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Oxygenation Highest priority in Maslow’s Hierarchy: Physiologic Need
Nursing Role in Oxygenation 1)Understand cardiopulmonary A&P;2);Assess oxygenation status of patient; 3)Provide Patient education; 4)Provide oxygen therapy safely Restore cardiopulmonary function: Perform CPR
Factors Essential to Normal Functioning of the Respiratory System Integrity of the airway system and Properly functioning alveolar system in lungs. In addition properly functioning alveolar system in lungs
Upper Airway Function warm, filter, humidify inspired air
Upper Airway Components Nose,Pharynx,Larynx,Epiglottis
Lower Airway Function conduction of air, mucociliary clearance, production of pulmonary surfactant
Lower Airway Components Trachea,,Right and left mainstem bronchi Segmental bronchi,Terminal bronchioles
Anatomy of the Lungs Extend from the base of diaphragm to the apex above first rib. The right lung has three lobes; left lung has two The lungs are composed of elastic tissue (alveoli, surfactant, pleura).
Inspiration the active phase of ventilation in which it Involves movement of muscles and thorax to bring air into the lungs
Expiration he passive phase of ventilation in which it involves the movement of air out of the lungs
Process of Ventilation (First part) The diaphragm contracts and descends, lengthening the thoracic cavity then the external intercostal muscles contract, lifting the ribs upward and outward. Next the sternum is pushed forward, enlarging the chest from front to back
Process of Ventilation (second part) Increased lung volume and decreased intrapulmonic pressure allow air to move from an area of greater pressure (outside lungs) to lesser pressure (inside lungs). Finally relaxation of these structures results in expiration
Gas Exchange Refers to the intake of oxygen and release of carbon dioxide which is made possible by respiration and perfusion. The process occurs via diffusion (movement of oxygen and carbon dioxide between the air and blood)
Four Factors Influencing Diffusion of Gases in the Lungs Change in surface area available, next thickening of alveolar-capillary membrane, also partial pressure of the gases (including oxygen) and finally solubility and molecular weight of the gas
How is oxygen carried? via plasma and red blood cells.
Oxygen Distribution between plasma and rbc Most oxygen (97%) is carried by red blood cells in the form of oxyhemoglobin. Remainder (3%) dissolved in the plasma.
How is carbon dioxide carried? Hemoglobin also carries carbon dioxide in the form of carboxyhemoglobin. Therefore Internal respiration between the circulating blood and tissue cells must occur.
Respiratory Functioning in the Older Adult Tissues and airways become more rigid; diaphragm moves less efficiently. Appearance includes Kyphosi and barrel chest. This is less subcu fat therefore bony landmarks are more prominent.
Factors Affecting Respiratory Functioning Levels of health,Developmental considerations,Medications Lifestyle,Environment , Psychological health
Guidelines for Obtaining a Nursing History Determine why the patient needs nursing care and what kind of care is needed to maintain a sufficient intake of air.
Discovering Problems during history Identify current or potential health deviations andidentify actions performed by the patient for meeting respiratory needs.
Nursing History - teaching Make use of aids to improve intake of air and effects on patient’s lifestyle and relationship with others. Raise head of bed, give a littel oxygen, teach breathing techniques,.
Nursing Interventions Promoting Adequate Respiratory Functioning Teaching about a pollution-free environment,Promoting optimal function,Promoting proper breathing,Promoting and controlling coughing,Promoting comfort,Meeting respiratory needs with medications
Deep breathing Demonstrate to them how to take a deep breathe
Using Incentive Spirometry Breathing in will make marker move up. Idea is how long you can keep it there.
using acapell device vibrates as you breathe in. Makes you cough therefore patien exportes
Pursed-lip breathing when you breathe out purse lips in order to slowly get the avoli open longer.
abdominal or diaphram breathing deep and slow
Mechanism of coughing suck air in the close epiglottis then push out cough
Promoting Comfort Positioning - make sure head is up. Maintaining adequate fluid intake will help make secreation thinner.Providing humidified air allows moister into airways.Performing chest physiotherapy by pounding on chest with cup hands. Maintaining good nutrition
Bronchodilators open narrowed airways
Mucolytic agents liquefy or loosen thick secretions
Corticosteroids reduce inflammation in airways
Nebulizers —disperse fine particles of medication into deeper passages of respiratory tract where absorption occurs
Metered-dose inhalers —deliver controlled dose of medication with each compression of the canister
Dry powder inhalers —activated by the patient’s inspiration
Nasal cannula narrow tubing that loops around ears in which may need foam on ears to releive pressure. Put on bubble bottle that is filled with sterile water then you humidy oxygen. Bottom of ball is the liter marker.
Simple Mask Won't see much in hospitals more in ambulance.
Paritial Rebreather One hole is block off. If there is oxygen bag much be blown up first. Provides 60% of oxygen
Rebreather Mask 90 % of oxygen - both holes are covered
Venturi mask can be specific about oxygen. Bottom of gadget tell you where to set the flow meter. Highest 50% - Lowest 24%. Mixes oxygen with room air. Keep side ports open and Delivers most precise concentrations of Oxygen
Precautions for Oxygen Administration Avoid open flames in patient’s room and place no smoking signs. Check to see electrical equipment in room is in good working order. Avoid wearing and using synthetic fabrics (builds up static electricity).Avoid using oils in the area.
Administering Cardiopulmonary Resuscitation (CAB) Circulation—check the pulse; if victim has no pulse, initiate chest compressions. Airway—tip the head and check for breathing Breathing—if victim is not breathing spontaneously, give two breaths lasting 1.5 to 2 seconds
Planning: Expected Outcomes One Demonstrate improved gas exchange in lungs by absence of cyanosis or chest pain and a pulse oximetry reading >95%.
Planning: Expected Outcomes Two Relate the causative factors and demonstrate adaptive method of coping.
Planning: Expected Outcomes Three Preserve pulmonary function by maintaining an optimal level of activity.
Planning: Expected Outcomes Four Demonstrate self-care behaviors that provide relief from symptoms and prevent further problems.
Created by: cjnnovak