Oxygenation Study Guide

v  Review

Ø  Oxygen is needed to sustain life.

Ø  Blood is oxygenated through ventilation, perfusion, and transport of respiratory gases.

Ø  Neural and chemical regulators control the rate and depth of respiration.

v  Cardiovascluar Anatomy and Physiology

Ø  Chambers of the heart

§  Right and left atria

§  Right and left ventricles

Ø  Heart Valves

§  Semilunar valves

·  Pulmonic

·  Aortic

§  Atrioventricular valves (A-V)

·  Tricuspid

·  Mitral

v  Cardiac Output

Ø  CO = SV x HR

Ø  ______Volume (SV)

§  Volume of blood ejected by the ventricles in one cardiac cycle

Ø  Heart Rate (HR)

§  Number of cardiac cycles in one minute

v  Respiratory Physiology

v  Factors Affecting Oxygenation

Ø  Physiological factors

§  Decreased oxygen-carrying capacity

§  Decreased inspired oxygen

§  Hypovolemia

§  Increased metabolic rate

Ø  Conditions affecting chest wall movement

§  Pregnancy

§  Obesity

§  Musculoskeletal abnormalities

§  Trauma

§  Neuromuscular disease

Disturbances in conduction
Caused by electrical impulses that do not originate from the SA node (dysrhythmias) / Altered cardiac output
Insufficient volume is ejected into the systemic and pulmonary circulation
Impaired valvular function
Is acquired or congenital disorder of a cardiac valve by stenosis or regurgitation / Myocardial ischemia
Coronary artery flow to the myocardium insufficient to meet myocardial oxygen demands

§  CNS alterations

v  Alterations in Cardiac Functioning

v  Alterations in Respiratory Functioning

Hyperventilation
Ventilation in excess of that required to eliminate carbon dioxide produced by cellular metabolism
RR>20 adults / Hypoventilation
Alveolar ventilation inadequate to meet the body’s oxygen demand or to eliminate sufficient carbon dioxide
RR<12 adults
Hypoxia
Inadequate tissue oxygenation at the cellular level / ______
Blue discoloration of the skin and mucous membranes

v  Developmental Factors

Ø  Infants and toddlers

Ø  School-age children and adolescents

Ø  Young and middle-age adults

Ø  Older adults

v  Lifestyle Risk Factors

Ø  Nutrition

Ø  Exercise

Ø  Smoking cessation

Ø  Substance abuse

Ø  Stress reduction

v  Assessment: Nursing History

Pain / Smoking
Dyspnea / Cough
Wheezing / Environmental/geographical exposures
Respiratory infections / Allergies
Health risks / Medications

v  Physical Examination

Ø  Inspection

Ø  Palpation

Ø  Percussion

Ø  Auscultation

v  Diagnostic Tests

Blood tests
  CBC
  Cardiac enzymes
  Serum electrolytes
  Cholesterol / X-rays
  Chest x-ray
  Cardiac catheterization / Noninvasive
  TB skin test
  Holter monitor
  ECG
  Thallium stress test
  EPS
  PFT

v  Nursing Diagnosis and Planning

Ø  Develop cardiopulmonary nursing diagnoses based on specific assessment data.

Ø  Individualized client outcomes and goals are identified to help clients meet their needs.

Ø  Examples:

§  Impaired gas exchange

§  Fatigue

§  Ineffective air clearance

v  Implementation: Health Promotion

Ø  Vaccinations

§  Influenza, pneumococcal

Ø  Healthy lifestyle

§  Eliminate risk factors, eat right, regular exercise

Ø  Environmental pollutants

§  Second-hand smoke, work chemicals, and pollutants

v  ______Management

Ø  Airway management

Ø  Mobilization of pulmonary secretions

Ø  Humidification

Ø  Nebulization

Ø  Chest physiotherapy

v  Suctioning

Ø  Oropharyngeal and nasopharyngeal

§  Used when the client can cough effectively but is not able to clear secretions

Ø  Orotracheal and nasotracheal

§  Used when the client is unable to manage secretions

Ø  Tracheal

§  Used with an artificial airway

v  Artificial Airways

Ø  Oral airway

§  Prevents obstruction of the trachea by displacement of the tongue into the oropharynx

Ø  ______airway

§  Short-term use to ventilate, relieve upper airway obstruction, protect against aspiration, clear secretions

Ø  Tracheostomy

§  Long-term assistance, surgical incision made into trachea

v  Maintenance and Promotion of Lung Expansion

Ø  Positioning

§  Reduces pulmonary stasis, maintains ventilation and oxygenation

Ø  Incentive spirometry

§  Encourages voluntary deep breathing

Ø  Chest tubes

§  A catheter placed through the thorax to remove air and fluids from the pleural space or to prevent air from reentering or to reestablish intrapleural and intrapulmonic pressures

v  Maintenance and Promotion of Oxygenation

Ø  Oxygenation therapy

§  To prevent or relieve hypoxia

Ø  Methods of supply

§  Nasal cannula

·  thin tube with two small nozzles that protrude into the patient's nostrils

·  Low rates

§  Oxygen mask

·  Simple

¨  between 6 and 12 LPM

·  ______

¨  accurately deliver a predetermined oxygen concentration to the trachea up to 40%.

·  Non-Rebreather

¨  featuring a reservoir bag, which increases the provided oxygen rate to 40–70% oxygen at 5 to 15 LPM

§  Restoration of Cardiopulmonary Functioning

v  Cardiopulmonary resuscitation

§  Circulation

§  Airway

§  Breathing

·  CAB now instead of ABC

§  Defibrillation

v  Restorative and Continuing Care

Ø  Cardiopulmonary rehabilitation

Ø  Hydration

Ø  Coughing techniques

§  Purse Lipped-Breathing

§  Diaphragmatic breathing