oxygenation.pptx

Study

1. Oxygenation: Respiratory Function & Cardiovascular System. By: Ibne Amin Khyber Medical University, Peshawar

2. Objectives At the completion of this unit learners will be able to: 1. Identify factors that can interfere with effective oxygenation of body tissues. 2. Describe common manifestations of altered respiratory and cardiovascular function 3. Discuss lifespan-related changes and problems in respiratory function and cardiovascular system 4. Describe nursing measures to ensure a patient airway

3. Cont.. 6. Recognize the emergencies related to respiratory and cardiovascular system 7. Explain ways that caregivers can decrease the exposure of clients to infection 8. Differentiate between medical and surgical asepsis. 5. Apply Nursing Process and teaching plan for a client with altered respiratory function and cardiovascular function

4. Oxygenation Oxygen, a clear, odorless gas that constitutes approximately 21%of the air we breathe, is necessary for proper functioning of all living cells. Oxygenation (the delivery of oxygen to the body’s tissues and cells), is necessary to maintain life and health.

5. PHYSIOLOGY OF OXYGENATION The delivery of oxygen to the body’s cells is a process that depends upon the interplay of the pulmonary, hematologic, and cardiovascular systems. Specifically, the processes involved include ventilation, alveolar gas exchange, oxygen transport and delivery, and cellular respiration. The absence of oxygen can lead to cellular, tissue, and organism death.

6. Respiration Respiration is the process of gas exchange between the individual and the environment and involves following components: Pulmonary ventilation –(breathing) movement of air in and out of the lungs Inspiration –(inhalation) act or breathing in Expiration –(exhalation) act of breathing out External respiration – exchange of O 2 and CO 2 between alveoli and blood Internal respiration – exchange of O 2 and CO 2 between blood and tissue cells Anatomy and Physiology of respiration

7. Cont.… The Air way begins at nose and ends at terminal bronchioles. Air way provides a pathway for transport of oxygen and carbon dioxide. Respiratory tract (Air Way) is divided into two: • Upper Respiratory Tract (URT): consists of nose, pharynx, larynx and epiglottis. The main function is to warm, filter and humidify inspired air. • Lower Respiratory Tract (LRT): consists of Trachea, Bronchi, bronchioles and lungs. Its major function are conduction of air and surfactant production.

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9. Factors Affecting Oxygenation Age Environment Life style Health Status Medication Stress

10. Age Oxygenation status can be influenced by age. Older adults are also more susceptible to respiratory infection because of decreased activity in the cilia, which normally are an effective defense mechanism. Other changes includes the following. Chest wall and airways become more rigid and less elastic. Decreases in muscle strength The amount of exchanged air is decreased. The cough reflex and cilia action are decreased. Mucous membranes become drier and more fragile. Decreases in muscle strength and endurance occur. If osteoporosis is present, adequate lung expansion may be compromised. A decrease in efficiency of the immune system occurs. Gastroesophageal reflux disease is more common in older adults and increases the risk of aspiration

11. Environmental Factors Environmental factors can significantly affect a client’s oxygenation status. Altitude, heat, cold, and air pollution affect oxygenation. The higher the altitude, the lower the PO2 an individual breathes. As a result, the person at high altitudes has increased respiratory and cardiac rates and increased respiratory depth, which usually become most apparent when the individual exercises. Healthy people exposed to air pollution, such as smog or secondhand tobacco smoke, may experience stinging of the eyes, headache, dizziness, and coughing. People who have a history of existing lung disease and altered respiratory function experience varying degrees of respiratory difficulty in a polluted environment. Some are unable to perform self-care in such an environment.

