rnsg 1413 oxygenation chapter 39[1]
TRANSCRIPT
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CHAPTER 39CHAPTER 39
• OXYGENATION• OXYGENATION
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Cardiovascular PhysiologyCardiovascular Physiology• Structure and function
– Myocardial pump– Myocardial blood flow– Coronary artery circulation– Systemic circulation– Blood flow regulation: cardiac output, preload,
afterload, contractility– Conduction system
• Structure and function– Myocardial pump– Myocardial blood flow– Coronary artery circulation– Systemic circulation– Blood flow regulation: cardiac output, preload,
afterload, contractility– Conduction system
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Respiratory PhysiologyRespiratory Physiology
• Structure and function (cont'd)– Breathing: inspiration, expiration– Lung volumes and capacities– Pulmonary circulation– Respiratory gas exchange: oxygen,
carbon dioxide– Regulation of respiration
• Structure and function (cont'd)– Breathing: inspiration, expiration– Lung volumes and capacities– Pulmonary circulation– Respiratory gas exchange: oxygen,
carbon dioxide– Regulation of respiration
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Factors Affecting OxygenationFactors Affecting Oxygenation
• Physiological factors: cardiac– Conduction disturbances– Impaired valvular function– Myocardial hypoxia– Cardiomyopathic conditions– Peripheral tissue hypoxia
• Physiological factors: cardiac– Conduction disturbances– Impaired valvular function– Myocardial hypoxia– Cardiomyopathic conditions– Peripheral tissue hypoxia
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Factors Affecting Oxygenation (cont'd)
Factors Affecting Oxygenation (cont'd)
• Physiological factors: respiratory– Hyperventilation– Hypoventilation– Hypoxia
• Physiological factors: respiratory– Hyperventilation– Hypoventilation– Hypoxia
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Factors Affecting OxygenationFactors Affecting Oxygenation• Additional physiological factors
– Decreased oxygen-carrying capacity– Decreased inspired oxygen
concentration– Hypovolemia– Increased metabolic rate– Conditions affecting chest wall
movement
• Additional physiological factors– Decreased oxygen-carrying capacity– Decreased inspired oxygen
concentration– Hypovolemia– Increased metabolic rate– Conditions affecting chest wall
movement
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Factors Affecting OxygenationFactors Affecting Oxygenation
• Additional physiological factors– Musculoskeletal abnormalities– Trauma– Neuromuscular diseases– Central nervous system alterations– Chronic disease
• Additional physiological factors– Musculoskeletal abnormalities– Trauma– Neuromuscular diseases– Central nervous system alterations– Chronic disease
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Alterations in Cardiac FunctioningAlterations in Cardiac Functioning
• Conduction disturbances
– Atrial and ventricular dysrhythmias• Altered cardiac output
– Heart failure• Impaired valvular function• Myocardial ischemia
– Angina, MI, acute coronary syndrome
• Conduction disturbances
– Atrial and ventricular dysrhythmias• Altered cardiac output
– Heart failure• Impaired valvular function• Myocardial ischemia
– Angina, MI, acute coronary syndrome
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Alterations in Respiratory Functioning
Alterations in Respiratory Functioning
• Hyperventilation
• Hypoventilation
• Hypoxia
• Hyperventilation
• Hypoventilation
• Hypoxia
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Developmental FactorsDevelopmental Factors
• Infants and toddlers
• School-age children and adolescents
• Young and middle adults
• Older adults
• Infants and toddlers
• School-age children and adolescents
• Young and middle adults
• Older adults
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Lifestyle FactorsLifestyle Factors
• Nutrition
• Exercise
• Smoking
• Substance abuse
• Stress
• Nutrition
• Exercise
• Smoking
• Substance abuse
• Stress
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Environmental FactorsEnvironmental Factors
• Residence location
• Occupation
• Residence location
• Occupation
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Nursing HistoryNursing History
• Fatigue• Dyspnea• Cough• Wheezing• Pain• Environmental or geographical exposures
• Fatigue• Dyspnea• Cough• Wheezing• Pain• Environmental or geographical exposures
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Nursing History (cont'd)Nursing History (cont'd)
• Respiratory infections
• Health risks
• Medications
• Respiratory infections
• Health risks
• Medications
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Assessment of OxygenationAssessment of Oxygenation
• Physical examination– Inspection– Palpation– Percussion– Auscultation
• Physical examination– Inspection– Palpation– Percussion– Auscultation
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Assessment of Oxygenation (cont'd)Assessment of Oxygenation (cont'd)
