Download Complex Respiratory Management

B260: Fundamentals of Nursing
Practice
Gas Exchange
Vema Sweitzer, MN, RN
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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.
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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
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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
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Pulmonary System
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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
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Factors Affecting Oxygenation
•
Factors Affecting Chest Wall Movement
• Pregnancy
• Obesity
• Musculoskeletal abnormalities
Kyphosis
Pectus
Excavatum
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Factors Affecting Oxygenation
Factors Affecting Chest Wall Movement
• Trauma
• Neuromuscular disease
• CNS alterations
• Chronic disease
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Alterations in Respiratory Functioning
Definition
Causes
Signs and
symptoms
Hypoventilation
Hyperventilation
Hypoxia
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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.
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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.
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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
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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.
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Intervention
Nasal cannula
• Delivers flow rate up to 6 L/min
(24% to 40% oxygen)
(Skill 40-4)
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Methods of Oxygen Delivery
Simple Face Mask.
Delivers 40% to 60% at liter flows of 5-8 L/min
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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
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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.
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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.
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Oxygenation
Safety
•Secure oxygen cylinders so they do not fall
over. Store them upright and either chained
or secured in appropriate holders.
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Suctioning
•Suctioning is necessary when patients are
unable to clear respiratory secretions from
the airways by coughing or other less invasive
procedures.
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How to Suction a Tracheostomy
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How to Suction a Tracheostomy
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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.
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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.
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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
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