2. Stressors that Affect Oxygen Needs NUR101 FALL 2010 K. BURGER, MSEd, MSN, RN, CNE LECTURE #19 PPP by Sharon Niggemeier RN, MSN Revised October 2005 by K. Burger

3. Oxygenation Ventilation- air moves in & out of lungs External respiration-exchange of O2 & CO2 between alveoli and blood Gas Transport- blood transports O2 & CO2 to body cells Internal respiration- exchange of O2 & CO2 between blood and cells.

4. Factors Affecting Respiration Integrity of the airway system (ventilation) Functioning cardiovascular system (perfusion) Functioning alveoli (diffusion) Functioning medulla & chemoreceptors

5. Pulmonary Ventilation Inspiration- air flows into lungs Expiration-gases flow out of lungs Intrapulmonic or intra-alveolar pressure- pressure within alveoli Intrapleural pressure-pressure within the intrapleural space (always negative)

6. Factors Affecting Ventilation Lung elasticity / compliance Airway obstruction Musculature condition Neurological controls

7. Alveoli Gas Exchange Air reaches alveoli Oxygen from alveoli space moves into pulmonary capillary (oxygen uptake) via diffusion Oxygen diffuses across alveoli membranes moving from high concentration (alveoli) to lower concentration (pulmonary capillary)

8. Alveoli Gas Exchange Surfactant- secreted by alveoli cells, keeps surfaces moist and prevents atelectasis Atelectasis- incomplete lung expansion or collapse of alveoli Lung Compliance- elasticity of lung tissue and flexibility of rib cage Lung recoil- ability of lungs to recoil

9. Other Factors Affecting Gas Exchange Surface area Thickness of tissue

10. Perfusion Transport of O2 & CO2 via blood to tissue Volume of blood flowing through lungs affects amount of oxygen and gases exchanged Adequate blood supply and cardiovascular functioning are needed Oxyhemoglobin HbO2 (or SaO2)

11. Perfusion Rate of O2 transport depends on: Cardiac output Activity level CO2 transport

12. Neurologic/Chemical Controls of Respiration Peripheral Chemoreceptors Central Chemoreceptors Medullary respiratory center Spinal cord Phrenic nerve Diaphragm

13. Factors Affecting Oxygenation Environment Emotions Exercise Health Age Life style Medications Respiratory History

14. Assessing Respiratory Functioning Difficulty breathing? SOB? Chest pain? Coughing? Sputum production? Nocturnal diaphoresis Fatigue Sleep with 2 or more pillows?

15. Assessing Respiratory Functioning Respiratory Hx includes: Allergies Medications Medical Hx Smoking Lifestyle / Activity Level Stressors Recent exposures Developmental level

16. Assessing Respiratory Functioning Patient states difficulty breathing: you can assess by using PQRST P- provokes Q- quality R- region/radiation S- severity scale T- timing

17. Assessing Respiratory Functioning Respiratory Rate: Tachypnea Bradypnea Apnea Respiratory Depth: Deep - diaphragmatic Shallow

18. Assessing Respiratory Functioning Respiratory Rhythm: Regular – “even and symmetrical” Cheyne-Stokes Kussmauls Biot’s Apneustic breathing

19. Assessing Respiratory Functioning Respiratory Quality: No difficulty- Eupneic/ Unlabored Dyspnea Orthopnea Retractions Use of accessory muscles Auscultation: Vesicular Bronchial Bronchovesicular

20. Assessing Respiratory Functioning Cough: Nonproductive Productive Sputum Hemoptysis Adventitious Sounds: Crackles: fine,medium,coarse Wheeze: sibilant,sonorous Stridor Stertor Pleural friction rub Breath sounds

21. Assessing Respiratory Functioning Diagnostic tests: Sputum Nose/throat cultures CBC (complete blood count) ABG (arterial blood gases) CXR (chest x ray) PFT (pulmonary function tests) Pulse Oximetry http://www.oximeter.org/pulseox/principles.htm http://www.oximeter.org/pulseox/principles.htm Other: Scopes, CT, MRI, PET

22. Alterations:Respiratory Functioning Hypoxia Hypoxemia Hyperventilation Hypercapnia Obstructed airway Foreign body obstruction (FBO)

23. Nursing Interventions Independent Airway maintenance Positioning Deep breathing & coughing Pursed-lip breathing Abdominal/diaphragmatic breathing Hydration Teaching of health habits

24. Nursing Interventions Collaborative/Dependent Incentive spirometry Percussion/postural drainage Suctioning Oxygen therapy Medications

25. Nursing Interventions Collaborative/Dependent Oxygen Therapy Indications Sources- wall outlet or portable tank Methods- cannula, mask, venturi mask, tent/isolette,BiPAP, CPAP

26. Postural Drainage

27. BiPAP Ventilator Support System

28. Administering Oxygen Therapy Flow rate Humidification Hydration Positioning Safety precautions Document MD order required

29. Oxygen Safety Precautions Signs: “No smoking. Oxygen in use.” Remove matches, lighters and cigarettes. Remove and store electrical equipment to avoid sparks. Ground electrical equipment. Avoid materials that generate static electricity Avoid use of volatile, flammable materials, such as alcohol. Know location & use of fire extinguishers & alarms.

30. Nursing Interventions Medications Nebulizer Tx Cough suppressants Mucolytic: expectorants Bronchodilators Corticosteroids

31. Documentation Routine Nurses Note Date Time LOC Rate Depth Rhythm Breath sounds (auscultated) Quality Color

32. Nursing Diagnosis Ineffective airway clearance Risk for aspiration Ineffective breathing pattern Impaired gas exchange Risk for suffocation Ineffective tissue perfusion; cardiopulmonary Impaired spontaneous ventilation Dysfunctional ventilatory weaning response

33. Summary: Oxygenation Oxygenation based on ventilation/perfusion/diffusion of oxygen Various factors effect oxygenation Assessment includes respiratory Hx, clinical exam, diagnostic tests Interventions include airway maintenance /proper breathing/ oxygen therapy/meds