12. Lifestyle Factors Physical exercise or activity increases the rate and depth of respirations and hence the supply of oxygen in the body. Sedentary people , by contrast, lack the alveolar expansion and deep-breathing patterns of people with regular activity. Clients who are exposed to dust, animal dander, asbestos, or toxic chemicals in the home or workplace are at increased risk for alterations in oxygenation. Silicosis is seen more often in sandstone blasters and potters than in the rest of the population Asbestosis in asbestos workers Anthracosis in coal miners Organic dust disease in farmers and agricultural employees who work with moldy hay

13. Health Status In the healthy person, the respiratory system can provide sufficient oxygen to meet the body’s needs. Diseases of the respiratory system, however, can adversely affect the oxygenation of the blood.

14. Medications A variety of medications can decrease the rate and depth of respirations. The most common medications having this effect are the benzodiazepine sedative-hypnotics and antianxiety drugs (e.g., diazepam [Valium], lorazepam [Ativan], midazolam [Versed]), barbiturates (e.g., phenobarbital), and narcotics such as morphine and meperidine hydrochloride (Demerol).

15. Cont.. When administering these, the nurse must carefully monitor respiratory status, especially when the medication is begun or when the dose is increased. Older clients are at high risk of respiratory depression and, hence, usually require reduced dosages.

16. Stress When stress and stressors are encountered, both psychological and physiological responses can affect oxygenation. Some people may hyperventilate in response to stress. When this occurs, arterial PO2 rises and PCO2 falls. The person may experience light-headedness and numbness and tingling of the fingers, toes, and around the mouth as a result. Physiologically, the sympathetic nervous system is stimulated and epinephrine is released during stress. Epinephrine causes the bronchioles to dilate, increasing blood flow and oxygen delivery to active muscles. Although these responses are adaptive in the short term, when stress continues they can be destructive, increasing the risk of cardiovascular disease.

17. Maintaining Healthy Oxygenation Encourage clients to: Leave windows open for ventilation instead of using an air conditioner or humidifier. Wear a mask when working with hazardous materials, such as asbestos. Limit physical exertion if it causes shortness of breath. Refrain from smoking. Change filters on furnaces, heaters, and range hoods as recommended by manufacturer.

18. Common Manifestations Of Altered Respiratory And Cardiovascular Function Apnea: Temporary cessation of breathing. Dyspnea: Difficulty in breathing. Eg. SOB Eupnea: Normal breathing. 12 to 20 b/m Hyperpnea: Increased rate and depth of breathing. Hyperventilation: Increased pulmonary ventilation leading to low blood level of CO 2 Hypoventilation: Decreased pulmonary ventilation leading to increased blood level of CO 2

19. Cont.… Orthopnea: Dyspnea that occurs when a person is lying down. Tachypnea: Accelerated respiration Bradypnea : Abnormal slowness of breathing. Hypoxia: Low oxygen level in tissues Hypercarbia: (c): Accumulation of CO2 in the blood Hypoxemia: Reduced oxygen in the blood ,

20. Cont.. Tachycardia – heart rate over 100 Bradycardia – heart rate below 60

21. Life span Consideration Changes Respiratory rate New born : 40-80breath /min Infant : 30breath /min Preschooler: 25breath/min Adult : 12-18 breath/min 2. Heart Rate New born : 80-200beats/min Infant- : 80-150 beats /min Preschooler-Adult : 55-100 beats /min 21

22. Blood pressure: Newborn -3 days : 65/40 After one month: 90/55 Adult : 120/80 22

23. Life Span Considerations Problems Premature infant: Lack of surfactant ( A substance in alveoli which keeps the lungs wet and prevents collapse). Infants & Toddlers: Risk of upper respiratory tract infections due to exposure to other children and second hand smoke. Risk of airway obstruction also. 23

24. Life Span Considerations Problems School age children & Adolescents: Respiratory infections and respiratory risk factors such as second hand smoke & cigarette smoking. Can lead to cardiopulmonary disease if continues. Young & Middle age adults: Multiple cardiopulmonary risk factors due to unhealthy diet, lack of exercise, stress, drugs & smoking. 24

