Ms Oxygenation

OXYGENATION Prepared by: John Gil B. Ricafort, RN

Respiratory III. IV. V. VI. VII.

Review of Respiratory System Common Manifestations Diagnostic Tests/ Procedures Common Pharmacologic Agents Disturbances a. Restrictive Lung Disease b. COPD/ CAL c. Pulmonary Vascular Disease

Restrictive: Atelectasis Tuberculosis Pneumonia

COPD: Asthma Emphysema Chronic Bronchitis

Pulmonary Vascular Disease: Cor Pulmonale Pulmonary Embolism

Hematopoietic III. IV.

Review of the Hematopoietic System Disturbances a. Anemia b. Polycythemia Vera c. Bleeding Tendencies - DIC - Hemophilia - Thrombocytopenia

Cardiovascular III. IV. V.

Review of the Cardiovascular System Common Diagnostic Tests/ Procedures Disturbances a. Infection - Rheumatic Heart Disease b. Coronary Artery Disease - Atherosclerosis - Arteriosclerosis

- Angina Pectoris - Myocardial Infarction IV. Congestive Heart Failure - Right Sided Heart Failure - Left Sided Heart Failure V. Congenital Heart Defects - Cyanotic Heart Defects - Acyanotic Heart Defects

RESPIRATORY SYSTEM

Measures That Promotes Adequate Respiratory Functions: 1.

2. 3. 4. 5. 6.

Adequate OXYGEN supply from the environment. Deep breathing and coughing exercises. Proper positioning Patent airway (FEMS) Adequate hydration Avoid pollutants, alcohol and smoking.

7. Chest Physiotherapy (CPT) * Percussion * Vibration * Postural Drainage 8. Bronchial Hygiene Measures * Steam Inhalation * Suctioning - Oropharyngeal - Nasopharyngeal

Things to Remember:SUCTIONING Assess: AUDIBLE SECRETIONS during respiration Position: Conscious: SEMI-FOWLER’s POSITION Unconscious: LATERAL POSITION

Pressure: Wall Unit: Adult: 100-120mmHg Child: 95-110mmHg Infant: 50-95mmHg Portable Unit: Adult: 10-15mmHg Child: 5-10mmHg Infant: 2-5mmHg

Appropriate Size of Catheter: Adult: Fr. 12-18 Child: Fr. 8-10 Infant: Fr. 5-8 Lubricate Catheter: Nasopharyngeal: water-soluble lubricant Oropharyngeal: Sterile water or NSS

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Apply suction during withdrawal of the suction catheter (NEVER during insertion) Apply suction for 5 to 10 seconds (maximum of 15 seconds) Allow 20-30 seconds interval between each suction and limit suction to 5 minutes in total Encourage patient to breathe deeply and to cough between suctions. Assess effectiveness of suctioning

9. Incentive Spirometry - done to enhance deep inspiration

10. Administration of supplemental oxygen Signs of Hypoxemia 1. Increased pulse rate 2. Rapid, shallow respiration 3. Increased restlessness 4. Flaring of nares 5. Substernal or intercostal retractions 6. Cyanosis

OXYGEN SYSTEMS: 1.

Low-flow Administration Devices a. Nasal Cannula (24-45% at 2-6LPM) b. Simple Face Mask (40-60% at 5-8LPM) c. Partial Rebreathing Mask (60-90% at 6-10LPM) d. Non-rebreathing Mask (95-100% at 6-15LPM) e. Oxygen Tent

2. High flow Administration Devices a. Venturi Mask b. Oxygen Hood c. Incubator / Isolette

Common Manifestations: 1. Cough - the cardinal symptom of respiratory problem 2. Dyspnea - refers to difficulty on breathing * EXERTIONAL DYSPNEA * PAROXYSMAL NOCTURNAL * ORTHOPNEA

3. Clinical Signs of Hypoxia EARLY SIGNS Tachycardia Kussmaul’s Respiration N/V Headache Irritability Memory loss Dizziness

LATE SIGNS Bradycardia Dyspnea Decreased Systolic BP Cough Increased RBC Increased Hgb Clubbing of fingers

4. Clubbing of Fingers

5. Hemoptysis 6. Chestpain 7. Headache 8. Easy fatigability 9. Cyanosis 10. Skin flushing 11. Seizures 12. Altered level of consciousness

Common Pharmacologic Agents 1. 2. 3. 4. 5. 6.

