Oxygenation Study Guide ADN-MGCCC

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Oxygenation Study Guide ADN-MGCCC
2010-04-20 20:39:53

Oxygenation- Cardiac and Respiratory
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  1. What is the heart?
    An organ at the "heart" of the circulatory system

    Made up of 4 chambers - 2 Atrium and 2 Ventricles

    How the blood flows

    The heart valves

    The coronary arteries

    The average heart beats 73 times a minute or 38 million beats a year
  2. How does the blood flow through the heart?
    • Superior and Inferior Vena Cava bring DeO2 blood to the R Atrium
    • Blood flows from the R Atrium through the Tricuspid Valve into the R Ventricle
    • R Ventricle pumps blood through Pulmonary Semi-Lunar Valve into the Pulmonary Trunk (pulmonary circuit)
    • Pulmonary Trunk divides into a right and left pulmonary artery where it delivers blood to the alveoli in the lungs where gas is exchanged
    • Blood is O2 and flows back to the heart by right and left pulmonary veins
    • Right & left pulmonary veins deliver blood to the L Atrium
    • Blood flows from the L Atrium through the Mitral/Bicuspid Valve to the L Ventricle
    • Blood pumps from the L Ventricle through the Aortic Semi-Lunar Valve to the Ascending Aorta
    • Blood flows through the Aortic Arch to the Descending Aorta
  3. Cardiac Output (Definition)
    Amount of blood ejected from the ventricle each minute

    CO= Stroke Volume x Heart Rate

    • Typical CO per minute for adult= 5-8L per minute
    • w/strenous activity it can increase to 25L per minute
  4. Cardica Index (CI) Definition
    The adequacy of the cardiac output for an individual
  5. Stroke Volume (Definition)
    Amount of blood ejected from the left ventricle with each contraction
  6. Preload (Definition)
    • -The end-diastolic volume
    • -The ventricles stretch when filling with blood. The greater the stretch, the greater the contraction, and -the greater the stroke volume (STARLING'S LAW)
    • -May be manipulated by changing amounts of circulating volume
    • Ex)Fluid replacement (blood, Lasix)
    • -Stretch of muscle fibers at end of diastole
    • -As BV increases muscle fiber stretch increases thus preload increases=Greater Stroke Volume
    • -Trauma=Decreased preload
    • -Increase heart rate (150 or greater beats per min), cardiac output starts to reduce so stroke volume goes down.
  7. Afterload (Definition)
    Resistance to left ventricular ejection; The load the heart must eject the blood against; closely related to aortic pressure

    Can be described as the pressure that the chamber of the heart has to generate in order to eject blood out of the chamber

    Usually measured in critical care settings and relates injury to myocardial muscle

    In HTN, afterload is increased thus increasing cardiac workload. Can be decreased by giving antihypertenstives

    Ex) Watergun or blowing a spit ball through a straw.
  8. Contractility (Definition)
    Ability of the cardiac muscle to shorten in response to an electrical impulse

    Refers to the force generated by the contracting myocardium under any given condition

    When the heart contracts (squeezes blood out) during diastole

    Deals with electrical conduction

    Under 50 indicates heart failure

    Causes that lower EF: MI, Problems with heart valves, Any problem with heart muscle itself (hypertrophy, cardiomegally)
  9. Lifestyle Risk Factors for Heart Problems/Disease:
    • Nutrition
    • Exercise
    • Smoking Cessation
    • Stress Reduction
    • Substand Abuse
  10. Nutrition (Risk Factor)
    Obesity, anemia, malnourished
  11. Exercise (Risk Factor)
    Decreases P, BP, cholestrol, increases blood flow and oxygen extraction by using muscles

    Good for us
  12. Smoking Cessation (Risk Factor)
    Smoking associated with lung cancer, heart disease, HTN, COPD, Emphysema
  13. Stress Reduction (Risk Factor)
    Stress increases metabolic reate and oxygen demand

    Good for us
  14. Substance Abuse (Risk Factor)
    Alcohol and other drugs decrease oxygenation
  15. Conduction System
    • Starts in sinoatrial (SA) node- pacemaker of the heart located in the right atria (60-100 beats per minute, intrinsic/inherent rate)
    • Through atria to atrioventricular (AV) node- Second highest inheret rate; SA node stops working AV node picks up but is slow (40-60 beats per minute)
    • To bundle of HIS and ventricular Perkinje network- R & L Bundle Branches, Purkinje fibers
  16. Electrocardiogram (ECG)
    Reflects electrical activity of the conduction system

