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OXYGENATION NURS 1510. Basic human need O2 is classified as a drug Must have MD order for rate and route. PULMONARY. Nose and nasal cavities: mm, ciliated, vascular Pharynx: posterior to nasal & oral cavity Nasopharynx=air passage way, eustachian tubes from middle ears

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OXYGENATIONNURS 1510


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  • Basic human need

  • O2 is classified as a drug

  • Must have MD order for rate and route


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PULMONARY

  • Nose and nasal cavities: mm, ciliated, vascular

  • Pharynx: posterior to nasal & oral cavity Nasopharynx=air passage way, eustachian tubes from middle ears

  • Trachea: 4-5in tube from larynx to bronchi. Ciliated

  • Bronchial tree: air passage ways within lungs

  • Lungs: lobes 3=R 2=L


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continue

  • Gases move in and out due to pressure in atmosphere. Lungs stay inflated due to pressure around them which is less than pressure within them.

  • Alveolar level: sacs exchange CO2 and O2 Surfactant must be present for alveoli to function correctly


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Pulmonary muscles/CNS

  • Diaphragm: does 80% of the work of breathing

  • Intercostals

  • Accessory

  • Involuntary control of breathing: Medulla oblongata

  • Voluntary control of breathing: Cerebral cortex


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Ventilation & Perfusion

  • Process of moving air in & out of the lungs:

    • Compliance

    • Surfactant

    • Airway resistance

  • Perfusion: moving blood to & from alveolar-capillary membrane for gas exchange

    • Pulmonary circulation

    • Distribution

  • Diffusion: > to < concentration


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CARDIOPULMONARY SYSTEM

  • Heart=pump

  • 4 chambers-R atrium-tricuspid valve-R ventricle-pulmonic valve-pulmonary artery-lungs

  • Return via pulmonary veins to L atrium- bicuspid valve-L ventricle-aortic valve out to aorta

  • Electrical conductive system


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Electrical Conduction of Heart

  • Impulse begins in SA node located in R atrium (pacemaker)

  • Travels thru both atrium ( A=contracts)

  • Thru mid heart called AV node

  • To the Bundle of His

  • Down the R and L bundles

  • To purkinje fibers which stimulate the V to contract


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Neural and Chemical Regulation of Respiration

  • Cerebral cortex: voluntary

  • Medulla oblongata: involuntary

  • Chemical: is based on the amount of CO2, hydrogen, and O2 present in blood at any given moment. Chemoreceptors in aortic arch and carotids sense the chemical content and adjusts rate and depth of respirations to meet needs.


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Factors affecting O2

  • Decreased hemoglobin: will > HR & RR

  • Decreased inspiration: will > HR

  • Hypovolemia: will > HR & RR

  • Increased metablolism: will > HR & RR

  • Chest wall movements: can decrease ventilation yet may see > RR but more shallow


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Chest Wall Movements

  • Pregnancy

  • Obesity

  • Musculoskeletal abnormalities

    • Trauma

    • Muscle or musculoskeletal disease: scoliosis

    • CNS diseases: ALS (Lou Gehrings)

    • COPD, other pulmonary disorders


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Additional factors

  • Age: premature, children, elderly

  • Nutrition: obesity & malnutrition

  • Exercise: with CV fitness enhances O2 exchange

  • Smoking: increases HR and RR

  • Substance Abuse: depresses resp centers

  • Anxiety: increases metabolic=>>02 demand

  • Environmental—Smog, hi altitude, dust,etc


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Alteration in Respiratory Functioning

  • Hyperventilation: ventilation in excess of that required to maintain normal CO2 levels in tissues. CO2 is expired in greater amounts

  • Hypoventilation: depressed resp rate causing retention of CO2=hypercapnia

  • Hypoxia: state of inadequate oxygenation from deficient delivery or utilization of O2 at the cellular level.


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Nursing Assessment

  • Rate, Rhythm, Work of breathing

  • Dyspnea: deals with work of breathing

  • Wheezing: narrowed air passages, hi-pitched

  • Pain: evaluate, onset, location, duration, radiation, effects on respirations

  • Cough: Secretions+characteristics of

  • Lung sounds: bilateral chest assessment

  • Risk factors:family Hx of lung CA, pulmonary ds, smoking

  • Medical history of respiratory infections, smoking


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Nursing Interventions

  • Maintain lung expansion

    • Positioning

      • Semi-fowlers, Fowlers, orthopneic

      • Change position frequently

    • Breathing exercises

      • Pursed lip

      • Diaphragmatic breathing

      • Incentive spirometry


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Continued

  • Mobilization of pulmonary secretions:

    • TCDB every 2 hours

    • Hydration to thin secretions

    • Humidify environment to moisten mm

    • Postural drainage & chest precussions to mobilize secretions


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Evaluate Effectiveness

  • Vital signs: pulse rate, respiratory rate

  • Color: cyanosis, pink, dusky, ruddy

  • Dyspnea: the difficulty and work of breathing

  • Restlessness/anxiousness

  • Retractions

  • O2 saturation/ABG’s

  • Mental alertness/awareness


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Administration of O2

  • Room air=21%

  • Nasal 1L=21%-24%

  • 2L=24%-28%

  • 3L=28%-32%

  • 4L=32%-36%

  • 6L=40%-44%

  • = max O2 level for Nasal O2


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Mask

  • 5-6 L = 40% O2

  • 6-7 L = 50% O2

  • 7-10 L= 60% O2

  • Simple mask: 40% to 60% (varies)

  • Venturi mask: 24%=50% with O2 flow rate of 4L to 10L (more exact)

  • Non-rebreathing mask: up to 80%-90%

  • Partial rebreathing mask: 60-90%


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Calculate the correct amount of O2 in a ‘E’ cylinder

  • Gauge pressure(psi) X cylinder factor (0.28)/liter flow per minute

    Example:

    900 X 0.28/3 liters per min

    =84 min

    O2 in cylinder will last 84 min


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Safety Measures

  • Correct liter flow

  • System on then to patient

  • Correct positioning of cannula or mask

  • No smoking-signs and remove ashtrays

  • Avoid use of electrical equipment-avoid sparks, razors, electric hand held games


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Trach Care

  • Must keep airway patent

  • Inner cannula cleaned per protocol

  • Suction no greater 10 seconds

  • Sterile technique

  • O2 setting per respiratory care/orders

  • Care of trach ties, trach dressing


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