RNSG 1413 Oxygenation Chapter 39[1]

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CHAPTER 39CHAPTER 39

• OXYGENATION• OXYGENATION


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


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


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


Factors Affecting Oxygenation (cont'd)

Factors Affecting Oxygenation (cont'd)

• Physiological factors: respiratory– Hyperventilation– Hypoventilation– Hypoxia

• Physiological factors: respiratory– Hyperventilation– Hypoventilation– Hypoxia


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


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


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


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


Lifestyle FactorsLifestyle Factors

• Nutrition

• Exercise

• Smoking

• Substance abuse

• Stress

• Nutrition

• Exercise

• Smoking

• Substance abuse

• Stress


Environmental FactorsEnvironmental Factors

• Residence location

• Occupation

• Residence location

• Occupation


Nursing HistoryNursing History

• Fatigue• Dyspnea• Cough• Wheezing• Pain• Environmental or geographical exposures

• Fatigue• Dyspnea• Cough• Wheezing• Pain• Environmental or geographical exposures


Nursing History (cont'd)Nursing History (cont'd)

• Respiratory infections

• Health risks

• Medications

• Respiratory infections

• Health risks

• Medications


Assessment of OxygenationAssessment of Oxygenation

• Physical examination– Inspection– Palpation– Percussion– Auscultation

• Physical examination– Inspection– Palpation– Percussion– Auscultation


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



• 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



• 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



• Diagnostic tests: ventilation studies (cont'd)

– Thoracentesis– Throat cultures– Sputum specimens

• Diagnostic tests: ventilation studies (cont'd)

– Thoracentesis– Throat cultures– Sputum specimens


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


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


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


Implementation: Health Promotion (cont'd)

Implementation: Health Promotion (cont'd)

• Vaccinations/immunizations– Influenza– Pneumonia

• Vaccinations/immunizations– Influenza– Pneumonia


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


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


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



• 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



• Restoration of cardiopulmonary functioning—CPR

• Restoration of cardiopulmonary functioning—CPR


Implementation: Restorative Care

Implementation: Restorative Care

• Hydration

• Coughing techniques

• Respiratory muscle training

• Breathing exercises

• Hydration

• Coughing techniques

• Respiratory muscle training

• Breathing exercises


EvaluationEvaluation

• Client care

• Client expectations

• Client care

• Client expectations

RNSG 1413 Oxygenation Chapter 39[1]

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