Oxygenation - جامعة آل...

Re'eda Almashagba 1

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


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.


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


Nursing History

Fatigue

Dyspnea

Cough

Wheezing

Pain

Environmental or geographical exposures


Nursing History (cont'd)

Respiratory infections

Health risks

Medications


Assessment of Oxygenation

Physical examination

Inspection

Palpation

Percussion

Auscultation


Clubbing of Fingers


Assessment of Oxygenation (cont'd)

Diagnostic tests: blood studies

Complete blood count

Cardiac enzymes

Cardiac troponin I

Serum electrolytes

Cholesterol



Diagnostic tests: cardiac function

Electrocardiogram (ECG)

Holter monitor

Exercise stress test

Thallium stress test

Electrophysiological study (EPS)

Echocardiography

Scintigraphy

Cardiac catheterization



Diagnostic tests: ventilation studies

Pulmonary function

Peak expiratory flow rate (PEFR)

Arterial blood gases

Oximetry

Chest x-ray

Bronchoscopy

Lung scan



Diagnostic tests: ventilation studies (cont'd)

Thoracentesis

Throat cultures

Sputum specimens


Nursing Diagnoses

Ineffective airway clearance

Ineffective breathing pattern

Decreased cardiac output

Impaired gas exchange

Risk for infection

Ineffective tissue perfusion

Impaired spontaneous ventilation


Planning

Goals and outcomes

Client’s lungs are clear on auscultation

Client coughs productively

Setting priorities

Continuity of care


Implementation:

Body weight, Diet, Exercise, Stress reduction, Occupational safety, Smoke-free,

Regular physical examinations

Dyspnea management

Airway maintenance

Mobilization of secretions

Suctioning

Artificial airways


Implementation:

Maintenance and promotion of lung expansion

Positioning

Incentive spirometry

Chest tubes

Hydration

Coughing techniques

Respiratory muscle training

Breathing exercises


9. Incentive Spirometry

- done to enhance deep inspiration


Evaluation

Client care

Client expectations


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


OXYGEN SYSTEMS:

2. High flow Administration Devices

a. Venturi Mask

b. Oxygen Hood

c. Incubator / Isolette

Oxygenation - جامعة آل...

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