Chapter 41 Oxygenation

Chapter 41 - Oxygenation

Page 1

• Oxygenation Overview

  • Introduction to the chapter on oxygenation with reference code N266.

Page 2 - Scientific Knowledge Base

Respiration

• Definition: The exchange of oxygen (O2) and carbon dioxide (CO2).

Respiratory Physiology

• Key Components:

  • Structure and Function:

    • Respiratory Muscles: Essential for the process of breathing.

    • Pleural Space: A key area in relation to lung mechanics.

    • Lungs and Alveoli: Sites for gas exchange.

  • Work of Breathing:

    • Inspiration: Process of inhaling air.

    • Expiration: Process of exhaling air.

  • Lung Volumes: The amount of air the lungs can hold.

  • Pulmonary Circulation: Moves blood between the heart and lungs for gas exchange..

Page 3 - Scientific Knowledge Base

Respiratory Gas Exchange

• ✔ Key Points

  • Respiratory Gas Exchange:

    • Oxygen Transport: Hemoglobin (Hgb) carries O₂ in the blood.

    • Anemia (low Hgb levels) reduces O₂ transport, leading to fatigue and weakness.

    • Carbon Dioxide Transport: CO₂ is carried back to the lungs for exhalation.

  • Regulation of Ventilation:

    • The body adjusts breathing rate to maintain O₂ and CO₂ balance.

    • Example: During exercise, breathing increases to meet higher oxygen demands.

  ✔ Why Is This Important?
  Nurses must recognize signs of poor oxygen transport (e.g., anemia, respiratory distress) and understand how ventilation is regulated to manage conditions like hypoxia and hyperventilation effectively.

Page 4 - Scientific Knowledge Base

Cardiovascular Physiology

• Key Components:

  • ✔ Key Points

    • Cardiovascular Physiology plays a vital role in oxygenation. It includes:

      • Myocardial Pump: The heart pumps oxygenated blood to the body.

      • Myocardial Blood Flow: Supplies oxygen and nutrients to the heart muscle.

      • Coronary Artery Circulation: Provides blood to the heart itself.

      • Systemic Circulation: Moves oxygen-rich blood throughout the body.

      • Blood Flow Regulation: Maintains adequate circulation and pressure.

    • Conduction System: Controls the electrical impulses that make the heart beat.

    ✔ Why Is This Important?
    The heart and lungs work together to deliver oxygen to tissues. Nurses must monitor cardiac function to prevent complications like heart failure, arrhythmias, and poor circulation, which can lead to low oxygen levels in the body.

Page 5 - Scientific Knowledge Base

Factors Affecting Oxygenation

Physiological Factors

• • ✔ Key Points

    • Factors Affecting Oxygenation:

      • Physiological Factors:

        • Decreased oxygen-carrying capacity: Example: Anemia reduces oxygen transport.

        • Hypovolemia (low blood volume): Example: Shock or severe dehydration can limit oxygen delivery.

        • Decreased inspired oxygen concentration: Example: Airway obstruction (e.g., choking, asthma).

        • Increased metabolic rate: Example: Exercise or fever increases oxygen demand.

    ✔ Why Is This Important?
    Nurses must recognize these factors to identify breathing difficulties, circulatory issues, or increased oxygen needs in patients. Early intervention can prevent complications like hypoxia and respiratory failure.

Page 6 - Scientific Knowledge Base

Conditions Affecting Chest Wall Movement

• ✔ Key Points

  • Conditions Affecting Chest Wall Movement: These conditions restrict lung expansion, making breathing difficult.

    • Pregnancy: The growing fetus pushes against the diaphragm, reducing lung expansion.

    • Obesity: Excess weight on the chest and abdomen limits deep breathing.

    • Musculoskeletal Abnormalities: Conditions like scoliosis can restrict lung expansion.

    • Trauma: Rib fractures or chest injuries cause pain and limit movement.

    • Neuromuscular Diseases: Conditions like ALS or muscular dystrophy weaken breathing muscles.

    • Central Nervous System Alterations: Brain injuries or spinal cord damage can impair respiratory control.

    • Chronic Lung Disease: Conditions like COPD cause long-term breathing difficulties.

  ✔ Why Is This Important?
  Nurses must assess chest movement, breathing patterns, and oxygen levels in patients with these conditions to ensure adequate oxygenation and prevent complications like respiratory distress.

Page 7 - Alterations in Respiratory Functioning

1. ✔ Key Points

   • Alterations in Respiratory Functioning:

     1. Hypoventilation:

        • Slow or shallow breathing that doesn’t meet the body’s oxygen needs.

        • Causes CO₂ buildup, leading to symptoms like confusion, dizziness, and fatigue.

     2. Hyperventilation:

        • Rapid or deep breathing that removes too much CO₂.

        • Causes dizziness, numbness, and tingling (often seen in anxiety attacks).

