Fundamentals of Nursing NUR 102

1. Fundamentals of NursingNUR 102 Maintaining Oxygenation Module J

2. Objectives • Define terms associated with oxygenation • Explain the physiology of oxygenation • Explain the process of oxygenation administration • Explain pulse oximetry • Explain the process of connecting a pulse oximetry • Identify emergency techniques for restoring oxygenation • Explain the process of using various emergency techniques for restoring oxygenation • Explain the process of applying the nursing process to maintaining oxygenation.

3. TERMS • Afterload • Angina pectoris • Atelectasis • Bronchoscopy • Cardiac index • Cariac output • Cardiopulmonary rehabilitation • Cardiopulmonary resuscitation • Chest physiotherapy

4. Chest tube • Cyanosis • Diaphragmatic breathing • Diffusion • Dyspnea • Dysrhythmias • Electrocardiogram (ECG) • Expiration • Hematemesis • Hemoptysis • Hemothrorax • Humidification • Hyperventilation

5. Hypoventilation • Hypoxia • Incentive spirometry • Inspiration • Myocardial infarction (MI) • Nasal cannula • Nebulaizaation • Normal Sinus Rhythm • Orthopnea • Peak expiratory flow rate • Pneumothorax • Postural drainage • Preload • Pursed-lip breathing • Stroke volume • Thoracentesis • Ventilation • Ventricular fibrillation • Wheezing

6. Physiology of oxygenation: • Oxygen is required to sustain life. • Function of cardiac and respiratory systems is to supply the body’s oxygen demands. • Blood is oxygenation through mechanisms of ventilation, perfusion, and transport of respiratory gases. • Depth and rate of respiration is controlled by neural and chemical regulators-in response to changing tissue oxygen demands.

7. Cardiovascular Physiology: • Cardiopulmonary physiology involves delivery of deoxygenated blood (blood high in carbon dioxide and low in oxygen), to right side of heart and to pulmonary circulation and oxygenated blood from lungs to left side of heart and tissues. • Cardiac system delivers oxygen, nutrients, and other substances to tissues and removes waste products of cellular metabolism through cardiac pump, circulatory vascular system, and integration of other systems.

8. Structure and Function: • The right ventricle pumps blood through the pulmonary circulation. • The left ventricle pumps blood to the systemic circulation. • The circulatory system exchanges respiratory gases, nutrients, and waste products between the blood and the tissues.

9. Myocardial Pump • Pumping action of heart essential to maintaining oxygen delivery. • Coronary artery disease (CAD) and cardiomyopathic (enlarged heart) conditions result in diminished stroke volume. • Four chambers of heart fill with blood during diastole and empty during systole. • Factors affecting pump include hemorrhage and dehydration by decreasing amount of blood ejected from ventricles.

10. Myocardial Blood Flow: • Must supply sufficient oxygen and nutrients to myocardium in order to maintain adequate blood flow to pulmonary and systemic circulation. • Blood flow through heart is unidirectional. • There are four heart valves that ensure forward blood flow. • Ventricular diastole- atrioventricular (mitral and tricuspid) valves open and blood flows from higher pressure atria into relaxed ventricles=S1, or first heart sound. • After ventricular filling, systolic phase begins. • Systolic phase- semilunar (aortic and pulmonic) valves open and blood flows from ventricles into aorta and pulmonary artery. • Closure of aortic and pulmonic valves represents S2, or second heart sound.

11. Respiratory Physiology • Most cells in body obtain energy from chemical reactions involving oxygen and elimination of carbon dioxide. • Exchange of respiratory gases occurs between environmental air and blood. • Three steps in process of oxygenation: Ventilation, perfusion, and diffusion.

12. Structure and Function: • Ventilation- process of moving gases into and out of lungs. • Requires coordination of muscular and elastic properties of lung and thorax, as well as intact innervation. • Major inspiratory muscle of respiration is the diaphram- innervated by phrenic nerve, which exits spinal cord at 4th cervical vertebra. • Perfusion relates ability of cardiovascular system to pump oxygenated blood to tissues and return de-oxygenated blood to lungs.s

13. Inspiration- active process, stimulated by chemical receptors in aorta. Expiration is passive process that depends on elastic recoil properties of lungs, requiring little or no muscle work. Work of breathing:

14. Lung Volume: • Spirometry- is used to measure to measure volume of air entering or leaving the lungs. • Variations in lung volumes may be associated with health states such as pregnancy, exercise, obesity, or obstructive and restrictive conditions of the lungs. • Lung capacities- made up of two or more lung volumes (total lung capacity, and inspiratory and expiratory reserve volume).

15. Pulmonary Circulation: • Primary function of pulmonary circulation is to move blood to and from aveolocapillary membrane for gas exchange to occur. • Pulmonary circulation is a reservoir for blood so that lung can increase its blood volume without large increases in pulmonary artery or venous pressures. • Begins at the pulmonary artery, which receives poorly oxygenated mixed venous blood from the right ventricle.

16. Oxygen Transport: • Consists of lungs and cardiovascular system. • Delivery depends on amount of oxygen entering the lungs (ventilation), blood flow to lungs and tissues (perfusion), rate of diffusion, and oxygen-carrying capacity. • Capacity of blood to carry oxygen is influenced by the amt. of dissolved oxygen in the plasma, amt. of hemoglobin, and tendency of hemoglobin to bind with O2.

17. Breathing Patterns Factors Impairing Oxygenation Diagnostic Tests: Pulmonary Function Tests Pulse Oximetry Assessment

18. Airway Maintenance: • Humidification- process of adding water to gas. Temperature is most important factor affecting amt. water vapors a gas can hold. • Nebulization- process of adding moisture or medications to inspired air by mixing particles with the air. • Chest physiotherapy-(CPT) a group of therapies used in comb. To mobilize pulmonary secretions. • Nasopharyngeal suctioning- when client is unable to clear respiratory secretions to clear airway.

19. Oxygen Enhancement: • Nursing interventions include • Independent nursing actions (health promotion, prevention behaviors), positioning, and coughing techniques. • Interdependent or dependent interventions include oxygen therapy, lung inflation tech., hydration, medication admin., and chest psysiotherapy.

20. Nursing Process: • Assessment : • Physical examination (pain, fatigue, smoking, dyspnea, cough, wheezing, environment or geographical exposures, respiratory infections, allergies, health risks, medications. • Inspection, palpation, percussion, auscultation. • Diagnostic Tests

21. Nursing Process: • Nursing Diagnosis: • Based on specific defining characteristics and related etiology. • Use information gathered in assessment to identify defining characteristics. • Include: activity intolerance, risk for activity intolerance, ineffective airway clearance, anxiety, ineffective breathing pattern, decreased cardiac output, impaired comfort, fatigue, fear, risk for imbalanced fluid volume, impaired gas exchange, etc.

22. Nursing Process: • Implementation: • Health promotion (immunizations, vaccinations), healthy lifestyle behavior, environmental pollutants, dyspnea management, airway maintenance. • Suctioning (nasopharyngeal and nasotracheal suctioning), artificial airways, maintenance and promotion of lung expansion, chest tubes, methods of oxygen delivery.

23. Nursing Process: • Evaluation: • Client care • Client expectations

24. Review of CPR: *rescue breathing • Determine respiratory status (look, listen, feel). • Call for assistance if not breathing. • If has pulse but no breathing, initiate artificial airway (mouth to mouth, bag and mask). • Open airway. (Head tilt, chin lift). • Create tight seal over mouth. • Give one breath every 5 seconds. • Reassess after one full minute. • Continue rescue breathing if not breathing.