Chapter 21 Oxygenation

Oxygenation Oxygen: measures approximately 21% in the Earth’s atmosphere Each cell of the human body uses oxygen to metabolize nutrients and produce energy Without oxygen, cell death occurs rapidly

Anatomy and Physiology of Breathing Inspiration and expiration Ventilation: movement of air in and out of lungs; facilitates respiration Respiration: exchange of oxygen and carbon dioxide

Anatomy and Physiology of Breathing (cont’d) External and internal respiration External respiration takes place at most distal point in airway: between the alveolar-capillary membranes Internal respiration occurs at the cellular level between hemoglobin and body cells

Assessing Oxygenation Physical assessment Monitoring the client’s respiratory rate Observing breathing pattern and effort Checking chest symmetry Auscultating lung sounds

Assessing Oxygenation (cont’d) Arterial blood gases measure: Partial pressure of oxygen dissolved in plasma Percentage of hemoglobin saturated with oxygen The pH of blood

Arterial Blood Gases

Assessing Oxygenation (cont’d) Pulse oximetry Composed of a sensor and a microprocessor Noninvasive, transcutaneous technique for periodically or continuously monitoring the oxygen saturation of blood

Promoting Oxygenation Positioning: Fowler’s position Breathing techniques Deep breathing Incentive spirometry Pursed-lip breathing Diaphragmatic breathing Nasal strips

Diaphragmatic Breathing

Oxygen Therapy Oxygen sources Wall outlet Portable tanks Liquid oxygen unit Oxygen concentrator Equipment used in oxygen administration

Oxygen Therapy (cont’d) Equipment used in oxygen administration Flowmeter Oxygen analyzer Humidifier Common delivery devices Nasal cannula

Oxygen Therapy (cont’d) Common delivery devices (cont’d) Masks Simple mask Partial rebreather mask Non-rebreather mask Venturi mask

Oxygen Therapy (cont’d) Common delivery devices (cont’d) Face tent Tracheostomy collar T-piece Additional delivery devices Nasal catheter

Comparison of Oxygen Delivery Devices (Refer to Table 21-4 in the textbook.)

Oxygen Therapy (cont’d) Additional delivery devices (cont’d) Oxygen tent and CPAP mask Transtracheal oxygen Oxygen hazards Fire potential Oxygen toxicity

Administering Oxygen Safely

Question Which of the following is a common delivery device for oxygen? a. Flowmeter b. Nasal cannula c. Oxygen analyzer d. Humidifier

Answer b. Nasal cannula Nasal cannula is a common delivery device. Flowmeter, oxygen analyzer, and humidifier are equipment used in oxygen administration.

Related Oxygenation Techniques Water-seal chest tube drainage A technique for evacuating air or blood from the pleural cavity Hyperbaric oxygen therapy Delivery of 100% oxygen at 3 times the normal atmospheric pressure within an airtight chamber

Nursing Implications Nursing diagnoses: hypoxemia or hypoxia Ineffective breathing pattern Impaired gas exchange Anxiety Risk for injury (related to oxygen hazards)

Ineffective Breathing Pattern (Refer to Nursing Care Plan 21-1in the textbook.)

General Gerontologic Considerations Reduced gas exchange and efficiency in ventilation; major age-related changes occur in the respiratory system Respiratory muscles become weaker and the chest wall becomes stiffer as a result of calcification of the intercostal cartilage

General Gerontologic Considerations (cont’d) Diminished cough and gag reflexes, increased use of accessory muscles for breathing, increased mouth breathing, snoring Inactive, debilitated, or chronically ill clients or smokers are at a higher risk for respiratory infections and compromised respiratory function