oxygen insufficiency

oxygeninsufficiency

1. Seminar on OXYGEN INSUFFICIENY

2. Introduction : Oxygen insufficiency means “deficient in oxygen”. The normal range of oxygen in the external blood should be 80-100mm of Hg. For treating oxygen insufficiency effectively early diagnosis and correct cause should be ruled out. The only management for oxygen insufficiency is oxygen administration.

3. Definition : Oxygen insufficiency is a condition in which the body as a whole or a region is deprived of adequate oxygen supply .

4. Causes : Decreased hemoglobin High altitude Inability of the tissue to extract oxygen from the blood Decreased diffusion of oxygen from the alveoli to the blood Poor tissue perfusion with oxygenated blood Impaired ventilation

5. Factors affecting oxygenation: Developmental factors Physiological factors Behavioral factors Lifestyle factors Environmental factors Medication

6. Developmental factors

7. Physiological factors

8. Behavioral factors

9. Lifestyle factors

10. Environmental factors

11. Medication

12. HYPOXIA : Inadequate supply of oxygen to the cells. TYPES OF HYPOXIA:

13. HYPOXEMIC HYPOXIA: Hypoxemic hypoxia is a decreased oxygen level in the blood resulting in the decreased oxygen diffusion into the tissue It may be caused by hypoventilation , high attitude , ventilation- perfusion mismatch (as in pulmonary embolism) , shunts in which the alveoli are collapsed and cannot provide oxygen to the blood.(commonly caused by atelectasis ) , and pulmonary diffusion defects. It is corrected by increasing alveolar ventilation or providing supplement oxygen.

14. CIRCULATORY HYPOXIA: Circulatory hypoxia is hypoxia resulting from capillary circulation. It may be caused by decreased cardiac output, local vascular obstruction , low- flow states such as shock, or cardiac arrest. Although tissue partial pressure of oxygen (PO2) remains normal. Circulatory hypoxia is corrected by identifying and treating the underlying cause.  

15. ANAEMIC HYPOXIA: Anemic hypoxia is a result of decreased effective hemoglobin concentration, which caused a decreased in the oxygen carrying capacity of the blood. It is rarely accompanied by hypoxemia. Carbon monoxide poisoning , because it reduce the oxygen – carrying capacity of hemoglobin produced similar effects but is not strictly anemic hypoxia because hemoglobin levels may be normal.

16. HISTOTOXIC HYPOXIA: Histotoxic hypoxia occurs when a toxic substance, such as cyanide, interferes with the ability of tissues to use availability oxygen.

17. CLINICAL MANIFFESTATION OF OXYGEN INSUFFICIENCY : Shortness of breath Clubbing of finger Impairment if judgment Visual impairment Oliguria \ anuria Nausea Vomiting Headache Dizziness Irritability Memory loss Anxiety Tired

18. INDICATION : Anemia Lung disease [COPD, emphysema, bronchitis , pneumonia , pulmonary edema] Strong pain medicines and other drugs that hold back breathing.

19. DIAGNOSTIC EVALUVATION:

20. NURSING MANAGEMENT: Breathing exercise Nebulization Chest physiotherapy Postural drainage, Chest percussion , Vibration . Suctioning

21. Breathing exercise Breathing slowly and rhythmically to exhale completely and empty the lungs completely. Inhale through the nose to filter, humidify and warm the air before it enters the lungs. If you feels out of breath, breathe more slowly by prolonging the exhalation time. Keep the air moist with a humidifier.

22. Nebulization The nebulizer is a handheld apparatus that disperses a moisturizing agent or medication such as bronchodilator or mucolytic agent, into microscopic particles and delivers it to the lungs as the patient inhales.

23. Chest physiotherapy POSTURAL DRANAGE: Postural drainage allows the force of gravity to assist in the removal of bronchial secretions. The secretions rain from the affected bronchioles into the bronchi and trachea and are removed by coughing or suctioning. Postural drainage is used to prevent or relive bro0nchial obstruction caused by accumulation of secretions.

24. CHEST PERCUSSION AND VIBRATION: Percussion is carried out by cupping the hands and lightly stacking the chest wall in a rhythmic fashion over the lung segment to be drained. The wrist are alternatively flexed an extended so that the hest is cupped or clapped in a painless manner. Vibration is the technique of applying manual compression and tremor to the chest wall during the exhalation phase of respiration.

25. Oxygen therapy :

26. Nasal cannula : It is the most common in expensive method used to administer oxygen to client. It delivers a relatively low concentration of oxygen9 24% to 45%) at flow rate of 2-6 l/min. But this is not use these days. Now a day’s nasal prongs are used.

27. Face mask: The simple face mask delivers oxygen concentration from 40% to 60% at flowrate of 5 to 8 l/min respectively. The partial rebreather mask delivers oxygen concentrations of 60%% to 90% at flow of 6 to 10l/min respectively. In rebreather mask the oxygen reservoir bag that is attached allows the client to rebreath about first third of the exhaled air in conjunction with oxygen. This it increases FiO2 by recycling expired oxygen.

