Oxygenation (Class 15)

True

True

True or False: If the heart fails, the lungs fail, and vice versa.

True

True or False: Respiration is the exchange of oxygen and carbon dioxide during cellular metabolism.

True

True or False: The airways of the lungs transfer oxygen from the atmosphere to the alveoli, where the oxygen is exchanged for CO2.

True

True or False: The diaphragm and external intercostal muscles contract to create a negative pleural pressure increasing the size of the thorax for inspiration.

Ventilation

Process of moving gases into and out of the lungs with air flowing in and out during inspiration and expiration.

Perfusion

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

Diffusion

Responsible for moving the respiratory gases from one area to another by the concentration gradient

Inspiration

An active process, stimulated by chemical receptors which monitor pH, PaCO2, and PaO2 in the blood.

Expiration

A passive process that depends on the elastic recoil properties of the lungs, requiring little or no muscle work.

Compliance

The ability of the lungs to distend or expand in response to increased interalveolar pressure.

Atelectasis

Collapse of the alveoli that prevents normal exchange of oxygen and carbon dioxide.

Surfactant

Chemical produced in the lungs to maintain the surface tension of the alveoli, keeps the lungs from collapsing.

Myocardial Pump

• Two atria

• Two ventricles

• As the myocardium stretches, the strength of the subsequent contraction increases (Starling’s Law)

Myocardial Blood Flow

• Unidirectional flow through four valves.

• Ensures forward flow

Coronary Artery Circulation

• Supply the myocardium with nutrients

• Removes waste

Systemic Circulation

• Arteries deliver nutrients and oxygen to tissues.

• Veins remove waste from tissues.

Blood Flow Regulation

• Cardiac output

• Stroke volume

• Preload

• Afterload

Cardiac Conduction

• Transmits electrical impulses.

• Generates impulses needed to initiate the electrical chain of events for a normal heartbeat.

Factors that Influence Adequate Circulation, Etc.

1. Physiological Factors

2. Developmental Factors

3. Lifestyle Factors

4. Environmental Factors

Factors Affecting Chest Wall Movement

• Pregnancy

• Musculoskeletal abnormalities

• Influences of chronic lung disease

• Obesity

• Trauma

• Neuromuscular diseases

• CNS alterations

Lifestyle Factors Affecting Oxygenation

• Nutrition

• Hydration

• Exercise

• Smoking

• Substance abuse

• Stress

Hypoventilation

Occurs when alveolar ventilation is inadequate t meet the oxygen demand of the body or to eliminate sufficient CO2. The body retains CO2.

Hyperventilation

A state of ventilation in which the lungs remove CO2 faster than it is produced by cellular metabolism.

Hypoxia

Inadequate tissue oxygenation at the cellular level, results from deficiency in oxygen delivery or oxygen use at the cellular level. Can lead to fatal dysrhythmias.

True

True or False: Restlessness and acrocyanosis are early warning signs of hypoxia.

Acrocyanosis

Peripheral cyanosis

Left Side Heart Failure

Decreased functioning of the left ventricle. Less blood is being ejected leading to decreased cardiac output and fluid backup in the lungs.

• Fatigue

• Dizziness

• Breathlessness

• Confusion

• Crackles over the lung bases

Right Side Heart Failure

Impaired function of the right ventricle. Usually results from pulmonary disease and long-term left-side failure. (A systemic backup)

Impaired Valvular Function

Congenital disorder of the cardiac valves of hardening or impaired closure of the valves.

Myocardial Ischemia

Supply of blood to the myocardium is insufficient to meet demands leading to angina or myocardial infarction.

Angina

Transient imbalance between myocardium oxygen supply and demand. Results in chest pain and tingling.

Assessment Questions

1. Describe the breathing problems you’re having.

2. Does chest pain occur while coughing?

3. How has your breathing changed?

4. How do your symptoms affect your daily activities, appetite, sleeping, etc.?

5. Describe the problem that you’re having with your heart.

Inspection Cues

• Thorax

• Breathing effort

• Skin color extremities

• Level of consciousness

• Breathing patterns

• Chest wall movements

• General appearance

• Circulation

• Skin color

• Extremities

• Chest wall movement

Palpation Locations

• Chest

• Feet

• Legs

• Pulse

Percussion

• Prescence of abnormal fluid or air

• Diaphragmatic excursion

Auscultation

Normal and abnormal heart/lung sounds

Orthopnea

Patient cannot lie flat, they can’t breathe.

