Oxygenation Lecture Notes

Zoom Sign-in and Attendance

  • Importance of putting first and last name for attendance during the Zoom class.

Lecture Introduction

  • Time of Lecture: Started at approximately 10:40.
  • Recording Notice: This lecture is being recorded; previous lecture not recorded.
  • Communication Encouragement: Students encouraged to type questions in the chat; chat open for questions.

Instructor Introduction

  • Name: Miss Weinberger.
  • Background: Graduated from Charity School of Nursing in May 2019. Experience includes work in adult ER and pediatrics.

Statement of Learning Objectives (SLOs)

  • Aim: Break down components and implications of oxygenation, forming a care plan for altered oxygenation patients.
  • Text Reference: Visual aids or images are found in the textbook, Volume 1, Page 975.

SLO 1: Structure and Function of the Respiratory System

  • **Pulmonary System Components:

    • Airway:**
    • Nasal passages
    • Mouth
    • Pharynx (throat)
    • Larynx
    • Trachea
    • Bronchi
    • Bronchioles
    • Lungs: Cone-shaped organs separated by the mediastinum, containing alveoli for gas exchange.
    • Upper airway is above the larynx; lower airway, below.

  • Epiglottis Function: A flap preventing food/fluid entry into the trachea during swallowing, preventing aspiration, while allowing air passage during breathing.

  • Trachea: Sometimes known as the windpipe, extends from larynx to main bronchi; divided into right and left mainstem bronchi. Alveoli promote gas exchange.

  • Gas Exchange Process:

    • Inhalation allows oxygen uptake by hemoglobin, simultaneous carbon dioxide release.

SLO 2: Assessment of Oxygenation

  • Focus on Ventilation vs. Respiration:

    • Ventilation: Air movement in/out of lungs (active breathing).
    • Respiration: Gas exchange (oxygen and carbon dioxide).

  • Key Elements of Breathing:

    • Inhalation: Chest expansion; diaphragm contraction to facilitate air intake.
    • Exhalation: Diaphragm and intercostal muscles relax, allowing lung contraction.

  • Factors Affecting Ventilation:

    • Respiratory Rate and Depth: Normal ranges from 12-20 breaths/minute; significant deviations result in hyperventilation (>20 breaths/min), hypoventilation (<12).
    • Implications of Hyperventilation and Hypoventilation:
      • Hyperventilation causes rapid breathing; can be exacerbated by anxiety or certain medications.
      • Hypoventilation results in reduced alveolar air exchange, potential hypoxemia (low blood oxygen levels) progressing to hypoxia (low tissue oxygen levels).

  • Lung Elasticity and Compliance:

    • Lung elasticity refers to the ability of the lungs to return to original position after stretching.
    • Reduced lung compliance occurs due to conditions like pulmonary edema.

  • Airway Resistance: Increased resistance can result from narrowed airways or blockages, impeding effective air exchange.

Focused Respiratory Assessment Process

  • History of Present Illness (HPI): Determine conditions that exacerbate or alleviate symptoms, including duration and onset of shortness of breath.
  • Pain Assessment: Evaluate quality, location, severity, and provoking factors of any discomfort.
  • Cough Assessment:
    • Differentiate between productive (producing sputum) and nonproductive coughs (dry). Note sputum color, consistency, and odor when applicable.
  • Dyspnea: Note subjective perceptions of shortness of breath.
  • Health History and Medication Review: Gather information on prescribed and over-the-counter medications and herbal supplements.
  • Allergies and Past Medical History: Assess prior episodes of respiratory diseases and vaccine status (i.e., pertussis, pneumonia, flu).

Physical Assessment Techniques

  • Inspection: Check general appearance, level of consciousness, speech capability.
  • Palpation: Ensure trachea is midline and without tenderness.
  • Auscultation: Compare breath sounds bilaterally while listening to lung fields for abnormalities.

Assessment of Breathing Patterns

  • Types of Respiration:
    • Eupnea: Normal and unlabored breathing (12-20 breaths/min).
    • Tachypnea: Rapid, shallow breathing (>20 breaths/min).
    • Bradyapnea: Slow breathing (<12 breaths/min).
    • Kussmaul Respirations: Regular but deep breathing, indicates potential metabolic disorder compensation.
    • Cheyne-Stokes: Periods of increasing and decreasing depth of breathing, with apnea intervals, frequently seen near end-of-life.
    • Stridor: Harsh, inspiratory sound indicating upper airway obstruction.
    • Wheezing: Musical sound from narrowed smaller airways, as in asthma.

Oxygenation Assessment Indicators

  • Assess color of skin and oral mucosa, nail beds, and monitor capillary refill time for signs of poor perfusion.
  • Identifying clubbing, retractions, and increased work of breathing can provide additional insights.

Diagnostic Tests for Oxygenation

  • Pulse Oximetry: Normal values between 95-100%. Low readings prompt further evaluation.
  • Arterial Blood Gas (ABG): Important for assessing oxygenation status accurately.

Nursing Interventions for Oxygenation

  • Oxygen Administration Devices:
    • Low Flow Devices: Nasal cannula, simple face masks, partial and nonrebreather masks.
    • High Flow Devices: Venturi masks, aerosol masks, or high flow nasal cannulas.
  • Risks and Complications: Oxygen toxicity from high flow over extended periods, atelectasis from blockage, and drying of mucous membranes.

Home Oxygen Safety Education

  • Avoid smoking or flammable materials around oxygen supplies. Keep fire extinguishers accessible.
  • Use water-based lubricants to prevent mucosal dryness.
  • Ensure patients have an emergency plan for power failures, particularly if dependent on oxygen.

ADPIE Nursing Process for Oxygenation Issues

  • Assessment: Identify changes in consciousness, signs of hypoxia, check vitals including pulse oximetry and lung sounds.
  • Diagnosis Examples: Impaired gas exchange, ineffective airway clearance, or ineffective breathing pattern.
  • Planning Goals: Target oxygen saturation above 95%, improvement in respiratory rate, and a defined pain score to allow effective breathing.
  • Implementation Strategies: Encourage deep breathing, mobility, effective positioning, and ensure appropriate administration and monitoring of oxygen therapy.
  • Evaluation of Effectiveness: Monitor respiratory status and subjective feedback from patients. Maintain awareness of trends over time, and identify potential complications like pneumonia or atelectasis.

Atelectasis Insights

  • Etiology and Prevention: Causes include postoperative immobility, obstructive blockages, or external pressures (e.g., from fluid overflow or abdominal distention).

  • Risk Factors: Postoperative status, smoking history, neuromuscular conditions, obesity, etc.

  • Assessment Indicators: Watch for dyspnea, temperature changes, oxygen saturation drops, and changes in breath sounds (e.g., marked dyspnea and respiratory fatigue).

  • Nursing Care Strategies: Ensure deep breathing practices, early ambulation, and frequent monitoring of vitals and respiratory status to avoid complications like pneumonia or atelectasis. Evaluate patient discomfort and provide appropriate pain management.