10/6/2010 1 OXYGENATION NURSING FUNDAMENTALS FOCUS VI 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 clients 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 will pay 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
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10/6/2010
1
OXYGENATION
NURSING FUNDAMENTALS FOCUS VI
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 clients oxygenation status.
• Explain the major purpose of the tests and therelated nursing responsibilities.
• 107 million - a risk factor for CVD• AMI – 7.5 Million per year, 460,000 die• Americans will pay 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
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NORMAL OXYGENATION PROCESS
• Cardiovascular:
NORMAL OXYGENATION PROCESS
• Systemic:
NORMAL OXYGENATIONS PROCESS
INSPIRATION
• Diaphragm and intercostals contact • Thoracic cavity size increases• Volume of lungs increases• Intrapulmonary pressure decreases• Air rushes into the lungs to equalize
pressure
EXPIRATION
•Diaphragm and intercostalsrelax
•Volume of the lungs decreases• Intrapulmonary pressure rises•Air is expelled
GAS EXCHANGE
• Occurs after the alveoli are ventilated• Pressure differences on each side of
the respiratory membranes affect diffusion
• Diffusion of oxygen from the alveoli into the pulmonary blood vessels
• Diffusion of carbon dioxide from pulmonary blood vessels into alveoli
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ADEQUATE O2 BALANCE
• Maintenance of adequate O2 balance Gas Exchange
OXYGEN TRANSPORT
• Transported from the lungs to the tissues
• 97% of oxygen combines with hemoglobin in red blood cells and carried to tissues as oxyhemoglobin
• Remaining oxygen is dissolved and transported in plasma and cells
NORMAL OXYGENATION PROCESS
• Cell environment/ O2 carrying capacity:• O2 Carrying capacity of blood is expressed by:• Red blood cells • Hematocrit• Hemoglobin
CARBON DIOXIDE TRANSPORT
• Must be transported from the tissues to the lungs
• Continually produced in the process of cell metabolism
• 65% is carried inside the red blood cells as bicarbonate
• 30% combines with hemoglobin as carbhemoglobin
• 5% transported in solution in plasma and as carbonic acid
COMMON MANIFESTATIONS OF IMPAIRED RESPIRATORY FUNCTION
•Hypoxia•Altered breathing patterns
•Obstructed or partially obstructed airway
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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
• 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 or
•Tests to determine adequacy of cardiovascular function:
• CBC
• Lipid profile
• Coagulation studies
• EKG/ECG
• Angiography
• Doppler blood flow studies
BASIC NURSING INTERVENTIONS
Cardiovascular• Modify risk factors
• Preventing vasoconstriction
• Diet • Exercise• Co morbidities
• Positioning• Cold temperatures• Nicotine
BASIC NURSING INTERVENTIONS
• Cardiovascular- Prevent complications
• Promoting rest
•Risk DVT•Position changes•Early ambulation•Obstruction removal•Bypass surgery
•Schedule rest periods•Assistance with ADL’s•Monitor Vitals with activity•Place items, i.e. call light, water pitcher, strategically•Quiet environment, decrease stimuli
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BASIC NURSING INTERVENTIONS
Cardiovascular• Positioning to improve
CO
• Avoiding Valsalvamaneuver
- Position semi to high fowlers-> decrease venous return and preload, decease preload-> decreases risk of heart congestion
-• Teach client to avoid
valsalva maneuver- Hold breath while turning or moving inbed-> assist
- Bearing down during BM-> stool softenersand diet