Oxygenation

WOB

work of breathing,

-effort required to expand & contract the lungs

-inspiration & expiration

-surfactant

-atelectasis

-compliance & airway resistance

Ventilation

the process of moving gases into and out of the lungs

Diffusion

exchange of respiratory gases in the alveoli and capillaries

perfusion

the ability of the cardiovascular system to pump oxygenated blood to the tissues and return deoxygenated blood to the lungs.

transport

combined with ventilation & perfusion, the ability of hemoglobin to carry o2

Neural regulation

-CNS controls the RR, depth & rhythm

-Cerebral cortex regulates the voluntary control of respiration

Chemical regulation

-Normal lung function

-changes in co2, o2, pH

COPD

-normally have increased levels of co2

-normal o2 saturation levels (between 88-92%)

-work closely w a respiratory therapist

Physiological factors affecting oxygenation

-decreased oxygen-carrying capacity

-Hypovolemia

-Decreased inspired oxygen concentration

-increased metabolic rate

conditions affecting chest wall movement

pregnancy, obesity, trauma, neuro, musculoskeletal abnormalities, CNS alterations

Hypoventilation

Alveolar ventilation inadequate to meet the body’s o2 demand or to eliminate sufficient co2

Hyperventilation

lungs remove co2 faster than it is produced by cellular metabolism

hypoxia

inedaquate tissues oxygenation at cellular level

hypoxemia

deficiency of oxygen in the blood at the cellular level

disturbances in conduction

electrical impulses that do not originate from the SA node

impaired valvular function

acquired or congenital disorder of cardiac valve that causes hardening or impaired closure

altered cardiac output

failure of the myocardium to eject sufficient volume to the systemic and pulmonary circulation

myocardial ischemia

results when supply of blood to the myocardium from the coronary arteries is insufficient to meet myocardial demands

Factors that influence oxygenation

age, workplace, nutrition, exercise, stress, smoking, substance abuse

Hypoxia - early signs (RAT)

-restlessness

-apprehension

-pallor

-tachypnea

-tachycardia

-hypertension

-use of accessory muscles

hypoxia - late signs (BEDC)

-severe dyspnea

-confusion & stupor

-cyanosis (skin & mucous membranes)

-bradypnea

-bradycardia

-hypotension

-cardiac arrhythmias

Nursing diagnoses

impaired gas exchange, ineffective breathing pattern, ineffective airway clearance

implementation to help pt expand their lungs

-ambulation

-coughing & deep-breathing excercises

-positioning in bed

-incentive spirometry

incentive spirometry

-prevents or treats atelectasis

-encourages voluntary deep breathing- mobilizes secretions

-5-10 times per hour while awake

airway maintenance

oral airway, endotracheal tube, tracheostomy tube

care for pt with artificial airways

oral care !!!!

FiO2

inspired oxygen

room air FiO2

0.21 = 21%

PaO2

blood arterial oxygen gas (from artery) = 80-100 mm Hg

SpO2

O2 saturation on pulse oximeter (>=95%)

COPD patients = 88%-92% expected findings

Oxygen therapy

to prevent or relieve hypoxia

supply of oxygen

tanks or wall-piped system

methods of oxygen delivery

-nasal cannula (1-6Liters/min 24-44% o2)

room air is 21% O2

1L/min is 24% (each additional Liter adds 4%, 2Liters/min O2= 28%

advantage -

-safe,easily tolerated

-does not impede eating / talking

Disadvantages

-can dislodge easily

-may cause skin breakdown (check ears!)

mouth breathing may affect FiO2

-high-flow nasal cannula

-For people with high O2 demand

-20L/min-60L/min

-helpful when people on mask need to eat or mask is uncomfortable

-not same thing as a low flow nasal cannula

-different, special tubing

-special humidification device, warmed air is important

-oxygen masks

Simple = 5-12L/min (35-50%)

Venturi = 4-12L/min (24-50%)

Partial rebreather = 6-11L/min (60-75%)

Non-rebreather = 10-15L/min (80-95%)