Gas Exchange, Oxygenation, and Medication Administration

Gas Exchange and Oxygenation

  1. Explain the structure, function, and physiology of ventilation and perfusion.
    a. Structure and Function of the Lung

    • The lungs are critical for gas exchange.

    • Structure:

      • The right lung has three lobes.

      • The left lung has two lobes, accommodating space for the heart.

    • Function:

      • Responsible for regulating the size of airways via:
        i. Bronchodilation: Expansion of airways.
        ii. Bronchoconstriction: Restriction of airways.

    • Nervous System Connection:

      • Innervated by both parasympathetic and sympathetic systems.

    • Analogy: Lungs are likened to air balloons—one slightly smaller (left) for heart space. Airways resemble adjustable straws that can widen or tighten depending on sympathetic (gas pedal) or parasympathetic (brakes) responses.

    b. Ventilation

    • Defined as the flow of air into and out of the alveoli.

    • Key functions include:

      • Transporting oxygen into the alveoli.

      • Removing carbon dioxide from the body.

    • Analogy: Ventilation is like opening a window—fresh oxygen enters while stale CO₂ exits.

    c. Perfusion and Pulmonary Circulation

    • Perfusion: The flow of blood through the pulmonary capillaries for gas exchange.

    • Oxygenated blood goes into the capillaries; deoxygenated blood returns to the lungs.

    • Pathway of Pulmonary Circulation:

      1. Deoxygenated blood returns to the right atrium via the superior and inferior vena cava.

      2. Blood leaves the right ventricle into the pulmonary artery.

      3. Blood reaches pulmonary arterioles and capillaries for gas exchange.

      4. Oxygenated blood moves from pulmonary venules to pulmonary veins.

      5. Blood returns to the left atrium, then into the left ventricle, and is pumped via the aorta to body tissues.

    • Analogy: This process is like a delivery and pickup system—deoxygenated blood as a mail truck that picks up oxygen from the lungs and delivers it to the body.

    d. Physiology of Breathing

    • Key physiological concepts:
      i. Lung Compliance:
      - Definition: The extent to which a lung expands in response to increased intra-alveolar pressure.
      - Analogy: Lung compliance is like a balloon; some balloons stretch easily (good compliance), while others require more effort (poor compliance).
      ii. Airway Resistance:
      - Definition: The pressure present when the airway diameter is narrowed.
      - Analogy: Airway resistance is akin to blowing through a narrow straw; it takes more effort when the passage is tight.
      iii. Increased lung compliance and airway resistance result in increased work of breathing, possibly requiring the use of accessory muscles.

  2. Examine assessment findings related to cardiopulmonary function.
    a. Assessment of Cardiopulmonary Function: Involves obtaining a health history and conducting a physical examination.
    b. Components of Physical Examination:
    i. Inspection
    ii. Palpation
    iii. Percussion
    iv. Auscultation
    c. Clinical indications of respiratory distress:

    • Observed through the use of accessory muscles due to increased work of breathing resulting from heightened lung compliance or airway resistance.

    • Analogy: The physical examination components serve as “detective tools” for nurses—

      • Eyes for inspection

      • Hands for palpation

      • Ears for auscultation

      • Tapping for clues (percussion).

    • Analogy: When patients use accessory muscles, the body is akin to calling in “extra workers” to assist with a job that’s become too difficult.

  3. Discuss clinical outcomes related to alterations in ventilation and perfusion.
    a. Alterations in Function: Affect both oxygenation/respiratory function and cardiovascular function.
    b. Factors Affecting Oxygenation and Respiratory Function:

    • Common disorders include:
      i. Hyperventilation
      ii. Hypoventilation
      iii. Hypoxia

    • These disorders can lead to imbalances in the body's acid-base status, particularly affecting carbon dioxide (acid) levels in blood.

      1. Respiratory Acidosis:

        • Occurs when the lungs cannot expel enough carbon dioxide.

        • Common causes include:
          a. Airway diseases (COPD, asthma).
          b. Diseases of lung tissue.
          c. Diseases that affect chest and breathing (e.g., scoliosis).
          d. Severe obesity or obstructive sleep apnea.
          e. Medications that suppress breathing (e.g., narcotics).

