chapter 39 oxygenation. physiology of oxygenation ventilation alveolar gas exchange oxygen...
TRANSCRIPT
Chapter 39
Oxygenation
Physiology of Oxygenation
Ventilation Alveolar Gas Exchange Oxygen Transport and Delivery Cellular Respiration
Physiology of Oxygenation
Ventilation• Movement of air into and out of the lungs
- Inhalation - Exhalation
• Delivery of fresh air into the lung’s alveoli• Regulated by respiratory control centers• Hypoxemia is a decrease in blood oxygen
concentration.
Physiology of Oxygenation
Alveolar Gas Exchange• Oxygen uptake (external respiration) is the
exchange of oxygen from the alveolar space into the pulmonary capillary blood.
• Carbon dioxide diffuses from the blood to the alveolar space.
Physiology of Oxygenation
Circulation/Perfusion• The heart pumps oxygenated blood into the
arterial system, which carries it to the cells, and collects deoxygenated blood from the venous system.
Physiology of Oxygenation
Cellular Respiration (internal respiration)• Oxygen diffuses from the blood to the
tissues• Carbon dioxide moves from the tissues to
the blood.• The blood is then reoxygenated by the heart.
Process of Ventilation
The diaphragm contracts and descends, lengthening the thoracic cavity.
The external intercoastal muscles contract, lifting the ribs upward and outward.
The sternum is pushed forward, enlarging the chest from front to back.
Increased lung volume and decreased intrapulmonic pressure allows air to move from an area of greater pressure (outside lungs ) to lesser pressure (inside lungs).
The relaxation of these structures results in expiration.
Altered breathing patterns
Tachypnea(hyperventilation) Bradypnea(hypoventilation) Dyspnea Apnea Orthopnea Cyanosis Hypoxia
Factors Affecting Oxygenation
Environmental: altitude, heat and cold, air pollution
Lifestyle Factors: cigarette smoking, occupation, activity pattern
Disease Processes Exercise Emotions Narcotics
Diagnostic and Laboratory Data
Pulse Oximetry Arterial Blood Gases (ABGs) Sputum Collection Ventilatory Function Tests Lactic Acid, Hemoglobin, Hematocrit
Diagnostic and Laboratory Data
Chest X-Ray, Computerized Tomography Bronchoscopy Thoracentesis Echocardiography Electrocardiography Stress Test
Nursing Diagnosis
Primary Nursing Diagnoses• Ineffective Airway Clearance• Ineffective Breathing Patterns• Impaired Gas Exchange• Decreased Cardiac Output• Altered Tissue Perfusion
Secondary Nursing Diagnoses
Deficient Knowledge Activity Intolerance Disturbed Sleep Pattern Imbalanced Nutrition Acute Pain Anxiety
Implementation
Interventions to Promote Airway Clearance• Teach effective coughing.• Initiate postural drainage and chest
physiotherapy.• Monitor hydration.• Administer medications.
Implementation
Interventions to Promote Airway Clearance• Monitor environmental and lifestyle
conditions.• Manage artificial airways.• Suction the airway.
Suctioning an Endotracheal Tube
Implementation
Interventions to Improve Breathing Patterns• Position client properly.• Teach controlled breathing exercises.• Manage chest drainage systems.
Implementation
Interventions to Improve Oxygen Uptake and Delivery• Administer oxygen. *simple mask
*Nasal canula
*Ventori mask
*Rebreathing and Non-rebreathing mask
• Administer blood components.
Implementation
Interventions to Increase Cardiac Output and Tissue Perfusion• Manage fluid balance.• Encourage activity restrictions and
assistance with activities of daily living.• Position client properly.• Administer medications.
Implementation
Emergency Interventions• Remove airway obstruction.• Initiate cardiopulmonary resuscitation.
Implementations
Interventions to Address Associated Nursing Diagnoses• Explore lifestyle and activity
adaptations.• Encourage dietary and nutritional
modifications.• Promote comfort measures.
Precautions for Oxygen Administration
Avoid open flames in patient’s room Place no smoking signs in conspicuous places Check to see electrical equipment in room is in
good working order Avoid using oils in the area (ignite
spontaneously in oxygen)