1. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Chapter 32 Oxygenation

2. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Physiology of Oxygenation Ventilation Alveolar gas exchange Oxygen transport and delivery –Oxygen transport in blood –Circulation Cellular respiration

3. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Factors Affecting Oxygenation Age Environment Lifestyle (continued)

4. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Factors Affecting Oxygenation Disease processes: –Obstructive pulmonary disease –Restrictive pulmonary disease –Diffusion defects –Ventilation-perfusion mismatching –Atherosclerosis (continued)

5. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Factors Affecting Oxygenation Disease processes: –Heart failure –Anemia –Alterations in oxygen uptake

6. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Physiological Responses to Reduced Oxygenation Increased oxygen extraction Anaerobic metabolism Tissue ischemia and cell death Carbon dioxide transport and excretion

7. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Oxygenation and the Nursing Process Assessment –Health history Explore problem –Duration –Pattern Medical history (continued)

8. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Oxygenation and the Nursing Process Assessment –Health history ADLs Knowledge Coping (continued)

9. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Oxygenation and the Nursing Process Assessment –Physical examination Observation Rate and rhythm Signs of hypoxia Palpation Percussion Breath sounds (continued)

10. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Oxygenation and the Nursing Process Assessment –Diagnostic and laboratory data Pulse oximetry Arterial blood gases (ABGs) Sputum collection Chest x-ray CT MRI (continued)

11. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Oxygenation and the Nursing Process Assessment –Diagnostic and laboratory data Ventilation/perfusion (V/Q) scan Bronchoscopy Thoracentesis Echocardiography Electrocardiography Stress test (continued)

12. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Oxygenation and the Nursing Process Diagnosis –Prioritize Airway Breathing Circulation (continued)

13. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Oxygenation and the Nursing Process Diagnosis –NANDA statements Ineffective airway clearance Ineffective breathing patterns Impaired gas exchange Decreased cardiac output Ineffective tissue perfusion (continued)

14. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Oxygenation and the Nursing Process Diagnosis –Other nursing diagnoses: Deficient knowledge Activity intolerance Insomnia Imbalanced nutrition (continued)

15. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Oxygenation and the Nursing Process Diagnosis –Other nursing diagnoses: Acute pain Chronic pain Anxiety (continued)

16. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Oxygenation and the Nursing Process Planning and outcome identification –Collaboration (continued)

17. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Oxygenation and the Nursing Process Implementation –Airway clearance –Breathing patterns –Oxygen uptake and delivery –Cardiac output and tissue perfusion –Emergency interventions (continued)

18. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Oxygenation and the Nursing Process Implementation –Interventions to promote airway clearance Teach effective coughing Initiate postural drainage and chest physiotherapy Monitor hydration Administer medications (continued)

19. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Oxygenation and the Nursing Process Implementation –Interventions to promote airway clearance Monitor environmental and lifestyle conditions Introduce artificial airways Suction airway (continued)

20. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Oxygenation and the Nursing Process Implementation –Interventions to improve breathing patterns Properly position client Teach controlled breathing exercises Introduce chest drainage systems (continued)

21. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Oxygenation and the Nursing Process Implementation –Interventions to improve oxygen uptake and delivery Administer oxygen Administer blood components (continued)

22. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Oxygenation and the Nursing Process Implementation –Interventions to increase cardiac output and tissue perfusion Manage fluid balance Suggest activity restrictions and assistance with ADLs Properly position client Administer medications (continued)

23. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Oxygenation and the Nursing Process Implementation –Emergency interventions Remove airway obstruction Initiate cardiopulmonary resuscitation (CPR) (continued)

24. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Oxygenation and the Nursing Process Implementation –Interventions to address associated nursing diagnoses Explore lifestyle and activity adaptations Encourage dietary and nutritional modifications Promote comfort (continued)

25. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Oxygenation and the Nursing Process Implementation –Complementary therapies Herbs (continued)

26. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Oxygenation and the Nursing Process Evaluation –Physical and psychological needs –Revisions to plan of care