Oxygenation NRS 101

Overview of Oxygenation

  • Oxygen Importance: Essential for cells to metabolize nutrients and produce energy.

  • Properties of Oxygen: Tasteless, colorless, odorless; considered a medication requiring a doctor's order.

  • Oxygen Concentration: Room air contains ~21% oxygen; every 1 liter of supplemental oxygen increases concentration by 3-4%.

  • Priority: Oxygen administration is the number one priority.

Oxygenation Process

Systems Involved

  • Respiratory System: Involves ventilation (breathing) and gas exchange.

  • Cardiac System: Supplies blood to deliver oxygen to cells.

Processes of Breathing

  • Ventilation (Respiration): Involves inhalation (inspiration) and exhalation (expiration).

  • Terms to Know:

    • EIA: Normal respirations.

    • Dnia: Difficult respirations.

    • Apnea: Absence of breathing.

    • Hypoxia: Low oxygen at the cellular level.

    • Hypoxemia: Low oxygen levels in the blood.

    • Hypercapnia: Increased carbon dioxide levels.

Basic Concepts of Oxygenation

  • Ventilation: Automatic, regular, unlabored process involving diaphragm and intercostal muscle contraction.

    • Diaphragm contracts and moves down → lungs expand (inspiration).

    • Diaphragm relaxes and moves up → lungs decrease in size (expiration).

  • Diffusion: Movement of molecules from high concentration to low concentration, vital for oxygen and carbon dioxide exchange in the respiratory system.

  • Perfusion: Passage of fluids, particularly blood, delivering oxygen and nutrients.

  • Gas Exchange: Involves ventilation, diffusion, and perfusion; takes place in the alveoli, where oxygen and carbon dioxide are exchanged with blood.

Cellular Respiration

  • Definition: Process of breaking down glucose using oxygen, producing carbon dioxide as a waste product.

  • Respiratory System Role: Provides oxygen and removes carbon dioxide in the lungs, facilitated by blood circulation.

Alveolar Gas Exchange

  • Function: Oxygen diffuses from alveoli into the bloodstream; carbon dioxide moves from blood into alveoli.

  • Analogy of Diffusion: Similar to how smells spread through the air; applies even through membranes like balloon skin.

Breathing Control

  • Nervous System Control: Controlled by the autonomic nervous system; sympathetic system increases, while parasympathetic decreases the breathing rate.

  • Carbon Dioxide as Drive to Breathe: Increased CO2 levels trigger a deeper and faster respiration.

  • Hypoxic Drive: In patients with lung disorders like COPD, lowered oxygen levels become the trigger to breathe instead of CO2 levels.

Arterial Blood Gases (ABGs)

  • Normal Ranges:

    • Oxygen arterial blood levels: 80-100.

    • Carbon dioxide arterial blood levels: 35-45.

  • Factors Affecting Oxygenation:

    • Airway Obstruction (e.g., polyps, deviated septum).

    • Environmental factors (e.g., high altitude, air pollution).

    • Increased metabolic demand due to activity, pregnancy, sickness, stress.

    • Health status impacts such as cardiovascular disease and respiratory disease.

Signs and Symptoms of Hypoxia

  • Indicators: Confusion, restlessness, fatigue, tachycardia, shortness of breath, cyanosis, and altered breathing patterns.

  • Breathing Patterns:

    • Tachypnea: Rapid respirations.

    • Bradypnea: Slow respirations.

    • Hyperventilation: Fast, deep breaths (decreasing CO2).

    • Hypoventilation: Slow, shallow breaths (increasing CO2).

Assessment of Oxygenation

History Taking

  • Family history, personal factors like smoking, exposures, occupation, and respiratory infections.

Physical Assessment Techniques

  • Inspection: Observe breathing mechanics and muscle usage.

  • Auscultation: Listen for lung sounds with a stethoscope.

  • Palpation: Check temperature, tenderness, and moisture.

  • Percussion: Tap for determining density and location of structures.