Hemoptysis

Bloody sputum

Common Diagnostic Tests

• Arterial blood gases (ABGs)

• Complete blood count (CBC)

• Cardiac enzymes (CK-MB)

• Cardiac troponin

• Pulmonary function test (PFT)

• Peak expiratory flow rate (PEFR)

• Bronchoscopy

• Lung scan

Arterial Blood Gases (ABGs)

Provides important info for assessment of patient’s respiratory and metabolic acid/base balance and adequacy of oxygenation.

Values:

• pH: 7.35-7.45

• PCO2: 35-45 mmHg

• PO2: 80-100 mmHg

• HCO3: 21-28 mEq/L

• SaO2 Sat: 95-100%

Complete Blood Count (CBC)

Determines the number and type of red and white blood cells per cubic millimeters of blood. WBCs= Infection. RBCs= Anemia

Cardiac Enzymes (CK-MB)

Providers use cardiac enzymes, along with troponin, to diagnose acute myocardial infarctions. Greater than 4-6% is highly indicative of a myocardial infarction.

Cardiac Troponin

Plasma cardiac troponin T< 0.1 ng/mL- Value often remains elevated 10-14 days.

Plasma cardiac T< 0.03 ng/mL- Value elevates as early as three hours after myocardial injury.

Pulmonary Function Test (PFT)

Basic ventilation studies. Determines ability of the lungs to efficiently exchange oxygen and CO2. Used to differentiate pulmonary obstructive from restrictive disease.

Peak Expiratory Flow Rate (PEFR)

Reflects changes in large airway sizes; an excellent predictor of overall airway resistance in a patient with asthma. Daily measurement for early detection of asthma exacerbations. The point of highest flow during maximal expiration.

Bronchoscopy

Visual examination of the tracheobronchial tree through a narrow, flexible fiberoptic bronchoscope. Performed to obtain fluid, sputum, or biopsy samples; removes mucus plugs or foreign bodies. Normal= Normal airways without masses, foreign bodies, or pus.

Lung Scan

Nuclear scanning. Test used to identify abnormal masses, used in planning therapy and treatments. Also used to find a blood clot preventing normal perfusion or ventilation. Normal= Normal lung structure without masses.

Members of an Interdisciplinary Team For Oxygenation

• Family

• Physical therapists

• Nutritionists

• Community-based nurses

• Respiratory therapists

Health Promotion’s Role in Oxygen Maintenance

Maintaining a patient’s optimal level of health reduces the number and/or severity of respiratory symptoms.

Vaccinations for Health Promotion

• Influenza

• Pneumococcal

• COVID-19

Clients that Should Receive the Flu Vaccine

• Patients with chronic illnesses

• Annually for people 6 months+

• Infants

• Older adults

• Pregnant women

• Healthcare workers

Clients That Should Receive the Pneumococcal Vaccine

• Children <2 years of age

• Smokers

• Adults >65 years of age

• Women who plan to be pregnant (not pregnant women)

• Patients with certain conditions. Ex. Heart disease

Eliminating Risk Factors

• High cholesterol

• Inactivity

• Smoking

• Alcohol

• Inadequate

• Stress

• Hydration

Eating Right

• DASH diet

Regular Exercise

• At least 150 minutes of moderate activity per week.

• At least 2 days a week of muscle strength training.

Health Promotion for Oxygenation

• Vaccinations

• Healthy Lifestyle

  • Eliminating risk factors

  • Eating right

  • Regular exercise

• Environmental Pollutants

  • Secondhand smoke

  • Work chemicals

  • Pollutants

Nursing Interventions in the Acute Care Setting

• Airway management

• Mobilization of pulmonary secretions

• Hydration

• Humidification

• Nebulization

• Cough and deep breathing techniques

• Chest pathophysiology

Airway Management

Keeping the airway free from obstruction (Ex. Adequate Hydration) to prevent thick, tenacious secretions and proper coughing techniques.