Adrenergic (Sympathomimetic) Agents Bronchodilators Antibacterial Corticosteroids Antihistamine Mucolytic, Antitussive and Expectorant

Common Procedures/ Tests 1. Abdominal Thrust (Heimlich Maneuver) - a short, abrupt pressure against the abdomen, two fingerbreadths above the umbilicus, to raise the intrathoracic pressure. PARTIAL: Noisy respiration, repeated coughing TOTAL: Cessation of breathing, inability to speak

2. Radiographic Scanning Test (X-RAY)

3. Endoscopy (Bronchoscopy) 4. Chest Physiotherapy 5. Suctioning of Airway 6. Tracheostomy care 7. Pulmonary Function Test - Incentive Spirometry *Tidal Volume * Residual Volume * Expiratory Reserve Volume * Inspiratory Reserve Volume

(500ml) (1200ml) (1000-1200ml) (3000-3300ml)

8. Pulse Oximetry

9. Sputum Exam 10. Oxygen Therapy 11. Thoracentesis 12. Chest Tube (T-Tube) - to drain air : 2nd or 3rd ICS - to drain blood/ fluid: 8th or 9th ICS

13. Pulmonary Angiogram

TUBERCULOSIS

PNEUMONIA

EMPHYSEMA

BRONCHITIS

ASTHMA

Coronary Artery Diseases (CAD) 1. Atherosclerosis - an abnormal accumulation of lipid, or fatty, substances and fibrous tissues in the vessel wall 2. Arteriosclerosis - refers to hardening of the vessel walls

Risk Factors for CAD Nonmodifiable Risk Factors Family History of CAD Increasing Age Gender Race

Modifiable Risk Factors High Blood pressure Cigarette smoking High Blood cholesterol levels Diabetes Mellitus Lack of estrogen in women Physical inactivity Obesity

Controlling Cholesterol Normal Total Serum Cholesterol = 150-240mg/dl HDL = 29-77mg/dl LDL= 60-160mg/dl Triglycerides= 10-190mg/dl

Desired levels of LDL? < 160mg/dl for patients with one or no risk factors <130mg/dl for patients with two or more risk factors <100mg/dl for patients with CAD

Angina Pectoris Classifications of Angina Class

Activity Evoking

Limits to Activity

I

Prolonged exertion

None

II

Walking >2 blocks

Slight

III

Walking <2 blocks

Marked

IV

Minimal or Rest

Severe

Types of Angina Pectoris 1. 2. 3. 4. 5.

Stable Angina Unstable Angina Intractable Angina/ Refractory Angina Variant Angina Silent Angina

Myocardial Infarction Cardiac Enzymes CPK Normal: Male: 5-35; Female: 5-25 Rises: 4-8 hours Peak: ½ to 1 ½ days Returns to Normal: 3-4 days

LDH Normal: 100-190IU/L Rises: 12-24 hours Peak: 2-6 days Trop-T Normal: NEGATIVE Rises: immediate Peak: 4-24 hours Returns to Normal: 1-3 weeks

Management: M - morphine SO4 for pain O - Oxygen A – Aspirin/ ACE inhibitors (captopril) N – Nitroglycerin S – streptokinase ( thrombolytics ) – should be given in 6 hrs but better if in 3 hrs

Congestive Heart Failure Classifications: CLASSIFICATION I Ordinary physical activity does not cause fatigue, dyspnea, palpitations or chestpain ASYMPTOMATIC PROGNOSIS: Good

CLASSIFICATION II Slight limitations on ADL’s Patient reports no symptoms at rest but increased physical activity will cause symptoms PROGNOSIS: Good

CLASSIFICATION III Marked limitation on ADL Patient feels comfortable at rest but less than ordinary activity will cause symptoms

PROGNOSIS: Fair

CLASSIFICATION IV Symptoms of Cardiac insufficiency at rest

PROGNOSIS: Poor