• Diagnostic tests: blood studies– Complete blood count– Cardiac enzymes– Cardiac troponin I– Serum electrolytes– Cholesterol
• Diagnostic tests: blood studies– Complete blood count– Cardiac enzymes– Cardiac troponin I– Serum electrolytes– Cholesterol
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Assessment of Oxygenation (cont'd)Assessment of Oxygenation (cont'd)
• Diagnostic tests: cardiac function– Electrocardiogram (ECG)– Holter monitor– Exercise stress test– Thallium stress test– Electrophysiological study (EPS)– Echocardiography– Scintigraphy– Cardiac catheterization
• Diagnostic tests: cardiac function– Electrocardiogram (ECG)– Holter monitor– Exercise stress test– Thallium stress test– Electrophysiological study (EPS)– Echocardiography– Scintigraphy– Cardiac catheterization
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Assessment of Oxygenation (cont'd)Assessment of Oxygenation (cont'd)
• Diagnostic tests: ventilation studies– Pulmonary function– Peak expiratory flow rate (PEFR)– Arterial blood gases– Oximetry– Chest x-ray– Bronchoscopy– Lung scan
• Diagnostic tests: ventilation studies– Pulmonary function– Peak expiratory flow rate (PEFR)– Arterial blood gases– Oximetry– Chest x-ray– Bronchoscopy– Lung scan
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Assessment of Oxygenation (cont'd)Assessment of Oxygenation (cont'd)
• Diagnostic tests: ventilation studies (cont'd)
– Thoracentesis– Throat cultures– Sputum specimens
• Diagnostic tests: ventilation studies (cont'd)
– Thoracentesis– Throat cultures– Sputum specimens
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Nursing DiagnosesNursing Diagnoses• Ineffective airway clearance• Ineffective breathing pattern• Decreased cardiac output• Impaired gas exchange• Risk for infection• Ineffective tissue perfusion• Impaired spontaneous ventilation
• Ineffective airway clearance• Ineffective breathing pattern• Decreased cardiac output• Impaired gas exchange• Risk for infection• Ineffective tissue perfusion• Impaired spontaneous ventilation
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PlanningPlanning
• Goals and outcomes– Client’s lungs are clear on auscultation– Client coughs productively
• Setting priorities
• Continuity of care
• Goals and outcomes– Client’s lungs are clear on auscultation– Client coughs productively
• Setting priorities
• Continuity of care
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Implementation: Health PromotionImplementation: Health Promotion
• Body weight• Diet• Exercise• Stress reduction• Occupational safety• Smoke-free• Regular physical examinations
• Body weight• Diet• Exercise• Stress reduction• Occupational safety• Smoke-free• Regular physical examinations
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Implementation: Health Promotion (cont'd)
Implementation: Health Promotion (cont'd)
• Vaccinations/immunizations– Influenza– Pneumonia
• Vaccinations/immunizations– Influenza– Pneumonia
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Implementation: Acute CareImplementation: Acute Care
• Dyspnea management
• Airway maintenance– Mobilization of secretions– Suctioning– Artificial airways
• Dyspnea management
• Airway maintenance– Mobilization of secretions– Suctioning– Artificial airways
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Implementation: Acute Care (cont'd)Implementation: Acute Care (cont'd)
• Maintenance and promotion of lung expansion
– Positioning– Incentive spirometry– Chest tubes
• Maintenance and promotion of lung expansion
– Positioning– Incentive spirometry– Chest tubes
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Airway MaintenanceAirway Maintenance• Mobilization of pulmonary secretions:
– Humidification– Nebulization– Chest Physiotherapy- contraindications
Box 39-12• Postural drainage – ex. Cystic Fibrosis• Chest percussion• Vibration
• Mobilization of pulmonary secretions:– Humidification– Nebulization– Chest Physiotherapy- contraindications
Box 39-12• Postural drainage – ex. Cystic Fibrosis• Chest percussion• Vibration
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Implementation: Acute Care (cont'd)Implementation: Acute Care (cont'd)
• Maintenance and promotion of oxygenation: oxygen therapy
– Safety precautions– Oxygen supply– Methods of oxygen delivery– Home oxygen therapy
• Maintenance and promotion of oxygenation: oxygen therapy
– Safety precautions– Oxygen supply– Methods of oxygen delivery– Home oxygen therapy
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Implementation: Acute Care (cont'd)Implementation: Acute Care (cont'd)
• Restoration of cardiopulmonary functioning—CPR
• Restoration of cardiopulmonary functioning—CPR
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Implementation: Restorative Care
Implementation: Restorative Care
• Hydration
• Coughing techniques
• Respiratory muscle training
• Breathing exercises
• Hydration
• Coughing techniques
• Respiratory muscle training
• Breathing exercises
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EvaluationEvaluation
• Client care
• Client expectations
• Client care
• Client expectations