      • Analogy: Respiratory acidosis is like a stuffy room with closed windows—too much CO₂ builds up, making the air feel heavy.

      1. Respiratory Alkalosis:

        • Occurs when carbon dioxide levels drop too low—often caused by breathing too fast (hyperventilation).

      • Analogy: Respiratory alkalosis is like opening windows on a windy day—excess air rushes out, leaving the body too void of CO₂.

  4. Explore oxygen therapies and related potential complications.
    a. Oxygen Delivery Devices: Each device provides a specific range of oxygen concentration at a specified flow rate:
    i. Nasal Cannula:
    - 24-44% oxygen
    - 1-6 L/min
    ii. Simple Face Mask:
    - 35-60% oxygen
    - 5-10 L/min
    iii. Partial and Non-Rebreather Masks:
    - 60-90% oxygen
    - 10-15 L/min
    iv. Venturi Mask:
    - 24-70% oxygen
    - 4-12 L/min
    b. Other Oxygen Treatments:

    • Aerosol Nebulizer Treatments

    • Positive Airway Pressure Treatment
      c. Complications of Oxygen Therapy:

    • Primary concern is oxygen toxicity.

    • Analogy: Oxygen therapy is like adjusting a shower—too little pressure leaves you unclean (under-oxygenated); too much pressure can cause burns (oxygen toxicity).

  5. Explore nursing actions used to improve oxygenation.
    a. Nursing Actions to Enhance Client Oxygenation:

    • Include various therapeutic interventions and the utilized supportive devices and airways.
      b. Actions Implemented:
      i. Chest Physiotherapy
      ii. Use of Incentive Spirometer
      iii. Pursed Lip Breathing
      iv. Use of Flutter Valve
      v. Coughing and Deep Breathing Techniques
      vi. Huff Coughing
      vii. Suctioning
      viii. Closed-Chest Drainage
      ix. Use of Artificial Airways (e.g., Nasotracheal tube, Endotracheal tube, Tracheostomy)
      c. Analogies for Nursing Actions:

    • Chest Physiotherapy: Like patting a ketchup bottle to loosen what’s stuck inside.

    • Incentive Spirometer: Similar to blowing into a video game to keep the ball afloat; it trains your lungs.

    • Pursed-Lip Breathing: Comparable to blowing out candles slowly to control your breath.

    • Flutter Valve: Like shaking a soda can to mobilize bubbles (mucus).

    • Coughing/Deep Breathing: Like refreshing your lungs.

    • Suctioning: Like using a vacuum to clear debris from a clogged pipe.

    • Closed-Chest Drainage: Similar to using a siphon hose to remove fluid or air.

    • Artificial Airways: Like inserting a straw to keep an airway open.

Medication Administration

  1. Discuss nursing actions that support safe medication administration.
    a. Safe Medication Administration: Centers on adhering to the Six Rights of Medication Administration and systematic safety checks.
    b. Six Rights of Medication Administration:
    i. Right Client: Verify identity using two identifiers.
    - Analogy: Like checking two forms of ID before giving someone their mail.
    ii. Right Medication: Confirm correct name and form of a medication.
    - Analogy: Like ensuring the label on a box matches a delivery order.
    iii. Right Dose: Check against the medical record.
    - Analogy: Like measuring exact ingredients in a recipe.
    iv. Right Route: Confirm specified administration route (e.g., IV, IM, SC).
    - Analogy: The route is the “delivery method”—mail, email, or hand delivery, each matters!
    v. Right Time: Confirm time of administration and previous dose.
    - Analogy: Like watering a plant—timing affects how it grows.
    vi. Right Documentation: Document time and any relevant notes.
    - Analogy: Signing the delivery receipt proves the “package” arrived.
    c. Checking Medications: Recommended three checks for medication safety:
    i. Check against the MAR upon drug removal from the dispensing device.
    ii. Check during preparation.
    iii. Check immediately prior to administration.
    - Analogy: Like scanning a product three times during checkout—prevention of mistakes.

