Nursing Fundamentals Focus VIII

Oxygenation
 Objectives
• List and discuss the major body structures.
• Discuss functions responsible for proper oxygenation
• Describe factors that may alter ones O2 balance.
• Identify the behaviors indicating negative O2 balance.
• Review the common diagnostic tests medically
prescribed in order to determine the client’s
oxygenation status.
• Explain the major purpose of the tests and the related
nursing responsibilities.
 Staggering statistics
• Pulmonary Diseases
• Lung CA -

• TB –

• Pneumonia –

• Chronic Airflow Limitation (formerly COPD) –

 Staggering statistics

• Cardiovascular Diseases – # 1 killer

• HTN – 65 million
• Artheriosclerosis
• Arteriosclerosis
• Stroke
• Hypercholesterolemia
• 107 million - a risk factor for CVD
• AMI – 7.5 Million per year, 460,000 die
• Americans paid 393.5 billion in 2005 for CVD
related medical costs
Respiratory System
 Process of Breathing

•Inspiration
• Air flows into lungs
•Expiration
• Air flows out of lungs
 Normal Oxygenation Process
• Cardiovascular:
 Normal Oxygenation Process
• Systemic:
Normal Oxygenation Process
 Inspiration

• Diaphragm and intercostal muscles contract

• Thoracic cavity size increases
• Volume of lungs increases
• Intrapulmonary pressure decreases
• Air rushes into the lungs to equalize pressure
 Expiration

• Diaphragm and intercostal muscles relax

• Lung volume decreases
• Intrapulmonary pressure rises
• Air is expelled
 Gas Exchange
• Occurs after the alveoli are ventilated
• Pressure differences (gradient) on each side of the
respiratory membranes affect diffusion
• Alveoli:
• PO2 100mmHg
• PCO2 40mmHg
• Venous blood:
• PO2 60mmHg
• PCO2 45mmHg
• O2 diffusion from alveoli pulmonary blood vessels
• CO2 diffusion from pulmonary blood vessels  alveoli
 Adequate O2 Balance
• Maintenance of adequate O2 balance Gas Exchange
 Oxygen Transport

• Transported from the lungs to the tissues

• 97% of O2 combines with RBC Hgb
 oxyhemoglobin carried to tissues
• Remaining O2 is dissolved and transported in
plasma and cells (PO2)
 Normal Oxygenation Process

• Cell environment / O2 carrying capacity:

• O2 Carrying capacity of blood is expressed by:
• Red blood cells (#)
• Hematocrit
• % of blood that is RBCs
• Men 40-54%
• Women 37-50%
• Hemoglobin
 Carbon Dioxide Transport

• Must be transported from tissues  lungs

• Continually produced in the process of cell
metabolism
• 65% – carried inside RBCs as bicarbonate (HCO3-)
• 30% – combines with Hgb  carbhemoglobin
• 5% – transported in plasma as carbonic acid (H 2CO3)
 Factors that Influence
Respiratory Function

• Age
• Environment
• Lifestyle
• Health status
• Medications
• Stress
 Common Manifestations of Impaired
Respiratory Function

•Hypoxia
•Altered breathing patterns
•Obstructed or partially
obstructed airway
 Hypoxia

• Condition of insufficient oxygen anywhere in the body

• Rapid pulse
• Rapid, shallow respirations and dyspnea
• Increased restlessness or lightheadedness
• Flaring of nares
• Substernal or intercostal retractions
• Cyanosis
 Abnormal Respiratory Patterns

• Tachypnea (rapid rate)

• Bradypnea (abnormally slow rate)
• Apnea (cessation of breathing)
• Kussmaul’s breathing
• Cheyne-Stokes respirations
• Biot’s respirations
 Alterations in Ease of Breathing

• Orthopnea

• Dyspnea
 Obstructed or Partially
Obstructed Airway

• Partial obstruction
• low-pitched snoring during inhalation

• Complete obstruction
• extreme inspiratory effort with no chest
movement
 Adequate O2 Balance
Example of Obstructive Disease: Asthma