Mobilization of Pulmonary Secretions

Repositioning and suctioning assist in achieving and maintaining a clear airway and help promote lung expansion/gas exchange.

Hydration

Keeps mucociliary clearance normal. Good fluid intake (unless contraindicated) is 1500-2500 mL per day.

Humidification

The process of adding water to gas to keep airways moist. Flows greater than 4L/min are needed for adults.

False

True or False: You can use clean water in humidification devices.

Nebulization

Adds moisture to inspired air by mixing particles of varying sizes with the air. Medications can be administered this way.

Cough and Depp Breathing Techniques

Deep inhalation increases the lung volume and airway diameter, allowing greater air movement. Different coughs can clear the airway.

Chest Physiotherapy

External chest wall manipulation using percussion, vibration, or high-frequency chest wall compression. Use in conjunction with postural drainage and can help mobilize pulmonary secretions in a select group of patients. Aggressive treatment.

Incentive Spirometer

• Promotes deep breathing to prevent or treat atelectasis.

• 5-10 breaths every hour during INHALATION while the patient is awake.

• Splint and pain medication before use helps those with abdominal or chest pain.

Positive Expiratory Pressure (PEP)

• On EXHALATION sends resistance and vibrations to the chest

• Loosens mucus making a cough more productive

• Acapella and Flutter are common brands

Artificial Airway

For patients with decreased level of consciousness or airway obstruction who need prolonged ventilatory support and aids in removal of tracheobronchial secretions and maintaining a patient’s airway.

Oral Airway

Used for patients with a decreased level of consciousness, airway obstruction, or who need prolonged ventilatory support. Does not go past they larynx.

Endotracheal and Tracheal Airways

Short-term use to ventilate, relieve upper airway obstruction, protect against aspiration, and clear secretions.

Tracheostomy

Long-term assistance, placed surgically directly into the trachea.

Noninvasive Positive Pressure Ventilation Options

• Continuous Positive Airway Pressure (CPAP)

• Bilevel Positive Airway Pressure (BiPAP)

CPAP and BiPAP

• Purpose is to maintain a positive airway pressure and improve alveolar ventilation without the need for an artificial airway.

• Goal: Improve gas exchange, improves sleep, enhances quality of life, reduction of morbidity, and improves physical function.

Oxygen Therapy Goal

Prevent or relieve hypoxia by delivering the lowest amount of oxygen possible to achieve adequate tissue oxygenation.

Nasal Cannula

• Delivers 1-6L/min at 24-44%

• Safe and simple

• Does not impede activities

True

True or False: Humification must be apply to oxygen of 4L/min or more.

Simple Face Mask

• Delivers 6-12 L/min at 35-50%

• Used for short term oxygen therapy

Partial and Nonrebreather Mask

• Most precise way to deliver oxygen

• 10-15 L/min at 60-90%.

• Has a reservoir bag that is capable of delivering high concentrations for a short time.

Venturi Mask

• 4-12 L/min at 24-50%

• Reserved for patients with CPOD who need low, constant oxygen concentration.

High Flow Nasal Cannula

• Up to 60 L/min at 21-100%

Safety Precautions for Oxygen Therapy at Home

• Notify the local fire department

• Check smoke detectors

• Do not adjust the gas yourself

• Keep oxygen 10 ft away from flames

• Store the canister upright and in a safe place (they can become projectiles if dropped)

• Make sure all electrical equipment works

• Check for adequate tubing and oxygen level before travel

• Post “no smoking signs” around property

FALSE

True or False: Oxygen is not flammable and patients can still smoke cigarettes around their oxygen therapy.

Cardiopulmonary Rehabilitation

Helps patients achieve and maintain an optimal level of health through controlled physical exercise, nutritional counseling, relaxation, and stress/management techniques, prescribed medications, and oxygen.

True

True or False: As physical reconditioning occurs, a patient’s complaints of dyspnea, chest pain, fatigue, and activity intolerance decrease