Post on 25-Apr-2018
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Oxygenation
Chapter 45
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Respiratory Physiology
Structure and function Breathing: inspiration, expiration
Lung volumes and capacities
Pulmonary circulation
Respiratory gas exchange: oxygen, carbon dioxide
Regulation of respiration
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Measures That Promotes Adequate
Respiratory Functions:
1. Adequate OXYGEN supply from the environment.
2. Deep breathing and coughing exercises.
3. Proper positioning
4. Patent airway (FEMS)
5. Adequate hydration
6. Avoid pollutants, alcohol and smoking.
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Oxygen is a clear, odorless gas that constitute approximately 21% of the air we breath
Respiration is the process of gas exchange between the individual and the environment
Process of ventilation involve two component
pulmonary ventilation or breathing : the movement of the air between the atmosphere and the alveoli in the lung
diffusion of the oxygen and carbon dioxide between the alveoli and the pulmonary capillaries
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The function of the respiratory system is gas exchange
Pulmonary ventilation: inspiration (inhalation) when air flows into the lung and expiration (exhalation) as ear move out of the lung
Adequate ventilation depends on several factors
clear air way
an intact central nervous system and respiratory system
an intact thoracic cavity capable of expanding and contracting
adequate pulmonary compliance and recoil
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Tidal volume: the amount of air expired and inspired each breath, it is about 500 ml of are in adult.
Surfactant: a lipoprotein produced by specialized alveolar cell, reducing the service tension of alveolar fluid .without surfactant the lung collapse.
Alveolar gas exchange: exchange between oxygen and carbon dioxide
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Transport of oxygen and carbon dioxide:
Normally most of the oxygen (97%) combined loosely with hemoglobin and produce oxyhemoglobin
Factor affecting the rate of oxygen transport from the lung to the tissue
cardiac output
number of erythrocyte and blood Hematocrit
exercise
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Respiratory regulation:
Respiratory regulation include both neural and chemical control to maintain the correct concentration of oxygen
A chemosensitive center in the medullaoblongada is highly responsive to increasing in blood CO2 or hydrogen ion concentration
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Factor affecting respiratory function
Age (Developmental Factors)
Lifestyle (Nutrition, Exercise,Smoking, Substance abuse, Stress)
Environment (Occupation, air pollutions )
health status
medication
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Alteration in respiratory function:
Respiratory function can be altered by condition that affects:
The movement of air into or out the lung.
The diffusion of oxygen and carbon dioxide between the alveoli and the pulmonary capillaries.
The transport of oxygen and carbon dioxide via the blood to and from the tissue cell.
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The major alterations in respiration are:
1. Hypoxia: is a condition of insufficient oxygen any where in the body, from inspired gas to the tissue
Hypercapnia: accumulation of carbon dioxide in the blood
Hypoxemia: insufficient oxygen in blood
2. Altered breathing pattern:
Tacypnea, bradypnea apnea
Orthpnia (is the inability to breathe except in an upright or standing position)
Dyspnia (difficult or uncomforted berthing).
3. Obstructed airway
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Nursing History
Fatigue
Dyspnea
Cough
Wheezing
Pain
Environmental or geographical exposures
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Nursing History (cont'd)
Respiratory infections
Health risks
Medications
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Assessment of Oxygenation
Physical examination
Inspection
Palpation
Percussion
Auscultation
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Clubbing of Fingers
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Assessment of Oxygenation (cont'd)
Diagnostic tests: blood studies
Complete blood count
Cardiac enzymes
Cardiac troponin I
Serum electrolytes
Cholesterol
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Assessment of Oxygenation (cont'd)
Diagnostic tests: cardiac function
Electrocardiogram (ECG)
Holter monitor
Exercise stress test
Thallium stress test
Electrophysiological study (EPS)
Echocardiography
Scintigraphy
Cardiac catheterization
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Assessment of Oxygenation (cont'd)
Diagnostic tests: ventilation studies
Pulmonary function
Peak expiratory flow rate (PEFR)
Arterial blood gases
Oximetry
Chest x-ray
Bronchoscopy
Lung scan
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Assessment of Oxygenation (cont'd)
Diagnostic tests: ventilation studies (cont'd)
Thoracentesis
Throat cultures
Sputum specimens
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Nursing Diagnoses
Ineffective airway clearance
Ineffective breathing pattern
Decreased cardiac output
Impaired gas exchange
Risk for infection
Ineffective tissue perfusion
Impaired spontaneous ventilation
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Planning
Goals and outcomes
Client’s lungs are clear on auscultation
Client coughs productively
Setting priorities
Continuity of care
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Implementation:
Body weight, Diet, Exercise, Stress reduction, Occupational safety, Smoke-free,
Regular physical examinations
Dyspnea management
Airway maintenance
Mobilization of secretions
Suctioning
Artificial airways
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Implementation:
Maintenance and promotion of lung expansion
Positioning
Incentive spirometry
Chest tubes
Hydration
Coughing techniques
Respiratory muscle training
Breathing exercises
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9. Incentive Spirometry
- done to enhance deep inspiration
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Evaluation
Client care
Client expectations
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OXYGEN SYSTEMS:
1. Low-flow Administration Devices:
a. Nasal Cannula (24-45% at 2-6LPM)
b. Simple Face Mask (40-60% at 5-8LPM)
c. Partial Rebreathing Mask (60-90% at 6-10LPM)
d. Non-rebreathing Mask (95-100% at 6-15LPM)
e. Oxygen Tent
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OXYGEN SYSTEMS:
2. High flow Administration Devices
a. Venturi Mask
b. Oxygen Hood
c. Incubator / Isolette
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