  2. Discuss actions to reduce the risk of medication errors.
    a. Strategies to Minimize Errors:
    i. Medication Reconciliation: Critical for continuity and safety in care; performed during transition points:
    1. Client admission
    2. Transitioning levels of care
    3. Transfer between healthcare facilities
    4. Client discharge
    - Analogy: Like updating a playlist when switching phones to avoid loss/duplication.
    ii. Management of High-Alert Medications: Highly associated with increased client harm risk when misadministered (e.g., insulin, opiates).
    - Core strategy: Require manual independent double checks by two nurses prior to administration.
    - Analogy: Like two pilots verifying the flight plan—ensuring safety in high-risk situations.
    iii. Reporting Serious Adverse Drug Events (ADEs): Life-threatening reactions must be reported to the FDA for safety improvements. A Black Box Warning (BBW) signals potential lethal effects.
    - Analogy: Reporting is like a recall for a dangerous car part—it prevents future accidents.

  3. Compare and contrast the various routes by which medication can be administered.
    a. Routes of Administration: Categorized as Enteral, Topical, or Parenteral.
    i. Enteral: Directly into the gastrointestinal tract.
    ii. Topical: Applied to skin or mucous membranes (eyes, nose, etc.).
    iii. Parenteral: Administered via injections or catheters.
    - Analogy: Routes are like “roads” medications take to reach destinations: stomach (enteral), skin (topical), bloodstream (parenteral).
    b. Comparison Table of Common Routes:
    i. Oral (PO):
    - Advantage: Convenient, cheaper, self-administered
    - Disadvantage: Slow onset, unsuitable for unconscious patients.
    - Analogy: Like mailing a letter—it’s easy but takes time.
    ii. Sublingual (SL):
    - Advantage: Rapid onset, self-administered
    - Disadvantage: Not suitable for children.
    - Analogy: Like slipping a message under the door—direct and fast.
    iii. Rectal (PR):
    - Advantage: Rapid onset, can be used on children/unconscious patients.
    - Analogy: Backdoor delivery—effective but unpopular.
    iv. Intravenous (IV):
    - Advantage: Rapid onset, suitable for noncompliant patients.
    - Disadvantage: Essential aseptic technique; expensive; invasive procedures; complications include phlebitis and infiltration.
    - Analogy: Like express shipping—instant delivery but costly and risky.
    … (remainder of routes would continue here)

  4. Perform basic dosage calculations.
    a. Dosage Calculation Techniques:
    i. Metric System: A decimal system for precise dosing.
    ii. Dimensional Analysis: Minimizes miscalculations during conversions.
    iii. Ratio Proportion: For single conversion expressed as fractions.
    - Analogy: Like using various “math tools” to achieve the same result.
    b. Essential Conversion Factors:

    • 1 mg = 1000 mcg

    • 1 g = 1000 mg

    • 1 L = 1000 mL

    • 30 mL = 1 ounce

    • 1 tsp = 5 mL

      • Analogy: Like knowing currency conversions to keep your “math wallet” balanced.

  5. Discuss the role of the nurse related to educating clients about their medications.
    a. Educative Role: Nurses serve as tour guides for patients' medications—describing action, timing, precautions, and warning signs.
    b. Importance of Education: Builds trust and prevents confusion in patients' medication routines.

Fluid, Electrolyte, and Acid-Base Regulation

  1. Explain the process for regulating fluid and electrolyte balance.
    a. Fluid and Electrolyte Balance: Vital for bodily functions, muscle, heart, nerve, and brain activities. Responsible for balancing bodily water, nutrient movement into cells, and waste removal.

    • Analogy: The body is like a fish tank; proper water levels keep fish alive, the kidneys filter waste, and blood circulation provides oxygen.
      b. Body Composition: Average body weight consists of one-half to two-thirds water; important for hydration.

    • Analogy: A plant wilting without water indicates inadequate hydration. c. Regulation Mechanisms: i. Thirst: Brain's response indicating need for water.

