Stressors that Affect
Oxygen Needs
NUR101 FALL 2008
K. BURGER, MSEd, MSN, RN, CNE
LECTURE #19
PPP by Sharon Niggemeier RN, MSN
Revised October 2005 by K. Burger
Oxygenation
• Ventilation- air moves in & out of lungs
• External respiration-exchange of O2 &
CO2 between alveoli and blood
• Gas Transport- blood transports O2 &
CO2 to body cells
• Internal respiration- exchange of O2 &
CO2 between blood and cells.
Checkpoint
1) T / F The pulmonary artery carries
oxygenated blood away from the lungs.
FALSE
Factors Affecting Respiration
• Integrity of the airway system
(ventilation)
• Functioning cardiovascular system
(perfusion)
• Functioning alveoli (diffusion)
• Functioning medulla & chemoreceptors
Pulmonary Ventilation
• Inspiration- air flows into lungs
• Expiration-gases flow out of lungs
According to pressure gradiant – Boyle
• Intrapulmonic or intra-alveolar pressurepressure within alveoli
(fluctuates: Inspiration 759mm Hg
Expiration 761mm Hg)
• Intrapleural pressure-pressure within the
intrapleural space (always negative)
(756 mm Hg)
• Note: Atmospheric Pressure = 760 mm Hg
Factors Affecting Ventilation
• Lung elasticity / compliance
(ability to stretch and recoil)
• Airway obstruction
• Musculature condition
• Neurological controls
Checkpoint
What is the name of the nerve that supplies
the diaphragm?
PHRENIC NERVE
Alveoli Gas Exchange
• Air reaches alveoli
• Oxygen from alveoli space moves into
pulmonary capillary (oxygen uptake)
via diffusion
• Oxygen diffuses across alveoli
membranes moving from high
concentration (alveoli) to lower
concentration (pulmonary capillary)
Alveoli Gas Exchange
• Surfactant- secreted by alveoli cells,
keeps surfaces moist and prevents
atelectasis
• Atelectasis- incomplete lung expansion
or collapse of alveoli
• Lung Compliance- elasticity of lung
tissue and flexibility of rib cage
• Lung recoil- ability of lungs to recoil
Other Factors Affecting
Gas Exchange
• Surface area
• Thickness of tissue
Fick’s Law of Diffusion:
Rate of a diffusion of gas is dependent on surface
area and thickness of the membrane
Perfusion
• Transport of O2 & CO2 via
blood to tissue
• Volume of blood flowing through lungs
affects amount of oxygen and gases
exchanged
• Adequate blood supply and
cardiovascular functioning are needed
• Oxyhemoglobin HbO2 (or SaO2)
Checkpoint
The majority of CARBON DIOXIDE
molecules are transported in the blood as:
???
BICARBONATE
HCO3
Perfusion
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Rate of O2 transport depends on:
Cardiac output
Activity level
CO2 transport
Neurologic/Chemical
Controls of Respiration
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Peripheral Chemoreceptors
Central Chemoreceptors
Medullary respiratory center
Spinal cord
Phrenic nerve
Diaphragm
Factors Affecting Oxygenation
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Environment
Emotions
Exercise
Health
Age
• Life style
• Medications
• Respiratory
History
Checkpoint
What is the normal respiratory rate
of a newborn?
30-60 breaths/min
Assessing Respiratory Functioning
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Difficulty breathing?
SOB?
Chest pain?
Coughing? Sputum production?
Nocturnal diaphoresis
Fatigue
Sleep with 2 or more pillows?
