Transcript Oxygenation and Perfusion depend on…..

Chapter 38
Oxygenation and Perfusion
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Oxygenation and Perfusion depend on…..
• The condition of the airway system from nose to alveoli
• Properly functioning alveolar system in lungs to facilitate
gas exchange
• Properly functioning cardiovascular and hematologic
systems that carry nutrients and wastes to and from
body cells
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Function of the Airway
• Warm, filter, humidify inspired air
• Movement of air
• Clearance of mucus by cilia
• Production of pulmonary surfactant
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Anatomy of the Lungs
• Main organs of respiration
• Extend from the base of the diaphragm to the apex
above the first rib
• The right lung has three lobes; the left lung has two.
• The lungs are composed of elastic tissue (alveoli,
surfactant, pleura).
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The Organs of the Respiratory Tract
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Pulmonary Ventilation
• Inspiration: the active phase of ventilation
– Involves movement of muscles and the thorax to
bring air into the lungs
• Expiration: the passive phase of ventilation
– Movement of air out of the lungs
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Process of Ventilation
• Inspiration begins when the diaphragm contracts and
descends, lengthening the thoracic cavity.
• The external intercostal muscles contract, lifting the ribs
upward and outward.
• The sternum is pushed forward, enlarging the chest from
front to back
• The relaxation of these structures results in expiration.
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Gas Exchange (Respiration)
• Refers to the intake of oxygen and release of carbon
dioxide
• Made possible by respiration and perfusion
• Gas exchange occurs via diffusion at the alveolar level
• Alveoli have a single layer membrane that allows the
exchange of oxygen and carbon dioxide between the
alveolar sacs and the capillaries
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Transport of Respiratory Gases
• Oxygen is carried in the body via plasma and red blood
cells.
• Oxygen and carbon dioxide are carried by red blood cells
in the form of oxyhemoglobin and carboxyhemoglobin.
• Internal respiration occurs between the circulating blood
and tissue cells in the body. This is called perfusion.
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Cardiovascular System
• Vital for exchange of gases
• Composed of the heart and the blood vessels
• The heart is a cone shaped, muscular pump, divided into
four hollow chambers:
– Atria receive blood from the veins: superior and
inferior vena cava (from body) and the left and right
pulmonary veins (from lungs).
– Ventricles force blood out of the heart through the
arteries: aorta (to body) and the left and right
pulmonary arteries (to lungs).
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Factors Affecting Cardiopulmonary
Functioning and Oxygenation
• Developmental considerations
• Alterations in health
• Medications
• Lifestyle
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Developmental Considerations
– Infants are nose-breathers
– Children have shorter airways
– Older adults have decreased elasticity in lungs and
CV system and skeletal changes that can affect lung
performance
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Alterations in Health Factors
• Cardiac disease
• Vessel disease
• Blood clots
• Pulmonary disease
• Skeletal abnormalities
• Diabetes
• Deconditioning and bedridden
• Swallowing difficulties
• Depression
• Trauma
• Infections
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Alterations in Respiratory Function
• Hypoxia: inadequate amount of oxygen available to the
cells
• Dyspnea: difficulty breathing
• Hypoventilation: decreased rate or depth of air
movement into the lungs
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Alterations in the Cardiovascular System
• Dysrhythmia (irregularity)
• Myocardial ischemia (meaning low oxygen and perfusion
to the heart muscle)
• Angina (pain from severe ischemia)
• Myocardial infarction (death of tissue from prolonged
ischemia)
• Heart failure (damaged pump)
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Medication factors
• Cardiac medications—can control irregularities, improve
pump function, control pressures, treat or prevent pain
• Anticoagulants and aspirin
• Pulmonary medications—can open airways
• Antibiotics—treat infection in the respiratory tract
• Narcotics—can slow respiratory rate and decrease air
exchange; however morphine is a vasodilator
• Herbals
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Lifestyle Factors
• Smoking
• Sedentary
• Illegal drugs
• Dietary choices
• Occupational exposure
• Geographic location
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Nursing Interventions Promoting
Adequate Respiratory Functioning
• Effective breathing techniques
• Effective coughing techniques
• Suctioning the airway
• Meeting oxygenation needs with medications
• Smoking cessation
• Avoiding environmental triggers
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Promoting Effective Breathing
• Deep breathing
• Using incentive spirometry (IS)
• Pursed-lip breathing
• Diaphragmatic breathing
• Positioning
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Promoting Comfort
• Positioning
• Maintaining adequate fluid intake
• Providing humidified air
• Performing chest physiotherapy
• Maintaining good nutrition
• Pacing physical activities
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Medications
• Cough suppressants
• Expectorants
• Lozenges
• Bronchodilators
• Antiinflammatories
• Antibiotics
• Oxygen
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Administering Inhaled Medications
• Bronchodilators: open narrowed airways. Can be given
po, IV, or by inhalation.
• Nebulizers: disperse fine particles of liquid medication
into the deeper passages of the respiratory tract
(breathing treatment to dilate bronchioles)
• Meter-dose inhalers: deliver a controlled dose of
medication with each compression of the canister. Can be
rescue or maintenance.
• Dry powder inhalers: breath-activated delivery of
medications
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Vehicles for Inhaled Meds
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Common Oxygen Delivery Systems
• Nasal cannula—1-6 L/min. Can be humidified.
• Venturi mask—4-10 L/min. O2 mixes with room air, CO2 is expelled.
Has large tube attached. Allows for the most accurate delivery of
whatever percentage the HCP wants.
• Simple mask—6-8 L/min. O2 mixes with room air, CO2 is expelled
• Partial rebreather mask—8-11 L/min. Has reservoir bag that traps
exhaled CO2. O2 mixes with small amount of trapped expelled CO2
on inspiration.
• Nonrebreather mask—12 L/min. Has reservoir bag that holds
oxygen. Highest delivery of O2. No mixing occurs because CO2 is
exhaled through vents.
• Tent—used for peds. Plastic cover over bed. Motor keeps air cool and
humidified. Side vents allow nsg care. Can cause damp linens and
clothing.
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Oxygen Masks
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Precautions for Oxygen Administration
• Avoid open flames in the patient’s room.
• Place “no smoking” signs in conspicuous places.
• Check to see that electrical equipment in the room is in
good working order.
• Avoid wearing and using synthetic fabrics (builds up
static electricity).
• Avoid using oils in the area (oils ignite spontaneously in
oxygen).
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Type of Artificial Airways
• Oropharyngeal and nasopharyngeal airway-to maintain
airway patency and facilitate suctioning
• Endotracheal tube-to deliver oxygen and medications
when patient is unconscious
• Tracheostomy tube-inserted directly into the trachea
from the outside to maintain airway patency when upper
airway is obstructed
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Oropharngeal Airway
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Endotracheal Tube
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Two Types of Tracheostomy Sets: Cuffless
and Cuffed (Cuffed allows ventilator)
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