Oxygenation Class Day Jill Ray 02.11.2025
Page 1
Title and development information
Revised by: Jill Ray 09/11/2024
Developed by: Laura Madden
Page 2: WHO Statistics on COPD
147,382 deaths in US in 2023 due to chronic lower respiratory diseases.
Nearly 90% of COPD deaths in those under 70 occur in low- and middle-income countries.
Tobacco smoking accounts for over 70% of COPD cases in high-income countries.
In low- and middle-income countries, smoking accounts for 30-40% of COPD cases.
Household air pollution is a major risk factor.
Page 3: Overview of COPD
Chronic Obstructive Pulmonary Disease (COPD)
Most common types:
Chronic Bronchitis
Emphysema
Asthma
Chronic Asthma-COPD Overlap Syndrome (ACOS)
HTTP airflow issues into and out of the lungs.
Page 4: Chronic Bronchitis
Causation by smoke or pollutants irritating airways.
Results in:
Inflammation and hypersecretion of mucus
Reduced ciliary function
Thicker bronchial walls and narrowed airways
Mucus may plug airways
Increased susceptibility to respiratory infections.
Diagnostic criteria: Cough and sputum production for at least 3 months in each of 2 consecutive years.
Page 5: Emphysema
Characterized by:
Abnormal distention of air spaces beyond terminal bronchioles.
Destruction of walls of the alveoli.
Decreased alveolar surface area, resulting in impaired oxygen diffusion.
Consequences include hypoxemia and increased pulmonary artery pressure leading to right-sided heart failure (cor pulmonale).
Page 6: Atelectasis vs Pneumothorax
Atelectasis: Alveoli in the lung deflate, causing partial or complete collapse.
Pneumothorax: Air leaks into the space around the lung, compressing it and causing collapse.
Page 7: Case Study - Lou Jones
58-year-old male with shortness of breath.
Smoking history: 2 packs/day for 40 years.
Symptoms include productive cough for 3 months, exertional dyspnea, and "rattling" in chest.
Crackles and rhonchi noted over lower lobes.
Admitting diagnosis is Stage 2 COPD.
Page 8: Significant Assessment Data for Lou Jones
Similar symptoms reported by wife.
Diagnostic findings under review.
Revisiting COPD type: Chronic Bronchitis or Emphysema?
Page 9 & 10: Assessment Inconsistencies
Data reviewed by RN needing reevaluation:
Temperature: 97.2℉
HR: 112
BP: 122/75
RR: 16
O2 Saturation: 99% on room air
Alert and oriented, lungs clear to auscultation.
Page 11: Reasons for Re-evaluation of Assessments
Respiratory Rate 16: Expected to be higher with shortness of breath.
Oxygen Saturation 99%: Unlikely for Stage 2 COPD on room air.
Lungs clear: Breath sounds usually diminished or wheezing.
Page 12: Priority Teaching for Lou Jones
Avoiding smoke and pollutants.
Energy conservation – promote rest periods.
Pursed-lip breathing technique instructions.
Page 13: Pursed Lip Breathing Technique
Relax neck and shoulder muscles.
Inhale through the nose (smelling roses).
Purse lips and exhale through pursed lips (blowing out a candle) slowly.
Page 14: Additional Pursed Lip Breathing Instructions
Inhale through nose counting to 3.
Exhale against pursed lips, counting to 7.
Encourage practice while moving/walking.
Page 15: Coughing Mechanism
Differentiation between dry and productive cough types.
Importance of voluntary coughing.
Page 18: Complications of COPD
Risk of:
Respiratory insufficiency/failure
Pneumonia
Atelectasis
Pneumothorax
Cor pulmonale.
Page 19: Drive to Breathe
Normal respiration driven by CO₂ levels increase.
COPD: Reduced ability to exhale CO₂ leading to hypercapnia.
Page 20 & 21: Lou's Clinical Status at Age 68
Managed on inhalers, increased respiratory distress.
Presenting to ED with confusion and increased O2 usage.
Vital signs show significant respiratory distress.
Page 22: Vital Signs of Lou
Temp: 101.2 F, BP: 150/88, HR: 92, RR: 10/min, SpO2: 84% on 4L.
Page 23 & 24: Nurse's Priorities in ED
Assess immediate actions:
Increase or decrease oxygen flow rate.
Encourage pursed-lip breathing techniques.
Page 25 & 26: Prioritizing Nurse Actions
Initiate with placing Lou in high-Fowler’s position.
Page 27: Lou's Condition and Pneumonia Diagnosis
Complaints and clinical signs indicative of pneumonia.
Page 28: Assessing for Exertional Dyspnea
Differentiate between exertional dyspnea and dyspnea at rest.
Page 29: Lou’s Chart: Nursing Note
Documented vital signs and treatment progression.
Page 30: Lou’s Chart: ABGs Analysis
Summary of ABG findings and critical interpretation.
Page 31: Interpretation of ABGs
Evaluate acidosis or alkalosis. Define as respiratory acidosis.
Page 32: Assessment Assumptions
Medications ineffective, secondary infections are present.
Page 34: Pneumonia Risk Factors
Includes underlying disorders, advancing age, malnutrition, etc.
Page 35: Pneumonia Prevention
Importance of pneumococcal vaccination for high-risk groups.
Page 36: Nursing Interventions for Pneumonia
Outline independent nursing interventions.
Page 39: ICOUGH Program for Prevention
Components: Incentive spirometry, cough techniques, hydration, etc.
Page 40: Aspiration Pneumonia Overview
Key facts and risk factors for aspiration pneumonia.
Page 42 & 43: Patient Education on Albuterol
Differences between SVN and MDI.
Page 49: Instructing on Nebulizer Use
Important steps in using a nebulizer correctly.
Page 51 & 52: Suggestions for Lou's Recovery
Recommendations for update on rest and diet.
Page 53: New Assessment upon Return to ED
Significant findings on assessment following return.
Page 56: Significant Findings Summary
Assess priority findings for immediate intervention.
Page 58 & 59: Prioritizing Actions in Response to Hypoxia
Structured order of interventions.
Page 60 & 61: Responding to Family Concerns
Clarifying confusion related to hypoxia as potential cause.
Page 63 & 64: Additional ABGs and Analysis
Retain focus on critical values.
Page 65 & 66: Rationale for Findings and Responses
Interpretations linked with patient distress signs.
Page 67: Provider's Orders for Lou Jones
Comprehensive list with medication plans and objectives.
Page 68-70: Nursing Prioritization and Assessments
Documenting actions stepwise for enhanced care.
Page 73-75: Diminished Breath Sounds and Prevention
Addressing predisposition to atelectasis and preventive strategies.
Page 79: Oxygen Delivery Devices
Overview and classifications of oxygen delivery methods.
Page 80: Purpose of Oxygen Therapy
Importance for cell oxygenation and respiratory issues.
Page 82: Nasal Cannula Usage and Considerations
Effective flow rates and cautions.
Page 83: High Flow Nasal Cannula
Characteristics for delivering oxygen.
Page 84: Simple Face Mask
Usage guidelines and avoidances.
Page 85: Venturi Mask Characteristics
Precision in oxygen delivery details.
Page 86: Non-Rebreather Mask Use
Features and requirements during administration.
Page 89: Precautions for Oxygen Administration
Safety and environmental demands in oxygen therapy.
Page 90: Home Oxygen Advocacy
Instructions for outpatient settings on oxygen safety.
Page 92-100: Case Study - MR. Z
Initial presentation, assessment, and lab results analysis. Potential causes and education for management.