Oxygenation

Introduction to the Class

  • Instructor Statement: Instructor addresses the class about reports of bullying and unprofessional behavior.

  • Expectations: All members are expected to act as professionals, regardless of personal feelings. It emphasizes teamwork in the nursing family.

  • Encouragement to Communicate: Students are encouraged to voice any concerns regarding bullying or professionalism.

Introduction of Instructor

  • Instructor Identity: Miss Weinberger, a Charity graduate of May 2019.

  • Empathy: Shares understanding of student struggles and assures them everything is manageable.

Student Learning Objectives (SLOs)

  • Explanation: SLOs are essential for understanding class material. Students should familiarize themselves with these objectives.

  • Communication Tool: Questions can be posted on the discussion board for clarification.

Functions of the Respiratory System

Structure of the Lungs

  • Alveoli: Millions of tiny air sacs in the lungs (like grapes) crucial for gas exchange

  • Gas Exchange: Oxygen and carbon dioxide are exchanged at the alveoli, which are closely aligned to capillaries.

Key Functions

  • Pulmonary System: Involves two main functions:

    • Ventilation: Movement of air in and out of the lungs during breathing.

    • Respiration: Exchange of oxygen and carbon dioxide.

Process of Breathing

  • Inspiration: Intake of air.

  • Exhalation: Expulsion of air.

Factors Affecting Ventilation

Variables Affecting Breathing

  • Respiratory Rate: Speed of breathing.

  • Depth: Extent of lung expansion.

  • Hyperventilation: Excessive breathing rapidly, leading to reduced CO2 causing issues.

    • Example: Anxiety attacks.

  • Hypoventilation: Shallow, slow breathing usually due to medication or sedation.

Lung Elasticity and Compliance

  • Lung Elasticity: Ability of lungs to return to resting state after expansion (affected by conditions like cystic fibrosis).

  • Lung Compliance: Ease with which lungs can expand (healthy generally high).

  • Airway Resistance: Resistance faced by air moving through the airways, influenced by obstructions.

Gas Exchange Alterations

Definitions and Effects

  • Hypoxemia: Low oxygen levels in the blood.

  • Hypoxia: Low oxygen levels in tissues and organs, leading to symptoms such as clubbed fingers, decreased urine output, and altered mental status.

  • Hypercapnia: Elevated carbon dioxide in the blood, possibly causing lethargy.

    • Causes: Hypoventilation, acute airway obstruction, drug overdose.

  • Hypocapnia: Low CO2 levels, may cause muscle spasm and numbness (can happen at high altitudes).

Lung Sounds

Normal Lung Sounds

  • Bronchial Sounds: Loudest, produced in the trachea.

  • Bronchovesicular Sounds: Intermediate; between bronchial and vesicular.

  • Vesicular Sounds: Softest; found in lung peripheries.

Abnormal Lung Sounds

  • Crackles (Rales): Irregular, high-pitched sounds associated with pneumonia or CHF.

    • Fine Crackles: Quieter, chronic conditions.

    • Coarse Crackles: Loud, acute situations.

  • Wheezing: High-pitched, tubular sounds prominent during expiration linked with asthma or airway constriction.

  • Stridor: High-pitched whistle during breathing indicating severe airway obstruction (urgent need for assessment).

  • Bronchi: Sounds like snoring due to mucus in larger airways (old man snoring).

  • Friction Rub: Grating sound due to pleurisy.

  • Diminished Lung Sounds: Likely indicates atelectasis (collapsed alveoli).

Terms to Know in Breathing Assessment

  • Eupnea: Normal breathing.

  • Tachypnea: Fast breathing (more than 24 breaths/minute).

  • Bradypnea: Slow breathing (less than 10 breaths/minute).

  • Apnea: No breathing.

  • Cheyne-Stokes: Periods of deep breathing followed by periods of apnea (common in dying patients).

  • Dyspnea: Difficulty or shortness of breath.

  • Kussmaul's Respiration: Rapid and deep air exchange, indicative of metabolic issues.

  • Orthopnea: Difficulty breathing while lying flat.

  • Biot's Respiration: Irregular respiratory pattern seen with brain injury.

Oxygen Measurement and Therapy

Measurement of Oxygen Levels

  • Pulse Oximetry: Non-invasive method to measure oxygen saturation (normal 95-100%).

  • Arterial Blood Gases (ABGs): More invasive method to assess blood gas levels and pH.

Oxygen Delivery Systems

  • Types of Devices:

    • Nasal Cannula: Generally comfortable, but check for correctness of prongs.

    • Simple Face Mask: Less popular among patients; accommodates more oxygen needs but restricts talking and eating.

    • Non-Rebreather Mask: Provides near 100% oxygen; must ensure bag is inflated during patient use.

    • Venturi Mask: Provides specific oxygen levels through colored attachments, often used for COPD patients.

    • Incentive Spirometer: Encourages deep breathing and lung expansion.

    • Use: Important for post-operative and bed rest patients.

    • Technique: Exhale first, inhale deeply through the device, hold breath for three seconds, repeat multiple times an hour to aid in lung re-expansion and prevent atelectasis.

Immunization and Preventive Measures

Vaccines Discussed

  • PCV13 and PCV23: Pneumococcal vaccines important for older adults and those with respiratory issues.

  • Influenza Vaccine: Available as injection (inactivated) and nasal spray (live attenuated). Important for preventing severe complications, especially in vulnerable populations

  • Post-vaccination awareness: The vaccine helps prepare the immune system but won't provide immediate immunity but helps reduce symptom severity if exposed.

Upper and Lower Airway Infections

Upper Airway Infections

  • Common Cold: Caused by various viruses, leading to respiratory symptoms.

  • Rhinosinusitis: Inflammation of nasal mucosa; can be bacterial/viral.

  • Pharyngitis: Inflammation of the throat, often bacterial (e.g., strep throat).

  • Influenza: Can be severe with risks of pneumonia and complications in high-risk groups (young children, elderly, immunocompromised).

Lower Airway Infections

  • RSV: Primarily dangerous for infants and the elderly. High contagion risk.

  • Acute Bronchitis: Either viral (nonproductive cough) or bacterial (productive cough).

  • Tuberculosis (TB): Can spread beyond lungs; requires strict adherence to lengthy treatment regimens.

Conclusions and Discussed Case Study

Priority Nursing Intervention

  • Case Study: Hank, 37, with flu symptoms.

  • Interventions: Prioritize oral fluid intake to address dehydration and promote comfort through analgesics.

  • Education: Importance of monitoring for symptoms of complications post-discharge, including secondary infections like otitis media or worsening cough.

  • Vaccination Awareness: Importance of vaccines in preventing serious conditions like influenza and pneumonia.

Questions and Engagement

  • Patient Education: While discussing care and comfort measures, students are encouraged to actively engage in the learning process and clarify doubts.

  • Facilitation of Discussion: Open dialogue on smoking cessation and preventive health strategies is encouraged, ensuring understanding of the significance in clinical practices.