    Normal sequence is called normal sinus rhythm (NSR)
  17. P- Wave

    • Represents atrial depolarization- contraction of atria (LUB)
    • P=First component of EKG complex
    • PR Interval= end of line of P to the beginning of R line
    • Normal PR Interval is anywhere from 0.12-0.2 seconds
  18. QRS Complex

    • Ventricular depolarization - Contraction
    • Q= First downward deflection
    • R= First upward deflection
    • S= Downward deflection after an R wave
    • Widening QRS complex indicates a blockage (or may have "rabbit ears")
  19. T Wave

    • Represents repolarization
    • Recovery Phase
    • It usually is in the same direction as the QRS (Depolarizes the same direction that it repolarizes)
    • Indicated ischemia if repolarization goes in opposite way of P wave (Inverted T wave)
  20. Calculating Heart Rate
    Using a 6-second EKG strip, count the number of QRS complexes and mulitply by 10. This will give you the heart rate

    • Ex) 8 QRS complexes are seen on the 6-second stip. What is the heart rate
    • 8x10=80
    • 80 beats per minute
  21. The Golden Standard
    Normal Sinus Rhythm

    The rhythm by which we measure all other rhythms

    Any deviation is NOT right
  22. Normal Sinus Rhythm
    • Rhythm: Regular
    • Rate: 60-100
    • P Waves: Present, normal appearance
    • PR Interval: .12-.20
    • QRS: Narrow
    • Note: None
  23. Dysrhythmia
    • Deviation from normal sinus rhythm
    • Occurs as a primary conduction disturbance in response to ischemia, valvular abnormality, anxiety, or drug toxicity
    • May result from caffeine, alcohol, tobacco use
    • May result from acid-base or electrolyte imbalance
  24. Sinus Bradycardia

    • Rhythm: Regular
    • Rate: 50 beats per minute or less
    • P Waves: Present, normal appearance
    • PR Interval: .12-.20
    • QRS Complex: Narrow
    • Note: None
  25. Sinus Tachycardia

    • Rhythm: Regular
    • Rate: 100 beats per minute or more
    • P Wave: Present, normal appearance
    • PR Interval: .12-.20
    • QRS Complex: Narrow
    • Note: Rate faster than 100, same as NSR
  26. Ectopy (Definition)
    The electrical impulse came from somewhere outside the SA node

    Early beats, they occur before you expect the next beat in rhythm

    Arrive either from the atrium or ventricles of the heart
  27. Atrial Flutter

    • Rhythm: Regular, usually
    • Rate: Depends on conduction ratio (4:1)
    • P Waves: Saw-tooth, rate 300
    • PR Interval: N/A
    • QRS Complex: Narrow
    • Note: Conduction varies
  28. Atrial Fibrillation

    • Rhythm: Irregular/Regular
    • Rate: Varies
    • P Waves: No consistent P wave
    • PR Interval: N/A
    • QRS Complex: Narrow
    • Note: Irregular irregularity
  29. Atrial Tachycardia

    • Rhythm: Regular
    • Rate: 140 beats per minute or more
    • P Waves: Present, normal
    • PR Interval: .12-.20
    • QRS Complex: Narrow
    • Note: Common in short runs, feels like heart is racing
  30. Supraventricular Tachycardia (SVT)

    • Rhythm: Regular
    • Rate: 140 and higher
    • P Waves: difficult to see due to rate
    • PR Interval: .12-.20
    • QRS: Narrow or wide
    • Note: Category for rhythms that are not clear
  31. Sinus Rhythm with PVC's

    • Rhythm: Underlying rhythm regular
    • Rate: Rate according to rhythm
    • P Waves: None for Ventricular beat
    • PR Interval: N/A
    • QRS: Wide, Bizarre
  32. Ventricular Tachycardia

    • Rhythm: Regular
    • Rate: 100 or higher
    • P Waves: Absent
    • PR Interval: N/A
    • QRS: Wide, bizarre
    • Note: Lethal rhythm, requires treatment

    • Patient is usually unresponsive and pulse less
    • 3 or more PVC's in a row occuring at a rate of over 100 beats per min.
    • Associated with CAD and may preceed V-fib
  33. Ventricular Fibrillation
    • Rhythm: Irregular
    • Rate: N/A
    • P Waves: Absent
    • PR Interval: N/A?
    • QRS: Wide, bizarre
    • Note: Lethal rhythm, requires defibrillation

    • Rapid disorganized rhythm that causes ineffective quivering of the ventricles
    • No audible heart beat, no pulse, no respirations, no coordinate cardiac activity is positive for cardiac arrest
  34. Asystole

