1. Oxygenation Chapter 32

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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)
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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
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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
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5. 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
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6. 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 and 32.8,
Box 32.4
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7. 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
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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
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Interventions:
Monitor Hydration
Chest Physiotherapy
Chest Percussion and Vibration Box 32.8, Fig
Postural Drainage Fig
Medications
Anti-Inflammatory Agents
Corticosteroids
Mast Cell Stabilizers
Leukotriene receptor Antagonists
Bronchodilators
2-Adrenergic agonists
Anticholinergic agents
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Interventions:
Administering Oxygen Box 32.9 and 32.10, Fig
Flow Meter Fig
Methods of Delivery Fig , Table 32.3, Skill 32.1
Low-Flow Systems
Reservoir Systems
Tracheostomy Fig
Oxygen Toxicity Box 32.11
Adult Respiratory Distress Syndrome (ARDS)
Manual Ventilation
Ambu Bag Fig
Mechanical Ventilation Fig
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Interventions:
An artificial airway is inserted to establish and maintain a patent airway
Artificial Airways
Oropharyngeal Table 32.4
Nasopharyngeal Fig
Endotracheal Tube Fig , and 32.23,
Box 32.21
Tracheostomy Tubes Fig
Increased risk for Infection Skill 32.2
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12. 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 Skill 32.3
Nasopharyngeal and Oropharyngeal Suctioning
Box 32.13, Fig , Table 32.5, Skill 32.4
Endotracheal Tube Suctioning Skill 32.5, Fig
Tracheostomy Tube Suctioning Skill 32.5
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13. 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
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14. 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.
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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
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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
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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
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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.
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