Oxygenation

dyspnea

difficulty or labored breathing

apnea

absence of breathing

tachypnea

rapid respirations, greater than 25 breaths per minute

bradypnea

slow respirations, less than 10 breaths per minute

orthopnea

difficulty breathing in all positions except sitting or standing

ventilation

the exchange of gases between the lungs and air

perfusion

the passage of fluid through the circulatory system or the lymphatic system to an organ or tissue

diffusion

movement of molecules through a semipermeable membrane from an area of high concentration to an area of low concentration

work of breathing

the amount of energy required to overcome resistive and elastic elements of the respiratory system and move gas into and out of th elungs during breathing

inspiration

the drawing in of breath

exhalation

the letting out of breath

respiration

the exchange of oxygen and carbon dioxide during cellular metabolism

what does oxygen transport consist of?

the cardiovascular system and the lungs

what does oxygen delivery depend on?

ventilation, perfusion, and oxygen carrying capacity

three things that influence the capacity of the blood to carry oxygen

1. the amt of dissolved oxygen in the plasma 2. the amt of hemoglobin 3. the ability of hemoglobin to bind to oxygen

the heart is, how many chambers

hollow, cone-shaped, atria (top), ventricles (bottom)

3 layers of the heart

1. epicardium (outer protective)

2. myocardium (middle muscular)

3. endocardium (inner)

right ventricle pumps to

pulmonary

left ventricle pumps to

circulatory

where does cardiac stimulation begin

SA node

cardiac output amount

4-8 liters/minute

preload

the amount of blood left in ventricles after diastole

afterload

the resistance to the ejection of blood from the left ventricle

cardiac output equation

heart rate x stroke volume

normal cardiac stroke volume range

50-75 mL per contraction

conduction through the heart

SA node, AV node, L&R bundle branches, and Purkinje fibers

P wave indicates

atrial depolarization leading to atrial contraction

PR segment indicates

delay created by the AV node so atria have time to dump blood into ventricles

PR interval indicates

time it takes for electrical signal to travel from atria to AV node, can also indicate a heart block

QRS complex indicates

ventricular depolarization leading to contraction and atrial repolarization

ST segment indicates

completion of ventricular depolarization and beginning of ventricular repolarization

T wave indicates

beginning of ventricular repolarization and ventricular relaxation

QT interval

time it takes for electrical signals to cause ventricles to contract and relax

what are some CV alterations?

interrupted electrical impulses, decreased blood flow, electrolyte disturbances, cardiac failure

what problems can CV alterations cause?

decreased oxygen carrying capacity, hypovolemia, decreased inspired oxygen concentration, increased metabolic rate

what can influence oxygenation?

age/development, lifestyle (stress, nutrition, exercise, smoking/substance abuse, hydration), environmental (pollution, industry)

patients with chronic lung diseases need more

nutrtion

physiological factors affecting oxygenation

decreased oxygen carrying capacity (anemia, blood loss, CO2 toxicity), hypovolemia, decreased inspired oxygen concentration, increased metabolic rate, condition affecting chest wall movement

conditions affecting chest wall movement

pregnancy, obesity, musculoskeletal abnormalities (kyphosis, scoliosis), trauma, neuromuscular diseases, CNS alterations, medications (anesthesia), chronic lung diseases

resppiratory alterations

COPD, asthma, pneumonia, atelectasis, respiratory failure

chronic bronchitis

blue bloater, trouble getting air in, cyanosis, digital clubbing, hypercapnia

emphysema

pink puffer, trouble getting air out, barrel chest, pursed lips, thin appearance

what is asthma?

chronic lung disease that causes narrowing and inflammation of airways, bronchi and bronchioles are chronica,,y inflammed

asthma is caused by

triggers

what are nursing onterventions ot asthma

decrease inflammation, ex. albuterol and steroids

asthma occurs more in

males

what does peak flow meter measure

Highest airflow during a forced expiration

atelectasis

collapse of alveoli

signs and symptoms of atelectasis

dyspnea, tachypnea, decreased breath sounds, asymmetrical chest movement, tachycardia, restlessness

pneumonia symptoms

headache, fever, sputum, chest pain/tightness, pale. coughing

how do we diagnose pneumonia

chest x-ray, blood work

what is respiratory failure?

