OXYGENATION NEEDS NURSING FOUNDATION 2ND SEM

OXYGENATION NEEDS

1. OXYGENATION NEEDS NURSING FOUNDATION UNIT 7 PRESENTED BY, RANI BABY NURSING TUTOR

2. ANATOMY OF SYSTEM INVOLVED IN OXYGENATION PROCESS The main organs involved in process of oxygenation are heart and lungs .Blood from all the body parts enters to the heart through superior and inferior vena cava to right atrium .During atrial systole the blood is ejected to right ventricle through tricuspid valve .From right ventricle ,pulmonary artery takes blood to lungs for oxygenation and oxygenated blood returns to left atrium and then ventricle via pulmonary vein .Left ventricle then supplies oxygenated blood to whole body via arteries .

3. PROCESSOF RESPIRATION Air enters through nose ,where it is warmed ,humidified and filtered Inspired air passes from the nose through the pharynx After this air moves to trachea passing through larynx Trachea branches into two bronchi supplying right and left lungs Through bronchi air enters into lungs and moves through primary bronchi ,smaller and capillary walls from respiratory membrane where the gas exchange occurs

4. PHYSIOLOGY OF RESPIRATION PULMONARY VENTILATION - This means movement of air into and out of the lungs .Its main purpose is to supply fresh air Ventilations is composed of ; INSPIRATION -When airflows into the lungs EXPIRATION -When air moves out of the lungs Adequate ventilation depends upon, Clean airways An intact central nervous system and respiratory centre An intact thoracic cavity capable of expanding and contracting Adequate pulmonary compliance and recoil

5. OXYGEN Oxygen is a colorless , odorless ,tasteless gas which can assist patients in a variety of circumstances and is universally accepted for routine use in hospital settings .Oxygen constitutes 88.8% of the water and 20.9%of the volume of air .

6. . DEFINITION Oxygenation is the process that includes both the inspiratory and expiratory activities hence there occurs the exchange or transport of respiratory gases Oxygen therapy is the administration of oxygen as a therapeutic modality Oxygen therapy benefits the patient by increasing the supply of oxygen to the lungs and thereby increasing the availability of oxygen to the body tissues

7. FACTORS AFFECTING RESPIRATORY FUNCTIONING PAIN – Pain alters rate and rhythm of respiration .patient inhibits chest wall movement while experiencing pain in chest or abdomen . EXERCISE –Exercise increases rate and depth of respiration to meet the bodys need for additional oxygen .

8. . Emotions: Some strong emotions, such as fear, anger and nervousness can stimulate respiratory centre,resulting in respiration pause or increased rate of respirations. Anxiety increases rate and depth as a result of sympathetic stimulation. Body posture: A straight, erect posture promotes full chest expansion and lying flat prevents full chest expansion.

9. . Neurological injury: Injury to brainstem impairs respiratory centre and inhibits respiratory rate and rhythm. Medication: Narcotic analgesics and sedatives depress rate and depth. Amphetamines and cocaine may increase rate and depth of respiration. Blood pressure: Blood pressure can influence respiration when it fluctuates in a large range. If the blood pressure increases, the respiration will decrease in rate and depth.

10. ALTERATIONS IN RESPIRATORY FUNCTIONING CONDITIONS AFFECTING AIRWAY ALLERGIES Definition – It occurs when immune system responds to foreign particle like pollen ,dust ,any food ,etc. Symptoms –sneezing ,running and stuffy nose ,cough ,chest tightness ,wheezing sounds

11. . ASTHMA Definition -It is characterized by inflammation ,bronchospasm and edema of the airway Symptoms –Coughing ,shortness of breath ,cyanosis ,anxiety ,rapid pulse ,chest tightness

12. . BRONCHITIS Definition -It is an inflammation of the bronchial tubes that carry airto the lungs. Symptoms- Cough, Mucus production, Shortness of breath, Chest tightness, Low grade fever

13. . COUGH Definition- . It is the forceful expulsion of respiratory content. It is the body's response when something irritates in throat or airways. An irritant stimulate the nerves that send a message to brain. The brain then send message to muscles of chest and abdomen to push air out of lungs to force out the irritant. Hardly cough is normal and healthy. A cough that persists for several weeks or one that brings up discolored or bloody mucus may indicate a condition that needs medical attention.

14. . Causes- Airways irritants(smoke ,pollen , dust,foreignbody ), parenchymal lung diseases –pneumonia ,TB,COPD ,Whooping cough ,acute sinusitis (nasal and sinus infection),corona virus disease 2019 Symptoms- Fever, Purulent postnasal discharge , Increased malaise, Dyspnea or localized pain, Productive cough with expectoration of purulentmaterial , sore throat, Wheezing and shortness of breath ,Heartburn or a sour taste in your mouth ,Rarely, coughing up blood.