Skin and Nail Assessment

  • Skin Color: Should be pink, warm, and dry; abnormal would be dusky or cyanotic.

  • Nail Clubbing: Indicates a long-term lack of oxygen (angle > 180°).

Level of Consciousness Assessment

  • Terms:

    • Alert: Easily aroused.

    • Confused: Inappropriate responses.

    • Lethargic: Easily aroused but falls asleep soon.

    • Stuporous: Needs vigorous stimuli.

    • Unconscious/Coma: Cannot be aroused.

  • Orientation: Assess awareness of person, place, time, and events.

Mucous Membranes and Circulation Assessment

  • Oral Mucosa: Inspect for moistness and color.

  • Circulation: Check pulses, compare bilateral, and assess capillary refill time (normal <3s, abnormal >5s).

Respiratory Assessment

  • Respiration Rates: Normal between 12-20 breaths per minute; check for rhythm, depth, and quality.

  • Cough Assessment: Determine if productive (with sputum) or nonproductive.

  • Chest Assessment: Check symmetry and shape (barrel chest, funnel chest, pigeon chest).

Breath Sounds

  • Normal vs. Abnormal Breath Sounds:

    • Crackles: Fluid in bronchi/alveoli.

    • Wheezes: Narrowed air passages.

    • Stridor: High-pitched sound indicating obstruction.

    • Pleural Friction Rub: Sounds like leather rubbing, indicates pleural inflammation.

Final Assessment Steps

  • Neck Veins: Normal is non-distended; measure for jugular vein distension.

  • Nares: Watch for flaring.

  • Pulse Oximetry: Ideal saturation >95%; concern if <90%.

Interventions to Improve Oxygenation

  • Positioning: Semi to high-Fowler’s position for maximum chest expansion.

  • Frequent Position Changes: Prevent pooling of secretions.

  • Encourage Ambulation: Keep patient active while minimizing fatigue.

  • Deep Breathing/Coughing: Techniques to clear secretions.

  • Hydration: Maintain moisture in respiratory mucosa.

  • Oxygen Therapy: Administer as per physician’s order, monitoring comfort and flow rate.

Patient Education on Oxygen Safety

  • Signs: "No smoking" or "Oxygen in use."

  • Safety Measures: No smoking near oxygen, use of appropriate electrical equipment, proper oxygen delivery methods.

  • Different Sources and Delivery Types: Nasal cannula, face masks, CPAP, BiPAP, etc.

Oxygen Delivery Devices

  • Nasal Cannula: Common, allows for talking/eating (1-6 L/min).

  • Face Masks: Covers mouth/nose; can interfere with eating (6-10 L/min).

  • Venturi Masks: Provide precise oxygen concentrations for COPD patients.

  • Non-Rebreather Masks: Offer highest concentration of oxygen (90-100% at 6-15 L/min).

  • Transtracheal Catheter: For home use and eliminates need for humidification.

  • CPAP/BiPAP: Increases airway pressure and assists in breathing.

Artificial Airways

  • Types: Oropharyngeal, endotracheal tubes, tracheostomy, laryngeal mask airways.

  • Endotracheal Tubes: Short-term ventilation; patient cannot speak.

  • Tracheostomy: Long-term support; needs careful monitoring and education on care/infection risk.

Care for Patients with Artificial Airways

  • Infection Risk Management: Regular suctioning and humidification to help clear secretions.

  • Positioning and Nutrition: Elevate head of bed; NPO for patients with ET tubes.

Patient Teaching for Oxygen Therapy

  • Instructions for equipment use; safety precautions; mobilization of secretions; and fluid intake recommendations.

  • Education on the rationale and side effects of medications, along with maintaining good oral hygiene.

Possible Patient Problems with Oxygenation

  • Statements: Inability to clear the airway, maintain adequate breathing patterns, or tolerate activities; anxiety due to dyspnea; compromised verbal communication due to tracheostomy/intubation.