Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Cardiovascular disease wikipedia , lookup
Coronary artery disease wikipedia , lookup
Management of acute coronary syndrome wikipedia , lookup
Myocardial infarction wikipedia , lookup
Jatene procedure wikipedia , lookup
Quantium Medical Cardiac Output wikipedia , lookup
Dextro-Transposition of the great arteries wikipedia , lookup
B260: Fundamentals of Nursing Practice Gas Exchange Vema Sweitzer, MN, RN 1 Gas exchange/Oxygenation •Oxygenation can be defined as the mechanisms that facilitate or impair the body’s ability to supply oxygen to all cells of the body. The function of the respiratory system is to obtain oxygen from atmospheric air, to transport this air through the respiratory tract into the alveoli, and ultimately to diffuse oxygen into the body that carries oxygen to all the cells of the body. 2 Pulmonary System Ventilation The process of moving gases into and out of the lungs Perfusion The ability of the cardiovascular system to pump oxygenated blood to the tissues and return deoxygenated blood to the lungs 3 Pulmonary System • Diffusion: Exchange of respiratory gases in the alveoli and capillaries. • The thickness of the alveolar capillary membrane affects the rate of diffusion. • Oxygen transport = Lungs + cardiovascular (CV) system • Hemoglobin carries O2 and CO2 • Carbon dioxide transport 4 Pulmonary System 5 Cardiovascular Physiology •Cardiopulmonary physiology involves delivery of deoxygenated blood (blood high in carbon dioxide and low in oxygen) to the right side of the heart and then to the lungs, where it is oxygenated. •Oxygenated blood (blood high in oxygen and low in carbon dioxide) then travels from the lungs to the left side of the heart and the tissues. Cardiovascular Physiology Blood Flow Regulation Cardiac output Stroke volume Amount of blood ejected Amount of blood ejected from the left ventricle from the left ventricle with each minute each contraction Cardiac output (CO) = Stroke volume (SV) × Heart rate (HR) Preload End-diastolic pressure Afterload Resistance to left ventricular ejection Factors Affecting Oxygenation •Physiological factors • Decreased oxygen-carrying capacity • Hypovolemia • Decreased inspired oxygen concentration • Increased metabolic rate 9 Factors Affecting Oxygenation • Factors Affecting Chest Wall Movement • Pregnancy • Obesity • Musculoskeletal abnormalities Kyphosis Pectus Excavatum 10 Factors Affecting Oxygenation Factors Affecting Chest Wall Movement • Trauma • Neuromuscular disease • CNS alterations • Chronic disease 11 Alterations in Respiratory Functioning Definition Causes Signs and symptoms Hypoventilation Hyperventilation Hypoxia 12 Lifestyle Factors Nutrition Cardioprotective nutrition = Diets rich in fiber; whole grains; fresh fruits and vegetables; nuts; antioxidants; lean meats; and omega-3 fatty acids. Exercise People who exercise for 30 to 60 minutes daily have a lower pulse rate and blood pressure, decreased cholesterol level, increased blood flow, and greater oxygen extraction by working muscles. 13 Lifestyle Risk Factors • Smoking • Associated with heart disease, COPD, and lung cancer • The risk of lung cancer is 10 times greater for a person who smokes than for a nonsmoker. • Substance abuse • Excessive use of alcohol and other drugs impairs tissue oxygenation. • Stress • A continuous state of stress or severe anxiety increases the metabolic rate and oxygen demand of the body. 14 Environmental Factors •The incidence of pulmonary disease is higher in smoggy, urban areas than in rural areas. •A patient’s workplace sometimes increases the risk for pulmonary disease. •Coccidioidomycosis •Asbestosis 15 Hemoglobin • The amount of hemoglobin is in whole blood • Adult males: 13.2 to 17.3 g/dL • Adult women: 11.7 to 15.5 g/dL • Men after middle age: 12.4 to 14.9 g/dL • Women after middle age: 11.7 to 13.8 g/dL Hematocrit • Hematocrit is a blood test that measures the percentage of the volume of whole blood that is made up of red blood cells • Normal results vary, but in general are as follows: • Male: 39% to 50.% • Female: 36.1 to 44.3% Pneumonia •Pneumonia is an acute inflammation of the lung that is most frequently caused by a microorganism. •Fluid and exudate in the alveoli. 18 Intervention Nasal cannula • Delivers flow rate up to 6 L/min (24% to 40% oxygen) (Skill 40-4) 19 Methods of Oxygen Delivery Simple Face Mask. Delivers 40% to 60% at liter flows of 5-8 L/min 20 Methods of Oxygen Delivery • A plastic face mask with a reservoir bag is capable of delivering higher concentrations of oxygen. A partial rebreather mask is a simple mask with a reservoir bag that should be at least one third to one half full on inspiration and delivers from 40% to 70% with a flow rate of 6-10 L/min 21 Methods of Oxygen Delivery • Venturi mask delivers higher oxygen concentrations of 24% to 60% with oxygen flow rates of 4 to 12 L/min, depending on the flowcontrol meter selected. 22 Oxygenation Safety • Oxygen must be prescribed and adjusted only with a HCP’s order. • Determine that all electrical equipment in the room is functioning correctly and properly grounded. An electrical spark in the presence of oxygen can result in a serious fire. • Check the oxygen level of portable tanks before transporting a patient to ensure there is enough oxygen in the tank. 23 Oxygenation Safety •Secure oxygen cylinders so they do not fall over. Store them upright and either chained or secured in appropriate holders. 24 Suctioning •Suctioning is necessary when patients are unable to clear respiratory secretions from the airways by coughing or other less invasive procedures. 25 How to Suction a Tracheostomy 26 How to Suction a Tracheostomy 27 Emergency Patient is having Acute Dyspnea • Acute dyspnea for patient with tracheostomy is most commonly caused by partial or complete blockage of the tracheostomy tube retained secretions. To unblock the tracheostomy tube: • 1. ASK THE PATIENT TO COUGH: A strong cough may be all that is needed to expectorate secretions. • 2. REMOVE THE INNER CANNULA: If there are secretions stuck in the tube, they will automatically be removed when you take out the inner cannula. The outer tube – which does not have secretions in it – will allow the patient to breath freely. Clean and replace the inner cannula. • 3. SUCTION: If coughing or removing the inner cannula do not work, it may be that secretions are lower down the patients airway. Use the suction machine to remove secretions. • 4. If these measures fail – commence low concentration oxygen therapy via a tracheostomy mask, and call for medical assistance. 28 Suctioning (Skill 40-1) • Key points: • Use sterile procedure • Suction set on continuous suction of 120-150 mm Hg • Insert catheter, suction intermittently 10-15 seconds and slowly rotate and withdraw • Monitor patient: • Risk for hypoxia • Hypotension • Arrhythmias • Trauma • Irritation • Nursing Diagnosis: Ineffective airway clearance r/t retention of secretions and poor cough effort. 29 Oxygenation: Chest Tubes Chest tubes •A catheter placed through the thorax to remove air and fluids from the pleural space Purpose •To remove air and fluids from the pleural space •To prevent air or fluid from reentering the pleural space •To re-establish normal intra-pleural and intrapulmonary pressures 30 31