15. . TYPES OF COUGH There are two types of cough: According to Severity Acute cough: It occurs due to irritation of trachea and it has sudden onset. 2. Chronic cough: It occurs in any disease condition likeTB , asthma, COPD, etc

16. CONDITIONS AFFECTING MOVEMENT OF AIRWAY DYSPNEA Definition- It is defined as the sensation of breathlessness or inadequate breathing. It is the abnormal uncomfortable awareness of breathing. Dyspnea, also called shortness of breath, is a tight feeling in chest in which person may not be able to take a deep breath. This is a symptom that can be connected to many different conditions, like asthma, heart failure and lung disease.

17. . GRADING Grade -Dyspnea occurs while doing strenuous activities. Grade 2: Person is restricted to some activities like climbing stairs. Grade 3 -Dyspnea occurs during usual activities but person can manage. Grade 4: Person requires assistance while performing activities of daily living Grade 5: Dyspnea occurs at rest.

18. . CAUSES- Anemia ,asthma ,anxiety ,heart or lungs problems like heartfailure ,COPD etc ,history of smoking ,severe obesity ,allergic reactions ,injury to the ribs,exposure to dangerous level of carbonmonoxide gas . SYMPTOMS- Shortness of breath,feeling of suffocation ,chest tightness ,chest pain .breathing difficulty ,blue finger or lips ,swelling in ankles and feets .

19. . TACHYPNEA DEFINITION - It is defined as when respiratory rate is more than 24 breath per minute CAUSES -Exercise ,heavy physical activity ,anxiety allergic reactions ,foreign body aspiration

20. . SYMPTOMS -Feeling of shortness of breath ,confusion ,sweating ,high body temperature BRADYPNEA DEFINITION –when the respiratory rate less than 16 breaths per minute CAUSES - Opiods overload ,smoking ,alcoholism ,lungs diseases like COPD ,Asthma ,hypothyroidism ,head injury ,use of sedatives and anesthesia ,exposure to carbonmonoxide gas. SYMPTOMS –Decrease alertness,itching ,dry skin ,headache ,weakness ,dizziness ,,cyanosis ,loss of consciousness .

21. ORTHOPNEA DEFINITION –It is defines as shortness of breath when the patient is lying down CAUSES - heartdisease,pneumonia ,obesity ,paralysis of diaphragm SYMPTOMS –shortness of breath ,chest tightness

22. . APNEA DEFINITION - It is the cessation of breathing in which there is no movement of respiratory muscles for inhalation and expiration and the volume of the lungs remain unchanged.

23. . SLEEP APNEA DEFINITION -It is the cessation of breathing during sleep. Types Central sleep apnea : In this apnea brain is unable to send signals to respiratory muscles for breathing during sleep. Obstructive Sleep Apnea : It is characterized by collapse of airway during deep sleep. Mixed sleep Apnea : It is the mixture of both central sleep apnea and obstructive sleep apnea.

24. . CAUSES Certain drugs,. Choking , Neurological disease , Trauma,Emotions , High altitude, Family history, Reduction in blood oxygen , Narrowed airway, Hypotonia(decreased muscle tone ), Heart disease ,Deviated septum. SYMPTOMS Dry mouth ,Headache , Insomnia ,Restless sleep ,Day time sleepiness, irritability ,poor memory and attention , confusion,mood and personality changes.

25. CONDITIONS AFFECTING DIFFUSION PULMONARY EDEMA DEFINITION -It is defined as an abnormal accumulation or collection of fluid in lung, lung tissue or alveolar space. It is a severe and life threatening condition. ETIOLOGY- Sudden, severe hypertension ,MI, cardiomyopathy , Mitral or aortic valve disorder Major injury, Lung damage caused by poisonous gas or severe infection, Kidney failure

26. . CARDIOGENIC CAUSES – Artherosclerosis , Valvular and myopathic disorders , Hypertension , Blood blocking up into the pulmonary circulation cause high pressure ,MI, cardiomyopathy Non-cardiogenic Causes - After pneumonectomy , Drug over dose and non cardiac pulmonary edema , Renal failure

27. . CLINICAL MANIFESTATIONS - Dyspnea , central cyanosis (cyanosis of lips or nails),anxiety, cough , While doing suctioning Frothy and blood mixed .secretions are seen,Respiratory distress ,irregular and rapid heart beat .pale skin ,leg swelling .