•
 Adequate O2 Balance
Example of Restrictive Disease: Hemothorax

•
 Inadequate O2 Balance
• Behaviors of Negative O2 balance
• Hypoventilation or hyperventilation
• Stridor, audible sounds with respiration,
wheezing, coughing
• Hypoxia
• Change in mental status
• Change vital signs
• Cyanosis
• Decrease in GI motility
• Change in renal function
• Hypercapnia
 Nursing Responsibilities
• Determine adequacy of cardiopulmonary function:
• Nursing assessment
• HEART
• Respiratory assessment
• PMH
• LIFESTYLE
 HEART
• Have client describe
• specific location, onset and duration of the problem

• Explore associated signs and symptoms

• Ask - activities that worsen or ease the problem
• Rate the severity of discomfort or incapacity
• Talk - treatments or interventions used to alleviate
the problem and their effectiveness
 Heart Problems

Artheroscleosis = Coronary Artery Disease (CAD)

 Nursing Measures to Promote Respiratory
Function

• Ensure a patent airway

• Positioning
• Encourage deep breathing, coughing
• Ensure adequate hydration
 Nursing Responsibilities

• Physical Assessment:
• Lung auscultation and breathing pattern
• Abdominal assessment
• Urine output
• Skin and mucous membranes
• Heart sounds
• Circulation
• Edema
• DVT
 Lung sounds
• Diminished or absent
• Crackles course and fine
• discontinuous course bubbling
• fine crackling sound at the middle or end of inspiration
• Rhonchi
• a continuous sonorous sound
• Wheezes
• high pitch musical sounds
• Pleural friction rub
• grating rubbing, sound
 Common Tests and Nursing Responsibilities

•Measure adequacy of ventilation and gas exchange

• Complete Blood Count (CBC)  phlebotomy

• Arterial Blood Gases (ABG) arterial puncture

• Pulmonary Function Tests preparation by teaching

 Common Tests and Nursing Responsibilities

•Tests to determine abnormal cell growth or infection

in respiratory system:

• Sputum culture
• growing microorganisms from sputum

• Throat culture
• growth of microorganisms from throat material
 Common Tests and Nursing Responsibilities
• Tests to visualize structures of
respiratory system:
• Bronchoscopy
• Chest radiographs
 Chest Xray
Adenocarcinoma
Common Tests and Nursing Responsibilities

Thorancentesis
 Nursing Responsibilities

• Medications
• Incentive spirometry
• Chest PT
• Postural drainage
• Oxygen therapy
• Artificial airways
• Airway suctioning
• Chest tubes
 Basic Nursing Interventions

• Airway Maintenance:
• Facilitate effective coughing
• Suctioning airways
• Liquefying and mobilizing sputum
 Basic Nursing Interventions

• Maintenance and promotion of proper lung

expansion:
Re-expanding collapsed lungs
- Closed Chest Tube Drainage
Chest Tubes
 Basic Nursing Interventions
• Improving Activity Tolerance:
• Determine etiology
• Assess appropriateness of activity level
• When appropriate gradually increase activity
• Ensure the client changes position slowly
• Observe for symptoms of intolerance
• Syncope with activity
• refer to MD
• Perform ROM exercises with activity intolerance if
is immobile
 Basic Nursing Interventions
• Mobilization of Pulmonary Secretions

• Auscultate breath sounds, monitor respiratory

patterns, monitor ABG’s
• Position client to optimize respiration
• Pulmonary toileting
• Incentive spirometry
• Suctioning
Incentive spirometry
 Basic Nursing Interventions
• Mobilization of Pulmonary Secretions
• Encourage activity and ambulation as tolerated
• Encourage increased fluid intake
• Chest physiotherapy
• O2
• Medications as ordered
 Basic Nursing Interventions
• O2 Therapy:
• Low flow
• High flow
• Humidification
• Nasal cannula
• Simple mask
• Nonrebreathing mask
• Partial rebreathing
 Basic Nursing Interventions

