Nurs 215 Oxygenation

Oxygen saturation

oxygen bound to the hemoglobin, normal 95%-100%

Physiology of oxygenation

-oxygenated blood is directed into the capillaries and deoxygenated blood is returned to the lungs

-INHALE: diaghragm and intercostal muscles contract, negative pressure, thorax increases in size for inhalation

-EXHALE: diaghragm and intercostal muscles relax and move downward

-Surfactant: helps lubricate lungs, keeps alveoli from collapsing (reduces surface tension)

Ventilation

movement of air in/out of lungs

Respiration

exchange of O2 and CO2 (alveoli)

Pulmonary system organs

airways and lungs

Hypoxemia

low arterial blood oxygen levels

Hypoxia

inadequate oxygen to organs/tissues

HyperCarbia

excess CO2

HypoCarbia

low levels of CO2

Factors affecting oxygenation/pulmonary function

-development

-environment: occupational, allergies, altitude

-lifestyle/socioeconomics

-disease

Pulmonary circulation

-Blood returned to LT atrium by the pulmonary vein

-Blood moves to the mitral valve in LT ventricle

-Blood flows to aorta via aortic valve into systemic circulation

-Pulmonary vein returns oxygenated blood to LT atrium

-Oxygenated blood leaves the lungs through pulmonary veins, which return it to the LT heart, completing pulmonary cycle

-Blood enters the LT atrium, and is pumped thorugh bicuspid valve into LT ventricle

-Blood passes thorugh aortic valve to aorta and distributed via systemic circulation

Factors that affect ventilation

-Tachypnea

-Bradypnea

-Depth: even and symmetrical during lung expansion

-Lung compliance: ease during inhalation/echalation (response to increased pressure in alveoli)

-Lung elasticity

-Airway resistance: pressure that exists when the diameter of airway is narrowed

Respiration

-External: alveoli capillary gas exchange, O2 in pulmonary capillaries, CO2 out of blood into alveoli exhaled

-Internal: capillaries allow tissue gas exchange, O2 from blood into tissues

Pulmonary assessments

-sputum/skin tests

-pulse ox

-capnography: measures CO2 exhaled over time

-ABGs (PO2-PaCO2: 25-45 mm/Hg PO2: 80-100 mm/Hg pH: 7.35-7.45)

-peak flow monitoring: measures amount of forcible air exhaled (asthma/changes)

Incentive spirometer

-strengthens and expands lungs (MUST INHALE)

-used to exercise lungs, after surgery, or illness (helps prevent pneumonia by clearing mucus or secretions)

-10-15 times every hour, make reasonable goals, get it to 1000

Alterations in oxygenation

-below 95% health related (ex: pneumonia, lung disease, pulmonary edema, cardiac issues)

-S/S: decreased mental alertness, confusion

-COPD pts RETAIN CO2 and can lead them to being acidotic

Important vaccines for respiratory conditions

-COVID

-Influenze yearly

-Pneumococcal pneumonia

-RSV: adults 60+ is severe

-Tdap: tetanus, diphtheria, pertussis (whooping cough) every 10 years

-Zoster: shingles

Respiratory interventions

-meds

-ventilators cleaned every 4 hours/oxygen therapy

-prevent HAI

-immunizations

-lung exercises/incentive spirometer/deep breathing: every 1-2 hours

-prevent aspirations

-hydration

-chest physiotherapy

Early hypoxia (everything is fast)

-tachypnea/tachycardia/elevated BP

-restlessness

-pale

-accessory muscle usage, nasal flaring

Late hypoxia (everything slows down)

-bradypnea/bradycardia/hypotension

-stupor

-cyanotic

-cardiac dysrhythmias

Oxygen delivery for trach collar

during CPR put the bag on the trach collar

Oxygen masks

-Nasal cannula: 1-6 L/min ***HUMIDIFY FOR 4L/MIN OR MORE

-Simple face mask: 6-12 L/min

-Non-rebreather: 10-15 L/min (asthma)

-Venturi: 4-12 L/min (COPD, most precise)

