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

2. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Oxygenation Oxygen: measures approximately 21% in the Earth’s atmosphere Each cell of the human body uses oxygen to metabolize nutrients and produce energy Without oxygen, cell death occurs rapidly

3. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? Expiration creates more chest space, causing the pressure within the lungs to fall below that in the atmosphere.

4. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False. Inhalation creates more chest space, causing the pressure within the lungs to fall below that in the atmosphere.

5. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Anatomy and Physiology of Breathing Inspiration and expiration Ventilation: movement of air in and out of lungs; facilitates respiration Respiration: exchange of oxygen and carbon dioxide

6. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Anatomy and Physiology of Breathing (cont’d) External and internal respiration –External respiration takes place at most distal point in airway: between the alveolar-capillary membranes –Internal respiration occurs at the cellular level between hemoglobin and body cells

7. 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

8. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Assessing Oxygenation (cont’d) Arterial blood gases measure: –Partial pressure of oxygen dissolved in plasma –Percentage of hemoglobin saturated with oxygen –The pH of blood

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

10. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Assessing Oxygenation (cont’d) Pulse oximetry –Composed of a sensor and a microprocessor –Noninvasive, transcutaneous technique for periodically or continuously monitoring the oxygen saturation of blood

11. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Which of the following is used for monitoring the oxygen saturation of blood? a. Arterial blood gases b. Pulse oximetry c. Incentive spirometry d. Oxygen analyzer

12. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer b. Pulse oximetry Pulse oximetry is a technique for periodically or continuously monitoring the oxygen saturation of blood. Arterial blood gases monitor the pH of blood. Incentive spirometry is a technique for deep breathing using a calibrated device. Oxygen analyzer is a device that measures the percentage of delivered oxygen to the client.

13. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Promoting Oxygenation Positioning: Fowler’s position Breathing techniques –Deep breathing oIncentive spirometry –Pursed-lip breathing –Diaphragmatic breathing –Nasal strips

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

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

16. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Oxygen Therapy (cont’d) Equipment used in oxygen administration –Flowmeter –Oxygen analyzer –Humidifier Common delivery devices –Nasal cannula

17. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Oxygen Therapy (cont’d) Common delivery devices (cont’d) –Masks oSimple mask oPartial rebreather mask oNon-rebreather mask oVenturi mask

18. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Oxygen Therapy (cont’d) Common delivery devices (cont’d) –Face tent –Tracheostomy collar –T-piece Additional delivery devices –Nasal catheter

19. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Comparison of Oxygen Delivery Devices (Refer to Table 21-4 in the textbook.)

20. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Oxygen Therapy (cont’d) Additional delivery devices (cont’d) –Oxygen tent and CPAP mask –Transtracheal oxygen Oxygen hazards –Fire potential –Oxygen toxicity

21. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Administering Oxygen Safely

22. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Which of the following is a common delivery device for oxygen? a. Flowmeter b. Nasal cannula c. Oxygen analyzer d. Humidifier

23. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer b. Nasal cannula Nasal cannula is a common delivery device. Flowmeter, oxygen analyzer, and humidifier are equipment used in oxygen administration.

24. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Related Oxygenation Techniques Water-seal chest tube drainage –A technique for evacuating air or blood from the pleural cavity Hyperbaric oxygen therapy –Delivery of 100% oxygen at 3 times the normal atmospheric pressure within an airtight chamber

25. 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)

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

27. 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

28. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins General Gerontologic Considerations (cont’d) 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