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Stressors that Affect Oxygen Needs NUR101 FALL 2008 K. BURGER, MSEd, MSN, RN, CNE LECTURE #19 PPP by Sharon Niggemeier RN, MSN Revised October 2005 by.

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Presentation on theme: "Stressors that Affect Oxygen Needs NUR101 FALL 2008 K. BURGER, MSEd, MSN, RN, CNE LECTURE #19 PPP by Sharon Niggemeier RN, MSN Revised October 2005 by."— Presentation transcript:

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2 Stressors that Affect Oxygen Needs NUR101 FALL 2008 K. BURGER, MSEd, MSN, RN, CNE LECTURE #19 PPP by Sharon Niggemeier RN, MSN Revised October 2005 by K. Burger

3 Oxygenation Ventilation- air moves in & out of lungs External respiration-exchange of O2 & CO2 between alveoli and blood Gas Transport- blood transports O2 & CO2 to body cells Internal respiration- exchange of O2 & CO2 between blood and cells.

4 Checkpoint 1)T / F The pulmonary artery carries oxygenated blood away from the lungs. FALSE

5 Factors Affecting Respiration Integrity of the airway system (ventilation) Functioning cardiovascular system (perfusion) Functioning alveoli (diffusion) Functioning medulla & chemoreceptors

6 Pulmonary Ventilation Inspiration- air flows into lungs Expiration-gases flow out of lungs According to pressure gradiant – Boyle Intrapulmonic or intra-alveolar pressure- pressure within alveoli (fluctuates: Inspiration 759mm Hg Expiration 761mm Hg) Intrapleural pressure-pressure within the intrapleural space (always negative) (756 mm Hg) Note: Atmospheric Pressure = 760 mm Hg

7 Factors Affecting Ventilation Lung elasticity / compliance (ability to stretch and recoil) Airway obstruction Musculature condition Neurological controls

8 Checkpoint What is the name of the nerve that supplies the diaphragm? PHRENIC NERVE

9 Alveoli Gas Exchange Air reaches alveoli Oxygen from alveoli space moves into pulmonary capillary (oxygen uptake) via diffusion Oxygen diffuses across alveoli membranes moving from high concentration (alveoli) to lower concentration (pulmonary capillary)

10 Alveoli Gas Exchange Surfactant- secreted by alveoli cells, keeps surfaces moist and prevents atelectasis Atelectasis- incomplete lung expansion or collapse of alveoli Lung Compliance- elasticity of lung tissue and flexibility of rib cage Lung recoil- ability of lungs to recoil

11 Other Factors Affecting Gas Exchange Surface area Thickness of tissue Fick’s Law of Diffusion: Rate of a diffusion of gas is dependent on surface area and thickness of the membrane

12 Perfusion Transport of O2 & CO2 via blood to tissue Volume of blood flowing through lungs affects amount of oxygen and gases exchanged Adequate blood supply and cardiovascular functioning are needed Oxyhemoglobin HbO2 (or SaO2)

13 Checkpoint The majority of CARBON DIOXIDE molecules are transported in the blood as: ??? BICARBONATE HCO3

14 Perfusion Rate of O2 transport depends on: Cardiac output Activity level CO2 transport

15 Neurologic/Chemical Controls of Respiration Peripheral Chemoreceptors Central Chemoreceptors Medullary respiratory center Spinal cord Phrenic nerve Diaphragm

16 Factors Affecting Oxygenation Environment Emotions Exercise Health Age Life style Medications Respiratory History

17 Checkpoint What is the normal respiratory rate of a newborn? breaths/min

18 Assessing Respiratory Functioning Difficulty breathing? SOB? Chest pain? Coughing? Sputum production? Nocturnal diaphoresis Fatigue Sleep with 2 or more pillows?

