1. JUDITH M. WILKINSON LESLIE S. TREAS KAREN BARNETT MABLE H. SMITH FUNDAMENTALS OF NURSING Copyright © 2016 F.A. Davis Company Chapter 36: Oxygenation

2. Copyright © 2016 F.A. Davis Company Oxygenation Oxygen Atomic number: 8 Atomic mass: 16

3. Copyright © 2016 F.A. Davis Company Pulmonary System Airways and lungs Ventilation – Movement of air into/out of the lungs Respiration – Exchange of oxygen/carbon dioxide – Alveolar capillary/capillary cell membrane

4. Copyright © 2016 F.A. Davis Company ClickerCheck Which diagnostic test/exam would best measure a client’s level of hypoxemia? a.Chest x-ray b.Pulse oximeter reading c.ABG d.Peak expiratory flow rate

5. Copyright © 2016 F.A. Davis Company ClickerCheck (cont’d) Correct answer: C The term “hypoxemia” means low blood oxygen level. Arterial blood gas sampling is the most direct way in which the level of oxygen in the blood can be measured.

6. Copyright © 2016 F.A. Davis Company Factors That Influence Pulmonary Function Life span and development (e.g., respiratory distress syndrome, upper respiratory infections [URIs], adolescent smoking, cardiac insufficiency) Environment (e.g., stress, allergies) Lifestyle (e.g., nutrition, exercise, substance abuse) Medications Smoking

7. Copyright © 2016 F.A. Davis Company Factors That Influence Pulmonary Function (cont’d) Pulmonary system abnormalities (structure, airway inflammation/obstruction, alveolar-capillary membrane disorder, atelectasis) Pulmonary circulation abnormalities Central nervous system abnormalities Neuromuscular abnormalities

8. Copyright © 2016 F.A. Davis Company Assessing Oxygenation Status Physical examination Breathing pattern Respiratory effort Pulse oximetry Using inspection, palpation, percussion, and auscultation

9. Copyright © 2016 F.A. Davis Company ClickerCheck The term “Kussmaul” refers to a high-pitched, harsh, crowing inspiratory sound that occurs due to partial obstruction of the larynx. a.True b.False

10. Copyright © 2016 F.A. Davis Company ClickerCheck (cont’d) Correct answer: B The term for this sound of respiratory distress is “stridor.”

11. Copyright © 2016 F.A. Davis Company Assessing Oxygenation Status Diagnostic testing Arterial blood gases (ABGs) – PO 2, PCO 2 Peak flow monitoring

12. Copyright © 2016 F.A. Davis Company Interventions for Optimal Oxygenation Use of a mechanical ventilator Use of chest tube drainage systems Administering respiratory medications

13. Copyright © 2016 F.A. Davis Company Interventions for Optimal Oxygenation (cont’d) Promoting respiratory function Immunizations/prevent URIs Positioning: maximum lung excursion Incentive spirometry Aspiration precautions

14. Copyright © 2016 F.A. Davis Company Interventions for Optimal Oxygenation (cont’d) Mobilizing secretions – Deep breathing and coughing – Hydration – Chest physiotherapy Oxygen therapy – Cannula – Mask – Transtracheal catheter

15. Copyright © 2016 F.A. Davis Company Interventions for Optimal Oxygenation (cont’d) Using artificial airways – Oropharyngeal – Nasopharyngeal – Endotracheal tubes – Tracheostomy tube Artificial airway patency – Suctioning

16. Copyright © 2016 F.A. Davis Company ClickerCheck In caring for a client with a tracheostomy, the nurse would give priority to the nursing diagnosis of a.Risk for ineffective airway clearance b.Anxiety related to suctioning c.Social isolation related to altered body image d.Impaired tissue integrity

17. Copyright © 2016 F.A. Davis Company ClickerCheck (cont’d) Correct answer: A While other diagnoses may be applicable, maintaining a patent airway by tending to excessive secretions is a priority.

18. Copyright © 2016 F.A. Davis Company Think Like a Nurse Ms. Saunders (Meet Your Patients) has adequate blood oxygen levels based on a pulse oximeter reading of 98%. Can you conclude that organ and tissue oxygenation are adequate? Explain your thinking.