25. Life Span Considerations Problems Older Adults: Body systems undergo changes throughout the aging process, eg , atherosclerosis which leads to increased BP. Respiratory system changes-----thoracic cage changes----- eg , barrel chest-------decreased ventilation. 25

26. Respiratory Emergencies Hypoxia Hypoventilation: Hypercarbia Hypoxemia Tachypnea: Hypoventilation Bradypnea Dyspnea: 26

27. Signs of Hypoxia Rapid pulse Rapid, shallow respiration & dyspnea Increased restlessness Flaring of nares Substernal / Intercostal retractions. Cyanosis 27

28. Cardiac Emergencies Cardiac Arrest (the abrupt loss of heart function, breathing and consciousness.) Myocardial infarction (MI) (permanent damage to the heart muscle.) Congestive Heart Failure :(Heart failure is a condition in which the heart can't pump enough blood to meet the body's needs. Heart failure does not mean that your heart has stopped or is about to stop working. It means that your heart is not able to pump blood the way it should.) Disturbances of Cardiac Rhythm (Arrhythmias) 28

29. Nursing Process Assessment: History Taking / Interviewing Physical Examination:- 29

30. Nursing Process Assessment: (History Taking) Current respiratory problems History of respiratory diseases Current or past cardiovascular problems Life style Presence of Cough Signs of hypoxia 30

31. Nursing Process Assessment: Sputum / (Characteristics of sputum) Description of sputum Presence of chest pain Presence of risk factors Medication history 31

32. Nursing Diagnosis Primary Nursing Diagnoses Ineffective Airway Clearance Ineffective Breathing Patterns Impaired Gas Exchange Decreased Cardiac Output Altered Tissue Perfusion

33. Secondary Nursing Diagnoses Deficient Knowledge Activity Intolerance Disturbed Sleep Pattern Imbalanced Nutrition Acute Pain Anxiety

34. Planning Client maintains a patent airway. Client mobilizes pulmonary secretions. 34

35. Implementation 1. Interventions to Promote Airway Clearance Teach the patient effective coughing. Initiate postural drainage and chest physiotherapy. Monitor hydration. Administer medications. Monitor environmental and lifestyle conditions. Manage artificial airways. Suction the airway.

36. Suctioning an Endotracheal Tube

37. Implementation 2 . Interventions to Improve Breathing Patterns Position client properly. Teach controlled breathing exercises. Manage chest drainage systems.

38. Implementation 3. Interventions to Improve Oxygen Uptake and Delivery Administer oxygen. simple mask Nasal canula Venturi mask Rebreathing and Non-rebreathing mask Administer blood components.

39. Implementation 4 . 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.

40. Implementation Emergency Interventions Remove airway obstruction. Initiate cardiopulmonary resuscitation (CPR).

41. Implementation Interventions to Address Associated Nursing Diagnoses Explore lifestyle and activity adaptations. Encourage dietary and nutritional modifications. Promote comfort measures.

42. Asepsis Asepsis is the absence of microorganisms. Medical asepsis uses practices to reduce the number, growth, and spread of microorganisms. Medical asepsis is also referred to as “clean technique. Surgical asepsis , or sterile technique, consists of those practices that eliminate all microorganisms and spores from an object or area. 42

43. Decrease the Exposure of Clients to Infection . 43

44. Ways That Can Decrease The Exposure Of Clients To Infection

45. Oxygen Therapy is the administration of oxygen at a concentration greater than that found in the environmental atmosphere. Goal : Is to provide adequate transport of oxygen in the blood while decreasing the work of breathing and reducing stress on the myocardium To prevent Hypoxia Oxygen administration : Oxygen therapy is prescribed by the physician who specifies the concentration, method of delivery and liter flow per minute. The concentration is of more importance than the liter flow per minute

