoms 4. Auscultation – may reveal adventitious breath sounds (crackles, Pain wheezes, rhonchi, pleural friction rub or stridor) SOB Diagnostic and Lab Data: Wheezing 1. Pulse Oximetry – non-invasive device measuring oxygen saturation Alleviating Factors 2. Arterial Blood Gas (ABG) – measure a number of indicators that can Vaporizers affect oxygenation status OTC medications 3. Sputum collected for the ff. reasons: b. Sputum 3.1 Culture and sensitivity – to identify a specific microorganism Qualifiers and drug sensitivities. Amount, color, odor DINGCONG, PHOEBE JOY M. BSN 1 – A FUNDAMENTALS OF NURSING 3.2 Cytology – to identify the origin, structure, function and 2.2 Positioning for drainage pathology Chest Physiotherapy (CPt) group of therapies used to mobilized 3.3 Acid-fast bacillus – to identify the presence of tuberculosis pulmonary secretions. 4. Chest X-ray These includes: 5. Computerized Tomography Scan (CT Scan) a. Percussion 6. Magnetic Resonance Imaging (MRI) b. Vibration 7. Ventilation Perfusion Scan c. Postural Drainage 8. Bronchoscopy 9. Thoracentesis Vibration is a series of vigorous quivering produced by hands that are placed. b. Nursing Diagnosis Postural drainage is the drainage by gravity of secretions from Examples: various lung segments. Ineffective breathing pattern related to dyspnea Inhalation treatments containing bronchodilator or Ineffective airway clearance related to accumulation of secretions mucolytic. Altered tissue perfusion related to decrease cardiac output 2.3 Measured should be taken to minimize the client Anxiety related to ineffective airway clearance 2.4 Administer pain medications so that their effectiveness peaks Activity intolerance related to fatigue at the time 2.5 c. Planning and Outcome Identification 3. Monitor Hydration Carefully consider individual goals for each nursing diagnosis and each 3.1 Provision of adequate fluid intake important in thinning the client. pulmonary The goals should be individualized to reflect the client’s capabilities and 4. Administer Medications limitations. 4.1 Includes expectorants, mucolytics, anti-inflammatory drug 4.2 Beneficial to administer before chest physiotherapy d. Implementation 5. Monitor Environmental and Lifestyle Conditions Interventions to promote airway clearance 5.1 Allergic conditions (asthma) may improve dramatically if the 1. allergens to which the client is sensitive are identified and 1.1 removed from the client’s environment. 1.2 Evaluate the effectiveness of coughing by: 5.2 Exposure to chemicals and pollutants in the work a. sputum, expectoration environment. b. client’s report of swallowed sputum 5.3 Smoking cessation may not reverse advanced disease but will c. cleaning of adventitious sounds by auscultation often reduce the client’s symptoms and improve the quality of 1.3 Encourage client’s with chronic pulmonary disease, upper life. respiratory tract infections, lower respiratory tract infections to 6. Introduce Artificial Airways deep breathe - inserted to maintain a patent air passage for client whose 1.4 Coughing techniques airways has become a. Cascade cough – slow, deep breath and hold it for 2 6.1 Nasal Airway/ Nasal Trumpets secs while contracting expiratory muscles A soft, flexible, uncuffed tube that is designed to b. Huff cough – stimulates a natural gag reflex and is Used to maintain the free passage of air to and from the generally effective only for clearing central airways lungs in patients with c. Quad cough – clients with abdominal muscle control Nursing Intervention: 2. Initiate Postural Drainage and Chest Physiotherapy (CPt) 1. Provide frequent oral and nares care. 2.1 Techniques intended to promote the drainage of secretions 2. Repositioning the airway in the nares every 8 hours or from the lungs as ordered.
DINGCONG, PHOEBE JOY M. BSN 1 – A FUNDAMENTALS OF NURSING
6.2 Oral Airway – the simplest type of artificial airway, prevents Suctioning – aspirating secretions obstruction; used by preventing the tongue from covering the Suctioning Techniques epiglottis which could prevent the person from breathing; a. Oral and Oropharyngeal Suctioning – removes secretions from the stimulate gag reflex and are only used upper respiratory tract Nursing Intervention: b. Nasopharyngeal and Nasotracheal Suctioning – provides closer 1. Place the client in a supine position or semi-fowler’s access to the trachea and requires sterile technique position c. Tracheal Suctioning – occurs through an artificial urinary; apply 2. Don gloves. suction intermittently while withdrawing the catheter; rotating the 3. catheter will enhance removal of secretions that have adhered 4. 5. Interventions to Improve Breathing 6. Provide mouth care at least every 2-4 hrs. 1. Properly Position Client – upright/supine position 6.3 Endotracheal Tubes – a short term artificial airways to 2. Teach Controlled Breathing Exercises administer mechanical ventilator 2.1 Pursed-lip Breathing – involves deep inspiration and 6.3.1 Ventilator 2.2 Deep Breathing Exercises 6.3.2 2.3 Diaphragmatic Breathing (Abdominal Breathing) 6.3.3 Mouth care must be provided for the client 2.4 Incentive Spirometry – measure the flow of air 6.3.4 Frequent cleansing and suctioning of the oral cavity (every 2 hrs) reduces discomfort and the risk of Intervention to Improve Oxygen Uptake and Delivery breakdown of the oral mucosa 1. Administer Oxygen a. Interventions to Promote Airway Clearance b. 6.4 Tracheostomy Tube c. Tracheostomy – an opening into the trachea through the > Oxygen is supplies in several ways. neck; usually inserted through this opening and an artificial airway is created OXYGEN DELIVERY SYSTEMS Parts of Tracheostomy Tube: 1. Nasal Cannula (Nasal Prongs) – most common, simple, comfortable a. Outer Cannula – inserted into the trachea & a Advantages: flange that risks against the neck & allows tube Permits some freedom of movement (eat & talk) to be secured in place with tapes or ties Well tolerated by client b. Obturator – used to insert the outer cannula Disadvantages: and then removed Inability to deliver higher c. Inner Cannula – pits inside the outer cannula 2. Face Mask – a device that cover the client’s nose and mouth It has a lock to keep it from being Two (2) primary types of oxygen masks: coughed. a. Nursing Interventions (Tracheostomy) b. 1. Care with new Types of oxygen mask: 2. Tracheostomy may need to be suctioned & a. cleaned every 1-2 hrs b. Partial Breather Mask – delivers oxygen concentration Tracheostomy (2 methods of communication) c. Nonrebreather Mask – delivers the highest oxygen conc. a. writing of messages Possible b. use of alphabet board d. Venturi Mask – deliver oxygen conc. of 24% to 60% with O2 flow rates of 1 to 12L/min. 7. Suction the Airway
DINGCONG, PHOEBE JOY M. BSN 1 – A FUNDAMENTALS OF NURSING
DINGCONG, PHOEBE JOY M. BSN 1 – A FUNDAMENTALS OF NURSING