Oxygenation. Chapter 45. Re'eda Almashagba 1

Transcription

1 Oxygenation Chapter 45 Re'eda Almashagba 1

2 Respiratory Physiology Structure and function Breathing: inspiration, expiration Lung volumes and capacities Pulmonary circulation Respiratory gas exchange: oxygen, carbon dioxide Regulation of respiration Re'eda Almashagba 2

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4 Measures That Promotes Adequate Respiratory Functions: 1. Adequate OXYGEN supply from the environment. 2. Deep breathing and coughing exercises. 3. Proper positioning 4. Patent airway (FEMS) 5. Adequate hydration 6. Avoid pollutants, alcohol and smoking. Re'eda Almashagba 4

5 Oxygen is a clear, odorless gas that constitute approximately 21% of the air we breath Respiration is the process of gas exchange between the individual and the environment Process of ventilation involve two component pulmonary ventilation or breathing : the movement of the air between the atmosphere and the alveoli in the lung diffusion of the oxygen and carbon dioxide between the alveoli and the pulmonary capillaries Re'eda Almashagba 5

6 The function of the respiratory system is gas exchange Pulmonary ventilation: inspiration (inhalation) when air flows into the lung and expiration (exhalation) as ear move out of the lung Adequate ventilation depends on several factors clear air way an intact central nervous system and respiratory system an intact thoracic cavity capable of expanding and contracting adequate pulmonary compliance and recoil Re'eda Almashagba 6

7 Tidal volume: the amount of air expired and inspired each breath, it is about 500 ml of are in adult. Surfactant: a lipoprotein produced by specialized alveolar cell, reducing the service tension of alveolar fluid.without surfactant the lung collapse. Alveolar gas exchange: exchange between oxygen and carbon dioxide Re'eda Almashagba 7

8 Transport of oxygen and carbon dioxide: Normally most of the oxygen (97%) combined loosely with hemoglobin and produce oxyhemoglobin Factor affecting the rate of oxygen transport from the lung to the tissue cardiac output number of erythrocyte and blood Hematocrit exercise Re'eda Almashagba 8

9 Respiratory regulation: Respiratory regulation include both neural and chemical control to maintain the correct concentration of oxygen A chemosensitive center in the medullaoblongada is highly responsive to increasing in blood CO2 or hydrogen ion concentration Re'eda Almashagba 9

10 Factor affecting respiratory function Age (Developmental Factors) Lifestyle (Nutrition, Exercise, Smoking, Substance abuse, Stress) Environment (Occupation, air pollutions ) health status medication Re'eda Almashagba 10

11 Alteration in respiratory function: Respiratory function can be altered by condition that affects: The movement of air into or out the lung. The diffusion of oxygen and carbon dioxide between the alveoli and the pulmonary capillaries. The transport of oxygen and carbon dioxide via the blood to and from the tissue cell. Re'eda Almashagba 11

12 The major alterations in respiration are: 1. Hypoxia: is a condition of insufficient oxygen any where in the body, from inspired gas to the tissue Hypercapnia: accumulation of carbon dioxide in the blood Hypoxemia: insufficient oxygen in blood 2. Altered breathing pattern: Tacypnea, bradypnea apnea Orthpnia (is the inability to breathe except in an upright or standing position) Dyspnia (difficult or uncomforted berthing). 3. Obstructed airway Re'eda Almashagba 12

13 Nursing History Fatigue Dyspnea Cough Wheezing Pain Environmental or geographical exposures Re'eda Almashagba 13

14 Nursing History (cont'd) Respiratory infections Health risks Medications Re'eda Almashagba 14

15 Assessment of Oxygenation Physical examination Inspection Palpation Percussion Auscultation Re'eda Almashagba 15

16 Clubbing of Fingers Re'eda Almashagba 16

17 Assessment of Oxygenation (cont'd) Diagnostic tests: blood studies Complete blood count Cardiac enzymes Cardiac troponin I Serum electrolytes Cholesterol Re'eda Almashagba 17

18 Assessment of Oxygenation (cont'd) Diagnostic tests: cardiac function Electrocardiogram (ECG) Holter monitor Exercise stress test Thallium stress test Electrophysiological study (EPS) Echocardiography Scintigraphy Cardiac catheterization Re'eda Almashagba 18

19 Assessment of Oxygenation (cont'd) Diagnostic tests: ventilation studies Pulmonary function Peak expiratory flow rate (PEFR) Arterial blood gases Oximetry Chest x-ray Bronchoscopy Lung scan Re'eda Almashagba 19

20 Assessment of Oxygenation (cont'd) Diagnostic tests: ventilation studies (cont'd) Thoracentesis Throat cultures Sputum specimens Re'eda Almashagba 20

21 Nursing Diagnoses Ineffective airway clearance Ineffective breathing pattern Decreased cardiac output Impaired gas exchange Risk for infection Ineffective tissue perfusion Impaired spontaneous ventilation Re'eda Almashagba 21

22 Planning Goals and outcomes Client s lungs are clear on auscultation Client coughs productively Setting priorities Continuity of care Re'eda Almashagba 22

23 Implementation: Body weight, Diet, Exercise, Stress reduction, Occupational safety, Smokefree, Regular physical examinations Dyspnea management Airway maintenance Mobilization of secretions Suctioning Artificial airways Re'eda Almashagba 23

24 Implementation: Maintenance and promotion of lung expansion Positioning Incentive spirometry Chest tubes Hydration Coughing techniques Respiratory muscle training Breathing exercises Re'eda Almashagba 24

25 9. Incentive Spirometry - done to enhance deep inspiration Re'eda Almashagba 25

26 Evaluation Client care Client expectations Re'eda Almashagba 26

27 OXYGEN SYSTEMS: 1. Low-flow Administration Devices: a. Nasal Cannula (24-45% at 2-6LPM) b. Simple Face Mask (40-60% at 5-8LPM) c. Partial Rebreathing Mask (60-90% at 6-10LPM) d. Non-rebreathing Mask (95-100% at 6-15LPM) e. Oxygen Tent Re'eda Almashagba 27

28 OXYGEN SYSTEMS: 2. High flow Administration Devices a. Venturi Mask b. Oxygen Hood c. Incubator / Isolette Re'eda Almashagba 28

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