     3. Hypoxia:

        • Low oxygen in tissues, a life-threatening condition.

        • Signs include restlessness, confusion, cyanosis (bluish skin), and shortness of breath.

   ✔ Why Is This Important?
   Nurses must recognize and treat breathing abnormalities quickly to prevent serious complications like respiratory failure, cardiac arrest, or brain damage due to low oxygen levels.

Page 8 - Alterations in Cardiac Functioning

✔ Key Points

• Alterations in Cardiac Functioning:

  1. Disturbances in Conduction:

     • Dysrhythmias (irregular heartbeats) disrupt normal oxygen delivery.

  2. Altered Cardiac Output:

     • Left-Sided Heart Failure: Causes fluid buildup in the lungs (pulmonary congestion).

     • Right-Sided Heart Failure: Causes swelling (edema) in extremities due to fluid retention.

  3. Impaired Valvular Function:

     • Stenosis (stiff valves): Prevents normal blood flow.

     • Regurgitation (leaky valves): Causes blood to flow backward, reducing circulation.

  4. Myocardial Ischemia (Reduced Blood Flow to Heart):

     • Angina: Chest pain due to reduced oxygen supply.

     • Myocardial Infarction (Heart Attack): Occurs when blood supply to the heart is blocked.

✔ Why Is This Important?
Nurses must monitor heart function closely to detect heart failure, dysrhythmias, or heart attacks early and intervene to prevent serious complications like organ damage or cardiac arrest.

Page 9

• Oasis Video: Provides visual/interactive content on oxygenation and perfusion.

Page 10 - Nursing Knowledge Base

Factors Influencing Oxygenation

• ✔ Key Points

  • Factors Influencing Oxygenation:

    • Developmental Stage:

      • Infants & Toddlers: Small airways increase the risk of infections (e.g., RSV, colds).

      • School-age Children & Adolescents: High risk for asthma, smoking-related damage.

      • Young & Middle-Age Adults: Lifestyle choices (smoking, poor diet, stress) impact lung health.

      • Older Adults: Weakened lungs, decreased elasticity, and higher risk of infections like pneumonia.

  ✔ Why Is This Important?
  Age-related changes affect oxygenation and breathing efficiency. Nurses must adjust care based on a patient’s developmental needs to prevent breathing issues, infections, and complications.

Page 11 - Nursing Knowledge Base

Continued Factors Influencing Oxygenation

✔ Key Points

• Lifestyle & Environmental Factors Affecting Oxygenation:

  • Lifestyle Factors:

    • Nutrition & Hydration: Poor diet and dehydration can weaken respiratory muscles.

    • Exercise: Improves lung capacity and oxygen efficiency.

    • Smoking: Damages lung tissue, increasing risk of COPD and lung cancer.

    • Substance Abuse: Depresses the respiratory center in the brain, leading to slow or ineffective breathing.

    • Stress: Can cause hyperventilation or worsen conditions like asthma.

  • Environmental Factors:

    • Secondhand Smoke Exposure: Increases risk of lung disease.

    • Occupational Pollutants: Chemicals, dust, and asbestos can cause lung damage over time.

✔ Why Is This Important?
Nurses must educate patients on healthy habits, smoking cessation, and environmental risks to help prevent respiratory diseases and improve lung health.

Page 12 - Critical Thinking

• ✔ Key Points

  • Critical Thinking in Oxygenation & Respiratory Care:

    • Understanding cardiac and respiratory physiology helps nurses assess and treat patients effectively.

    • Using a methodical and logical approach ensures proper patient assessment and intervention.

    • Professional Standards & Guidelines help nurses provide high-quality, evidence-based care.

  ✔ Why Is This Important?
  Nurses must think critically when assessing breathing patterns, oxygen levels, and cardiac function to provide timely and effective interventions for patients with respiratory or cardiac issues.

Page 13 - Nursing Process: Assessment

Through the Patient’s Eyes

• ✔ Key Points

  • Assessing Oxygenation from the Patient’s Perspective:

    • Nursing History:

      • Health Risks: Family history of respiratory or cardiac disease.

      • Pain: Chest pain or discomfort that affects breathing.

      • Fatigue: Can indicate poor oxygenation or underlying heart/lung issues.

      • Dyspnea (Shortness of Breath): A key symptom of respiratory distress.

      • Cough: Can signal infection, fluid buildup, or airway irritation.

  ✔ Why Is This Important?
  A thorough patient assessment helps nurses detect early signs of respiratory or cardiac issues, allowing for faster intervention and better patient outcomes.

Page 14 - Nursing Process: Assessment (cont.)

Environmental and Occupational Factors

• ✔ Key Points

  • Additional Factors Affecting Oxygenation:

    • Environmental & Occupational Factors: Exposure to chemicals, smoke, or allergens.