    • Rhythm: None
    • Rate: None
    • P Waves: Absent
    • PR Interval: N/A
    • QRS: None
    • Note: Treatment ineffective unless underlying cause can be corrected

    No cardiac output=no blood flow
  35. Signs and symptoms of cardiac disease
    -Decreased heart rate, SOB or chest pain, lightheadedness, or low blood pressure-signs of heart block

    -Fast rate my also reduce cardiac output, resulting in significant signs and symptoms such as restlessness, chest pain, SOB, pallor, hypotension, and loss of consciousness - Tachycardia

    -Commom s/sx- fatigue, chest pain, feeling of impending doom
  36. S/SX associated with decreased cardiac output and tissue perfusion
    • Arrhythmias
    • Capillary refill > 3 seconds
    • Altered respirations
    • Use of accessory muscles, chest retraction, nasal flaring
    • Abnormal blood gases
    • Skin discolorations, delayed healing, skin temp. changes
    • Weak/absent pulses
    • Edema
    • Orthopnea
    • Anxiety
  37. S/SX associated with CHF
    • Left heart failure (lungs)
    • -blood backs up in the lungs
    • -crackles, hypoxia, SOB, cough, nocturnal dyspnea
    • Right heart failure (Body-systemic)
    • -Blood backs up in the systemic circulation
    • -Weight gain, distended neck veins (JVD), hepatomegaly, sleenomegaly, dependent peripheral edema
  38. Cardiopulmonary Diagnostic Blood Studies
    • CBC- number or red and white blood cells
    • Cardiac Enzymes- diagnose acute MI
    • -CK, MB
    • Troponin- elevates within 12 hours of cardiac event and remains elevated for 10-14 days
    • Potassium (k+)- Clients on diuretics increased risk for hypo, on ACE inhibitors risk for hyper
    • Cholestrol- HDL(good) & LDL(bad)
    • -HDL- low levels caused by cigs, obesity, lack of exercise
    • -LDL- high levels caused by high intake of saturated fats, obesity, genetics
    • -Brain (B-type)- Natriuretic peptide (BNP) is a neurohormone that helps regulate BP and fluid volume-diagnose CHF
    • CIS- Cardiac Injection Series- CK, MB & Troponin
    • CK & MB- detect damaged muscle band so a pulled leg muscle can elevate it
  39. Cardiac Function Tests
    • 12-Lead EKG
    • Holter Monitor
    • Exercise and Thallium Stress Test
    • Electrophysiologial Studies (EPS)
    • Echocardiography
    • Cardiac catheterization and angiography
  40. 12-Lead EKG
    Graphic reading of the electrical activity of the heart
  41. Holter Monitor
    Portable EKG worn by client with diary entries
  42. Exercise and Thallium Stress Test
    Walks on treadmill with EKG or is injected with thallium, used to evalute cardiac response to stress
  43. Electrophysiological Study (EPS)
    Invasive measure of electrial pathways used to assess adequacy of antiarrythmic drugs
  44. Echocardiography
    Non-invasive measure of heart structure and heart wall movement
  45. Cardiac catheterization and Angiography
    Used to visualize cardiac chambers, valves, vessels, and coronary arteries
  46. Cardiac Physical Assessment
    • Assessment of the heart commonly involves techniques such as auscultation, palpation, and sometimes percussion
    • Assess the skin color and temperature
    • Assess for the presence of edema
    • Assess the pulse for strength, rate, and rhythm
    • Monitor BP, LOC, ABG's, Pulse ox
    • Monitor for JVD
    • Peripheral edema in PVD or PAD
  47. Physical Assessment of Skin
    Peripheral cyanosis

    Central cyanosis

  48. Peripheral cyanosis
    A bluish tinge, most often of the nails and skin of the nose, lips, gums, earlobes, and extremities.

    Results of anemia or decreased arterial perfusion
  49. Central cyanosis
    A bluish tinge observed in the tongue and buccal mucosa

    Denotes a serious cardiovascular disorder such as pulmonary edema or congenital heart disease

    Venous blood passing through pulmonary circulation is not being oxygenated
  50. Pallor
    A decrease in the color of the skin
  51. Pulse Quality
    • 0= Pulse not palpable or absent
    • 1+= Weak, thready pulse, difficult to palapte; obliterated with pressure
    • 2+= Diminished pulse; cannot be obliterated
    • 3+= Easy to palpate, full pulse; cannot be obliterated
    • 4+= Strong, bounding pulse; may be abnormal
  52. Nursing Diagnosis we can use for Cardiovascular
    • Decreased Cardiac Output
    • Excess Fluid Volume
    • Acute Pain
    • Deficient Knowledge
    • Ineffective Health Maintenance
    • Activity Intolerance
    • Anxiety
    • Impaired Gas Exchange
    • Ineffective Tissue Perfusion
  53. Nursing Process: Planning
    • Goals & Outcomes- individualized, realistic expectations
    • Ex) Client's lungs will be clear to auscultation