• Effective Breathing Techniques

• Position for maximal respiratory function

• Pursed lip breathing

• Diaphragmatic or abdominal breathing

 Basic Nursing Interventions
Stress and anxiety reduction:
• Remove pertinent cause of anxiety at that moment
- help client gain control over respiration
- reassure client not in immediate danger

• Chronic clients
• exacerbations and remissions
• goal is to reduce general level of anxiety
• learn to control episodes of anxiety to improve quality
of life
• desensitization program
• guided mastery
 Administration of Prescribed
Medications
• Expectorants • Vasoconstrictors
• Mucolytics
• Bronchodilators
• Cough suppressants
• Corticosteroids
• Antihistamines
• Antibiotics
 Basic Nursing Interventions
• Physical Exercise health teaching
Activity and rest -- a priority !
Activity stimulates respiratory function
Rest conserves energy and reduces metabolic demand
• MD’s treatment plan
• guidelines for activity
• may simply call for activity as tolerate.
• prioritize activities
• arrange need items conveniently
• Provide emotional support and encouragement
• gradually increase activity
• Simplify daily life
• Work at a steady state
• Conserve energy
 Adequate O2 Balance

• Behaviors of Negative O2 balance 

Cardio Vascular Disease

• Arterial
• Venous:
• Impaired tissue perfusion
 Adequate O2 Balance

• Behaviors of Negative O2 balance  CV

• Restlessness, dizziness, syncope, bradycardia,

decreased urine
• cold and clammy skin, cyanosis, slow capillary refill
• Decreased cardiac output
 Common Tests and Nursing Responsibilities

Tests
• to determine adequacy of cardiovascular
function:
• CBC
• Lipid profile
• Coagulation studies
• EKG/ECG
• Angiography
 Basic Nursing Interventions

Cardiovascular •Diet
• Modify risk factors •Exercise
•Co morbidities
• Preventing vasoconstriction

•Positioning
•Cold temperatures
•Nicotine
 Basic Nursing Interventions
• Cardiovascular •Risk DVT
•Position changes
- Prevent •Early ambulation
complications •Obstruction removal
•Bypass surgery

• Promoting rest •Schedule rest periods

•Assistance with ADL’s
•Monitor Vitals with activity
•Place items, i.e. call light,
water pitcher, strategically
•Quiet environment,
decrease stimuli
 Basic Nursing Interventions
- Position semi to high
Cardiovascular fowlers-> decrease venous
• Positioning to improve return and preload, decease
preload-> decreases risk of
CO
heart congestion

-
• Avoiding Valsalva • Teach client to avoid
valsalva maneuver
maneuver - Hold breath while
turning or moving in
bed-> assist
- Bearing down during
BM-> stool softeners
and diet
 Basic Nursing Interventions

Cardiovascular •Avoid appetite suppressants, cold

• Avoid stimulants meds, coffee, tea, chocolate

• Maintaining fluid
balance •Assess fluid status, monitor I&O,
assess breath sounds, JVD, pitting
edema in dependent areas, fluid
and NA+ restriction, daily Wgt with
diuretic therapy, electrolyte
monitoring-> MD
 Basic Nursing Interventions

• Administer O2
Cardiovascular
• Educate client
• Increase O2 supply
NO SMOKING!

• Position to facilitate
breathing
 Administration of Prescribed
Medications

• Anti coagulants

• Vasodilator
Medications

• Inotropic Medications

• Anti Dysrhythmics

• Anti hypertensives
 Basic Nursing Interventions

• Dietary control

• Assess nutritional status

• Consider a dietician referral to assess

nutritional needs related to clients

• Chronicity of CAL and CAD and nutrition

 Basic Nursing Interventions
• Weight control

• Evaluate the client’s physiological status in relation

to condition

• More than body requirements

• Less than body requirements