CHAPTER 39

• OXYGENATION

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 Cardiovascular Physiology
• Structure and function
– Myocardial pump
– Myocardial blood flow
– Coronary artery circulation
– Systemic circulation
– Blood flow regulation: cardiac output,
preload, afterload, contractility
– Conduction system
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Respiratory Physiology
• Structure and function (cont'd)
– Breathing: inspiration, expiration
– Lung volumes and capacities
– Pulmonary circulation
– Respiratory gas exchange: oxygen,
carbon dioxide
– Regulation of respiration
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Factors Affecting Oxygenation

• Physiological factors: cardiac

– Conduction disturbances
– Impaired valvular function
– Myocardial hypoxia
– Cardiomyopathic conditions
– Peripheral tissue hypoxia
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Factors Affecting Oxygenation
(cont'd)

• Physiological factors: respiratory

– Hyperventilation
– Hypoventilation
– Hypoxia

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Factors Affecting Oxygenation
• Additional physiological factors
– Decreased oxygen-carrying capacity
– Decreased inspired oxygen
concentration
– Hypovolemia
– Increased metabolic rate
– Conditions affecting chest wall
movement
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Factors Affecting Oxygenation
• Additional physiological factors
– Musculoskeletal abnormalities
– Trauma
– Neuromuscular diseases
– Central nervous system alterations
– Chronic disease

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Alterations in Cardiac Functioning
• Conduction disturbances
– Atrial and ventricular dysrhythmias
• Altered cardiac output
– Heart failure
• Impaired valvular function
• Myocardial ischemia
– Angina, MI, acute coronary syndrome
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Alterations in Respiratory
Functioning

• Hyperventilation
• Hypoventilation
• Hypoxia

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Developmental Factors

• Infants and toddlers

• School-age children and
adolescents
• Young and middle adults
• Older adults
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 Lifestyle Factors

• Nutrition
• Exercise
• Smoking
• Substance abuse
• Stress
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Environmental Factors

• Residence location
• Occupation

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 Nursing History
• Fatigue
• Dyspnea
• Cough
• Wheezing
• Pain
• Environmental or geographical
exposures Mosby items and derived items © 2005 by Mosby, Inc.
 Nursing History (cont'd)

• Respiratory infections
• Health risks
• Medications

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Assessment of Oxygenation

• Physical examination
– Inspection
– Palpation
– Percussion
– Auscultation
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 Assessment of Oxygenation
(cont'd)

• Diagnostic tests: blood studies

– Complete blood count
– Cardiac enzymes
– Cardiac troponin I
– Serum electrolytes
– Cholesterol Mosby items and derived items © 2005 by Mosby, Inc.
Assessment of Oxygenation (cont'd)
• Diagnostic tests: cardiac function
– Electrocardiogram (ECG)
– Holter monitor
– Exercise stress test
– Thallium stress test
– Electrophysiological study (EPS)
– Echocardiography
– Scintigraphy
– Cardiac catheterization
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Assessment of Oxygenation (cont'd)
• Diagnostic tests: ventilation studies
– Pulmonary function
– Peak expiratory flow rate (PEFR)
– Arterial blood gases
– Oximetry
– Chest x-ray
– Bronchoscopy
– Lung scan
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 Assessment of Oxygenation
(cont'd)
• Diagnostic tests: ventilation studies
(cont'd)
– Thoracentesis
– Throat cultures
– Sputum specimens

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 Nursing Diagnoses
• Ineffective airway clearance
• Ineffective breathing pattern
• Decreased cardiac output
• Impaired gas exchange
• Risk for infection
• Ineffective tissue perfusion
• Impaired spontaneous ventilation
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 Planning

• Goals and outcomes

– Client’s lungs are clear on auscultation
– Client coughs productively
• Setting priorities
• Continuity of care
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 Implementation:
Health Promotion
• Body weight
• Diet
• Exercise
• Stress reduction
• Occupational safety
• Smoke-free
• Regular physical examinations
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 Implementation: Health
Promotion (cont'd)
• Vaccinations/immunizations
– Influenza
– Pneumonia

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 Implementation: Acute Care

• Dyspnea management
• Airway maintenance
– Mobilization of secretions
– Suctioning
– Artificial airways

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Implementation: Acute Care
(cont'd)

• Maintenance and promotion of lung

expansion
– Positioning
– Incentive spirometry
– Chest tubes
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 Airway Maintenance
• Mobilization of pulmonary secretions:
– Humidification
– Nebulization
– Chest Physiotherapy- contraindications
Box 39-12
• Postural drainage – ex. Cystic Fibrosis
• Chest percussion
• Vibration
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 Implementation: Acute Care
(cont'd)
• Maintenance and promotion of
oxygenation: oxygen therapy
– Safety precautions
– Oxygen supply
– Methods of oxygen delivery
– Home oxygen therapy
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Implementation: Acute Care
(cont'd)

• Restoration of cardiopulmonary
functioning—CPR

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Implementation: Restorative
Care
• Hydration
• Coughing techniques
• Respiratory muscle training
• Breathing exercises

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 Evaluation

• Client care
• Client expectations

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