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 Assess the client’s oxygenation status

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

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

Systems Involved in Oxygenation Pulmonary Respiration Circulatory Perfusion Musculoskeletal Ventilation Neurological Ventilation

Pulmonary Review Airway- Upper nasal passages mouth pharynx larynx trachea bronchi bronchioles

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

Gas Exchange

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

Pulmonary Ventilation Inhalation Diaphragm contracts Exhalation Diaphragm Hyperventilation Hypoventilation

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

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

How is Breathing Controlled Respiratory Center Brainstem Feedback system Chemoreceptors in the medulla, aorta, and carotid arteries Blood pH, O 2 levels, and CO 2 levels Lung receptors provide feedback

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

Blood Flow Song

Heart Sinoatrial Node Atrio-ventricular Node Ventricular <40

Vascular System Arteries Arterioles Capillaries- one cell thick Veins Venules

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

Autonomic Nervous System Regulates Cardiovascular Function Sympathetic Parasympathetic

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

Factors Affecting Oxygenation Developmental factors Lifestyle factors Environment Stress Medications Stop

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

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

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

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

Examination Lung Heart Circulatory Function

Ventilation and oxygenation studies Pulmonary Function Tests Arterial Blood Gas Tests pO2 Arterial blood range mmHg Venous 40 mmHg pCO mm Hg Pulse Oximetry Capnography Peak Flow Monitoring

Lung Volume and Capacity

Diagnostics Visualizing Respiratory system Chest x-ray Bronchoscopy Lung scan

Basic cardiac monitoring lead placement cardiac cycle/wave form

Alterations in Oxygenation Hypoxemia Hypoxia Hypercarbarbia Hypocarbia

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

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

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

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

Artificial Airway Management Oropharyngeal Nasopharnygeal Endotracheal Tracheostomy Care Maintaining placement Suctioning

Mechanical Ventilation Acute Long term

Chest Tubes Purpose to remove air or fluid from the pleural space to reestablish negative pressure Flow of air or fluid is in one direction Water sealed

Promotion of oxygenation Oxygen therapy safety precautions Methods of oxygen delivery nasal cannula nasal catheter transtracheal masks

Home Oxygen Therapy compressed gas cylinders liquid oxygen systems concentrators

Breathing exercises pursed-lip breathing diaphragmatic breathing

Promote Optimum Circulation Promote Venous Return Ambulation Positioning ROM Compression devices Prevent Clot Formation CPR Pharmacotherapy

Nursing Diagnosis Pulmonary Ineffective Airway Clearance Ineffective Breathing Pattern Impaired Gas Exchange Impaired Spontaneous Ventilation Dysfunctional Ventilatory Weaning Response Risk for Aspiration

Nursing Diagnosis Cardiac Decreased Cardiac Output Ineffective Tissue Perfusion Risk for Shock Ineffective coping Anxiety Pain Risk for Activity Intolerance