Oxygenation Study Guide ADN-MGCCC

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

• 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

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

The adequacy of the cardiac output for an individual

Amount of blood ejected from the left ventricle with each contraction

• -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.

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.

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)

• Nutrition
• Exercise
• Smoking Cessation
• Stress Reduction
• Substand Abuse

Obesity, anemia, malnourished

Decreases P, BP, cholestrol, increases blood flow and oxygen extraction by using muscles

Good for us

Smoking associated with lung cancer, heart disease, HTN, COPD, Emphysema

Stress increases metabolic reate and oxygen demand

Good for us

Alcohol and other drugs decrease oxygenation

• 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

Reflects electrical activity of the conduction system

Normal sequence is called normal sinus rhythm (NSR)

• 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

• 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")

• 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)

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

Normal Sinus Rhythm

The rhythm by which we measure all other rhythms

Any deviation is NOT right

• Rhythm: Regular
• Rate: 60-100
• P Waves: Present, normal appearance
• PR Interval: .12-.20
• QRS: Narrow
• Note: None

• 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

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

• 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

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

• 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

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

• 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

• 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

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

• 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

• 
• 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

• 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

-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

• 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

• 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

• 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

• 12-Lead EKG
• Holter Monitor
• Exercise and Thallium Stress Test
• Electrophysiologial Studies (EPS)
• Echocardiography
• Cardiac catheterization and angiography

Graphic reading of the electrical activity of the heart

Portable EKG worn by client with diary entries

Walks on treadmill with EKG or is injected with thallium, used to evalute cardiac response to stress

Invasive measure of electrial pathways used to assess adequacy of antiarrythmic drugs

Non-invasive measure of heart structure and heart wall movement

Used to visualize cardiac chambers, valves, vessels, and coronary arteries

• 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

Peripheral cyanosis

Central cyanosis

Pallor

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

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

A decrease in the color of the skin

• 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

• Decreased Cardiac Output
• Excess Fluid Volume
• Acute Pain
• Deficient Knowledge
• Ineffective Health Maintenance
• Activity Intolerance
• Anxiety
• Impaired Gas Exchange
• Ineffective Tissue Perfusion

• 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

• -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

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

Response to intervention/teaching actions performed

Attainment/progress toward desired outcome(s)

Modifications to plan of care

• 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

• PULMONARY ARTERIES - CARRY DEOXYGENATED BLOOD
• PULMONARY VEINS - CARRY OXYGENATED BLOOD

Integrity of the airway system to transport air to and from lungs

Properly functioning alveolar system in lungs

Properly functioning cardiovascular and hematological system

Pulmonary ventilation (breathing)

Respiration (breathing in and out=1 respiration)

Perfusion

Two phases: Inspiration and expiration.

Exchange of outside air and the alveoli.

The movement of air into and out of the lungs.

The active phase

Involves movement of muscles and the thorax to bring air into the lungs

The passive phase

The movement of air out of the lungs

Gas exchange between the atmospheric air in the alveoli and the blood in the capillaries

Process where 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.

• 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

• Nose
• Pharynx
• Larynx
• Epiglottis
• FUNCTION: To warm, filter and humidify air

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

• MAIN FUNCTIONS:
• Conduction of air
• Mucociliary clearance
• Production of pulmonary surfactant

Cilia

Surfactant

Alveoli

Hair like projections that line the airways

They propel mucous and trapped material towards the upper airway to be expelled by coughing

A detergent-like phospholipid that reduces surface tension between the moist membranes of the alveoli and prevent alveoli collapse

• -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

The movement of gas or particles from areas of higher pressure or concentration to areas of lower pressure or concentration.

• 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)

B.

Alveoli are the small air sacs that are the site of gas exchange

Line the thoracic cavity and the chest wall

Enclosed sac

Smooth surface

Pleural space negative pressure

Keeps the lungs expanded

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

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

• 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

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

• Early Signs & Symptoms:
• -Nares flaring
• -Grunting
• -Stridor
• -Feeding problems

High pitch stretch sound, like blowing on blade of grass

• 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

• -Pollution
• -Asbestos
• -Dust
• -Paints
• -Plastics
• -Allergens

• -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

• -Level of health
• -Developmental level
• -Medications
• -Lifestyle
• -Enviromental
• -Psychological health

• -Health history
• -Skin tones
• -Respiratory rate
• -Respiratory comfort
• -Accessory muscle use
• -Are they using oxygen?
• -Auscultation, what do the lungs sound like?
• -Pulse oximetry

PULSE OXIMETER

Measures the arterial oxyhemoglobin saturation of arterial blood

-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

-Monitoring patients recieving oxygen therapy

-Titrating oxygen therapy (adjusting)

-Monitoring those at risk for hypoxia

-Monitorig postop patients

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

******ALWAYS DOUBLE CHECK MACHINES*******

• -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)
• ******ALWAYS VERIFY LOW READINGS BEFORE INITIATING TREATMENT******
• ******CORRELATE READING WITH CLIENT ASSESSMENT********************

• #1 Physiological / Respiratory
• -Decreased oxygen carrying capacity
• -Decreased inspired oxygen concentration
• -Hypovolemia-decreased circulating volume of oxygenated blood
• -Increased Metabolic Rate (Increased BMR)

• -Nutrition
• -Exercise
• -Smoking Cessation
• -Stress reduction
• -Substance Abuse

Administration of oxygen at levels higher than normally found in the atmosphere...to clients who are in need

Room air=21% O2

• 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

• 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

-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)

-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

-CPAP

-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

• -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

• -At bedside in Oxygen tank
• -Permanent piped-in system in wall
• -Regulators control flow
• -Several different regulator types.

• 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

Pink & moist

• -Increased respiratory effor
• -Respiratory distress with apnea
• -Tachycardia, bradycardia
• -Central cyanosis
• -Oxygen saturation 89-92%

• You can place a oxygen hood over the baby
• You can also use 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

• -Type of masked used
• -Amount of oxygen used
• -Oxygen saturation level
• -Lung sounds
• -Rate/pattern of respirations
• -Pre and post intervention

• 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

T- Piece

Tracheostomy Collar

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)

• -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

• 
• 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

• -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"

• -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

• -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

• -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

• -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

• 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

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

Gravity works to get the drainage out

• 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

• -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

• -Activity intolerance
• -Ineffective airway clearance
• -Ineffective breathing pattern
• -Decreased cardiac output
• -Impaired gas exchange
• -Ineffective tissue perfusion

• 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