Oxygenation Chapter 32

Copyright © 2015 Wolters Kluwer • All Rights Reserved Oxygenation: The respiratory system delivers oxygen (the gaseous element required to release energy) to the bloodstream and removes excess carbon dioxide from the body Respiratory System Structures Fig. 32-1 Respiration Carbon dioxide (CO2) Ventilation Alveolar gas exchange Fig. 32.2 External respiration Oxygen transport and perfusion Partial pressure of oxygen (PaO2) Saturation of arterial blood (SaO2) Copyright © 2015 Wolters Kluwer • All Rights Reserved

Copyright © 2015 Wolters Kluwer • All Rights Reserved Circulation: Once bound to hemoglobin, the oxygen is delivered to the cells of the body for tissue perfusion by the process of circulation Structures Fig. 32.3 Cardiac cycle Conduction system Fig. 32.4 Atrioventricular node (AV) node Diastole Fig. 32.5 Aorta Fig. 32.6 Autoregulation Cellular Respiration Copyright © 2015 Wolters Kluwer • All Rights Reserved

Copyright © 2015 Wolters Kluwer • All Rights Reserved Assessment: Health History Common Respiratory Symptoms Wheezing Cough Dyspnea History of Respiratory Illness Cigarette Smoking Box 32.1 Substance Abuse and Exposures Pain Fatigue Treatment of symptoms Physical Assessment Box 32.2 and Box 32.3 Copyright © 2015 Wolters Kluwer • All Rights Reserved

Alterations in Respiratory Function: Conditions and illnesses that affect ventilation or oxygen transport cause alterations in respiratory function Hypoxia The PaO2 falls Hypoxemia tachypnea Pneumonia Table 32.1 Aspiration Inhalation Hematogenous spread Assessment and Care Guidelines 32.1 Oxygen Therapy Copyright © 2015 Wolters Kluwer • All Rights Reserved

Alterations in Respiratory Function: Airway Obstruction Complete or Partial Aspiration/Edema/CNS Depression/Allergic Reaction Chronic Obstructive Pulmonary Disease (COPD) Emphysema and Chronic Bronchitis Assessment and Care Guidelines 32.2 Asthma Bronchoconstriction Bronchospasm Assessment and Care Guidelines 32.3, Fig. 32.7 and 32.8, Box 32.4 Copyright © 2015 Wolters Kluwer • All Rights Reserved

Alterations in Respiratory Function: Nursing Diagnosis Table 32. 2 Care of the patient experiencing oxygenation issues need to be prioritized based upon: Airway Patency Breathing Circulation Copyright © 2015 Wolters Kluwer • All Rights Reserved

Copyright © 2015 Wolters Kluwer • All Rights Reserved Interventions: Interventions to promote airway clearance focus on clearing the airway secretions, relieving bronchial spasm, and, when necessary, using an artificial airway Promoting Airway Clearance Hypoxia Box 32.5 Positioning Orthopnea Fig. 32.9 Deep breathing and Coughing Box 32.6 Incentive Spirometer Box 32.7, Fig. 32.10 Copyright © 2015 Wolters Kluwer • All Rights Reserved

Copyright © 2015 Wolters Kluwer • All Rights Reserved Interventions: Monitor Hydration Chest Physiotherapy Chest Percussion and Vibration Box 32.8, Fig. 32.11 Postural Drainage Fig. 32.12 Medications Anti-Inflammatory Agents Corticosteroids Mast Cell Stabilizers Leukotriene receptor Antagonists Bronchodilators 2-Adrenergic agonists Anticholinergic agents Copyright © 2015 Wolters Kluwer • All Rights Reserved