    Setting Priorities- Most important- airway more important than bowel elimination

    Continuity of Care- Limited hospital stay, may need home health or rehab
  54. Nursing Process: Outcome Identification & Planning
    • -Demonstrate improved gas exchange by absence of cyanosis or chest pain, pulse ox greater than 95
    • -Demonstrate hemodynamic stability by BP 130/85, Pulse 70
    • -Demonstrate an increase activiy tolerance
    • -Participate in activities that reduce the workload of the heart such as stress managment or therapeutic medication regimen
    • -Verbalize knowledge of the disease process: risk factors, treatment plan
    • -Increased Perfusion: peripheral pulses present/strong, balanced intake/output, absence of edema or decreased edema
  55. Nursing Process: Implementation
    Health promotion - vaccinations, lifestyle changes (nutrition, anxiety, smoking)

    Assessment is continuous

    Supplemental oxygen

    Medications related to disease process

    I & O

    Weigh patient daily if CHF
  56. Nursing Process: Evaluation
    Response to intervention/teaching actions performed

    Attainment/progress toward desired outcome(s)

    Modifications to plan of care
  57. What is the purpose of the respiratory system?
    • Provides oxygen to the cells
    • Removes Carbon Dioxide
    • Lungs are the largest organs of the respiratory system
    • Located in the thoracic cavity
    • Lungs work in synergy with the heart as the cardiopulmonary system
    • The left lung has 2 lobes and subdivides into 8 segments
    • Right lung has 3 lobes, subdivides into 10 segments and is slightly larger than the left lung
    • The heart is anteriorly located between the right and left lungs
  58. Anatomy of the Cardiopulmonary System
  59. Cardiopulmonary Pathway

  60. What factors are essential to normal functioning of the Repiratory System?
    Integrity of the airway system to transport air to and from lungs

    Properly functioning alveolar system in lungs

    Properly functioning cardiovascular and hematological system
  61. Respiratory System Physiology
    Pulmonary ventilation (breathing)

    Respiration (breathing in and out=1 respiration)

  62. Pulmonary Ventilation
    Two phases: Inspiration and expiration.

    Exchange of outside air and the alveoli.

    The movement of air into and out of the lungs.
  63. Inspiration
    The active phase

    Involves movement of muscles and the thorax to bring air into the lungs
  64. Expiration
    The passive phase

    The movement of air out of the lungs
  65. Respiration
    Gas exchange between the atmospheric air in the alveoli and the blood in the capillaries
  66. Perfusion
    Process where oxygenated capillary blood passes through body tissues
  67. True or False?
    Pulmonary ventilation is the process by which oxygenated capillary blood passes through body tissues?
    FALSE, that is Perfusion

    Pulmonary Ventilation is the exhange of outside air and the alveoli. Inspiration and expiration.
  68. Respiratory Function: Work of Breathing
    • Inspiration (active)
    • -The lungs expand
    • -Diaphragm contracts and drops down
    • -The external intercostal muscles contract lifting the ribs up and outward
    • -Sternum is pushed forward enlarging the chest front to back
    • Expiration (passive)
    • -Recoil or relaxation of the structures
    • -Compliance - Ability of the lungs to distend or to expand in response to intra-alveolar pressure
    • -Airway Resistance - An obstruction or force that increases the resistance of air flow. Can be a physical obstruction such as food or a physiological as in narrowing bronchioles due to disease process/increased secretions.
    • Ex) Mucous buildup, kyphosis, physical deformity
  69. Upper Airway

    • Nose
    • Pharynx
    • Larynx
    • Epiglottis
    • FUNCTION: To warm, filter and humidify air
  70. Lower Airway Tracheobronchial Tree

    • Trachea
    • Right and left mainstem bronchi
    • Segmental bronchi
    • Terminal bronchi

    • Conduction of air
    • Mucociliary clearance
    • Production of pulmonary surfactant
  71. Components of the Respiratory System


  72. Cilia
    Hair like projections that line the airways

    They propel mucous and trapped material towards the upper airway to be expelled by coughing
  73. Surfactant
    A detergent-like phospholipid that reduces surface tension between the moist membranes of the alveoli and prevent alveoli collapse
  74. Alveoli

