OXYGENATIONNURS 1510

Basic human need

O2 is classified as a drug

Must have MD order for rate and route

Nose and nasal cavities: mm, ciliated, vascular

Pharynx: posterior to nasal & oral cavity Nasopharynx=air passage way, eustachian tubes from middle ears

Trachea: 4-5in tube from larynx to bronchi. Ciliated

Bronchial tree: air passage ways within lungs

Lungs: lobes 3=R 2=L

PULMONARY

Gases move in and out due to pressure in atmosphere. Lungs stay inflated due to pressure around them which is less than pressure within them.

Alveolar level: sacs exchange CO2 and O2 Surfactant must be present for alveoli to function correctly

continue

Diaphragm: does 80% of the work of breathing

Intercostals Accessory Involuntary control of breathing: Medulla

oblongata Voluntary control of breathing: Cerebral

cortex

Pulmonary muscles/CNS

Process of moving air in & out of the lungs:◦ Compliance◦ Surfactant◦ Airway resistance

Perfusion: moving blood to & from alveolar-capillary membrane for gas exchange◦ Pulmonary circulation◦ Distribution

Diffusion: > to < concentration

Ventilation & Perfusion

Heart=pump 4 chambers-R atrium-tricuspid valve-R

ventricle-pulmonic valve-pulmonary artery-lungs

Return via pulmonary veins to L atrium- bicuspid valve-L ventricle-aortic valve out to aorta

Electrical conductive system

CARDIOPULMONARY SYSTEM

Impulse begins in SA node located in R atrium (pacemaker)

Travels thru both atrium ( A=contracts) Thru mid heart called AV node To the Bundle of His Down the R and L bundles To purkinje fibers which stimulate the V to

contract

Electrical Conduction of Heart

Cerebral cortex: voluntary Medulla oblongata: involuntary Chemical: is based on the amount of CO2,

hydrogen, and O2 present in blood at any given moment. Chemoreceptors in aortic arch and carotids sense the chemical content and adjusts rate and depth of respirations to meet needs.

Neural and Chemical Regulation of Respiration

Decreased hemoglobin: will > HR & RR Decreased inspiration: will > HR Hypovolemia: will > HR & RR Increased metablolism: will > HR & RR Chest wall movements: can decrease

ventilation yet may see > RR but more shallow

Factors affecting O2

Pregnancy Obesity Musculoskeletal abnormalities

◦ Trauma◦ Muscle or musculoskeletal disease: scoliosis◦ CNS diseases: ALS (Lou Gehrings)◦ COPD, other pulmonary disorders

Chest Wall Movements

Age: premature, children, elderly Nutrition: obesity & malnutrition Exercise: with CV fitness enhances O2

exchange Smoking: increases HR and RR Substance Abuse: depresses resp centers Anxiety: increases metabolic=>>02

demand Environmental—Smog, hi altitude, dust,etc

Additional factors

Hyperventilation: ventilation in excess of that required to maintain normal CO2 levels in tissues. CO2 is expired in greater amounts

Hypoventilation: depressed resp rate causing retention of CO2=hypercapnia

Hypoxia: state of inadequate oxygenation from deficient delivery or utilization of O2 at the cellular level.

Alteration in Respiratory Functioning

Rate, Rhythm, Work of breathing Dyspnea: deals with work of breathing Wheezing: narrowed air passages, hi-pitched Pain: evaluate, onset, location, duration, radiation,

effects on respirations Cough: Secretions+characteristics of Lung sounds: bilateral chest assessment Risk factors:family Hx of lung CA, pulmonary ds, smoking Medical history of respiratory infections, smoking

Nursing Assessment

Maintain lung expansion◦ Positioning

Semi-fowlers, Fowlers, orthopneic Change position frequently

◦ Breathing exercises Pursed lip Diaphragmatic breathing Incentive spirometry

Nursing Interventions

Mobilization of pulmonary secretions:◦ TCDB every 2 hours◦ Hydration to thin secretions◦ Humidify environment to moisten mm◦ Postural drainage & chest precussions to mobilize

secretions

Continued

Vital signs: pulse rate, respiratory rate Color: cyanosis, pink, dusky, ruddy Dyspnea: the difficulty and work of

breathing Restlessness/anxiousness Retractions O2 saturation/ABG’s Mental alertness/awareness

Evaluate Effectiveness

Room air=21% Nasal 1L=21%-24% 2L=24%-28% 3L=28%-32% 4L=32%-36% 6L=40%-44% = max O2 level for Nasal O2

Administration of O2

5-6 L = 40% O2 6-7 L = 50% O2 7-10 L= 60% O2 Simple mask: 40% to 60% (varies) Venturi mask: 24%=50% with O2 flow rate

of 4L to 10L (more exact) Non-rebreathing mask: up to 80%-90% Partial rebreathing mask: 60-90%

Mask

Gauge pressure(psi) X cylinder factor (0.28)/liter flow per minute

Example: 900 X 0.28/3 liters per min

=84 minO2 in cylinder will last 84 min

Calculate the correct amount of O2 in a ‘E’ cylinder

Correct liter flow System on then to patient Correct positioning of cannula or mask No smoking-signs and remove ashtrays Avoid use of electrical equipment-avoid

sparks, razors, electric hand held games

Safety Measures

Must keep airway patent Inner cannula cleaned per protocol Suction no greater 10 seconds Sterile technique O2 setting per respiratory care/orders Care of trach ties, trach dressing

Trach Care