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Oxygenation

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 (H2CO3)

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)
Kussmauls breathing
Cheyne-Stokes respirations
Biots 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 ABGs
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
Mucolytics
Bronchodilators
Cough
suppressants
Corticosteroids
Antihistamines
Antibiotics

Vasoconstrictors

BASIC NURSING
INTERVENTIONS
Physical Exercise health teaching
Activity and rest
-a priority!
Activity stimulates respiratory function
Rest conserves energy and reduces metabolic demand
MDs 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
Modify risk factors

Diet
Exercise
Co morbidities

Preventing
vasoconstriction

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 ADLs
Monitor Vitals with
activity
Place items, i.e. call
light, water pitcher,
strategically
Quiet environment,
decrease stimuli

BASIC NURSING
INTERVENTIONS
Cardiovascular

Positioning to
improve CO

Avoiding Valsalva
maneuver

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 in
bed-> assist
- Bearing down
during
BM-> stool
softeners

BASIC NURSING
INTERVENTIONS
Cardiovascular

Avoid stimulants

Avoid appetite suppressants,


cold 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
Cardiovascular

Administer O2

Increase O2 supply

Educate client
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 clients physiological status in
relation to condition
More than body requirements
Less than body requirements