    • -Located at the end of the terminal bronchioles they are clusters of small air sacs that are the site of gas exchange
    • -They are surrounded in capillaries which allows for the exchange of gases
    • -The average human has more than 300 million alveoli that if stretched ou cover a surface size of a tennis court
  75. Diffusion
    The movement of gas or particles from areas of higher pressure or concentration to areas of lower pressure or concentration.
  76. Diffusion of Gases in the Lungs
    • Four factors influencing deficits with diffusion:
    • -Change in surface area available (lung removal-Thoracotomy)
    • -Thickening of alveolar-capillary membrane (Pulmonary edema, Pneumonia)
    • -Partial pressure (higher altitudes less O2)
    • -Solubility & molecular weight of the gas (carbon dioxide has greater solubility...and diffuses more rapidly) (Increased CO2 level)
  77. Which of the following respiratory organs is the site of gas exchange?

    A. Mediastinum
    B. Alveoli
    C. Diaphragm
    D. Parietal pleura

    Alveoli are the small air sacs that are the site of gas exchange
    (this multiple choice question has been scrambled)
  78. Pleura

    Line the thoracic cavity and the chest wall

    Enclosed sac

    Smooth surface

    Pleural space negative pressure

    Keeps the lungs expanded
  79. Neurologic Respiratory Control Center
    The medulla in the brainstem immediately above the spinal cord is the respiratory center. It stimulates respiration by sensing the increase in carbon dioxide and hydrogen ions. It also, to some extent, senses the decrease in oxygen in arterial blood

    Damage to the neuro respiratory center can alter and/or cause respiratory depression
  80. Respiratory Activity in the Infant:
    Lungs are transformed from fluid-filled structures structures to air-filled organs

    The infant's chest is small, airways are short, and aspiration is a potential problem

    Respiratory rate is rapid & respiratory activity is primarily abdominal

    Synthetic surfactant can be given to the infant to reopen alveoli (by IV or inhalation)

    Crackles heard at the end of deep respiration are normal
  81. Development Considerations in Infant & Toddlers:
    • Infants:
    • -Airways smaller, easily obstructed
    • -Have increased chance for aspiration
    • -Less protection against infections
    • -Preemies are born before lungs are fully developed
    • -Synthetic Surfactant can be administered to help open the alveoli and prevent collapse
    • Toddlers:
    • -Increased risk URI - tonsils and adenoids large; predisopses to tonsilitis
    • -Exposure to germs at preschool & daycare
    • -Have more subq fat so when listening to chest it sounds staticy
  82. Respiratory Activity in the Child:
    Some subcutaneous fat is deposited on the chest wall making landmarks less prominent

    Eustachian tubes, bronchi & bronchioles are elongated and less angular

    The average number of routine colds and infections decreases until children enter daycare or school

    Good hand hygiene & tissue etiquette are encouraged

    By end of late childhood, the immune system protects from most infections
  83. Hypoxia in Children
    • Early Signs & Symptoms:
    • -Nares flaring
    • -Grunting
    • -Stridor
    • -Feeding problems
  84. Stridor
    High pitch stretch sound, like blowing on blade of grass
  85. Developmental Considerations throughout the ages:
    • Preschool & School-age:
    • -Usually resolve URI without difficulty
    • -School-age children may begin smoking
    • Adolescents:
    • -Exposed to cigarette smoke - leading cause of lung disease
    • -By 12th grade, 62% have tried smoking
    • -Increased childhood obesity R/T increased pediatric CV disease
    • Young & Middle Adults:
    • -Exposed to multiple cardiopulmonary risk factors (smoking, poor diet, stress, lack of exercise)
    • -Lifestyle choices- Exercise #1 way to improve body & relieve stress
    • -Enviromental factors
  86. Enviornment Risk Factors:
    • -Pollution
    • -Asbestos
    • -Dust
    • -Paints
    • -Plastics
    • -Allergens
  87. Developmental Considerations in the Older Adult:
    • -Calcification of heart
    • -Unable to expand lungs fully
    • -Difficulty expelling mucus
    • -Decreased immune response
    • -Bony landmarks more prominent due to decreased SQ fat
    • -Kyphosis
    • -Barrel chest deformity (Emphysema & COPD)
    • -Tissues, diaphragm, & airways become more rigid
    • -Increased risk for disease, especially pneumonia
  88. Factors which Affecting Respiratory Function
    • -Level of health
    • -Developmental level
    • -Medications
    • -Lifestyle
    • -Enviromental
    • -Psychological health
  89. Assessing your Patients Oxygenation
    • -Health history
    • -Skin tones
    • -Respiratory rate
    • -Respiratory comfort
    • -Accessory muscle use
    • -Are they using oxygen?
    • -Auscultation, what do the lungs sound like?
    • -Pulse oximetry

