oxygenation nad alteration

Interventions for Alterations in Oxygenation

Review of Key Anatomy and Physiology

• Oxygen (O2)
    - Required for creating energy.

• Carbon Dioxide (CO2)
    - By-product of energy production.
    - Not utilized by the body.

• Gas Exchange
    - O2 and CO2 exchanged between the environment and cells through:
      - Ventilation
      - Respiration
      - Perfusion

Ventilation, Respiration, & Perfusion

• Ventilation
    - Movement of air into and out of the lungs.

• Respiration
    - Gas exchange occurs between atmospheric air in the alveoli and the capillaries.

• Perfusion
    - Oxygenated capillary blood passing through body tissues for utilization.

Ventilation (Breathing)

• Phases of Ventilation
    - Two distinct phases:
      - Inspiration:
        - Diaphragm and intercostal muscles contract, enlarging the thorax and decreasing intrathoracic pressure.
        - Result: air rushes into the lungs.
      - Expiration:
        - Diaphragm and intercostal muscles relax.
        - Thorax decreases in size, increasing pressure, which forces air out of the lungs.

Regulation of Ventilation

• Regulatory Mechanisms
    - Controlled by the Central Nervous System (CNS), particularly the medulla and brainstem.
    - Stimuli for Breathing:
      - Increasing levels of CO2 and hydrogen ions in the blood prompts the drive to breathe.
    - Proprioceptors:
      - Send signals to increase ventilation during increased physical activity.
    - Influenced by:
      - Airway resistance.
      - Muscle tone.
      - Lung compliance.

Anatomy Involved in Respiration

• Key Components Include:
    - Frontal sinus, nasal cavity, epiglottis, right lung, sphenoidal sinus, nasopharynx, oropharynx, larynx, trachea, bronchi, alveoli, capillaries.

• Diagram labeled with key components and their physiological function in circulation and gas exchange:
    - Blood gases represented in mm Hg:
      - PO2 in the lungs: 100 mm Hg.
      - PCO2 in lungs: 46 mm Hg.
      - Oxygenated blood: PO2 = 100 mm Hg and PCO2 = 40 mm Hg.

Perfusion

• Definition:
    - Delivery of oxygen to the body’s cells and CO2 return to the lungs.

• Factors Impacting Perfusion:
    - Body position, activity level, adequacy of blood supply.
    - Requires proper cardiovascular function (pumping efficiency).

Altered Respiratory Function

• Hyperventilation
    - Defined as ventilation exceeding what is necessary to remove CO2.
    - Possible Causes:
      - Anxiety, infection/fever, hypoxia, diabetic ketoacidosis, aspirin overdose.

• Hypoventilation
    - Inadequate ventilation to meet O2 demand or remove CO2 sufficiently.
    - Possible Causes:
      - Chronic Obstructive Pulmonary Disease (COPD), obesity hypoventilation syndrome, atelectasis.

• Hypoxia
    - Insufficient oxygen available for cellular use.
    - Possible Causes:
      - Decreased hemoglobin, hypoventilation, aspiration, poor tissue perfusion.

Signs & Symptoms of Hypoxia

• Acute Hypoxia: Emergency condition.
    - Symptoms include:
      - Anxiety, restlessness, confusion, drowsiness, increased pulse, dyspnea, tachypnea, increased blood pressure, cardiac arrhythmias.

• Chronic Hypoxia: Ongoing symptoms.
    - Symptoms include:
      - Pallor, fatigue, altered thought processes, headache, chest pain, clubbing of the nails, anorexia, constipation, decreased urine output.

Transition to Cardiovascular Discussion

• Topic shift: from airway & breathing to circulation (ABC).

Cardiovascular Structure

• Key components highlighted:
    - Superior vena cava, pulmonary valve, right pulmonary artery, left atrium, aortic arch, left ventricle, right ventricle, inferior vena cava.

• Blood Flow Through the Heart:
    - Arteries, veins, capillaries, valves shaped by anatomical structures to manage the flow of high and low oxygenated blood.

Cardiovascular System Functions

• Main Functions:
    - Circulates blood, delivering oxygen and nutrients while removing wastes.

• Plumbing & Electrical Functions:
    - Plumbing: Heart acts as a pump; vessels are the pipes.
    - Electrical: Controlled by the SA node, electrical signals must move orderly for proper heart function.

Altered Cardiovascular Function

• Key Issues:
    - Arrhythmia (Dysrhythmia): Irregular or ineffective heartbeats due to electrical conduction issues.
    - Ischemia: Impaired oxygen delivery to tissue; can lead to myocardial infarction (heart attack), angina, or cerebrovascular accidents (stroke).
    - Cardiac Valve Stenosis: Causes inefficient heart pumping.
    - Heart Failure: Inefficient blood pumping leading to systemic issues.
    - Hypovolemia: Insufficient blood volume affects perfusion.

Assessing for Alterations in Oxygenation

• Assessment Steps:
    - Ensure patient is not in acute respiratory distress.
    - History Taking:
      - Identify abnormal respiratory/cardiovascular functions.
      - Use yes/no questions if dyspneic; ask for help if necessary.
    - Physical Exam:
      - Inspect, palpate, auscultate; account for age-related findings.

Diagnostic Tests

• Blood Work:
    - Arterial Blood Gas (ABG), Complete Blood Count (CBC), cardiac enzymes (CK-MB and Troponin), cholesterol profiles, microbiological cultures.

• Cardiac Function Tests:
    - EKG/ECG, Holter monitor, echocardiograms (thoracic or esophageal), cardiac stress tests, cardiac angiography.