28. Non breather mask: It delivers the highest oxygen concentration possible 95% to 100% by means other than intubation or mechanical ventilation at liter flow of 10 to 15% l/min.

29. Venture mask: It delivers oxygen concentration varying from 24% to 40% at flow rate of 4 to 5 l/min. The venture mask has wide bore tubing and colour coded jet adapters that correspond to a precise oxygen concentration and flow rate. Nurse should take care while selecting the mask as it should fit to the face of patient snuggly.

30. Trans tracheal oxygenation: This is used for oxygen dependent client. Oxygen is delivered through a small narrow plastic cannula surgically inserted through the skin directly into trachea. A collar around the neck holds the catheter in place.

31. METHODS USED IN CASE OF PEDIATRICS: IN CASE OF INFANTS: Oxygen hood: It is a rigid plastic dome that encloses on infant head. It provided precise oxygen levels and high humidity. Special consideration: The gas should not be allowed to blow directly into the infants face and hood should not rub against the infants face, neck, chin or shoulder .   IN CASE OF CHILDREN: It is made up of rectangular clear plastic canopy with outlets that connect to an oxygen source. Flow rate is adjusted at 10 to 15 l/min after flooding the tent for 5 min .At rate of 15l/m.

32. HAZARDS OF OXYGENATION INHALATION : INFECTION. COMBUSTION DRYING MUCUS MEMBRANE OF THE RESPIRATORY TRAT OXYGEN TOXICITY ATELECTASIS OXYGEN INDUCED APNOEA  REROLENTAL FIBROPLASIAS DAMAGE ASPHYXIA

33. MECAHNICAL VENTILATION TO A PATIENT WITH OXYGEN INSUFFICIENCY

34. MECHANICAL VENTILATION: It is a positive or negative pressure breathing device that can maintain ventilation and oxygen delivery for a prolonged period. INDICATION Continuous decrease in PaO2 Increase in arterial CO2 levels. Persistent acidosis.

35. TYPES: Negative pressure ventilation : This exerts negative pressure on the external chest; which in turn decrease intra- thoracic pressure during inspiration and allows the air o flow to lungs, filling its volumes. These are mainly used in case of client with neuromuscular conditions. Advantages : Easy to use and do not require intubation. Disadvantages: Unsuitable for patients who requires frequent ventilator changes.

36. Positive pressure ventilation: These inflate the lungs by exerting pressure on the airways, forcing the alveoli to expand during inspiration. Expiration occurs passively which further includes time cycled ventilators, pressure cycled ventilators and volume cycled ventilators.

37. Modes of mechanical ventilation: Continuous mandatory volume (CMV): Means continuous mandatory volume, without allowances for spontaneous breathing. Assist control ventilation(ACV): Where assisted breaths are facsimiles of controlled breaths. Intermittent mandatory ventilation(IMV): Which mixes controlled breaths and spontaneous breaths.

38. Pressure support ventilation(PSV): Where the patient has control over all aspect of his/her breathe expect the pressure limits. High frequency ventilation: Where mean airway pressure is maintained constant and hundreds of tiny breaths are delivered/ minutes.

39. Continuous positive airway pressure(CPAP): Spontaneous ventilation with continuous positive airway pressure(CPAP). The ventilator adjunct is used only with spontaneous ventilations. The patient breathes spontaneously through the ventilator at an elevated baseline pressure throughout the breathing cycle.

40. Synchronized intermittent mandatory ventilation(SIMV): Gas flow in the synchronized intermittent mandatory ventilation (SIMV) mode. A present minimum number of breaths are synchronously delivered to the patient but the patient may also take spontaneous breaths of varying volume. Note how inspiratory and expiratory pressure between spontaneous and ventilator breaths.

41. Positive end expiratory pressure: Airway pressure with varying levels of positive and expiratory pressure Note that at end expiration the airway is not allowed to return to zero.  

42. NURSING CARE OF PATIENT ON VENTILATOR: The nurse has a vital role in assessing the patient status and functioning of the ventilator. The nurse evaluates the patients physiologic status and how he or she is coping with mechanical ventilation. In physical assessment includes systematic assessment of all body system, with an in depth focus on the respiratory system.

43. Respiratory assessment includes vital signs respiratory rate and pattern breath sounds, evaluation of spontaneous ventilator effort and potential evidence of hypoxia. Increased adventitious breath sound may indicates a need for suctioning. The nurse also evaluates the sittings and functioning of the mechanical ventilator as described previously.

44. Assessment also addresses the patient neurologic status and effectiveness of coping with the need for assisted ventilation and the changes that accompany it. The nurse should assess the patient comfort level and ability o communicate as well. Finally, weaning from mechanical ventilation requires adequate nutrition. Therefore, it is important to assess the function of the gastro-intestinal system and nutritional status.