funds ch. 40 oxygenation

Perfusion

oxygenated capillary blood passing through the bodies tissues

what affects perfusion

a person’s activity level

muscle of respirations

diaphragm
intercostals
accessory muscles - sternocleidomastoids, trapezius, scalenes 

three primary alterations in respiratory function

hyperventilation
hypoventilation
hypoxia

Hypercapnia

elevated PaCO2 (present in hypoventilation)

hypoxemia

low oxygen in the blood

causes of hypoventilation

narcotic OD
brainstem injury
chest well trauma
atelectasis
immobility

hypocapnia

lowered PaCO2 (present in hyperventilation)

causes of hyperventilation

acute anxiety, pain, fever, infection

s/s of hypoventilation

confusion, headache, drowsiness, dysrhythmias, coma

s/s of hyperventilation

lightheadedness, blurred vision, numbness, tingling hands/feet, tachycardia

causes of hypoxia

decreased Hgb
impaired ventilation
decreased inspired O2

s/s of hypoxia

pallor, cyanosis - last sign of hypoxia
dizziness
clubbing fingernails - chronic
nasal flaring 
accessory muscle use

types of cyanosis

central
peripheral

central cyanosis

tongue, soft palate, oral mucosa, conjunctiva

peripheral cyanosis

nail beds, extremities, earlobes

ECG nursing intervention

no caffeinated drinks or smoking for 24 hours

Angiogram nursing interventions (pre-test)

NPO after midnight
inspect allergy to iodine

Angiogram nursing (post-test)

assess pulses
assess catheter insertion for bleeding or bruising 
avoid strenuous activities for 3 days 
no baths until wound is healed 

Cheyne-Stokes breathing pattern

gradually becomes faster and deeper than normal, then goes slower (apnea in between)

Kussmaul breathing pattern

faster and deep respirations with pauses

Nursing implementations: acute care

hydration
cough and deep breathing exercises (DB/C)
chest physiotherapy
humidification
nebulizer 

chest physiotherapy postural drainage bed position

patient is in trendlenburg position

Inhaled medication

nebulizer
metered-dose inhaler
powder inhaler 

Bronchoscopy pre-test

NPO 6-8 hrs
remove dentures and oral prosethetics

Bronchoscopy post-test

sit or lie on side
NPO until gag reflex returns
have emergency resuscitation equipment on standby