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

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

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

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

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.

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

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

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

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

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

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

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

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

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

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

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

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.

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.