Fundamental

Muscles Used for Breathing

• Diaphragm

  • Primary muscle for breathing

• Muscles in the Rib Cage

  • Assists with breathing

  • Become less elastic over time, making breathing harder

Changes in Alveoli with Age

• Alveoli may appear dry, akin to raisins rather than grapes

• Poor alveoli functioning leads to:

  • Difficulty in breathing

  • Impaired gas exchange

• Importance of Alveoli:

  • Site of gas exchange

  • Reduced oxygen saturation (PaO2 levels) with age

Respiratory Reserve

• Older adults & infants have less respiratory reserve

  • Decreases ability to increase respiratory rate or depth when ill

  • Example: A cold can become a medical emergency due to these changes

Hypoxemia

• Definition of Hypoxemia

  • Low oxygen in blood

  • "Hypo" indicates low; "emia" relates to blood

• Consequences of Hypoxemia:

  • Hypoxia if low oxygen persists

  • Physical signs: cyanosis, confusion

Causes of Hypoxemia

• Obstruction in Airway

  • Reversible

• Inadequate ventilation / impaired gas exchange

• Muscle weakness

• Central nervous system depression due to issues like a stroke or disease

Anoxia

• Definition of Anoxia

  • Complete lack of oxygen

• Nursing Responsibilities

  • Maintain airway and adequate ventilation

  • Position patients optimally

  • Suction as necessary

  • Deliver oxygen therapy as per physician orders

Nursing Interventions for Patients in Distress

• Initial Actions

  • If a patient uses diaphragm/accessory muscles and has cyanotic lips:

  • First action: Raise the head of the bed

• Other actions:

  • Assessing patient's breathing

  • Possible suctioning if mucus present

  • Administering oxygen via a nasal cannula or mask

Assessment of Respiratory Rate

• Labored vs. Non-Labored Breathing

  • Labored Breathing: Difficulty breathing, increased rate, nasal flaring, accessory muscle use

  • Non-Labored Breathing: Normal ease of breathing, should be charted as such

Distress Situations and Patient Monitoring

• During Monitoring

  • Nurse stays with the patient

  • Increased anxiety worsens breathing

Advanced Airway Management

• In cases where less invasive methods fail, intubation may be necessary

  • Role of Intubation: Control of the airway, assist in ventilation

  • Managing airway can include bagging or ventilator support

Conditions Leading to Hypoxia

• Possible causes:

  • Mucus, tongue swelling, inflammation, or aspiration

  • Injuries leading to restricted chest movement (e.g., pneumothorax, obesity)

  • CNS depression and diffusion disorders (e.g., pulmonary fibrosis, embolism)

Environmental Factors and Symptoms of Hypoxia

• Poor functioning at high altitudes due to reduced atmospheric oxygen

• Symptoms to monitor for hypoxia:

  • Restlessness, memory lapses

  • Increased blood pressure, heart rate, initial respiratory rate

  • As reserves are depleted, risk of decompensation increases

  • Possible arrival of arrhythmias

Late Signs of Hypoxia

• Indicators include:

  • Cyanosis

  • Muscle retractions and stridor

  • Importance of early intervention to prevent cyanosis

  • Noting capillary refill times and potential interference from factors like nail polish or artificial nails

Treating Hypoxemia

• Initiate treatment with the least invasive methods:

  • Positioning and oxygen as starters

  • More invasive methods (e.g., intubation) only if required

Hypoxemia vs. Hypoxia Explained

• Analogy:

  • Blood oxygen levels are compared to packages of oxygen being delivered from lungs (fountain) to body cells (houses)

  • Hypoxemia = partial delivery (not enough oxygen in blood)

  • Hypoxia = no delivery (insufficient oxygen reaching tissues)

Airway Obstruction and Responding to Choking

• Recognizing choking signs through universal indicators

• Assessing airway before acting (e.g., asking if they can speak)

• Intervene appropriately based on the situation of air exchange

CPR Protocols for Non-Breathing Patients

• Hands-only CPR:

  • 30 compressions followed by callous but compassionate interventions

  • Consider song rhythm (e.g., "Stayin' Alive") for CPR pace

Techniques for Improving Airway Clearance

• Techniques include:

  • Effective coughing for clearing airways

  • Deep breathing to stimulate alveoli

  • Posterior drainage to remove mucus and secretions

Timing for Specimen Collection

• Best practice:

  • Morning or after nebulizers to collect more concentrated sputum specimens

Importance of Lung Auscultation

• Auscultate before and after procedures for comparing effectiveness of interventions

Posterior Drainage Positions

• Different positions help gravity assist in mucus clearance

Conclusion

• Discuss the importance of hydration and medications for liquefying mucus to ensure patient health.