28. . CHRONIC OBSTRUCTIVE PULMONARY DISEASES(COPD ) It is a respiratory disease in which airflow is obstructed by emphysema( airsacs in the lungs damaged), chronic bronchitis or both. Asthma is also considered within this disease group but asthma is reversible. Etiology - Passive smoking , Family history , Infection ,Lung growth , Bronchitis , Asthma , Air pollution , Cigarette smoking .

29. . Clinical Manifestations -Chronic coughing (productive cough) , Dyspnea, Frequent respiratory infection, Wheezing. Weight loss, Tachypnea, Pitting edema, Fatigue, Hemoptysis, Purulent sputum, Weakness ATELECTASIS It is a respiratory disorder characterized by collapsed lung.It may be chronic or acute. Atelectasis is the collapse of part or (much less commonly) all of a lung.

30. . Etiology Atelectasis is caused by blockage of the air passages(bronchus or bronchioles) or by pressure on the outside of the lung. Risk factors for developing atelectasis include: Anesthesia ,foreign body in the airway (most common in children),lung diseases ,prolonged bedrest with less changes in position ,tumors that block an airway

31. . CLINICAL MANIFESTATIONS Dyspnea : Rapid and shallow breathing, Chest pain , Cough , Fever, Excessive sweating ,Malaise and weight loss , Tachypnea , tachycardia,cyanosis .

32. . CONDITIONS AFFECTING OXYGEN TRANSPORT HEART FAILURE Heart failure is the inability of heart to pump the sufficient blood to meet the needs of tissue for oxygen and nutrient. CAUSES . Pulmonary embolism(blood clot develop in a blood vesselin the body travels to an artery in the lungand suddenly form blockage of artery); chronic lung disease, Hemorrhage and anemia , Anesthesia and surgery , Transfusions or infusions ,Physical and emotional stress ,Excessive sodium intake. RISK FACTORS – Hypertension , Hyperlipidemia ,Diabetes ,CAD ,Family history , Smoking , Alcohol consumption of cardiotoxic drugs .

33. . HYPOVOLEMIA Loss of extracellular fluid volume and decreased circulating blood volume. Dehydration Dehydration occurs when there is not enough fluid in the body, especialy in the blood (intravascular area). Although ,there are several types of dehyration . Etiology Long-term nothing by mouth (NPO) status , Hemorrhage , Profuse diaphoresis (sweating) , Diarrhea ,Vomiting , Draining abscesses , Severely draining wounds ,Systemic infection ,Fever ,Frequent enemas ,Diabetes insipidus (when the body produces toomuch urine )

34. . Clinical Manifestations With a rapid fluid loss manifestations of hypovolemia occur rapidly. When loss of fluid occurs gradually, the patient’s fluid volume may be very low before symptoms develop Mucous Membranes -Dry, may be sticky. Neurologic -Anxiety, Restlessness, Possible coma. Integumentary System -Diminished skin turgor, Dry skin, Pale, Cool extremities. Cardiovascular System -Tachycardia, Orthostatic hypotension(form of low BP that happens when standing after sitting or lying down ), Falling systolic/diastolic pressure , Flat neck vein, Decreased capillary refill, Decreased hematocrit . Potential Complication -Hypovolemic shock

35. . . ALTERATIONS OF OXYGENATION The alterations of oxygenation indudes : 1. Hypoventilation 2. Hyperventilation 3. Hypoxia HYPOVENTILATION Definition - It is the condition when the level of carbon dioxide in body get higher than oxygen level. It is defined as an increase in partial pressure of carbondioxide (more than 45mm Hg).

36. . CAUSES High altitude ,medications overdose like opioids ,benzodiazepines ,sedatives ,,CNS disease like encephalitis ,trauma etc .,obesity ,chest wall trauma ,sepsis ,lung and airway disease like asthma ,pneumonia. SYMPTOMS Shortness of breath,fatigue , cyanosis,headache ,restlessness, sleepiness at day time ,insomnia ,confusion ,abnormal breath sounds ,visual disturbances . HYPERVENTILATION It is defined as when the partial pressure of oxygen is more than the partial pressure of carbondioxide .The amount of carbondioxide is less in blood .

37. . CAUSES Stress ,depression ,anxiety ,anger ,severe pain ,pregnancy ,vigorous exercise ,high altitude . SYMPTOMS Headache ,sweating ,changes in vision ,poor concentration ,chest tightness ,numbness or tinglng sensations in feet or hands ,muscle spasm . HYPOXIA It is a condition in which the body or a region of the body is deprived of adequate oxygen supply SIGNS AND SYMPTOMS Tachypnea ,dyspnea ,hypertension ,anemia ,restlessness ,disorientation ,cyanosis TYPES OF HYPOXIA HYPOXIC HYPOXIA – low PaO2 (arterial oxygen tension)

38. . CIRCULATORY HYPOXIA – Inadequate pumping of the blood from the lungs to tissues. HEMIC HYPOXIA – D ecreased oxygen carrying capacity as in anemia or carbon monoxide poisoning . DEMAND HYPOXIA – increased tissue consumption of oxygen in hypermetabolic states like fever ,malignant hyperthermia . HISTOTOXIC HYPOXIA – utilization of oxygen is abnormal such as in cyanide poisoning there is inability for tissues oxygen available .

