1. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 21 Oxygenation

2. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Assessing Oxygenation Physical assessment –Monitoring the client’s respiratory rate –Observing breathing pattern and effort –Checking chest symmetry –Auscultating lung sounds

3. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Arterial blood gases measure: –Partial pressure of oxygen dissolved in plasma –Percentage of hemoglobin saturated with oxygen –The pH of blood

4. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Arterial Blood Gases

5. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Pulse oximetry –Composed of a sensor and a microprocessor –Noninvasive, transcutaneous technique for periodically or continuously monitoring the oxygen saturation of blood

6. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Promoting Oxygenation 1-Positioning: Fowler’s position

7. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins 2-Breathing techniques –Deep breathing oIncentive spirometry: a method of encouraging voluntary deep breathing by providing visual feedback about inspiratory volume. The patient inhales until a preset volume is reached, then sustains the inspiratory volume by holding his or her breath for 3 to 5 seconds. It reduces the risk of atelectasis and pulmonary consolidation.

8. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

9. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins –Pursed-lip breathing –

10. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins –Diaphragmatic breathing

11. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Diaphragmatic Breathing

12. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins -Nasal strips: gently open your nasal passages helping you to breathe better by providing temporary relief from nasal congestion and stuffiness which can be caused by colds and allergies. Each drug-free nasal strip consists of flexible “spring-like” bands that when placed correctly across the nose, gently opens the nasal passages to make breathing easier.

13. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Oxygen Therapy Oxygen sources –Wall outlet –Portable tanks –Liquid oxygen unit –Oxygen concentrator

14. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Equipment used in oxygen administration –Flowmeter

15. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins –Oxygen analyzer

16. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins -Humidifier

17. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Common delivery devices –Nasal cannula

18. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins –Masks oSimple mask oPartial rebreather mask oNon-rebreather mask oVenturi mask

19. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

20. –Face tent

21. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins –Tracheostomy collar

22. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins T-piece

23. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Additional delivery devices –Nasal catheter

24. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins –Oxygen tent and CPAP mask (continuous positive airway pressure): Very helpful for patients with sleep apnea.

25. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins –Transtracheal oxygen Oxygen hazards –Fire potential –Oxygen toxicity

26. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins General Gerontologic Considerations Reduced gas exchange and efficiency in ventilation; major age-related changes occur in the respiratory system Respiratory muscles become weaker and the chest wall becomes stiffer as a result of calcification of the intercostal cartilage

27. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Diminished cough and gag reflexes, increased use of accessory muscles for breathing, increased mouth breathing, snoring Inactive, debilitated, or chronically ill clients or smokers are at a higher risk for respiratory infections and compromised respiratory function

28. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Implications Nursing diagnoses: hypoxemia or hypoxia –Ineffective breathing pattern –Impaired gas exchange –Anxiety –Risk for injury (related to oxygen hazards)

29. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Ineffective Breathing Pattern (Refer to Nursing Care Plan 21-1in the textbook.)