  90. What is this device?
  91. What is the purpose of using a pulse oximeter?
    Measures the arterial oxyhemoglobin saturation of arterial blood
  92. How does a pulse oximeter work?
    -A sensor or probe, uses a beam of red & infrared light which travels through tissue and blood vessels

    -The oximeter calculates the amount of light absorbed by arterial blood

    -Oxygen saturation is determined by the amount of each light absorbed
  93. Uses for Pulse Oximetry:
    -Monitoring patients recieving oxygen therapy

    -Titrating oxygen therapy (adjusting)

    -Monitoring those at risk for hypoxia

    -Monitorig postop patients
  94. Pulse Oximetry
    • -Typical goal: 95-00%
    • -Correct probe selection & placement (finger, earlobes, toes)
    • -Alarm limits
    • -Assess skin for pressure
    • -Correlate readings with assessment
    • -Document

  95. What can cause an inaccurate pulse ox reading?
    • -Movement / Incorrect probe use
    • -Hypothermia at site / Edema at site
    • -Decreased peripheral blood flow / Decreased hemoglobin
    • -Carbon monoxide
    • -Vasoconstrictive meds
    • -Low cardiac output & hypotension
    • -Dark nail polish, artificial nails

    • (Dr may order ABG's)
    • ******CORRELATE READING WITH CLIENT ASSESSMENT********************
  96. Factors Affecting Oxygenation
    • #1 Physiological / Respiratory
    • -Decreased oxygen carrying capacity
    • -Decreased inspired oxygen concentration
    • -Hypovolemia-decreased circulating volume of oxygenated blood
    • -Increased Metabolic Rate (Increased BMR)
  97. Lifestyle Risk Factors
    • -Nutrition
    • -Exercise
    • -Smoking Cessation
    • -Stress reduction
    • -Substance Abuse
  98. Oxygen Therapy
    Administration of oxygen at levels higher than normally found in the atmosphere...to clients who are in need

    Room air=21% O2
  99. Oxygen Delivery Systems:
    • Two major types:
    • -High flow
    • -Low flow
    • Type used depends on:
    • -Concentration required vs. concentration delivered by system
    • -Need for accuracy & control of delivery
    • -Importance of humidity
    • -Client comfort & mobility, expense to client
  100. What is the difference between high and low flow oxygen?
    • High Flow:
    • -For critically ill clients, when it's important to know the precise concentration of oxygen delivered
    • -Endotracheal tube- Intubation, mechanical ventilation
    • Low Flow:
    • -Not enough oxygen provided to meet the total needs of the client:
    • -Part of the oxygen is provided by client breathing in room air
    • -Total oxygen concentration delivered depends on respiratory rate and tidal volume
    • -Nasal Canula
  101. Low Flow Oxygen Delivery Systems
    -Nasal Canula (plastic tube with prongs)- can set at up to 6L/min, providing 24-44% FiO2

    -Simple Face Mask (covers nose and mouth)- for short term therapy at 30-60% FiO2 (<5L/min)
  102. High Flow Oxygen Delivery Systems
    -Non-rebreather Mask (covers nose & mouth)- 80-90% FiO2 with flow rate set at 10L/min

    -Venturi Mask- most precise concentration of oxygen. Can draw in 100% oxygen but delivers a controlled 21% to the patient

  103. Goals of Oxygen Therapy
    -Least amount of oxygen

    -No harmful side effects

    -To prevent and relieve hypoxia

    Oxygen can improve the level of 02 in arterial blood, but is cannot cure or stop the disease process

    Oxygen is a medicine
  104. How do we care for a client on O2 therapy?
    • -Check MD order
    • -Humidification if giving 2L/per minute or more
    • -Assess skin for irritation, pad pressurer areas, clean and dry
    • -Mouth care Q8 hrs, water soluble jelly
    • -Rinse nasal cannula or mask with warm H2O Q4-8 hrs & prn
    • -Use safety signs to educate (O2 Flammable)
    • -Assess & document client's response
  105. How is oxygen supplied to the patient in their hospital room?
    • -At bedside in Oxygen tank
    • -Permanent piped-in system in wall
    • -Regulators control flow
    • -Several different regulator types.
  106. Hypoxia S/Sx:
    • Early s/sx:
    • -Restlessness -Tachycardia -Tachypnea & dyspnea -Increased agitation -Diaphoresis
    • -Nasal Flaring -Altered LOC -Headache -Use of accessory muscles

    • Late s/sx:
    • -Increased restlessness -Confustion & stupor -Somnolence -Decreased respirations
    • -Bradycardia -Cyanosis of skin & mucous membranes
  107. Chronic Hypoxia Nail Profile
  108. A healthy conjunctiva is....

