Oxygenation. Chapter 21. Anatomy and Physiology of Breathing. Anatomy and Physiology of Breathing*

Transcription

1 Oxygenation Chapter 21 Anatomy and Physiology of Breathing Inspiration ~ breathing in Expiration ~ breathing out Ventilation ~ Movement of air in & out of the lungs Respiration ~ exchange of O2 & carbon dioxide Anatomy and Physiology of Breathing* External Respiration ~ occurs in the airway between the alveolar & capillary membranes Internal Respiration ~ takes places at the cellular level between hemoglobin and the body cells Increased levels of carbon dioxide triggers Breathing 1

2 External Respiration Internal Respiration 2

3 External & Internal Respiration biology.bangor.ac.uk Anatomy and Physiology of Breathing Ventilation results from pressure change within the thoracic cavity produced by the contraction and relaxation of respiratory muscles 3

4 A&P of Breathing: During Inspiration The diaphragm contracts & moves downward in the thorax The intercostals muscles move the chest outward Expanding the chest space and decreasing the pressure within the lungs Air is pulled in through the nose filling the lungs A&P of Breathing: During Expiration The Respiratory Muscles relax The thoracic cavity decreases The lung tissue recoils The Intrathoracic pressure increases Air moves out of the respiratory tract 4

5 Inspiration / Expiration Assessing Oxygenation Physical Assessment Monitoring Arterial Blood Gases Pulse Oximetry Hypoxemia & Hypoxia Hypoxemia ~ insufficient O2 with in arterial blood Hypoxia ~ inadequate O2 at the cellular level 5

6 Physical Assessment Monitor Respiration Rate Breathing Pattern Breathing Effort Chest Symmetry Auscultation Vital Signs Level of Consciousness Color of Skin, Lips, Nail beds and Mucous Membranes Signs of Inadequate Oxygenation Decreased energy Restlessness Rapid, shallow breathing Rapid heart rate Nasal flaring Use of accessory muscle HTN Sleepiness, confusion, stupor, Coma Cyanosis Arterial Blood Gases Arterial blood gas (ABG) ~ a lab test using arterial blood to assess Oxygenation Ventilation And acid-base balance 6

7 Arterial Blood Gases It measures the Ph ~ Ph of the blood PaO2 ~ Partial pressure of O2 dissolved in plasma PaCO2 ~ Partial pressure of CO2 dissolved in plasma SaO2 ~ the percentage of hemoglobin saturated with O2 HCO3 ~ level of Bicarbonate See Table 20.1 for values for ABG s Arterial Blood Gases See Nursing Guidelines 20.1 Perform Allen Test Rest 30min before ABG S Record V/S, Activity and amount of O2 pt s on Assist with collection Apply pressure for 5-10 min Apply a 4x4 pressure dressing Monitor the site for bleeding Report findings ABG 7

8 Pulse Oximetry Pulse Oximetry ~ monitors the O2 saturation of blood See Skill 20-1 page 427 Normal SpO2 ~ % SpO2 less than 90% is cause for concern May need O2 therapy See Table 20.2 ~ interfering factors for SpO2 Pulse Oximetry Promoting Oxygenation Positioning Breathing Techniques 8

9 Positioning Fowler s Positions ~ upright seated position Eases breathing Allows the abdomen organ to descend The lung have the potential to fill with more air Orthopneic Position ~ variation of the Fowler s position Seated position with arms elevated The pt leans forward Allows room for the maximum chest expansion Provides comfort while resting or sleeping Positions Breathing Techniques Deep Breathing Incentive Spirometry Pursed-Lip Breathing Diaphragmatic Breathing Nasal Strips 9

10 Breathing Techniques Deep Breathing~ is a technique for maximizing ventilation Take in a large volume of air Fills alveoli to a greater capacity Improving gas exchange Therapeutic for patients who Breath shallowly Inactive In pain Incentive Spirometry Incentive Spirometry ~ a technique for deep breathing using a calibrated device Marked in 100 ml increments with a visual cue Assist the nurse in evaluating the effectiveness of deep breathing See C&F Teaching box 20-1 Page 412 See figure 20.6 Incentive Spirometry 10

11 Pursed-Lip Breathing Pursed-Lip Breathing ~ form of controlling ventilation in which the pt prolong the expiration phase of breathing Helps to eliminate more CO2 from lungs Perform Pursed-Lip Breathing by Inhaling slowly through nose counting to 3 Pursed the lips ( whistle) Contract the ABD muscles Exhale through pursed lips for a count of 6 or more Diaphragmatic Breathing Diaphragmatic Breathing ~ is breathing that promotes the use of the diaphragm rather than the chest muscles See C&F Teaching box 20-1 Page 413 Nasal Strips Nasal Strips ~ are used reduce the airflow resistance by widening the breathing passageways of the nose Oxygen Therapy Oxygen Sources Wall Outlet / Portable Tanks Liquid Oxygen Unit Oxygen Concentrator 11

12 Wall Outlet / Portable Tanks Liquid Oxygen Unit Oxygen Concentrator 12

13 Equipment Used in O2 Administration Flow meter Oxygen analyzer Humidifier Flow meter Oxygen analyzer 13

14 Humidifier* Common Delivery Devices Nasal Cannula Masks Simple Mask Partial Rebreather Mask Non-Rebreather Mask Venturi Mask Face Tent Tracheostomy Collar T-Piece Nasal Cannula 14

15 Masks Masks Face Tent 15

16 Tracheostomy Collar Trach Collar T-Piece 16

17 Other Delivery Devices Nasal Catheter Oxygen Tent CPAP Mask Transtracheal Oxygen Nasal Catheter BI-PAP 17

18 C-PAP Transtracheal Oxygen Transtracheal Oxygen 18

19 Oxygen Tent Oxygen Tent ashleyadamsjournal.blogspot.com Fire Potential Oxygen Toxicity Oxygen Hazards 19

20 Related Oxygenation Techniques Water-Seal Chest Tube Drainage Hyperbaric Oxygen Therapy Water-Seal Chest Tube Drainage Chest Tube Insertion 20

21 Hyperbaric Oxygen Therapy Nursing Implications Assess the pt on a day by day and shift by shift basis Know the sign and symptoms of hypoxia and hypoxemia Nursing Dx Ineffective Breathing Pattern Impaired Gas Exchange Anxiety Risk for Injury R/T O2 hazards General Gerontologic Considerations MULTIPLE AGE-RELATED CHANGES IN THE RESPIRATORY SYSTEM. SMOKING, INACTIVITY, AND CHRONIC ILLNESS INCREASE THE RISK OF RESPIRATORY INFECTION AND COMPROMISED RESPIRATORY FUNCTION. SMOKERS NEED COUNSELING ABOUT SMOKING CESSATION. 21

22 General Gerontologic Considerations ENCOURAGE A LIBERAL FLUID INTAKE (UNLESS CONTRAINDICATED) AND REGULAR EXERCISE. WEIGHT LOSS AND DECREASED SUBCUTANEOUS FAT IN THE CHEEKS MAKE OXYGEN MASKS LESS EFFECTIVE. General Gerontologic Considerations ANNUAL INFLUENZA IMMUNIZATION. PNEUMONIA IMMUNIZATION PER GUIDELINES. ENCOURAGE OLDER ADULTS WHO REQUIRE HOME OXYGEN TO CONTINUE TO SOCIALIZE OUTSIDE THE HOME TO PREVENT FEELINGS OF ISOLATION AND DEPRESSION. Review Skill Sections 21-1 through 21-3 Pages