Copyright © 2015 Wolters Kluwer • All Rights Reserved Interventions: Administering Oxygen Box 32.9 and 32.10, Fig. 32.12 Flow Meter Fig. 32.14 Methods of Delivery Fig. 32.15, Table 32.3, Skill 32.1 Low-Flow Systems Reservoir Systems Tracheostomy Fig. 32.16 Oxygen Toxicity Box 32.11 Adult Respiratory Distress Syndrome (ARDS) Manual Ventilation Ambu Bag Fig. 32.17 Mechanical Ventilation Fig. 32.18 Copyright © 2015 Wolters Kluwer • All Rights Reserved

Copyright © 2015 Wolters Kluwer • All Rights Reserved Interventions: An artificial airway is inserted to establish and maintain a patent airway Artificial Airways Oropharyngeal Table 32.4 Nasopharyngeal Fig. 32.20 Endotracheal Tube Fig. 32.21, 32.22 and 32.23, Box 32.21 Tracheostomy Tubes Fig. 32.24 - 32.27 Increased risk for Infection Skill 32.2 Copyright © 2015 Wolters Kluwer • All Rights Reserved

Promoting Airway Clearance: Administration of supplemental oxygen provides a sufficient concentration of inspired oxygen to permit full use of the oxygen-carrying capacity of the arterial blood to ensure adequate tissue perfusion Yankauer Fig. 32.28 Skill 32.3 Nasopharyngeal and Oropharyngeal Suctioning Box 32.13, Fig. 32.29, Table 32.5, Skill 32.4 Endotracheal Tube Suctioning Skill 32.5, Fig. 32.30 Tracheostomy Tube Suctioning Skill 32.5 Copyright © 2015 Wolters Kluwer • All Rights Reserved

Respiratory System: Question What is the function of the upper respiratory airway system when considering the air that is inhaled? Select all that apply. A. Warming B. Diffusing C. Filtering D. Humidifying E. Exchanging Copyright © 2015 Wolters Kluwer • All Rights Reserved

Respiratory System: Answer Answer(s):A, C, D Rationale: The upper airway warms, filters, and humidifies inhaled air and before it travels to the lower airway. Diffusion that involves the exchange of oxygen and carbon dioxide occurs in the lower respiratory system. Copyright © 2015 Wolters Kluwer • All Rights Reserved

Copyright © 2015 Wolters Kluwer • All Rights Reserved Assessment: Question What term is used to describe the state of a patient’s respiratory status when their ability to speak is impaired by ineffective breathing patterns? A. Atelectasis B. Bradypnea C. Crackles D. Dyspnea Copyright © 2015 Wolters Kluwer • All Rights Reserved

Copyright © 2015 Wolters Kluwer • All Rights Reserved Assessment: Answer Answer: D Rationale: Dyspnea is the presence of difficult breathing or shortness of breath. If the patient is experiencing dyspnea, he or she may be unable to speak or answer your questions or may need additional time to pause while speaking. Atelectasis is the collapse of some or all of the alveoli in the lungs. Bradypnea is the state of a slow respiratory rate. Crackles are adventitious lung sounds heard on auscultation of the chest, produced by air passing over retained airway secretions or the sudden opening of collapsed airways Copyright © 2015 Wolters Kluwer • All Rights Reserved

Copyright © 2015 Wolters Kluwer • All Rights Reserved Assessment: Question What will the nursing monitor regularly when a patient is receiving oxygen therapy? Select all that apply. A. Oxygen saturation (SaO2) levels B. Respiratory rate C. Cognitive function D. Vital signs E. Skin colour Copyright © 2015 Wolters Kluwer • All Rights Reserved

Copyright © 2015 Wolters Kluwer • All Rights Reserved Assessment: Answer Answer(s): A, B, D, E Rationale: When a patient is receiving oxygen therapy, regular monitoring of SaO2 levels, respiratory rate, vital signs, and assessment of the patient’s colour and indicators of respiratory effort are necessary. While cognitive function can be impaired when a patient is in need of supplemental oxygen, it is a function that is affected when the deficient of oxygen is very significant. Copyright © 2015 Wolters Kluwer • All Rights Reserved