Download Fundamentals of Nursing NUR 102

Fundamentals of Nursing
NUR 102
Maintaining Oxygenation
Module J
Objectives
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Define terms associated with oxygenation
Explain the physiology of oxygenation
Explain the process of oxygenation
administration
Explain pulse oximetry
Explain the process of connecting a pulse
oximetry
Identify emergency techniques for restoring
oxygenation
Explain the process of using various
emergency techniques for restoring
oxygenation
Explain the process of applying the nursing
process to maintaining oxygenation.
TERMS
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Afterload
Angina pectoris
Atelectasis
Bronchoscopy
Cardiac index
Cariac output
Cardiopulmonary rehabilitation
Cardiopulmonary resuscitation
Chest physiotherapy
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Chest tube
Cyanosis
Diaphragmatic breathing
Diffusion
Dyspnea
Dysrhythmias
Electrocardiogram (ECG)
Expiration
Hematemesis
Hemoptysis
Hemothrorax
Humidification
Hyperventilation
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Hypoventilation
Hypoxia
Incentive spirometry
Inspiration
Myocardial infarction (MI)
Nasal cannula
Nebulaizaation
Normal Sinus Rhythm
Orthopnea
Peak expiratory flow rate
Pneumothorax
Postural drainage
Preload
Pursed-lip breathing
Stroke volume
Thoracentesis
Ventilation
Ventricular fibrillation
Wheezing
Physiology of oxygenation:
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Oxygen is required to sustain life.
Function of cardiac and respiratory
systems is to supply the body’s
oxygen demands.
Blood is oxygenation through
mechanisms of ventilation,
perfusion, and transport of
respiratory gases.
Depth and rate of respiration is
controlled by neural and chemical
regulators-in response to changing
tissue oxygen demands.
Cardiovascular Physiology:
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Cardiopulmonary physiology involves
delivery of deoxygenated blood (blood high
in carbon dioxide and low in oxygen), to
right side of heart and to pulmonary
circulation and oxygenated blood from
lungs to left side of heart and tissues.
Cardiac system delivers oxygen, nutrients,
and other substances to tissues and
removes waste products of cellular
metabolism through cardiac pump,
circulatory vascular system, and integration
of other systems.
Structure and Function:
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The right ventricle pumps blood
through the pulmonary circulation.
The left ventricle pumps blood to the
systemic circulation.
The circulatory system exchanges
respiratory gases, nutrients, and
waste products between the blood
and the tissues.
Myocardial Pump
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Pumping action of heart essential to
maintaining oxygen delivery.
Coronary artery disease (CAD) and
cardiomyopathic (enlarged heart)
conditions result in diminished stroke
volume.
Four chambers of heart fill with blood
during diastole and empty during
systole.
Factors affecting pump include
hemorrhage and dehydration by
decreasing amount of blood ejected
from ventricles.
Myocardial Blood Flow:
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Must supply sufficient oxygen and nutrients to
myocardium in order to maintain adequate blood flow
to pulmonary and systemic circulation.
Blood flow through heart is unidirectional.
There are four heart valves that ensure forward blood
flow.
Ventricular diastole- atrioventricular (mitral and
tricuspid) valves open and blood flows from higher
pressure atria into relaxed ventricles=S1, or first heart
sound.
After ventricular filling, systolic phase begins.
Systolic phase- semilunar (aortic and pulmonic)
valves open and blood flows from ventricles into
aorta and pulmonary artery.
Closure of aortic and pulmonic valves represents S2,
or second heart sound.
Respiratory Physiology
Most cells in body obtain energy
from chemical reactions involving
oxygen and elimination of carbon
dioxide.
 Exchange of respiratory gases
occurs between environmental air
and blood.
 Three steps in process of
oxygenation:
Ventilation, perfusion, and diffusion.
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Structure and Function:
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Ventilation- process of moving gases
into and out of lungs.
Requires coordination of muscular and
elastic properties of lung and thorax, as
well as intact innervation.