      • Analogy: Like a low fuel light in a car signaling refueling.
        ii. Hormonal Control (Vasopressin): Pituitary gland releases ADH to conserve water, decreasing urine output.

      • Analogy: ADH is like saving battery on a phone.
        iii. Osmosis: Water flow between compartments to maintain equilibrium.

      • Analogy: Like water moving through a sponge until both sides are damp.
        iv. Kidney Function: Balances salt and fluid like filters in a pool.
        d. Electrolytes: Essential minerals (K⁺, Na⁺, Ca²⁺, Mg²⁺) support cellular function, blood pressure maintenance, and fluid balance.

    • Imbalances can result from dehydration, overhydration, or medical conditions.

    • Analogy: Electrolytes are like electric wiring for vital operations. e. Fluid Imbalances: i. Hypovolemia: Decreased blood volume due to fluid loss.

      • Analogy: Like a kink in a hose which reduces pressure and flow.
        ii. Hypervolemia: Fluid overload conditions leading to edema.

      • Analogy: Like an overfilled bathtub.

  2. Discuss the process of rehydration and potential complications.
    a. Rehydration Process: Often involves the administration of IV Therapy, using crystalloid solutions.

    • Analogy: Like refilling a sponge through tiny pores for even water distribution.
      b. IV Solutions and Tonicity:

    • Hypotonic: Moves water into cells (e.g. like overwatering a balloon).

    • Hypertonic: Causes water to leave cells (e.g., like salt drawing moisture from a slug).

    • Isotonic: Results in no movement across compartments (e.g., like two equal cups of water). c. Complications of IV Administration: i. Infiltration: Incorrect administration into surrounding tissue, evidenced by local swelling and dampness.

      • Analogy: Like a hose leaking underground instead of watering plants.
        ii. Phlebitis: Inflammation of the vein, indicated by redness and swelling at the site.

      • Analogy: Like a road damaged due to excessive traffic.

  3. Discuss the use of blood transfusion for replacement of blood volume and components.
    a. Blood Transfusions: Various blood products used to restore volume and components.

    • Packed Red Blood Cells (RBCs): Restore levels without significantly increasing volume.

    • Whole blood, plasma, and platelets for specific conditions.

    • Analogy: Like car maintenance—sometimes you refill the tank (whole blood), other times just replace oil (RBCs).

  4. Explore the role of the nurse when caring for clients with a fluid or electrolyte imbalance.
    a. Monitoring Intake and Output (I&O): Key in assessing fluid balance.

    • Intake: Total fluid intake including oral, IV, and feeding tubes.

    • Output: Fluid expelled from the body, such as urine and vomit.

    • Analogy: Like balancing a bank account, watching what goes in and out.
      b. IV Therapy Nursing Actions: Include maintaining IV site patency and employing aseptic techniques.

    • Analogy: Treat the IV as a clean straw—keeping it unblocked and sterile.

  5. Explain the process for regulating acid–base balance.
    a. Acid-Base Balance: The necessary balance of acids and bases in the blood.

    • Acidosis: High acid levels in blood.

    • Alkalosis: High base levels in blood.

    • Analogy: Balancing coffee and cream; excess of either alters flavor (pH).
      b. Type of Imbalances:

    • Classified into metabolic or respiratory based on causes. c. Respiratory Acidosis and Alkalosis: i. Respiratory Acidosis: Reduced removal of carbon dioxide.

      • Causes include airway diseases and respiratory suppression.

      • Analogy: Like a room without ventilation, where CO₂ accumulates.
        ii. Respiratory Alkalosis: Excessive loss of carbon dioxide due to hyperventilation.

      • Analogy: Like rapidly shaking a soda can—losing gas too quickly.
        d. Metabolic Acidosis and Alkalosis:

    • Metabolic Acidosis: Related to kidney disease or significant fluid loss.

      • Analogy: Like adding too much lemon juice; the solution becomes acidic.

    • Metabolic Alkalosis: Results from excessive vomiting or use of diuretics.

      • Analogy: Like adding too much baking soda, resulting in an alkaline mix.