46. Indications for Oxygen Therapy Respiratory Conditions –Cyanosis –Tachypnea –Hypoxemia –Partially obstructed airway Cardiac Conditions –Chest pain –Shock –Tachycardia –Arrhythmias Neurological Deficits –CVA –Spinal injuries –Coma Lung disease Heart Failure Chest injuries Airway obstruction Stroke Shock Seizures Diabetes Trauma Major blood loss Head Injuries

47. Cont.. Humidifiers – prevent mucous membranes from drying and becoming irritated and loosens secretions for easier expectoration. Oxygen passing through water picks up water vapor before it reaches the client The oxygen passes through sterile distilled water or tap water and then along a line to the device through which the moistened oxygen is inhaled ( e.g. a Cannula, Nasal Catheter, or Oxygen Mask).

48. Types of Oxygen Delivery 1. Cannula 2.Face Masks 3.Face Tents 4.Transtracheal Oxygen Delivery 5.Artificial Airways Simple face masks Partial rebreather masks Non-rebreather masks Venturi masks -Oropharyngeal - Nasopharyngeal - Endotracheal - Tracheostomy

49. Nasal Cannula/Nasal Prongs) Flow rate up to 6L/min Unable to determine exact concentration Comfortable – allows patient to eat, drink talk Can still be used if patient’ mouth breathing Delivers O2 into the patient’s nostrils by way of two small plastic prongs Delivers low concentration of O2 (24% to 45%) at flow rates of 2-6 L/min Most common inexpensive device

50. Face Masks Face masks that cover the client’s nose and mouth may be used for oxygen inhalation. Exhalation ports on the sides of the masks allowed exhaled carbon dioxide to escape. Simple Face Masks delivers oxygen concentrations from 40% to 60% at liters flows of 5 – 8 L/minute, respectively Partial Rebreather Masks delivers oxygen concentrations of 60% to 90% at liter flows of 6 to 10 L/ minute, respectively. The oxygen reservoir bag that is attached allows the client to rebreathe about the first third of the exhaled air in conjunction with oxygen

51. Non Rebreather Masks It delivers the highest oxygen concentration possible – 95% to 100% - by means other than intubation or mechanical ventilation at liter flows of 10 – 15 L/ minute,respectively . Venturi Masks The venturi masks delivers oxygen concentrations varying from 24% to 40% or 50% at liter flows of 4 to 10 L/ minute. is often used with air-entrainment nebulizers to provide humidification and oxygen therapy. Face Masks

52. Face Tents (Face Shield) Can replace oxygen masks when masks are poorly tolerated by clients. Face tents provide varying concentration of oxygen, for example 30% to 50% concentration of oxygen at 4 to 8 L/minute.

53. Artificial Airways Oropharyngeal Airways An OPA is a device usually made of plastic It is inserted into patients mouth and into back of throat Helps to maintain an open airway for breathing/ resuscitation Use OPA’s only on unconscious patients who DON’T have a gag reflex Oropharyngeal airways stimulate the gag reflex and are only used for clients with altered level of consciousness; Example: o Because of general anesthesia o Overdose o Head injury

54. Suctioning NEVER suction for longer than 15 seconds at a time NEVER suction as you are inserting the catheter, place the suction tip in the patients mouth before starting suction

55. Nurses Responsibilities The nurse should explain the reason and the objective for the therapy The nurse should know the proper care of and administration of oxygen Instruct the patient and family the methods for administering oxygen Demonstrate safe and appropriate use of oxygen and oxygen device Identify to patient and family the signs and symptoms indicating the need for oxygen

56. References Berman, A., Snyder, S. J., Kozier , B., Erb , G., Levett -Jones, T., Dwyer, T., ... & Park, T. (2010). Kozier and Erb's fundamentals of nursing (Vol. 1). Pearson Australia. Delaine, S., & Lander, P. (2008). Fundamentals of nursing standard and practice. Waugh, A., & Grant, A. (2001). Ross and Wilson anatomy and physiology in health and illness. Churchill Livingstone. 56