Oxygenation & Thermoregulation

OXYGENATION & THERMOREGULATION

LEARNING OUTCOMES

  • Identify stressors that could alter oxygenation.

  • Describe signs and symptoms associated with altered respiratory functioning.

  • Using the nursing process, outline nursing care for a patient with altered respiratory functioning that facilitates optimal wellness.

  • Describe the body's regulatory mechanism for controlling temperature.

  • Identify extraneous factors that influence body temperature.

  • Describe signs and symptoms, causes, complications, and nursing care of a patient with temperature alterations.

OXYGENATION
WHY IS OXYGENATION IMPORTANT?

  • Oxygen is essential for the proper functioning of all living cells.

  • Absence of oxygen can lead to cellular, tissue, and organism death.

EXTERNAL RESPIRATION

  • Definition: Refers to the gas exchange process between the atmosphere and the blood via the alveoli in the lungs.

  • Incorporates:

    • Pulmonary ventilation: The act of breathing, which includes inspiration (inhaling) and expiration (exhaling).

    • Respiration: The broader process of gas exchange both internally within the body and externally with the environment.

    • Perfusion: The flow of blood to the lung's capillaries, enabling gas exchange.

PULMONARY VENTILATION

  • Definition: The breathing process involving inhalation and exhalation.

  • Adequate ventilation requires:

    • Clear airways

    • Intact Central Nervous System (CNS) and respiratory center

    • Intact thoracic cavity

    • Adequate pulmonary compliance and recoil (ability of the lung to expand and contract).

FACTORS AFFECTING RESPIRATORY FUNCTION

  • Age: Changes in lung function and capacity.

  • Environment: Pollution and altitude can impact respiratory efficiency.

  • Lifestyle: Smoking, exercise levels, and nutrition influence lung health.

  • Health Status: Chronic illnesses (e.g., COPD, asthma).

  • Medications: Some drugs may depress respiratory function.

  • Psychological factors: Stress and anxiety can obstruct effective respiratory function.

CONDITIONS AFFECTING THE AIRWAY

  1. Upper airway obstruction: Blockage of airflow in the upper respiratory tract.

  2. Lower airway obstruction: Blocked airflow in the lower respiratory tract, affecting gas exchange.

CONDITIONS AFFECTING MOVEMENT OF AIR

  • Breathing patterns:

    • Eupnea: Normal, unlabored breathing.

    • Tachypnea: Abnormally rapid breathing.

    • Bradypnea: Abnormally slow breathing.

    • Apnea: Temporary cessation of breathing.

  • Hypoventilation: Inadequate ventilation leading to increased carbon dioxide levels.

  • Hyperventilation: Excessive ventilation leading to decreased carbon dioxide levels.

  • Orthopnea: Difficulty breathing when lying flat.

  • Dyspnea: Shortness of breath.

  • Kussmaul breathing: Deep and labored breathing usually associated with metabolic acidosis.

  • Cheyne-Stokes respirations: Cycles of deep breathing followed by periods of apnea.

  • Biot’s respirations: Irregular breathing with varying depths, followed by periods of apnea.

ALTERATIONS IN RESPIRATORY FUNCTION

  • Hypoxemia: Reduced oxygen levels in blood.

  • Hypoxia: Result of uncompensated hypoxemia; insufficient oxygen available to cells.

Acute Hypoxia Symptoms:

  • Dyspnea

  • Anxiety

  • Elevated heart rate (HR), respiratory rate (RR), and blood pressure (BP)

  • Restlessness, confusion, drowsiness

  • Pallor, cyanosis, lightheadedness, nasal flaring

Chronic Hypoxia Symptoms:

  • Fatigue, lethargy

  • Altered thought processes

  • Headaches, chest pain

  • Enlarged heart, anorexia

  • Constipation, decreased libido, urinary output

  • Muscle pain, clubbing of fingers and toes

CONDITIONS AFFECTING GAS TRANSFER

  • Coughing: Reflex that clears the airway.

  • Pleural effusion: Excess fluid around lungs impacting gas exchange.

  • Swelling in abdomen (ascites): Can affect lung expansion.

  • Tiredness and shortness of breath: May indicate pulmonary issues.

  • Pulmonary edema: Excess fluid in lungs impacting oxygenation.

  • Hypovolemia: Low blood volume affecting circulation.

NURSING PROCESS: OXYGENATION

  1. ASSESS

    • Collect nursing history and physical examinations.

    • Determine current problems, lifestyle habits, and presence of sputum.

    • Physical exam includes inspecting rate and depth of respirations, specific chest movements, and thorax shape.

    • Diagnostic studies: Cultures, arterial blood gas (ABG), oxygen saturation, pulmonary function tests (PFT), capnography, bronchoscopy.

  2. ANALYZE

    • Ineffective breathing patterns related to ineffective airway clearance.

    • Impaired oxygenation due to inadequate ventilation.

    • Ineffective tissue perfusion linked to impaired gas exchange.

    • Impaired activity tolerance due to insufficient physiological energy, which may cause feelings of anxiety, fatigue, fear, powerlessness, and potential social isolation.

  3. PLAN

    • Establish goals for clients with oxygenation problems:

      • Maintain airway

      • Improve comfort and ease of breathing

      • Maintain ventilation and oxygenation

      • Improve activity tolerance

      • Prevent risks associated with oxygenation issues.

  4. IMPLEMENT

    • Promote optimal function, comfort, proper breathing, and effective coughing control.

  5. EVALUATE

    • Assess achievement of goals and desired outcomes set in the planning phase.