39. MAINTENANCE OF PATENT AIRWAY Airway patency is the ability of a person to breathe, with airflow passing to and from the lungs through the oral and nasal passages. By maintaining an open airway, air can flow from nose, mouth into lungs. Airway can be obstructed by foreign body inhalation, allergic ,trauma, head injury, respiratory tract infection etc .A. Patency of airway can be managed by Provide high fowler/sitting position to expand chest for easing breathing. Assist in deep breathing and coughing exercises Coughing –it is the most easy method of clearing the throat but person may not be able to cough properly in case of respiratory muscle fatigue ,weakness

40. . Use of pillow for chest support Use of incentive spirometery . Early ambulation and frequent position change. B. Other interventions to maintain patent airway are, Removal of foreign body by sweeping mouth with finger and ensure not to push foreign body towards airway. Removal of vomit and regurgitation stuff by suctioning Airway manoeuver - Head tilt/chin lift, jaw thrust Invasive airway management includes oropharyngeal airway, nasopharyngeal airway and tracheal intubation.

41. NURSING INTERVENTIONS TO PROMOTE OXYGENATION

42. . ASSESSMENT- current health problem , cough,sputum ,shortness of breath ,history and physical examination . PHYSICAL EXAMINATION – Inspection ( cyanosis,chest retractions) , ,palpation ,percussion ,auscultation (breath sounds). NURSING INTERVENTIONS Positioning : semi fowlers or fowlers position Oxygen administration ,artificial airways Suctioning Chest physiotherapy Postural drainage (technique that involves laying /sitting in certain in certain positions to drain secretions from your airways using gravity) breathing exercises .

43. . Assess the airway and optimize airway position (head tilt or chin lift)as necessary . Incentive spirometry Chest drainage Educate about effective coughing method Intake and output chart Daily weight measurement Oral care Bedrest

44. DOCUMENTATION Clinical assessment and documentation including cardiovascular ,respiratory and neurological systems .This should be done at the commencement of each shift and with any change in the patients condition . Change and document oxygen equipment set up at the commencement of each shift and with any change in the patients condition . Hourly checks should be made for the following ; Oxygen flow rate Oxygen saturation Patency of tubings . Humidifier settings (if being used) Patients pulse rate

45. , Patients respiratory rate Continuos pulse oximetry is recommended for patients who are severely unwell .

46. . INHALATIONS Inhalation means breathing air or vapor into the lungs through the nose or mouth .Inhalation is of two types: DRY INHALATION. MOIST INHALATION. DRY INHALATION A substance such as ammonia may be inhaled in the treatment of fainting . Amyl nitrate may be inhaled to relieve angina Oxygen inhalation Inhalation of general anesthetic drugs Aerosol spray MOIST INHALATIONS - STAEM INHALATIONS

47. METHODS OF OXYGEN ADMINISTRATION NASAL CATHETER NASAL CANNULA /NASAL PRONGS SIMPLE FACE MASK VENTURI MASK AMBU BAG OXYGEN HOOD OXYGEN TENT NON-REBREATHER MASK PARTIAL REBREATHER MASK CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP)

48. . BILEVEL POSITIVE AIRWAY PRESSURE (BiPAP) MECHANICAL VENTILATOR Equipment required for Oxygen Administration Patient's chart Oxygen connecting tube Flow meter Humidifier bottle half filled with distilled water Oxygen source: Wall Outlets or Oxygen cylinder Tray with; Nasal cannula of appropriate size or Oxygen mask

49. . Nasal catheter Size-8-14 F the unit of measurement of French scale (for nasal catheter insertion) Xylocaine Jelly 2% as lubricant (for nasal catheter insertion) Kidney tray Gauze pieces, Cotton swabs – bowl with sterile water "No smoking" sign board

50. INSERTION OF NASAL CANNULA STEPS RATIONALE Check the doctors order including date ,time ,flow liter /minute and methods Perform hand hygiene To prevent avoid medical errors To prevent the spread of infection Explain the purpose and procedure to the patient and assemble the equipment Attach the flow meter to the wall outlet or oxygen cylinder .fill the humidifier about 1/2 with distilled water Humidification prevents the drying of the nasal mucosa Attach the cannula to the connecting tubing of the adapter on the humidifier Testing flow before use is needed to provide prescribed oxygen to the patient .