Major inspiratory muscle of respiration
is the diaphram- innervated by phrenic
nerve, which exits spinal cord at 4th
cervical vertebra.
Perfusion relates ability of
cardiovascular system to pump
oxygenated blood to tissues and return
de-oxygenated blood to lungs.s
Work of breathing:
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Inspirationactive process,
stimulated by
chemical
receptors in
aorta.
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Expiration is
passive process
that depends on
elastic recoil
properties of
lungs, requiring
little or no
muscle work.
Lung Volume:
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Spirometry- is used to measure
to measure volume of air
entering or leaving the lungs.
Variations in lung volumes may
be associated with health states
such as pregnancy, exercise,
obesity, or obstructive and
restrictive conditions of the lungs.
Lung capacities- made up of two
or more lung volumes (total lung
capacity, and inspiratory and
expiratory reserve volume).
Pulmonary Circulation:
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Primary function of pulmonary
circulation is to move blood to and
from aveolocapillary membrane for
gas exchange to occur.
Pulmonary circulation is a reservoir
for blood so that lung can increase its
blood volume without large increases
in pulmonary artery or venous
pressures.
Begins at the pulmonary artery, which
receives poorly oxygenated mixed
venous blood from the right ventricle.
Oxygen Transport:
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Consists of lungs and cardiovascular
system.
Delivery depends on amount of
oxygen entering the lungs
(ventilation), blood flow to lungs and
tissues (perfusion), rate of diffusion,
and oxygen-carrying capacity.
Capacity of blood to carry oxygen is
influenced by the amt. of dissolved
oxygen in the plasma, amt. of
hemoglobin, and tendency of
hemoglobin to bind with O2.
Assessment
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Breathing
Patterns
Factors
Impairing
Oxygenation
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Diagnostic
Tests:
Pulmonary
Function Tests
Pulse Oximetry
Airway Maintenance:
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Humidification- process of adding
water to gas. Temperature is most
important factor affecting amt. water
vapors a gas can hold.
Nebulization- process of adding
moisture or medications to inspired
air by mixing particles with the air.
Chest physiotherapy-(CPT) a group
of therapies used in comb. To
mobilize pulmonary secretions.
Nasopharyngeal suctioning- when
client is unable to clear respiratory
secretions to clear airway.
Oxygen Enhancement:
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Nursing interventions include
Independent nursing actions
(health promotion, prevention
behaviors), positioning, and
coughing techniques.
Interdependent or dependent
interventions include oxygen
therapy, lung inflation tech.,
hydration, medication admin., and
chest psysiotherapy.
Nursing Process:
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Assessment :
Physical examination (pain, fatigue,
smoking, dyspnea, cough,
wheezing, environment or
geographical exposures,
respiratory infections, allergies,
health risks, medications.
Inspection, palpation, percussion,
auscultation.
Diagnostic Tests
Nursing Process:
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Nursing Diagnosis:
Based on specific defining
characteristics and related etiology.
Use information gathered in
assessment to identify defining
characteristics.
Include: activity intolerance, risk for
activity intolerance, ineffective
airway clearance, anxiety,
ineffective breathing pattern,
decreased cardiac output, impaired
comfort, fatigue, fear, risk for
imbalanced fluid volume, impaired
gas exchange, etc.
Nursing Process:
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Implementation:
Health promotion (immunizations,
vaccinations), healthy lifestyle
behavior, environmental pollutants,
dyspnea management, airway
maintenance.
Suctioning (nasopharyngeal and
nasotracheal suctioning), artificial
airways, maintenance and
promotion of lung expansion, chest
tubes, methods of oxygen delivery.
Nursing Process:
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Evaluation:
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Client care
Client expectations
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Review of CPR:
*rescue breathing
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Determine respiratory status (look, listen,
feel).
Call for assistance if not breathing.
If has pulse but no breathing, initiate
artificial airway (mouth to mouth, bag and
mask).
Open airway. (Head tilt, chin lift).
Create tight seal over mouth.
Give one breath every 5 seconds.
Reassess after one full minute.
Continue rescue breathing if not
breathing.