    Pink & moist
  109. Indications for Pediatric Oxygen Use:
    • -Increased respiratory effor
    • -Respiratory distress with apnea
    • -Tachycardia, bradycardia
    • -Central cyanosis
    • -Oxygen saturation 89-92%
  110. How do we give oxygen to an infant?

    • You can place a oxygen hood over the baby
    • You can also use nasal cannula
  111. Administering Oxygen by Nasal Cannula

    • -Most commonly used oxygen delivery device
    • -Disposable 2-prong device in nostrils
    • -Connects to O2 source with a flowmeter & often a humidifier
    • -Delivers from 1L per minute to 6L per minute of O2; 2L or more needs humidifier
    • -Does not impede eating or speaking; easily used at home
    • -Can be easily dislodged & cause dryness of the nasal mucosa
  112. How do we document use of O2 mask?
    • -Type of masked used
    • -Amount of oxygen used
    • -Oxygen saturation level
    • -Lung sounds
    • -Rate/pattern of respirations
    • -Pre and post intervention
  113. What complications are associated with O2 therapy?
    • Safety hazards include:
    • -Combustion
    • -O2 induced hypoventilation or O2 toxicity
    • Drying of mucous membranes:
    • -Humidification prevents drying
    • -Check for mist / Check water level in container
    • -Ensure ordered flow rate
    • Infection- Sources include:
    • -Humidification container (clean & change water on schedule)
    • -Equipment used in oxygen therapy
    • -Inadequate oral care
  114. T- Piece
  115. Tracheostomy Collar
  116. Safe Administration of Oxygen:
    Know the goal of O2 therapy / have MD order

    • Know hazards & complications of O2 therapy
    • -Safety...oxygen in use, no smoking
    • -Ground all electrical equipment
    • -Repair frayed cords
    • -No flammable solutions (oil, rubbing alcohol)
  117. Home Oxygen Use:
    • -Must have 88% or less oxygen saturation levels to qualify
    • -Usually by nasal cannula / sometimes BIPAD
    • -Improves client's exercise tolerance & fatigue levels
    • -May assist with dyspnea
    • -Clients need extensive teaching
  118. Chronic Obstructive Pulmonary Disease
    • Less air flows in and out of the airways because of one or more of the following:
    • -The airways and air sacs lose their elastic quality
    • -The walls between many of the air sacs are destroyed
    • -The walls of the airways become thick and inflamed (swollen)
    • -The airways make more mucous than usual, which tends to clog the airways
    • -Most common cause of COPD is smoking
    • -Chronic bronchitis defined by a long term cough with mucous
    • -Emphysema defined by destruction of the lungs overtime
    • -Most people with COPD have some combination of both
  119. Asthma
    • -The airways are often swollen and red (or inflammed)
    • -This makes them extra sensitive to things that you are exposed to in the environment every day or asthmas "triggers"
    • -A trigger could be a cold, the weather, or things in the environment, such as dust, chemicals, smoke and pet dander
    • -When someone with Asthma breathes in a trigger, the insides of the airways make extra mucous and swell even more
    • -This narrows the space for the air to move in and out of the lungs
    • -The muscles that wrap around your airways can also tighten, making breathing even harder
    • -When that happens it's called an asthma flare-up, asthma episode or asthma "attack"
  120. Healthy Lung vs Cancerous Lung
  121. Nursing Care for Incentive Spirometry
    • -Semi or High Fowler's
    • -Set level....client's goal
    • -Clear secretions or cough before IS (spirometer) use
    • -Seal lips
    • -Repeat 10-20 times, Q1-2 hrs while awake (WA)
    • -Cleaning IS
    • -Disposal of soiled tissue
    • -COPD, pursed lip technique
  122. Incentive Spirometry
    • -Provides visual reinforcement for deep breathing by the patient
    • -Assists the patient to breathe slowly & deeply
    • -Helps the patient to sustain maximal inspiration, while providing immediate positive reinforcement
    • -Encourages the patient to maximize lung inhalation to prevent or reduce atelectasis
    • -Supports optimal gas exchange
    • -Helps patient to clear and expectorate secretions
  123. Respiratory Oxygenation Nursing Interventions
    • -Encourage cough and deep breath
    • -Splint incision site prior to cough
    • -Assist with upright posture to allow for maximal lung expansion
    • -Encourage ambulations
    • -Assist wtih frequent turning for bedbound patients
    • -Increase fluid / water intake
    • -Education
  124. Ventilation & Oxgenations Dx Studies:
    • -Pulmonary Function Tests (PFT's)- determine the ability of the lungs to efficiently exchange O2 & CO2
    • -Arterial Blood Gases (ABG's)- measure the pH, CO2, & oxygen concentration of arterial blood
    • -Oximetry- measures oxygen saturation / perfusion of probed tissues
    • -Chest x-ray- visualizes lung fields to identify fluid, masses, abnormal processes
    • -Bronchoscopy- visual exam of tracheobronchial tree through a narrow, flexible scope
    • -Lung Scan- used to identify abnormal masses by size & location
    • -Thoracentesis- needle aspiration of pleural fluid obtained for cytological exam
    • -Throat Cultures- Swabbing tissues to determine pathologic organisms
    • -Sputum Specimen- Obtained to identify specific organisms, identifies drug resistance and sensitivities; First morning sputum is preferred because it has been sitting over night
  125. Nursing Process IMPLEMENTATION: Respiratory Oxygenation
    • Health promotion- vaccinations, lifestyle changes, environmental pollutants
    • In acute care- dyspnea management and airway maintenance
    • -O2 therapy
    • -Hydration
    • -Medications administration
    • -Chest physiotherapy
    • -Slow deep breathing
    • -Relaxation techniques
    • Mobilization of Pulmonary Secretions
    • -Humidifications- humidity keeps airways moist & helps loosen secretions
    • -Nebulization- process of adding moisture or medications to inspired air-bronchodialators
    • -Chest Physiotherapy (CPT)- therapy used to mobilize secretions
    • -Postural drainage
    • -Chest percussion
    • -Vibration
    • Restorative and Continuing Care
    • -Hydration
    • -Suctioning
    • -Coughing techniques
    • -Respiratory muscle training
    • -Breathing exercises
    • -Pursed lip breathing
    • -Diaphragmatic breathing
  126. Positioning for Thoracentesis

