Module 3A - oxygenation

concepts related to oxygen

• cognition/mental status

• comfort

• perfusion

ventilation

breathing → exchange of oxygen and carbon dioxide through the lungs

inspiration

inhalation, active phase of bringing air into the lungs

expiration

exhalation, passive phase of pushing air out of the lungs

diffusion

• the movement of O2 and CO2 between the alveoli and blood in the capillaries

• always from high to low concentration

flow of O2 and CO2

oxygen moves from alveoli to deoxygenated blood in capillaries → carbon dioxide moves from blood in capillaries to alveoli to be exhaled

perfusion

process by which oxygenated capillary blood passes through the body tissues

why assess lower lobes

because it is where fluid accumulated first

atelectasis

collapse/fluid accumulation in alveoli

hypercarbia

high CO2

chemo receptors

• located in the aorta and brainstem

• monitor blood CO2 levels

• regulate respiratory rate

• if CO2 is high in blood it triggers increased respirations

low O2

what drives breathing in patients who have COPD

tachypnea

>20 breaths/min

bradypnea

<12 breaths/min

apnea

absence of breathing

dyspnea

labored breathing or shortness of breath that is painful

orthopnea

difficulty breathing when supine (lying down)

subjective respiratory

• “I’ve been having trouble breathing recently”

• hx of tobacco use → interest in quitting

• exposure to second hand smoke

• occupational history

• pain related to ischemia

objective respiratory

• cyanosis

• clubbing of fingers

• decreased LOC

• barrel chest

• advantageous lung sounds

• SOB

lifestyle behaviors

• encourage/support quitting tobacco use

• encourage exercise

• educate on good nutrition

• immunize against flu/pneumonia

observe/inspection

• use of accessory muscles

• LOC

• barrel chest

• labored breathing

• rate/rhythm of breathing pattern

bronchial lung sounds

• heard on trachea

• loud, high pitched

• longer when breathing out

vesicular lung sounds

• heard over peripheral lobes

• longer on exhalation

• soft, low pitched

bronchovesicular lung sounds

• heard on each side of sternum and scapula

• medium volume/pitch

crackles or rales

• fine to course bubble sound

• does not clear with coughing

• indicated fluid accumulation

wheezes

• high pitched musical sound

• louder on expiration

• air passing through narrowed airway

rhonchi

• course, loud, low pitched rumbling

• clears w/ coughing

• caused by fluid/mucus build up

pleural friction rub

• sand paper → dry/grainy rubbing sound

• indicates inflamed visceral or parietal pleura

absence of breath sounds

• no air movement

• indicates a collapsed lung or surgically removed lobe

stridor

• high pitched sound

• indicated obstruction of upper airway

Lab related to respiratory

• sputum specimen

• Hemoglobin

• ABG

• pH

• SpO2

• PaO2

• HCO3

• PaCO2

pulse oximetry

• noninvasive

• measures percent of hgb bound to O2

• normal 95-100

• some 91-100

• COPD 85-89 goal 88-92

alterations in oxygenation

causes fatigue, irritability

discomfort, changes in LOC, hypoxemia, hypoxia

acute hypoxia early signs

tachypnea, tachycardia, restless, anxious, agitation, elevated BP, accessory muscle use

acute hypoxia late signs

decrease LOC, stupor, cyanosis, bradypnea, bradycardia, hypotension, cardiac dysrhythmias

independent nursing interventions

• raise HOB >30 to promote lung expansion

• encourage TCDB

• pursed lip breathing for COPD

• reposition

• encourage smoking cessation/fluid intake to thin secretions

incentive spirometer

• encourages deep breathing

• promotes lung expansion

• pt inhales through mouth piece

• 9-10 times per hour while awake

percussion/vibration contraindications

• pregnancy

• recent abd surgery

• head/neck injury

• must wait 2 hr after meals

• must do 2 hr before bed

FiO2

• percent of oxygen pt is receiving

• 21% on RA