• Pulmonary Function Tests:
    - Chest X-ray, capnography, lung scans (VQ scan), pulmonary function testing, thoracentesis, bronchoscopy.

Nursing Diagnoses

• Focus on oxygenation issues leading to other problems, including:
    - Ineffective airway clearance.
    - Impaired gas exchange.
    - Ineffective breathing patterns.
    - Impaired cardiac output.
    - Impaired verbal communication, activity intolerance, risk for infection, anxiety, fatigue.

Interventions

• Address alterations affecting oxygenation.

Health Promotion

• Healthy Lifestyle Choices:
    - Manage modifiable risk factors (diet, exercise, smoking cessation).
    - Resources:
      - National campaigns for smoking cessation (e.g., smokefree.gov).

• Disease Management:
    - Monitoring BP, cholesterol, and triglycerides; managing COPD, asthma, heart failure.

• Vaccinations:
    - Yearly flu shots, pneumococcal vaccines for at-risk populations, COVID-19 vaccine.

• Environmental Management:
    - Reduce exposure to pollutants at home, occupational safety precautions, use air filters and air conditioners.

Interventions for Altered Respiratory Function

• Dyspnea Management:
    - Techniques such as anxiety management, energy conservation, and specific breathing techniques (pursed-lip and diaphragmatic breathing).

• Airway Maintenance:
    - Mobilization of secretions, oral hydration, effective coughing, and management of artificial airways.

• Promotion of Lung Expansion:
    - Using strategic positioning, pain control techniques, and management of chest tubes.

Dyspnea Management Techniques

• Pursed-lip Breathing:
    - Reduces panic; how-to: inhale through the nose (count to 3), exhale through pursed lips (count to 7).

• Diaphragmatic Breathing:
    - Facilitates better respiratory patterns especially for COPD patients.
    - Technique involves placing one hand on the abdomen and one on the chest while breathing.

Airway Maintenance

• Secretions Management:
    - Encourage oral fluid consumption of 2-3 liters/day.
    - Use of expectorants and suppressants as needed.

• Coughing Techniques:
    - Differentiating productive and nonproductive coughing.

• Management of Artificial Airways:
    - Endotracheal tubes and tracheostomy care.

Breathing Exercises

• Deep Breathing:
    - Inhale deeply through the nose and exhale through the mouth to engage lower lungs.

• Incentive Spirometry:
    - Promotes lung expansion by taking deep breaths while using a spirometer; instructed to hold breath at peak.

Chest Physiotherapy

• Effective in mobilizing secretions in patients with large amounts of secretions.

• Techniques include percussion, vibration, and postural drainage, usually conducted by trained professionals.

Suctioning

• Necessary when patients cannot clear secretions.

• Types of Suctioning:
    - Oropharyngeal/Nasopharyngeal suctions (non-sterile).
    - Tracheal suctioning (requires sterile technique).

• Risks associated with suctioning:
    - Includes hypoxia, tissue trauma, anxiety, and potential death.

Promotion of Lung Expansion

• Positioning:
    - Use of upright, Fowler’s, or semi-Fowler’s positions; tripod positioning; and prone positioning to aid lung expansion.

• Management of chest tubes:
    - Removes trapped air, blood, or fluid, and helps create negative pressure in pleural space.

Fundamentals of Oxygen Administration

• Oxygen Composition:
    - Room air is 21% oxygen.

• Administration Guidelines:
    - Requires medical orders and licensed personnel to manage.
    - Emergency treatment prioritizes patient needs first before orders.

• Indications for Oxygen Use:
    - Hypoxia, decreasing SpO2, tachypnea, tachycardia/chest pain, recovery from anesthesia or opioid use.

• Safety Considerations:
    - Oxygen is combustible, stored in pressurized tanks; monitoring tubing and overall therapy effectiveness is critical.

Oxygen Administration Equipment

• Flow Meters:
    - Adjusts delivery amount of oxygen; requires regular checking.

• Humidifiers:
    - Provides moisture to oxygen to prevent mucosal drying and ensure sterility.

• Compressed Oxygen Tanks:
    - Must be stored properly to prevent accidents.

• Oxygen Compressors:
    - Convert room air to medical-grade oxygen for long-term care.

Methods of Oxygen Administration

• High Flow Oxygen System:
    - Provides complete and consistent oxygen delivery irrespective of breathing patterns.

• Low Flow Oxygen System:
    - Provides part of total inspired air; more comfortable as oxygen delivery is variable.

Oxygen Delivery Devices

• Nasal Cannula (NC):
    - Flow: 1-6 L/min.
    - FiO2: 24-44%.

• Simple Face Mask (SFM):
    - Flow: 5-10 L/min.
    - FiO2: 40-60%.

• Venturi Mask (Venti-Mask):
    - Flow: 2-15 L/min.
    - FiO2: 24-60%.

• High Flow Nasal Cannula (HFNC):
    - Flow: up to 60 L/min.
    - FiO2: 21-100%.

• Non-Rebreather Mask (NRM):
    - Flow: 10-15 L/min.
    - FiO2: 80-95%.

• Bipap/CPAP:
    - Mechanical support creating pressures during inhalation and exhalation.

• Ventilator:
    - Requires artificial airway and is used for artificial ventilation.
    - Settings for rate, depth, FiO2, and pressures determined per patient needs.

Evaluation

• Goals for Oxygen Therapy:
    - Titrate oxygen to maintain target SpO2.

• Monitoring Tools:
    - SpO2: Non-invasive, normal range is 90-99% (ideally >94%).
    - Cold or poor circulation may influence readings.

• Arterial Blood Gases:
    - Invasive measure used for precise oxygenation and CO2 levels when necessary.