oxygenation - 2012

8/2/2019 Oxygenation - 2012

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Ventilation Movement of air into and out of the lungs

Delivery of fresh air to the lungs aveoli

Regulated by the medulla (respiratory control center)


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Alveolar Gas Exchange

- Oxygen uptake (external respiration) is the

exchange of oxygen from the alveolar space into

the pulmonary capillary blood.

- Carbon dioxide diffuses from the blood to thealveolar space.

Cellular Respiration (internal respiration)

- Oxygen diffuses from the blood to the tissues

- CO2 diffuses moves from the tissues to the blood

- The blood is then reoxygenated.


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Oxygen transport and delivery

Oxygen transport in the blood

PaO2- O2 dissolved in the plasma, normal PaO2 of arterial

blood is 80-100 mmHg

SaO2- amount of O2 bound to the hgb. Also called O2

saturation (92% to 100%)

O2 is delivered to the cells by process of circulation- the

heart pumps oxygenated blood to the cells


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Age Environmental and lifestyle factors

Disease Processes

Obstructive pulmonary disease

Restrictive pulmonary disease: pneumonia, pulmonary fibrosis(scarring), traumatic injury to the thorax.

Diffusion defects: decrease in the efficiency of gas diffusion fromthe alveolar space into the pulmonary capillary blood.

Ventilation-perfusion mismatching

Atherosclerosis Heart Failure

Anemia Alterations in oxygen uptake (cyanide poisoning andsevere sepsis)


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Health History

The health history should begin with a thoroughexploration of the presenting problem; ask howlong has it been present and if it has gotten worse

Explore the medical history, impact of illness onactivities of daily living, clients knowledge leveland coping abilities

Physical Examination

General observation of clients efforts at ventilation Count respiratory rate, note the rhythm

Signs of hypoxia - cyanosis, clubbing of fingers

Adventitious breath sounds - crackles, rhonchi,wheezes, pleural friction rub, stridor


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Mental status changes are often the first signs of respiratoryproblems and may include restlessness and irritability.

Cyanosis is a late sign of hypoxia. Central cyanosis is the

most serious finding because it indicates hypoxemia

Central cyanosis is observed in the tongue, soft palate, and

conjunctiva of the eye, where blood flow is high


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Diagnostic and Laboratory Data

Pulse oximetry

Arterial blood gases (ABGs)

Lactic acid, H&H Sputum collection

Ventilatory function tests

Chest x-ray

Computerized tomography, MRI

Bronchoscopy, thoracentesis

Ekg, echo, stress test


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Primary Nursing Diagnoses

Ineffective Airway Clearance

Ineffective Breathing Patterns

Impaired Gas Exchange

Decreased Cardiac Output Altered Tissue Perfusion

Secondary Nursing Diagnoses Knowledge Deficit

Activity Intolerance Sleep Pattern Disturbance

Altered Nutrition

Pain

Anxiety


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The goals should be individualized to reflect the

clients capabilities and limitations.

Outcomes may be based on physiological

parameters such as respiratory rate or arterialblood gas values

The outcomes should be based upon the

assessment findings that led to the nursing

diagnoses at hand


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Interventions to promote airway clearance

Teach effective coughing

Initiate postural drainage and chest physiotherapy

Monitor hydration

Administer medications

Monitor environmental and lifestyle conditions

Suction the airway

Teach controlled breathing exercises


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Interventions to improve O2 uptake and delivery

Administer oxygen

Administer blood components

Interventions to increase cardiac output and tissueperfusion

Manage fluid balance

Suggest activity restrictions and assistance with

activities of daily living Position client properly

Administer medications


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The nurse caring for theclient with a nasal cannula

should plan to assess the

clients nares and superior

surface of both ears for skin

breakdown every 6 hours.


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Restoration of cardiopulmonary

functioning- CPR (remember

ABC!!)


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Body weight

Diet

Exercise

Stress reduction

Occupational safety

Smoke-free

Regular physical exams

Vaccinations/immunizations Influenza

pneumonia


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Hydration

Coughing techniques

Respiratory muscle training

Breathing exercises


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In many instances, the evaluation of the success of

the specific interventions will be based on the

degree to which the client is or can be returned to a

satisfactory state of respiratory function

oxygenation - 2012

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