    • Smoking History: Determines risk for chronic lung diseases like COPD.

    • Respiratory Infections: Frequent infections may indicate weakened lung function.

    • Allergies: Can cause airway inflammation and difficulty breathing.

    • Medications: Some drugs affect respiratory function (e.g., opioids can depress breathing).

  ✔ Why Is This Important?
  Identifying these risk factors allows nurses to educate patients, recommend lifestyle changes, and implement early interventions to prevent serious respiratory conditions.

Page 15 - Nursing Process: Assessment

Physical Examination 🏥

• Physical Examination for Oxygenation:

  • Inspection: Check for breathing effort, skin color (cyanosis), and chest shape.

  • Palpation: Feel for abnormal vibrations (e.g., fluid buildup).

  • Percussion: Tapping to detect lung abnormalities (e.g., fluid in the lungs).

  • Auscultation: Listening to breath sounds for wheezing, crackles, or diminished airflow.

• Diagnostic Tests: Used to confirm oxygenation problems.

✔ Why Is This Important?
A thorough physical exam helps nurses detect early signs of respiratory distress, infections, or chronic lung diseases and determine the need for further testing.

Page 16 - Nursing Process: Analysis and Nursing Diagnosis

Examples of Common Diagnoses

• Common Nursing Diagnoses for Oxygenation Issues:

  • Impaired Cardiac Output: Poor heart function affects oxygen delivery.

  • Acute Pain: Can limit deep breathing, worsening oxygenation.

  • Activity Intolerance: Due to insufficient oxygen supply.

  • Fatigue: A result of low oxygenation.

  • Impaired Airway Clearance: Mucus or obstruction blocking airways.

  • Impaired Gas Exchange: Oxygen and CO₂ are not properly balanced.

  • Impaired Breathing: Difficulty maintaining normal breathing patterns.

✔ Why Is This Important?
Correctly identifying oxygenation-related problems helps nurses develop a focused care plan to improve breathing and oxygen levels in patients.

Page 17 - Nursing Process: Planning and Outcomes Identification

Goals and Priorities

• Outcome Goals for Patients with Oxygenation Issues:

  • Setting Priorities: Address life-threatening issues first.

  • Immediate Needs: Focus on Airway, Breathing, and Circulation (ABCs).

  • Teamwork & Collaboration: Work with respiratory therapists, physicians, and other healthcare providers.

✔ Why Is This Important?
Nurses must prioritize interventions to ensure patients receive oxygen and maintain stable breathing, preventing respiratory failure or cardiac arrest.

Page 18 - Nursing Process: Implementation

Health Promotion Strategies

• Preventative Strategies to Improve Oxygenation:

  • Vaccinations: Flu and pneumonia vaccines prevent respiratory infections.

  • Healthy Lifestyle: Exercise, balanced diet, and avoiding smoking improve lung function.

  • Reducing Environmental Pollutants: Avoid secondhand smoke and workplace hazards.

✔ Why Is This Important?
Health promotion reduces the risk of respiratory infections and chronic diseases, ensuring better long-term oxygenation and lung function for patients.

Page 19 - Nursing Process: Implementation

Acute Care Interventions

• Interventions for Patients with Breathing Difficulties:

  1. Dyspnea Management: Techniques to ease breathing.

  2. Airway Maintenance: Keeping airways open.

  3. Mobilization of Pulmonary Secretions: Clearing mucus to improve breathing.

  4. Hydration: Helps thin mucus for easier clearance.

  5. Humidification: Adds moisture to prevent airway dryness.

  6. Nebulization: Delivers medication directly to the lungs.

  7. Coughing & Deep-Breathing Techniques: Helps clear airways.

  8. Chest Physiotherapy: Helps break up mucus in the lungs.

✔ Why Is This Important?
These interventions help patients breathe better, prevent respiratory complications, and improve oxygen delivery to the body

Page 20 - Nursing Process: Acute Care

Lung Expansion Strategies

• Techniques to Promote Lung Expansion:

  • Ambulation: Encourages deep breathing and prevents lung collapse (atelectasis).

  • Positioning: Keeping patients upright (semi- or high-Fowler’s position) improves lung expansion.

  • Incentive Spirometry: A device that encourages deep breathing to prevent lung complications.

✔ Why Is This Important?
These interventions prevent pneumonia, improve oxygenation, and reduce the risk of lung collapse, especially in post-surgical or immobile patients.

Page 21 - Nursing Process: Acute Care

Artificial Airways

• Types of Artificial Airways:

  • Oral Airway: Prevents obstruction in unconscious patients by keeping the tongue from blocking the airway.

  • Endotracheal (ET) & Tracheal Airways:

    • Used for mechanical ventilation in critically ill patients.

  • Tracheostomy Tubes:

    • Used for long-term airway support in patients with airway obstruction or respiratory failure.