    Can be done with the patient sitting up and leaning on a hard surface (provide pillow for some comfort) It can also be done laying down
  127. Postural Drainage:
    Lower lobes- anterior basal segment

    Gravity works to get the drainage out
  128. Nursing Process ASSESSMENT: Respiratory Oxygenation
    • Nursing History & Physical Assessment
    • -Pain & fatigue
    • -Smoking
    • -Dyspnea & orthopnea
    • -Cough & wheezing
    • -Environmental or geographic exposures- where are they from or where have they been
    • -Respiratory infections
    • -Allergies & medications
    • -Health risks- family history, genetics
  129. Nursing Process PLANNING: Respiratory Oxygenation
    • -Goals & Outcomes: "Ineffective airway clearance"
    • -Client will effectively clear secretions
    • -Lungs will be clear to auscultation within 48hrs
    • -Sputum will be thin, white, watery
    • -Set priorities- e.g., airway more critical than bowel elimination in sustaining life
    • -Continuity of Care- limited hospital stay may necessitate home health or cardiopulmonary rehabilitation
  130. Nursing Process DIAGNOSIS / ANALYSIS: Respiratory Oxygenation
    • -Activity intolerance
    • -Ineffective airway clearance
    • -Ineffective breathing pattern
    • -Decreased cardiac output
    • -Impaired gas exchange
    • -Ineffective tissue perfusion
  131. Alterations in Respiratory Function
    • Normal Ventilation
    • -PaO2 between 95 & 100 mm Hg
    • Alterations in alveolar ventilation
    • -#1: Hyperventilation
    • -Excess CO2 elimination occurs
    • -Possible causes: anxiety, infections, drugs, pulmonary embolus, shock, metabolic acidosis
    • -Acute anxiety may lead to increased respiratory rate, increased agitation, even loss of consciousness
    • -May be R/T ASA toxicity or DKA
    • -#2: Hypoventilation
    • -Insufficient CO2 elimination occurs
    • -Possible causes: atelectasis, inappropriate O2 administration to a COPD client
    • -Symptoms: mental status changes, dysrhythmias, possibly cardiac arrest; if untreated, convulsions, unconsciousness & death can ensue
    • -#3: Hypoxia
    • -Inadequate tissue oxygenation at cellular level
    • -Multiple possible causes of this deficiency
    • -Deficient oxygen delivery
    • -Inadequate oxygen utilization
    • -Symptoms: include apprehension, restlessness, poor concentration, decreased LOC, dizziness, behavior changes
    • -Cyanosis is a late sign
    • -Life-threatening; if untreated can result in cardiac dsyrhythmias & death