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Oxygenation

Oxygenation. Janna Wickham RN MSN Lake Sumter Community College Nursing Foundation January 2013. Learning Objectives. Safe, Effective Care Environment . Describe physiological processes affecting the client's ventilation, perfusion , and exchange of respiratory gases

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Oxygenation

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  1. Oxygenation Janna Wickham RN MSN Lake Sumter Community College Nursing Foundation January 2013

  2. Learning Objectives

  3. Safe, Effective Care Environment • Describe physiological processes affecting the client's ventilation, perfusion, and exchange of respiratory gases • Assess the client’s oxygenation status

  4. Health Promotion and Maintenance • Develop nursing interventions that promote oxygenation • Describe the impact of a client's level of health, age, lifestyle, and environment on tissue oxygenation

  5. Physiological Integrity • Interpret diagnostic testing related to oxygenation, breathing, circulation, and gas exchange

  6. Systems Involved in Oxygenation • Pulmonary • Respiration • Circulatory • Perfusion • Musculoskeletal • Ventilation • Neurological • Ventilation

  7. Lungs-Lower- considered sterile • Right- 3 lobes • Left- 2 lobes • Mediastinum- separates right from left • Alveoli • Alveoli-capillary membrane • Gas Exchange • Surfactant • Pleura • Pleural Space

  8. Gas Exchange

  9. Functions of Pulmonary System • Ventilation • Respiration • Oxygenation • Hypoxemia (blood) • Perfusion • Hypoxia

  10. Pulmonary Ventilation • Inhalation • Diaphragm contracts • Exhalation • Diaphragm • Hyperventilation • Hypoventilation

  11. Lung Compliance • Conditions that reduce lung compliance • Edema • Scar tissue • Loss of surfactant • Lung elasticity • Loss of elasticity results in lungs that inflate but air is trapped • Airway resistance • Small changes can cause increased airway resistance

  12. Respiration • External Respiration • Alveolar-Capillary Membrane • Diffusion • Conditions that slow or reduce gas exchange • Internal Respiration

  13. How is Breathing Controlled • Respiratory Center • Brainstem • Feedback system • Chemoreceptors in the medulla, aorta, and carotid arteries • Blood pH, O2 levels, and CO2 levels • Lung receptors provide feedback

  14. Cardiovascular • Deoxygenated blood flows into the right atrium • Pulmonary circulation • Alveolar-capillary membrane external gas exchange occurs • Oxygenated blood flows from the lungs to the left side of the heart of out into the arterial circulation

  15. Blood Flow Song

  16. Heart • Sinoatrial Node • 60-100 • Atrio-ventricular Node • 40-60 • Ventricular • <40

  17. Vascular System • Arteries • Arterioles • Capillaries- one cell thick • Veins • Venules

  18. Oxygen Transport • Requires adequate • Cardiac output • Circulation • Effective regulation of cardiovascular system • Hemoglobin-reservoir for oxygen • 97% of blood oxygen is bound to hemoglobin • 3% of oxygen is dissolved • Carbon Dioxide • Dissolves into plasma for diffusion into the alveoli

  19. Autonomic Nervous System • Regulates Cardiovascular Function • Sympathetic • Parasympathetic

  20. Brain Stem Center • Baroreceptors • Heart • Aortic arch • Blood vessels • Carotid artery • Chemoreceptors • Blood pH • Oxygen • Carbon dioxide levels

  21. Factors Affecting Oxygenation Stop • Developmental factors • Lifestyle factors • Environment • Stress • Medications

  22. Developmental • Preterm infants surfactant system is not fully developed putting them at risk for respiratory distress syndrome- atelectasis • Infant airways are small and this puts them at risk for obstruction from mucous, edema, foreign objects • Toddlers are at risk for URI because of tonsils and adenoids are relatively large. Preschool introduces infectious agents. Still at risk for choking. • Age/Older Adults • Reduces lung expansion • Less alveolar inflation • Less effective cough • Declining immune system • Diminished ability to increase ventilation

  23. Lifestyle • Smoking • Sedentary lifestyle • Nutrition • Fat • Sugar • Pregnancy • Occupational Hazards • Obesity • Substance Abuse

  24. Environment • Stress • Catecholamine - SNS • Suppressed immune system • Release of cortisol • Allergic Reactions • Asthma –allergic reaction in the bronchioles of the lungs • Air Quality • Altitude • Low oxygen levels can cause hypoxemia and hypoxemia • Heat and Cold

  25. Physical Assessment & Examination

  26. Nursing history • fatigue • dyspnea • cough • wheezing • pain • environmental exposures • respiratory infections • risk factors • medications

  27. Examination • Lung • Heart • Circulatory Function

  28. Diagnostic tests

  29. Ventilation and oxygenation studies • Pulmonary Function Tests • Arterial Blood Gas Tests • pO2 • Arterial blood range 80-100mmHg • Venous 40 mmHg • pCO2 35-45 mm Hg • Pulse Oximetry • Capnography • Peak Flow Monitoring

  30. Lung Volume and Capacity

  31. Diagnostics • Visualizing Respiratory system • Chest x-ray • Bronchoscopy • Lung scan

  32. Basic cardiac monitoring • lead placement • cardiac cycle/wave form

  33. Alterations in Oxygenation • Hypoxemia • Hypoxia • Hypercarbarbia • Hypocarbia

  34. Pulmonary Causes • Structural Abnormalities • Airway Inflammation/Obstruction • Alveolar-capillary membrane disorders • Atelectasis • Pulmonary Embolism • Pulmonary Hypertension

  35. Cardiovascular Causes • Heart Failure • Cardiomyopathy • Cardiac Ischemia • Dysrhythmias • Valve Abnormalities • Anemia • CO poisoning • Peripheral Vascular Disease

  36. Promote Optimum Respiratory Function • Immunization/ Screening • Influenza, pneumonia, tuberculosis • Prevent URI • Position for maximum ventilation • Teach/Assist with Incentive Spirometer • Implement Aspiration Precautions

  37. Mobilization of pulmonary secretions • Hydration • Humidification • Nebulization • Chest physiotherapy • chest percussion • vibration • postural drainage • CPR • Pharmacotherapy

  38. Artificial Airway Management • Oropharyngeal • Nasopharnygeal • Endotracheal • Tracheostomy • Care • Maintaining placement • Suctioning

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