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Fundamentals of Nursing

NUR 102

Maintaining Oxygenation

Module J

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Objectives Define terms associated with oxygenation

Explain the physiology of oxygenation

Explain the process of oxygenationadministration

Explain pulse oximetry

Explain the process of connecting a pulseoximetry

Identify emergency techniques for restoringoxygenation

Explain the process of using variousemergency techniques for restoringoxygenation

Explain the process of applying the nursingprocess to maintaining oxygenation.

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TERMS

AfterloadAngina 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

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Physiology of oxygenation:

1. Oxygen is required to sustain life.

2. Function of cardiac and respiratorysystems is to supply the bodysoxygen demands.

3. Blood is oxygenation throughmechanisms of ventilation,perfusion, and transport ofrespiratory gases.

4. Depth and rate of respiration iscontrolled by neural and chemicalregulators-in response to changingtissue oxygen demands.

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Cardiovascular Physiology:

Cardiopulmonary physiology involvesdelivery of deoxygenated blood (blood highin carbon dioxide and low in oxygen), toright side of heart and to pulmonary

circulation and oxygenated blood fromlungs to left side of heart and tissues.

Cardiac system delivers oxygen, nutrients,and other substances to tissues andremoves waste products of cellular

metabolism through cardiac pump,circulatory vascular system, and integrationof other systems.

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Structure and Function:

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.

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Myocardial Pump

Pumping action of heart essential tomaintaining oxygen delivery.

Coronary artery disease (CAD) andcardiomyopathic (enlarged heart)conditions result in diminished strokevolume.

Four chambers of heart fill with bloodduring diastole and empty duringsystole.

Factors affecting pump includehemorrhage and dehydration bydecreasing amount of blood ejectedfrom ventricles.

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Myocardial Blood Flow: Must supply sufficient oxygen and nutrients to

myocardium in order to maintain adequate blood flowto pulmonary and systemic circulation.

Blood flow through heart is unidirectional.

There are four heart valves that ensure forward bloodflow.

Ventricular diastole- atrioventricular (mitral and

tricuspid) valves open and blood flows from higherpressure atria into relaxed ventricles=S1, or first heartsound.

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.

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Respiratory Physiology

Most cells in body obtain energyfrom chemical reactions involvingoxygen and elimination of carbondioxide.

Exchange of respiratory gasesoccurs between environmental airand blood.

Three steps in process ofoxygenation:

Ventilation, perfusion, and diffusion.

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Structure and Function:

Ventilation- process of moving gasesinto and out of lungs.

Requires coordination of muscular andelastic properties of lung and thorax, as

well as intact innervation. Major inspiratory muscle of respiration

is the diaphram- innervated by phrenicnerve, which exits spinal cord at 4th

cervical vertebra. Perfusion relates ability of

cardiovascular system to pumpoxygenated blood to tissues and returnde-oxygenated blood to lungs.s

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Work of breathing:

Inspiration-

active process,

stimulated by

chemicalreceptors in

aorta.

Expiration is

passive process

that depends on

elastic recoilproperties of

lungs, requiring

little or no

muscle work.

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Lung Volume:

Spirometry- is used to measureto measure volume of airentering or leaving the lungs.

Variations in lung volumes may

be associated with health statessuch as pregnancy, exercise,obesity, or obstructive andrestrictive conditions of the lungs.

Lung capacities- made up of twoor more lung volumes (total lungcapacity, and inspiratory and

expiratory reserve volume).

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Pulmonary Circulation:

Primary function of pulmonary

circulation is to move blood to andfrom aveolocapillary membrane forgas exchange to occur.

Pulmonary circulation is a reservoir

for blood so that lung can increase itsblood volume without large increasesin pulmonary artery or venouspressures.

Begins at the pulmonary artery,which receives poorly oxygenatedmixed venous blood from the rightventricle.

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Oxygen Transport:

Consists of lungs and cardiovascular

system.

Delivery depends on amount of

oxygen entering the lungs

(ventilation), blood flow to lungs andtissues (perfusion), rate of diffusion,

and oxygen-carrying capacity.

Capacity of blood to carry oxygen is

influenced by the amt. of dissolvedoxygen in the plasma, amt. of

hemoglobin, and tendency of

hemoglobin to bind with O2.

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Assessment

Breathing

Patterns

Factors

ImpairingOxygenation

Diagnostic

Tests:

Pulmonary

Function TestsPulse Oximetry

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Airway Maintenance:

Humidification- process of adding

water to gas. Temperature is mostimportant factor affecting amt. watervapors a gas can hold.

Nebulization- process of adding

moisture or medications to inspiredair by mixing particles with the air.

Chest physiotherapy-(CPT) a groupof therapies used in comb. To

mobilize pulmonary secretions. Nasopharyngeal suctioning- when

client is unable to clear respiratorysecretions to clear airway.

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Oxygen Enhancement:

Nursing interventions include

1. Independent nursing actions(health promotion, prevention

behaviors), positioning, andcoughing techniques.

2. Interdependent or dependentinterventions include oxygen

therapy, lung inflation tech.,hydration, medication admin., andchest psysiotherapy.

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Nursing Process:

Assessment :

1. Physical examination (pain, fatigue,smoking, dyspnea, cough,

wheezing, environment orgeographical exposures,respiratory infections, allergies,health risks, medications.

2. Inspection, palpation, percussion,auscultation.

3. Diagnostic Tests

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Nursing Process: Nursing Diagnosis:

1. Based on specific definingcharacteristics and related etiology.

2. Use information gathered inassessment to identify defining

characteristics.3. Include: activity intolerance, risk for

activity intolerance, ineffectiveairway clearance, anxiety,

ineffective breathing pattern,decreased cardiac output, impairedcomfort, fatigue, fear, risk forimbalanced fluid volume, impairedgas exchange, etc.

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Nursing Process:

Implementation:

1. Health promotion (immunizations,vaccinations), healthy lifestyle

behavior, environmental pollutants,dyspnea management, airwaymaintenance.

2. Suctioning (nasopharyngeal and

nasotracheal suctioning), artificialairways, maintenance andpromotion of lung expansion, chesttubes, methods of oxygen delivery.

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Nursing Process:

Evaluation:

1. Client care

2. Client expectations

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Review of CPR:

*rescue breathing

1. Determine respiratory status (look, listen,feel).

2. Call for assistance if not breathing.

3. If has pulse but no breathing, initiateartificial airway (mouth to mouth, bag andmask).

4. Open airway. (Head tilt, chin lift).

5. Create tight seal over mouth.

6. Give one breath every 5 seconds.

7. Reassess after one full minute.8. Continue rescue breathing if not

breathing.