Assessing Respiratory Functioning
Respiratory Hx
includes:
• Allergies
• Medications
• Medical Hx
• Smoking
• Lifestyle /
Activity Level
• Stressors
• Recent exposures
• Developmental
level
Assessing Respiratory Functioning
• Patient states difficulty breathing: you
can assess by using PQRST
• P- provokes
• Q- quality
• R- region/radiation
• S- severity scale
• T- timing
Assessing Respiratory Functioning
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Respiratory Rate:
Tachypnea R>24
Bradypnea R<10
Apnea
Respiratory Depth:
Deep - diaphragmatic
Shallow
Assessing Respiratory Functioning
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Respiratory Rhythm:
Regular – “even and symmetrical”
Cheyne-Stokes
Kussmauls
Biot’s (ataxic – without rhythm)
Apneustic breathing (gasping)
Assessing Respiratory Functioning
• Respiratory Quality:
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No difficulty- Eupneic/ Unlabored
Dyspnea
Orthopnea
Retractions
Use of accessory muscles
• Auscultation:
• Vesicular
• Bronchial
• Bronchovesicular
Assessing Respiratory Functioning
Cough:
• Nonproductive
• Productive
• Sputum
• Hemoptysis
Breath sounds
Adventitious
Sounds:
• Crackles:
fine,medium,coarse
• Wheeze:
sibilant,sonorous
• Stridor
• Stertor
• Pleural friction rub
Respiratory Assessment Review
• Oxygen delivery method correctly applied
• Obtain a pulse oximetry reading (norm is
>95%)
• Check Vital Signs ?T ?P ?R
• Auscultate the pt’s lungs
• Note changes in skin and mucosa color
• Assess capillary refill
Checkpoint
• What are some other elements of a
respiratory assessment not yet
mentioned?
Neurological state
Color
Nail clubbing
AP vs Transverse Diameter
Barrel Chest?
Assessing Respiratory Functioning
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Diagnostic tests:
Sputum
Nose/throat cultures
CBC (complete blood count)
ABG (arterial blood gases)
CXR (chest x ray)
PFT (pulmonary function tests)
Pulse Oximetry
http://www.oximeter.org/pulseox/principles.htm
• Other: Scopes, CT, MRI, PET
Alterations:Respiratory Functioning
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Hypoxia
Hypoxemia
Hyperventilation
Hypercapnia
• Obstructed
airway
• Foreign body
obstruction
(FBO)
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Nursing Interventions
Independent
Airway maintenance
Positioning
Deep breathing & coughing
Pursed-lip breathing
Abdominal/diaphragmatic breathing
Hydration
Teaching of health habits
Nursing Interventions
Collaborative/Dependent
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Incentive spirometry
Percussion/postural drainage
Suctioning
Oxygen therapy
Medications
Nursing Interventions
Collaborative/Dependent
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Oxygen Therapy
Indications
Sources- wall outlet or portable tank
Monitor pulse oximetry
Methods- cannula, mask, venturi
mask, tent/isolette,BiPAP, CPAP
Administering Oxygen Therapy
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Flow rate
Humidification
Hydration
Positioning
Safety precautions
Document
MD order required
Oxygen Safety Precautions
• Signs: “No smoking. Oxygen in use.”
• Remove matches, lighters and cigarettes.
• Remove and store electrical equipment to
avoid sparks. Ground electrical equipment.
• Avoid materials that generate static
electricity
• Avoid use of volatile, flammable materials,
such as alcohol.
• Know location & use of fire extinguishers
& alarms.
Nursing Interventions
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Medications
Nebulizer Tx
Cough suppressants
Mucolytic: expectorants
Bronchodilators
Corticosteroids
Documentation
Routine Nurses Note
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Date
Time
LOC
Rate
Depth
• Rhythm
• Breath sounds
(auscultated)
• Quality
• Color
Nursing Diagnosis
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Ineffective airway clearance
Risk for aspiration
Ineffective breathing pattern
Impaired gas exchange
Risk for suffocation
Ineffective tissue perfusion; cardiopulmonary
Impaired spontaneous ventilation
Dysfunctional ventilatory weaning response
Checkpoint
Select a priority nursing diagnosis for the
following scenario:
88 y.o. female with pneumonia who has a
non-productive cough, R= 24, course
crackles upon auscultation. She is weak,
undernourished and fatigued.
Ineffective airway clearance
Checkpoint
Select a priority nursing diagnosis for the
following scenario:
A patient with hx of emphysema with
decreased PO2, increased CO2 levels who
is dyspneic and restless.
Impaired Gas Exchange
Checkpoint
Select a priority nursing diagnosis for the
following scenario:
A patient admitted to the ER post MVA with
notable blood loss, BP= 80/50, P=120,
R=22
Ineffective Tissue Perfusion;
Cardiopulmonary
Summary: Oxygenation
• Oxygenation based on
ventilation/perfusion/diffusion of
oxygen
• Various factors effect oxygenation
• Assessment includes respiratory Hx,
clinical exam, diagnostic tests
• Interventions include airway
maintenance /proper breathing/ oxygen
therapy/meds