19 Assessing Respiratory Functioning Respiratory Hx includes: Allergies Medications Medical Hx Smoking Lifestyle / Activity Level Stressors Recent exposures Developmental level

20 Assessing Respiratory Functioning Patient states difficulty breathing: you can assess by using PQRST P- provokes Q- quality R- region/radiation S- severity scale T- timing

21 Assessing Respiratory Functioning Respiratory Rate: Tachypnea R>24 Bradypnea R<10 Apnea Respiratory Depth: Deep - diaphragmatic Shallow

22 Assessing Respiratory Functioning Respiratory Rhythm: Regular – “even and symmetrical” Cheyne-Stokes Kussmauls Biot’s (ataxic – without rhythm) Apneustic breathing (gasping)

23 Assessing Respiratory Functioning Respiratory Quality: No difficulty- Eupneic/ Unlabored Dyspnea Orthopnea Retractions Use of accessory muscles Auscultation: Vesicular Bronchial Bronchovesicular

24 Assessing Respiratory Functioning Cough: Nonproductive Productive Sputum Hemoptysis Adventitious Sounds: Crackles: fine,medium,coarse Wheeze: sibilant,sonorous Stridor Stertor Pleural friction rub Breath sounds

25 Respiratory Assessment Review Oxygen delivery method correctly applied Obtain a pulse oximetry reading (norm is >95%) Check Vital Signs ?T ?P ?R Auscultate the pt’s lungs Note changes in skin and mucosa color Assess capillary refill

26 Checkpoint What are some other elements of a respiratory assessment not yet mentioned? Neurological state Color Nail clubbing AP vs Transverse Diameter Barrel Chest?

27 Assessing Respiratory Functioning Diagnostic tests: Sputum Nose/throat cultures CBC (complete blood count) ABG (arterial blood gases) CXR (chest x ray) PFT (pulmonary function tests) Pulse Oximetry Other: Scopes, CT, MRI, PET

28 Alterations:Respiratory Functioning Hypoxia Hypoxemia Hyperventilation Hypercapnia Obstructed airway Foreign body obstruction (FBO)

29 Nursing Interventions Independent Airway maintenance Positioning Deep breathing & coughing Pursed-lip breathing Abdominal/diaphragmatic breathing Hydration Teaching of health habits

30 Nursing Interventions Collaborative/Dependent Incentive spirometry Percussion/postural drainage Suctioning Oxygen therapy Medications

31 Nursing Interventions Collaborative/Dependent Oxygen Therapy Indications Sources- wall outlet or portable tank Monitor pulse oximetry Methods- cannula, mask, venturi mask, tent/isolette,BiPAP, CPAP

32 Administering Oxygen Therapy Flow rate Humidification Hydration Positioning Safety precautions Document MD order required

33 Oxygen Safety Precautions Signs: “No smoking. Oxygen in use.” Remove matches, lighters and cigarettes. Remove and store electrical equipment to avoid sparks. Ground electrical equipment. Avoid materials that generate static electricity Avoid use of volatile, flammable materials, such as alcohol. Know location & use of fire extinguishers & alarms.

34 Nursing Interventions Medications Nebulizer Tx Cough suppressants Mucolytic: expectorants Bronchodilators Corticosteroids

35 Documentation Routine Nurses Note Date Time LOC Rate Depth Rhythm Breath sounds (auscultated) Quality Color

36 Nursing Diagnosis Ineffective airway clearance Risk for aspiration Ineffective breathing pattern Impaired gas exchange Risk for suffocation Ineffective tissue perfusion; cardiopulmonary Impaired spontaneous ventilation Dysfunctional ventilatory weaning response

37 Checkpoint Select a priority nursing diagnosis for the following scenario: 88 y.o. female with pneumonia who has a non-productive cough, R= 24, course crackles upon auscultation. She is weak, undernourished and fatigued. Ineffective airway clearance

38 Checkpoint Select a priority nursing diagnosis for the following scenario: A patient with hx of emphysema with decreased PO2, increased CO2 levels who is dyspneic and restless. Impaired Gas Exchange

39 Checkpoint Select a priority nursing diagnosis for the following scenario: A patient admitted to the ER post MVA with notable blood loss, BP= 80/50, P=120, R=22 Ineffective Tissue Perfusion; Cardiopulmonary

40 Summary: Oxygenation Oxygenation based on ventilation/perfusion/diffusion of oxygen Various factors effect oxygenation Assessment includes respiratory Hx, clinical exam, diagnostic tests Interventions include airway maintenance /proper breathing/ oxygen therapy/meds


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