51. . STEPS RATIONALE Test flow by setting the flow meter at 2-3L / minute and checking the flow on the hand The proper position allows unobstructed oxygen flow and eases the patients breathing Insert the nasal cannula into the patients nostrils ,adjust the tubing behind the patients ears and slide the plastic adapter under the patients chin until he or she is comfortable adjusting the tubings and maintaining proper positions helps in uninterrupted oxygen flow . Document the following :date ,time ,method ,flow rate ,respiratory condition ,and response to oxygen . Documentation provides coordination of care

52. HAZARDS OF OXYGEN ADMINISTRATION THERAPY INFECTION COMBUSTION DRYING OF MUCOUS MEMBRANES OXYGEN TOXICITY ATELECTASIS APNEA ASPHYXIA RETROLENTAL FIBROPLASIA

53. SUCTIONING

54. . lt is the procedure where the tracheobronchial secretions are suctioned out when the coughing reflex is ineffective or absent. .Purposes To remove secretions that obstruct the airway. To facilitate ventilation. To obtain secretions for diagnostic purposes. To prevent infection that may result from accumulated secretions.

55. . ASESSMENT Assess for clinical signs indicating the need for suctioning. They are, Restlessness, gurgling sounds during respiration. Adventitious sounds when the chest is auscultated. Change in mental status Change in skin color Rate and pattern of breathing. Decreased oxygen saturation

56. . EQUIPEMENT A tray containing- Oral and Nasopharyngeal suction catheter Sterile Suction set - bowl, kidney tray, gauzepieces Sterile water/Normal saline Mackintosh and towel Sterile gloves Suction apparatus

57. STEPS OF PROCEDURE Explain the procedure to the patient Provide privacy Collect the articles at the bedside Position a conscious person who has a functional gag reflex in a semi-Fowler's position with the head turned to one side for oral suctioning with the neck hyperextended for nasal suctioning ,Set the pressure on the suction gauge and turn on the suction. .Many suction devices are calibrated to three pressure ranges. Wall unit: .Adult: 80 to 120 mmHg Infants and Children: 80 to 100 mmHg

58. . . Newborn: 60 to 100 mmHg ORAL AND OROPHARYNGEAL SUCTION With your sterile gloved hand, pick up the catheter and attach it to the suction unit Moisten the tip of the suction catheter with sterile saline water. Rationale: This reduces friction. Pull the tongue forward, if necessary, using gauze. Do not apply suction Rationale: Applying suction during insertion causes trauma to the mucous membranes. Test the pressure of the suction and the patency of the catheter. Applying your sterile gloved thumb to the port or open branch of the Y- connector to create suction.

59. . Advance the catheter about 10-15 cm (4 to 6 inches)along oneside of the mouth into the oropharynx Rationale; Directing the catheter along the side prevents gagging Gentle rotation of the catheter ensures that all surfaces are reached and prevents trauma Apply suction for 5-10 seconds while slowly withdrawing the catheter Then remove the finger from the control and remove the catheter Rinse the catheter and repeat suctioning Allow sufficient time between each suction Document the procedure

60. VARIOUS TYPES OF AIRWAYS ,INDICATIONS AND POTENTIAL COMPLICATIONS AIRWAYS INDICATIONS POTENTIAL COMPLICATIONS REMARKS OROPHARYNGEAL UPPER AIRWAY OBSTRUCTION SECRETION REMOVAL UNCONSCIOUS PATIENT Trauma from insertion Vomiting Aspiration Improper insertion technique could push the tongue back and occlude the airway . NASOPHARYNGEAL Secretion removal Mouth to nose ventilation Oral trauma Trauma from insertion(bleeding) Useful with facial or jaw fractures or when oral airway is inappropriate May be used in conscious or unconscious patients.

61. . AIRWAYS INDICATION POTENTIAL COMPLICATION REMARKS ENDOTRACHEAL Establishes airway when nasopharyngeal or oropharyngeal airways are inadequate Secretion removal Secretion removal Improper placement Mucosal damage Laryngeal or tracheal edema Vocal cord damage Tracheal stenosis (narrow) sinusitis Has a cuff to prevent aspiration .the cuff should be maintained at better capillary filling pressure of the trachea (20 mm of hg to avoid damage TRACHEOSTOMY Provides long term airway management Secretion removal allow for mechanical ventilation Obstruction of the tube Infection Tracheoesophageal fistula Bleeding Requires surgery

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