THERMOREGULATION
BODY TEMPERATURE

  • Reflects the balance between heat produced and heat lost from the body.

    • Core Temperature: Temperature of deep tissues, which remains relatively constant.

    • Surface Temperature: Temperature of skin and subcutaneous tissue, which varies based on environment but is lower than core temperature.

Factors Affecting Body's Heat Production:

  • Basal metabolic rate

  • Muscle activity

  • Thyroid hormone output

  • Sympathetic stimulation

  • Fever

NORMAL TEMPERATURE

  • Normal range varies by age:

    • Adults: 96.4°F (35.8°C) to 99.5°F (37.5°C).

    • There is no single temperature that applies to all individuals; institutional policy should be followed.

REGULATION OF BODY TEMPERATURE

  • Sensors: Located in periphery and core.

  • Integrator: Located in the hypothalamus, adjusting body temperature regulation.

  • Effector system: Adjusts heat production and loss;

    • If too cold: Vasoconstriction, shivering, piloerection, and increased metabolism.

    • If too warm: Vasodilation, sweating, and increased respiration.

FACTORS INFLUENCING HEAT LOSS

  • Evaporation: Loss of heat through the evaporation of water.

  • Convection: Movement of air that removes radiated heat.

  • Radiation: Emission of electromagnetic radiation.

  • Conduction: Direct transfer of heat by contact.

FACTORS AFFECTING BODY TEMPERATURE

  • Age and biological sex: Age differences in temperature regulation.

  • Physical activity: Increased activity raises body temperature.

  • State of health: Illness may affect temperature.

  • Stress: Psychological stress can influence body temperature.

  • Environment: External temperature impacts body heat regulation.

  • Diurnal variations: Circadian rhythms affect body temperature throughout the day.

HYPERTHERMIA VS. PYREXIA/FEVER
HYPERTHERMIA

  • Conditions: Heat exhaustion and heat stroke; can be caused by extreme heat exposure or excessive heat production.

  • Symptoms of Heat Exhaustion:

    • Excessive sweating, pale skin, dizziness, nausea or vomiting, fainting, muscle cramps, rapid weak pulse.

  • Symptoms of Heat Stroke:

    • Warm, flushed, dry skin, no sweating, rapid strong pulse, confusion or unconsciousness, throbbing headache, seizures, and temperature greater than 103°F.

PYREXIA/FEVER

  • Definition: A body temperature above the usual range (commonly >100.4°F or 38°C).

  • Hyperpyrexia: Very high fever (>106°F or 41°C).

  • Causes: Infection, CNS damage, tissue trauma, and unknown origins.

FEVER: CLINICAL MANIFESTATIONS

  • Onset: Increased HR, RR, shivering, cold skin, feeling cold, cyanotic nail beds.

  • Course: Warm skin, increased HR, RR, thirst, drowsiness, restlessness, and weakness.

  • Defervescence (fever abatement): Skin appears flushed, warm, intense sweating, and decrease in shivering, with a potential for dehydration.

FEVER: NURSING INTERVENTIONS

  • Monitor vital signs and lab values.

  • Monitor intake and output.

  • Monitor skin color.

  • Remove excess blankets.

  • Provide fluids and simple carbohydrates.

  • Administer antipyretics and antibiotics as needed.

  • Reduce physical activity to conserve energy.

  • Provide oral hygiene.

  • Use tepid baths and cold packs to lower temperature.

HYPOTHERMIA

  • Definition: Core body temperature below 96°F (36°C).

  • Causes: Excessive heat loss, inadequate heat production, impaired hypothalamic thermoregulation.

  • Can be categorized as accidental vs. induced hypothermia.

  • Clients at risk include:

    • Cold weather sports participants

    • Infants and children

    • Elderly individuals

    • People with neurological deficits

    • Alcoholics

    • Homeless individuals

    • Those with infections or head trauma

    • Neonates and malnourished individuals

    • Perioperative patients and individuals with hypothyroidism.

HYPOTHERMIA: CLINICAL MANIFESTATIONS

  • Decreased body temperature.

  • Severe shivering, feelings of cold, pale, cool, waxy skin.

  • Potential frostbite.

  • Decreased urinary output, RR, and BP.

  • Weak and irregular HR.

  • Lack of muscle coordination, slurred speech.

  • Poor judgment, disorientation/amnesia/hallucinations.

  • Drowsiness that can progress to coma.

HYPOTHERMIA: NURSING INTERVENTIONS

  • Remove any identified stressors.

  • Provide warmth by applying dry clothing.

  • Keep limbs close to the body to conserve heat.

  • Cover the scalp to minimize heat loss.

  • Supply warm fluids to facilitate internal warming.

  • Apply warming pads, blankets, or radiant warmers to increase body temperature.

CASE STUDY

  • PNEUMONIA: An infection of the lungs caused by bacteria, viruses, or fungi.

    • Can be community-acquired, healthcare-associated, or aspiration-related.

    • Symptoms include:

    • Cough (productive with greenish, yellow, or bloody mucus)

    • Fever (may be mild or high)

    • Shaking chills

    • Shortness of breath, crackles, wheezes, dyspnea

    • Confusion, especially in older adults

    • Excessive sweating and clammy skin

    • Headache

    • Loss of appetite, low energy, fatigue

    • Sharp or stabbing chest pain increasing with deep breathing or coughing.

REFERENCES

  • Taylor, C., Lynn, P., & Bartlett, J. L. (2023). Fundamentals of Nursing: The art and science of person-centered nursing care (10th ed.). Wolters Kluwer.