✔ Why Is This Important?
Nurses must know how to manage, suction, and care for artificial airways to ensure proper breathing, oxygenation, and prevention of complications like infection or airway obstruction

Page 22 - Nursing Process: Acute Care

Airway Suctioning Techniques

• Airway Suctioning: Clears mucus or obstructions from the airway.

  • Open vs. Closed Suctioning: Closed is preferred for ventilated patients to reduce infection risk.

  • Suctioning Techniques:

    • Oropharyngeal & Nasopharyngeal: For patients who can’t clear secretions on their own.

    • Orotracheal & Nasotracheal: Deeper suctioning for severe airway blockages.

    • Tracheal Suctioning: For patients with artificial airways.

• Mechanical Ventilation: Provides breathing support for critically ill patients.

✔ Why Is This Important?
Proper suctioning and ventilation prevent respiratory distress, remove obstructions, and improve oxygenation, especially in patients unable to breathe effectively on their own.

Page 23 - Nursing Process: Acute Care

Oxygenation Maintenance

• Oxygen Therapy: Critical for patients with low oxygen levels.

  • Safety Precautions:

    • Avoid smoking or open flames near oxygen to prevent fires.

    • Ensure proper flow rates to avoid oxygen toxicity or CO₂ retention (especially in COPD patients).

  • Methods of Oxygen Delivery:

    • Nasal Cannula: Low-flow oxygen delivery (1-6 L/min).

    • High-Flow Nasal Cannula: Delivers humidified oxygen at higher rates.

    • Oxygen Masks: Provide higher oxygen concentrations than nasal cannulas.

• Restoration of Cardiopulmonary Functioning: Techniques such as CPR.

✔ Why Is This Important?
Nurses must know when and how to administer oxygen safely to improve oxygen levels while preventing complications like CO₂ retention or lung damage.

Page 24 - Nursing Process: Restorative and Continuing Care

Respiratory Muscle Training

• Breathing Exercises:

  • Pursed-lip Breathing: Helps control breathing rate.

  • Diaphragmatic Breathing: Strengthens the diaphragm.

• Home Oxygen Therapy:

  • Delivered via nasal cannula or face mask.

  • Requires patient education on safety and proper use.

✔ Why Is This Important?
These long-term strategies help patients maintain better oxygen levels, reduce breathing difficulties, and improve quality of life at home.

Page 25 - Nursing Process: Evaluation

Through the Patient's Eyes

• Patient Outcomes: Through the Patient’s Eyes: Evaluate how the patient feels about their breathing..

Page 26 - Nursing Process

✔ Key Points

Knowledge Base: Factors Affecting Oxygenation

• Pathophysiological Factors:

  • Understanding the underlying mechanisms that impact oxygenation, such as:

    • Chronic diseases (COPD, heart failure) that reduce oxygen supply.

    • Infections (pneumonia, bronchitis) that cause inflammation and mucus buildup.

    • Neuromuscular disorders (ALS, MS) that weaken respiratory muscles.

• Pharmacological Factors:

  • Medications can affect oxygenation:

    • Bronchodilators (Albuterol, Salmeterol): Open airways for better airflow.

    • Opioids (Morphine, Fentanyl): Can depress the respiratory center, slowing breathing.

    • Diuretics (Furosemide, Hydrochlorothiazide): Reduce fluid buildup in the lungs (useful for heart failure).

Evaluation:

• Assessing Knowledge of Oxygenation

  • Ensuring the patient understands their oxygenation status, medications, and breathing techniques.

  • Comparing assessment findings with patient expectations and symptoms.

Assessment Recognition:

• Recognizing Cues for Oxygenation Issues:

  • Dyspnea, cyanosis, confusion, restlessness, abnormal breath sounds.

  • Monitoring oxygen saturation (SpO₂) and respiratory rate.

✔ Why Is This Important?
Nurses need to recognize how different conditions and medications affect oxygenation, assess patients effectively, and adjust care plans to ensure optimal oxygen delivery and patient safety.,

Page 27 - Safety Guidelines

Key Safety Measures

• Essential Safety Guidelines for Respiratory Care:

  • Know the patient’s baseline vital signs before starting oxygen therapy.

  • Limit suctioning to 2 times per procedure to prevent airway trauma.

  • Suction tracheal airways before pharyngeal airways whenever possible.

  • Use caution when suctioning patients with head injuries to avoid complications.

  • Do not use normal saline instillation before suctioning as it may increase infection risk.

  • Review institutional policy before stripping or milking chest tubes.

  • The most serious tracheostomy complication is airway obstruction.

  • COPD patients should receive low-flow oxygen to prevent CO₂ retention.

✔ Why Is This Important?
Following safety protocols prevents complications like infection, airway damage, or respiratory distress, ensuring effective and safe oxygenation management.