Rnsg 1413 Oxygenation Chapter 39[1]

CHAPTER 39 •

OXYGENATION

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Cardiovascular Physiology • Structure and function – – – – –

Myocardial pump Myocardial blood flow Coronary artery circulation Systemic circulation Blood flow regulation: cardiac output, preload, afterload, contractility – Conduction Mosby items and derived items © 2005 by Mosby, Inc. system

Respiratory Physiology •

Structure and function (cont'd) – – – –

Breathing: inspiration, expiration Lung volumes and capacities Pulmonary circulation Respiratory gas exchange: oxygen, carbon dioxide – Regulation of respiration Mosby items and derived items © 2005 by Mosby, Inc.

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Factors Affecting Oxygenation •

Physiological factors: cardiac – – – – –

Conduction disturbances Impaired valvular function Myocardial hypoxia Cardiomyopathic conditions Peripheral tissue hypoxia Mosby items and derived items © 2005 by Mosby, Inc.

Factors Affecting Oxygenation (cont'd) •

Physiological factors: respiratory – Hyperventilation – Hypoventilation – Hypoxia

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Factors Affecting Oxygenation • Additional physiological factors – Decreased oxygen-carrying capacity – Decreased inspired oxygen concentration – Hypovolemia – Increased metabolic rate – Conditions affecting chest wall movement Mosby items and derived items © 2005 by Mosby, Inc.

Factors Affecting Oxygenation •

Additional physiological factors – – – – –

Musculoskeletal abnormalities Trauma Neuromuscular diseases Central nervous system alterations Chronic disease Mosby items and derived items © 2005 by Mosby, Inc.

Alterations in Cardiac Functioning • • • •

Conduction disturbances – Atrial and ventricular dysrhythmias Altered cardiac output – Heart failure Impaired valvular function Myocardial ischemia – Angina, MI, acute coronary syndrome Mosby items and derived items © 2005 by Mosby, Inc.

Alterations in Respiratory Functioning • • •

Hyperventilation Hypoventilation Hypoxia

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Developmental Factors • • • •

Infants and toddlers School-age children and adolescents Young and middle adults Older adults Mosby items and derived items © 2005 by Mosby, Inc.

Lifestyle Factors • • • • •

Nutrition Exercise Smoking Substance abuse Stress Mosby items and derived items © 2005 by Mosby, Inc.

Environmental Factors • •

Residence location Occupation

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Nursing History • • • • • •

Fatigue Dyspnea Cough Wheezing Pain Environmental or geographical exposures Mosby items and derived items © 2005 by Mosby, Inc.

Nursing History (cont'd) • • •

Respiratory infections Health risks Medications

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Assessment of Oxygenation •

Physical examination – – – –

Inspection Palpation Percussion Auscultation Mosby items and derived items © 2005 by Mosby, Inc.

Assessment of Oxygenation (cont'd) •

Diagnostic tests: blood studies – – – – –

Complete blood count Cardiac enzymes Cardiac troponin I Serum electrolytes Cholesterol Mosby items and derived items © 2005 by Mosby, Inc.

Assessment of Oxygenation (cont'd) •

Diagnostic tests: cardiac function – Electrocardiogram (ECG) – Holter monitor – Exercise stress test – Thallium stress test – Electrophysiological study (EPS) – Echocardiography – Scintigraphy – Cardiac catheterization Mosby items and derived items © 2005 by Mosby, Inc.

Assessment of Oxygenation (cont'd) •

Diagnostic tests: ventilation studies – Pulmonary function – Peak expiratory flow rate (PEFR) – Arterial blood gases – Oximetry – Chest x-ray – Bronchoscopy – Lung scan Mosby items and derived items © 2005 by Mosby, Inc.

Assessment of Oxygenation (cont'd) • Diagnostic tests: ventilation studies (cont'd) – Thoracentesis – Throat cultures – Sputum specimens Mosby items and derived items © 2005 by Mosby, Inc.

Nursing Diagnoses • • • • • • •

Ineffective airway clearance Ineffective breathing pattern Decreased cardiac output Impaired gas exchange Risk for infection Ineffective tissue perfusion Impaired spontaneous ventilation Mosby items and derived items © 2005 by Mosby, Inc.

Planning •

Goals and outcomes – Client’s lungs are clear on auscultation – Client coughs productively

• •

Setting priorities Continuity of care Mosby items and derived items © 2005 by Mosby, Inc.

Implementation: Health Promotion

• • • • • • •

Body weight Diet Exercise Stress reduction Occupational safety Smoke-free Regular physical examinations Mosby items and derived items © 2005 by Mosby, Inc.

Implementation: Health Promotion (cont'd) •

Vaccinations/immunizations – Influenza – Pneumonia

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Implementation: Acute Care • •

Dyspnea management Airway maintenance – Mobilization of secretions – Suctioning – Artificial airways Mosby items and derived items © 2005 by Mosby, Inc.

Implementation: Acute Care (cont'd) •

Maintenance and promotion of lung expansion – Positioning – Incentive spirometry – Chest tubes Mosby items and derived items © 2005 by Mosby, Inc.

Airway Maintenance •

Mobilization of pulmonary secretions: – – –

Humidification Nebulization Chest Physiotherapy- contraindications Box 39-12 • • •

Postural drainage – ex. Cystic Fibrosis Chest percussion Vibration Mosby items and derived items © 2005 by Mosby, Inc.

Implementation: Acute Care (cont'd) • Maintenance and promotion of oxygenation: oxygen therapy – – – –

Safety precautions Oxygen supply Methods of oxygen delivery Home oxygen therapy Mosby items and derived items © 2005 by Mosby, Inc.

Implementation: Acute Care (cont'd) •

Restoration of cardiopulmonary functioning—CPR

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Implementation: Restorative Care • • • •

Hydration Coughing techniques Respiratory muscle training Breathing exercises Mosby items and derived items © 2005 by Mosby, Inc.

Evaluation • •

Client care Client expectations

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