Fundamentals of Nursing: Assisting With Respiration and Oxygen Delivery

Structures and Function

  • Upper airways: Carry O_2.
  • Bronchi: Contain cilia.
  • CNS: Controls respiration.
  • Alveoli: Contain macrophages.
  • Most O_2 is attached to a hemoglobin molecule in RBCs.

Structures of the Respiratory System

  • Trachea
  • Bronchus
  • Secondary (lobar) bronchi
  • Tertiary (segmental) bronchi
  • Bronchioles
  • Pulmonary artery
  • Alveolar duct
  • Pulmonary vein
  • Alveoli

Changes with Aging

  • Decrease in elasticity of lungs.
  • Cilia are not as effective in removing foreign material.
  • Thickening of alveoli.
  • Decrease in total body water.

Focused Assessment

  • Chest expansion
  • Breath sounds
  • O_2 sats
  • Is the patient on oxygen?

Hypoxemia

  • Decreased amount of oxygen in blood = hypoxemia.
    • May be sudden or gradual.
  • Results in hypoxia.
    • Restlessness, irritability, confusion.
    • 'Just not right' but VS WNL (vital signs within normal limits).
    • Dyspnea -> anxiety -> tachypnea.
    • Cyanosis, retractions (late).

Hypoxia

  • Treatment of hypoxia: give O_2, correct the cause.
  • Pulse oximetry: % of hemoglobin attached to O_2.
    • Noninvasive.
    • Different from PaO_2.
    • Factors causing inaccurate readings.

Causes of Hypoxia

  • Obstruction: Tongue, mucous secretions, vomit.
  • Restricted movement: Injury, severe obesity.
  • Neuromuscular: CNS depression, MS (multiple sclerosis).
  • Gas diffusion: Emphysema, cancer.

Nursing Interventions

  • Deep breathing: Deep breath, hold 3 seconds, exhale through pursed-lips, 5-10 times every 2 hours.
  • Cough: Two deep breaths, third deep breath with forceful exhalation. Expectoration of sputum specimen.
  • Postural drainage: Laying in different positions to drain lungs (p. 519).
  • Percussion: Using cupped hands or vests.

Incentive Spirometer

  • (Image of incentive spirometer with a value of 2000)

Oxygen Therapy

  • Room air = 21% O_2.
  • Different forms of delivering O_2.
  • O_2 considered a drug.
  • O_2 can dry tissues.
  • COPD (chronic obstructive pulmonary disease): low flow O_2.
  • Safety concerns.

Nasopharyngeal Suctioning

  • Required for patients unable to clear secretions from their own airway effectively.
  • Aseptic technique.
  • Maintain patent airway by removing accumulated secretions.
  • Used most often for infants, gravely debilitated or unconscious patients, and those who have an ineffective cough.

Tracheobronchial Suctioning

  • Deep suctioning to remove secretions from the trachea and bronchi using sterile technique.
  • Patients need preoxygenation.
  • Sterile technique is mandatory.
  • Should be performed no longer than 10 seconds at a time, with oxygenation in between.

Nursing Process

  • Assessment: Focused assessment.
  • Diagnosis:
    • Ineffective airway clearance
    • Impaired gas exchange
    • Ineffective breathing pattern
  • Implementation:
    • Open airway
    • Breathing
    • Coughing up secretions
    • Sats increase
    • Lungs clear
    • Reports no shortness of air
  • Evaluation