Week #7 Oxygenation

Oxygenation and Respiratory Assessment

  • Presented by Dena Butchko MSN, RN

  • Based on Weber, Chapter 15

Concept of Oxygenation

  • Involves the exchange of gases in the body:

    • Ventilation/Perfusion

  • Key Components:

    • Oxygen

    • Carbon Dioxide

  • Important for:

    • Maintaining acid-base balance

    • Mechanisms that facilitate oxygen supply to cells

Factors for Normal Functioning

  • Three essential factors:

    1. Proper functioning airway system for intake and expulsion of air

    2. Efficient gas exchange system to remove CO2 and transport O2 to blood

    3. Properly functioning heart and vessels to transport nutrients and waste

Respiratory Assessment Components

  • Procedures:

    • Assessment History

    • Physical Exam

      • Inspection

      • Palpation

      • Percussion

      • Auscultation

    • Diagnostic Tests for Oxygenation

    • Arterial Blood Gases (ABG)

Normal and Abnormal Breath Sounds

  • Normal Breath Sounds

    • Characteristics include:

      • Bronchial (high pitch, loud)

      • Bronchovesicular (moderate pitch)

      • Vesicular (low pitch, soft)

  • Abnormal Breath Sounds

    • Fine Crackles, Coarse Crackles, Pleural Friction Rub, Wheeze

Major Structures of the Respiratory System

  • Visual representation includes:

    • Frontal Sinus, Nasal Cavity, Lungs, Trachea, Alveoli, Diaphragm

Inspection of the Patient

  • Assess:

    • Overall condition (nutrition, respiratory pattern)

    • Anteroposterior diameter of chest

    • Contour and clubbing of the nails

Signs and Symptoms of Labored Breathing

  • Evident Indicators:

    • Use of accessory muscles

    • Sternal retractions

    • Nasal flaring

    • Cyanosis (blue skin)

    • Tachycardia and anxious expression

Chest Dimensions and Movement

  • Anterior-Posterior (A/P) ratio is 1:2

  • Barrel Chest Characteristics:

    • A/P = Transverse

    • Can be normal in elderly or COPD patients

  • Chest Movement Assessment:

    • Observe symmetry of chest expansion during breaths

Respiratory Assessment Techniques

  • Percussion:

    • Determine lung position and size, detect fluid/air

  • Palpation:

    • Assess tactile fremitus by placing hands on chest while patient speaks

  • Auscultation:

    • Listen for breath sounds, start above clavicles and move down

Breathing Patterns

  • Normal: Eupnea

  • Decreased: Bradypnea

  • Increased: Tachypnea

  • Absence of Breathing: Apnea

  • Other patterns

    • Kussmaul's, Cheyne-Stokes, Biot's, Apneustic

Nursing Interventions

  • Common strategies include:

    • Pulse Oximetry, O2 Therapy, Chest PT

    • Deep Breathing exercises, Incentive Spirometry

    • Positioning for postural drainage

Acid-Base Balance

  • Measurement on pH scale

    • Normal: 7.35 - 7.45

    • Acidosis: Below 7.35

    • Alkalosis: Above 7.45

  • Major regulators include:

    • Respiratory system adjustments

    • Renal regulation of bicarbonate

Arterial Blood Gases (ABG)

  • Evaluation Parameters:

    • pH: 7.35-7.45

    • PO2: 80-100

    • PaCO2: 35-45

    • HCO3: 22-26

Acid-Base Imbalances

  • Types:

    • Respiratory Acidosis: Due to hypoventilation

    • Respiratory Alkalosis: Due to hyperventilation

    • Metabolic Acidosis: Kussmaul breathing

    • Metabolic Alkalosis: Slow shallow respirations

Clinical Indicators of Acid-Base Disturbances

  • Respiratory Acidosis Indicators:

    • Hypoventilation

    • Cyanotic skin, headache

  • Respiratory Alkalosis Indicators:

    • Hyperventilation, seizures

  • Metabolic Acidosis Indicators:

    • Headaches, decreased BP

  • Metabolic Alkalosis Indicators:

    • Restlessness, confusion