when the body is no longer able to maintain sufficient oxygen to maintain perfusion to tissues. due to disease or injury

respiratory failure can be ______ or _____

rapid, chronic

signs ans symptoms of low oxygen

difficulty with ADLs, SOB, DOE, drowsiness, cyanosis, tachypnea

signs and symptoms of high carbon dioxide

blurred vision, confusion, disorientation, headache, tachypnea, lethargy

hypoventilation

slow, shallow breathing, causes carbon dioxide buildup in the blood and acidosis

hyperventilation

rapid, deep breathing, cause oxygen CO2 to be blown off, alkalosis

hypoxia

inadequate tissue oxygenation at cellular level

causes of hypoxia

1. decreased hgb 2. decreased concentration of inspires O2 3. inability of tissues to extract O2 from blood 4. pneumonia or pulmonary edema 5. poor tissue perfusion (shock) 6. impaired ventilation (broke ribs or trauma)

signs and symptoms of hypoxia

resletness, inability to concentrate, decreased LOC, dizziness, behavioral changes, cyanosis

what history should we get on the patient for oxygenation?

pain, smoking, dyspnea, cough, wheezing, diet, fatigue, environmental exposure, past respiratory or cardiac problems

assessment for oxygenation

pulse oximetry (95-100%)

critical pulse ox

less than 75%

when is there an exception with normal pulse ox range

patients with COPD might have a normal 88-92 range

oxygenation assesment

inspection, palpation, percussion, auscultation

diagnostic exams r/t oxygenation

chest x ray, TB skin test, ECG

oxygenation blood tests

lipids/cholesterol, CBC 9hct and hgb), basal metabolic rate, ABGs

what are sputum cultures used for?

used to determine pathogenic bacteria in patient with a respiratory infection like pneumonia

what is the first step of analysis of sputum

gram staining

when is the best time to stain sputum and why

early morning, more concentrated and plentiful

what are some common nursing diagnosis/problems related to decreased oxygenation?

impaired gas exchange, impaired breathing, and impaired cardiac output

impaired gas exchange supporting data

destruction of alveolar walls, SpO2 of 90%, patient complains of difficulty breathing

impaired breathing supporting data

ineffective movement of air into and out of the lungs, difficulty breathing with activity and rest, use of pursed lip breathing

impaired cardiac output supporting data

decreased pumping ability of the heart and decreased activity tolerance

what are some tips for patent planning with oxygenation issues

each patient plan should be individualized, set priorities, and use team work collaboration

example of setting patient priorities

patient airway is higher an increasing activity

what are examples of teamwork collaboration

cardiology, respiratory therapy, physical therapy, nutrition, lab, home health

what are some examples of goal statements for patients with decreased oxygenation

patient will maintain SpO2 at 92% or greater by then end of the shift, patient will demonstrate a breathing cycle that returns to a normal pattern (define patient's normal) after aerosol treatment, patient will be able to walk to the bathroom without shortness of breath within 48 hours

what are some examples of restorative care for oxygenation

muscle training, chest physiotherapy, breathing exercises

examples of chest physiotherapy

postural drainage, coughing, deep breathing, incentive spirometry

examples of breathing exercises

pursed lip breathing, diaphragmatic breathing

oxygenation health promotion

vaccination, lifestyle, environment, dyspnea management, airway maintenance, hydration, humidification, nebulizer, cough and dep breathing, chest physiotherapy

ways to maintain and promot lung expansion

ambulation, positioning, and incentive spirometry

nasal cannula flow (L/min) and concentration (%)

2-6. 25-40

simple facemask flow (L/min) and concentration (%)

6-10, 35-50

ventura mask flow (L/min) and concentration (%)

3-10, 24-60

non rebreather flow (L/min) and concentration (%)

10-15, 80-90

high flow nasal cannula flow (L/min) and concentration (%)

30-60, 100

evaulation of goal statement helps the nurse

modify the plan of care

not achieving the desired outcome, prompts the nurse to

modify the care plan

patients with cardiopulmonary disorders often need

frequent reevaluation and modification of interventuons ot meet basic oxygen needs