Transcript Lecture 07 - Oxygenation

Oxygenation
Chapter 39
By N.Haliyash, MD, BSN
Lecture objectives
Upon completing the lecture students will be able to:
 Define key terms related to the theme.
 Identify physiological processes related to
oxygenation.
 Describe the impact of a client’s health, age,
lifestyle and environment on tissue oxygenation.
 Identify and describe clinical outcomes of
hyperventilation, hypoventilation and hypoxemia.
 Identify nursing care interventions that promote
oxygenation.
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 Most cells in the body obtain their energy
from chemical reactions involving oxygen
and the elimination of carbon dioxide.
 The exchange of respiratory gases occurs
between the environmental air and the
blood
 There are 3 steps in the process of
oxygenation:
• Ventilation; perfusion and diffusion.
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Physiology of Oxygenation
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Ventilation
Alveolar Gas Exchange
Oxygen Transport and Delivery
Cellular Respiration
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Physiology of Oxygenation
 Ventilation
• Movement of air into and out of the lungs
- Inhalation
- Exhalation
- Work of breathing Amount of muscular energy
(work) required to accomplish ventilation.
• Delivery of fresh air into the lung’s alveoli
• Regulated by respiratory control centers
• Hypoxemia is a decrease in blood oxygen
concentration.
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Physiology of Oxygenation
 Alveolar Gas Exchange
• Oxygen uptake (external respiration) is the
exchange of oxygen from the alveolar space
into the pulmonary capillary blood.
• Carbon dioxide diffuses from the blood to
the alveolar space.
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Physiology of Oxygenation
 Oxygen Transport and Delivery
• Oxygen Transport in the Blood
- PaO2
- SaO2
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Physiology of Oxygenation
 Circulation/Perfusion
• The heart pumps oxygenated blood into the
arterial system, which carries it to the cells,
and collects deoxygenated blood from the
venous system.
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Circulation/Perfusion
 Key terms:
• Cardiac output Amount of blood pumped by the
heart.
- Norm 4 to 6 L/min
• Cardiac index (CI) is the adequacy of the cardiac
output for the individual
- Cardiac output ÷ BSA
- Norm 2.5 to 4 L/min/m³
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• Cardiac conduction system Specialized
cells in the heart that generate and conduct
electrical impulses; consists of the sinoatrial
node, internodal pathways, atrioventricular
node, bundle of His, right and left bundle
branches, and Purkinje fibers.
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 Cardiac cycle Series of electrical and
mechanical events resulting in a cycle of atrial
and ventricular contractions and relaxation.
• Systole Process of cardiac chamber emptying or
ejecting blood.
• Diastole Process of cardiac chamber filling as the
right and left ventricles relax.
 Heart failure Inability of the heart to pump
enough blood to meet the metabolic needs of
the body; often accompanied by a backup of
blood in the venous circuits (congestive heart
failure).
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Physiology of Oxygenation
 Cellular Respiration (internal respiration)
• Oxygen diffuses from the blood to the
tissues
• Carbon dioxide moves from the tissues to
the blood.
• The blood is then reoxygenated by the heart.
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Factors Affecting Oxygenation
 Development: Age Differences
 Environmental and Lifestyle Factors
 Disease Processes
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Disease Processes
 Obstructive Pulmonary Disease
• Asthma, emphysema, and chronic
bronchitis, are collectively known as chronic
obstructive pulmonary disease (COPD), or
chronic airflow limitation.
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Disease Processes
 Restrictive Pulmonary Disease
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Pneumonia
Pulmonary fibrosis (scarring)
Traumatic injury to thorax
Break in pleural membrane surround lungs
 Atelectasis or alveolar collapse can be
caused by pleural defects.