-Aerosol (face tent/trach collar): minimum 10 L/min

Inhaler use

-remove cap, shake, prime

-for space put inhaler in rubber ring on the end of the spacer

-stand or sit up straight

-breathe out, empty lungs

-close lips around mouthpiece creating a seal

-breathe in, press down on top of canister, continue to slowly breathe 3-5 secs, take deep breath

-hold breath for 10 secs

-remove from mouth, exhale

-wait 1 min between puffs, repeat as needed

-for inhaled corticosteroid rinse mouth with water to prevent infection

Nursing diagnosis related to breathing

-Airway clearance impairment

-Breathing pattern impairment

-Gas exchange impairment

-Spontaneous ventilation impairment

-Ventilatory weaning response dysfunction

-Aspiration risk

Perfusion

flow of blood by the cardiopulmonary system into the alveolar capillaries, oxygenated blood is directed into the capillaries and deoxygenated blood is returned to the lungs

Alterations in function of oxygenation

-hypoxemia

-retractions: muscles are pulled inward and occur between the ribs when inspiration occurs

-intercostal retractions are a sign that the airway is blocked

-hypoxia

Lung compliance

point to which a lung expands in response to increased pressure within the alveoli

Airway resistance

pressure that exists when the diameter of the airway is narrowed

Compliance and resistance

increase the work of breathing resulting in accessory muscle use, an indication of respiratory distress

Tachypnea

-RR more than 20 bpm

-causes: physical activity, anxiety, pain, disease

-S/S: dizziness, tingling in hands

Bradypnea

-RR less than 12 bpm

-causes: disease, meds (opioids, sedatives)

-S/S: dizziness, fatigue, weakness, confusion, impaired coordination

Alterations in gas exchange

-hypoxemia (low ABG)

-hypoxia (low oxygen to organs/tissues)

-Hypercarbia/Hypercapnia (excess CO2 in blood)

-Hypocarbia/Hypocabnia (low CO2 in blood)

Atelectasis

lung collapse

Stridor

respiratory distress

Pulmonary artery

only artery without oxygen in the blood

Pulmonary semilunar valve

only vein with oxygen in the blood

Advantages to nasal cannula

-safe, simple, easy to apply, comfortable, well-tolerated

-client can eat, talk, and ambulate

Disadvantages to nasal cannula

-FiO2 varies with flow rate, and rate/depth of patients breathing

-extended use can cause skin breakdown and dry mucous membranes

-tubing easliy dislodged

Advantages of simple face mask

easy to apply, more comfortable than NC, simple delivery, provides humidified oxygenD

Disadvantages of simple face mask

-flow rates less than 6 L/min can result in rebreathing of CO2

-not good for anxiety/claustrophobia

-can’t eat, drink, talk

-moisture and pressure risk skin breakdown

-greater risk for aspiration

-MUST wear NC during meals

Advantages for non-rebreather

-delivers highest O2 concentration besides intubation

-one way valve allows the patient to inhale max O2 from resevoir bag

-2 exhalation ports have flaps that prevent room air from entering

Disadvantages to non-rebreather

-valve and flap must be intact and functional during each breath

-poorly tolerated

-can’t eat, drink, talk

-caution for risk of aspiration or airway obstruction

-hourly assessment of valve and flap

Advantages to venturi mask

-delivers most precise oxygen concentration with humidity added

-best for COPD patients

Disadvantages to venturi mask

-expensive

-can’t eat, drink, talk

-mask and humidity can cause skin breakdown

-NC during meals

Advantages to aerosol mask

-provides high humidification with oxygen delivery

-good for patients that do not tolerate face masks, have facial trauma, burns, or thick secretions

Disadvantages to aerosol mask

-high humidification requires frequent monitoring

-empty condensation from tubing often

Obtaining sputum specimen

-best to obtain early in the morning

-wait 1-2 hrs after the patient eats to decrease chance of emesis or aspiration

-chest physiotherapy to mobilize secretions

-use sterile container, label, lab slip, biohazard bag, clean gloves, mask, goggles

-endotracheal suction if patient can’t cough

Oxygen is combustible

-no smoking or oxygen in use signs

-educate patient of fire hazard

-patients should wear cotton gown other fabric can create static

-no flammable materials around

-caution with electric devices