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Disease Processes
 Diffusion Defects
• Decrease in the efficiency of gas diffusion
from the alveolar space into the pulmonary
capillary blood
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Disease Processes
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Ventilation-Perfusion Mismatching
Atherosclerosis
Heart Failure
Alterations in Oxygen Uptake
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Physiological Responses to
Reduced Oxygenation
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Increased Oxygen Extraction
Anaerobic Metabolism
Tissue Ischemia and Cell Death
Carbon Dioxide Transport and Excretion
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Assessment
 Health History
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Events leading up to the problem
Duration
Methods used to alleviate symptoms
Impact on activities of daily living (ADLs)
Medical, psychosocial, and family history
Client’s knowledge level and coping abilities
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Assessment
 Physical Examination
• Rate, rhythm, pattern of respirations
• Manifestations of hypoxia
- Behavior, clubbing, cyanosis, mottling
• Palpation findings related to compromised
ventilation include vocal fremitus, and
displacement of trachea.
• Percussion may reveal hyperresonance, dull
percussion tone.
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Assessment
 Physical Examination
• Auscultation may reveal adventitious breath
sounds.
- Rales (crackles), wheezes (rhonchi), pleural
friction rub, stridor
• Auscultation may also reveal gallops, or
extra heart sounds, and murmurs.
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Diagnostic and Laboratory Data
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Pulse Oximetry
Arterial Blood Gases (ABGs)
Sputum Collection
Ventilatory Function Tests
Lactic Acid, Hemoglobin, Hematocrit
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Diagnostic and Laboratory Data
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Chest X-Ray, Computerized Tomography
Bronchoscopy
Thoracentesis
Echocardiography
Electrocardiography
Stress Test
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Nursing Diagnosis
 Primary Nursing Diagnoses
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Ineffective Airway Clearance
Ineffective Breathing Patterns
Impaired Gas Exchange
Decreased Cardiac Output
Altered Tissue Perfusion
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Secondary Nursing Diagnoses
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Deficient Knowledge
Activity Intolerance
Disturbed Sleep Pattern
Imbalanced Nutrition
Acute Pain
Anxiety
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Outcome Identification
and Planning
 Expected outcomes should be
individualized to reflect the client’s
capabilities and limitations.
 Identifying desired outcomes of care is
best accomplished in small steps.
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Outcome Identification and
Planning
 Outcomes may be based on
physiological parameters such as
respiration rate or arterial blood gas
values.
 Outcomes should be based upon the
assessment findings that led to the
nursing diagnoses at hand.
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Implementation
 Interventions to Promote Airway
Clearance
• Teach effective coughing.
• Initiate postural drainage and chest
physiotherapy.
• Monitor hydration.
• Administer medications.
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Implementation
 Interventions to Promote Airway
Clearance
• Monitor environmental and lifestyle
conditions.
• Manage artificial airways.
• Suction the airway.
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Suctioning an Endotracheal
Tube
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Suctioning an Endotracheal
Tube
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Implementation
 Interventions to Improve Breathing
Patterns
• Position client properly.
• Teach controlled breathing exercises.
• Manage chest drainage systems.
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Implementation
 Interventions to Improve Oxygen Uptake
and Delivery
• Administer oxygen.
• Administer blood components.
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Implementation
 Interventions to Increase Cardiac Output
and Tissue Perfusion
• Manage fluid balance.
• Encourage activity restrictions and
assistance with activities of daily living.
• Position client properly.
• Administer medications.
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Implementation
 Emergency Interventions
• Remove airway obstruction.
• Initiate cardiopulmonary resuscitation.
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Implementations
 Interventions to Address Associated
Nursing Diagnoses
• Explore lifestyle and activity
adaptations.
• Encourage dietary and nutritional
modifications.
• Promote comfort measures.
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Implementation
 Complementary Therapies
• Therapies that enhance oxygenation
include mediation, aroma therapy, Tai
Chi, Qi Gong, and Yoga.
• Herbs are often used with relaxation
techniques, exercise, and diet to
prevent disease.
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Evaluation
 Based on expected outcomes that the
nurse and client have established
together.
 Success of the specific interventions may
be a matter of the degree to which the
client is or can be returned to a
satisfactory state of respiratory
functioning.
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Evaluation
 When evaluating progress, it is important
to determine if each initial expected
outcome was within reasonable
expectations.
 Revision of expected outcomes,
interventions, and plan of care should be
made to reflect truly reasonable
expectations.
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