2. Objectives
• List and discuss the major body structures.
• Discuss functions responsible for proper oxygenation
• Describe factors that may alter ones O2 balance.
• Identify the behaviors indicating negative O2 balance.
• Review the common diagnostic tests medically
prescribed in order to determine the client’s
oxygenation status.
• Explain the major purpose of the tests and the related
nursing responsibilities.
4. Staggering statistics
•Cardiovascular Diseases – # 1 killer
• HTN – 65 million
• Artheriosclerosis
• Arteriosclerosis
• Stroke
• Hypercholesterolemia
• 107 million - a risk factor for CVD
• AMI – 7.5 Million per year, 460,000 die
• Americans paid 393.5 billion in 2005 for CVD
related medical costs
12. Gas Exchange
• Occurs after the alveoli are ventilated
• Pressure differences (gradient) on each side of the
respiratory membranes affect diffusion
• Alveoli:
• PO2 100mmHg
• PCO2 40mmHg
• Venous blood:
• PO2 60mmHg
• PCO2 45mmHg
• O2 diffusion from alveoli pulmonary blood vessels
• CO2 diffusion from pulmonary blood vessels alveoli
14. Oxygen Transport
• Transported from the lungs to the tissues
• 97% of O2combines with RBC Hgb
oxyhemoglobin carried to tissues
• Remaining O2is dissolved and transported in
plasma and cells (PO2)
15. Normal Oxygenation Process
• Cell environment / O2carrying capacity:
• O2Carrying capacity of blood is expressed by:
• Red blood cells (#)
• Hematocrit
• % of blood that is RBCs
• Men 40-54%
• Women 37-50%
• Hemoglobin
16.
17.
18. Carbon Dioxide Transport
• Must be transported from tissues lungs
• Continually produced in the process of cell
metabolism
-
• 65% – carried inside RBCs as bicarbonate (HCO3 )
• 30% – combines with Hgb carbhemoglobin
• 5% – transported in plasma as carbonic acid (H2CO3)
20. Common Manifestations of Impaired
Respiratory Function
•Hypoxia
•Altered breathing patterns
•Obstructed or partially
obstructed airway
21. Hypoxia
• Condition of insufficient oxygen anywhere in the body
• Rapid pulse
• Rapid, shallow respirations and dyspnea
• Increased restlessness or lightheadedness
• Flaring of nares
• Substernal or intercostal retractions
• Cyanosis
25. Obstructed or Partially
Obstructed Airway
•Partial obstruction
•low-pitched snoring during inhalation
•Complete obstruction
•extreme inspiratory effort with no chest
movement
38. HEART
•Have client describe
• specific location, onset and duration of the problem
•Explore associated signs and symptoms
•Ask - activities that worsen or ease the problem
•Rate the severity of discomfort or incapacity
•Talk - treatments or interventions used to alleviate
the problem and their effectiveness
40. Nursing Measures to Promote Respiratory
Function
•Ensure a patent airway
•Positioning
•Encourage deep breathing, coughing
•Ensure adequate hydration
42. Lung sounds
• Diminished or absent
• Crackles course and fine
• discontinuous course bubbling
• fine crackling sound at the middle or end of inspiration
• Rhonchi
• a continuous sonorous sound
• Wheezes
• high pitch musical sounds
• Pleural friction rub
• grating rubbing, sound
43. Common Tests and Nursing Responsibilities
•Measure adequacy of ventilation and gas exchange
• Complete Blood Count (CBC) phlebotomy
• Arterial Blood Gases (ABG) arterial puncture
• Pulmonary Function Tests preparation by teaching
44. Common Tests and Nursing Responsibilities
•Tests to determine abnormal cell growth or infection
in respiratory system:
• Sputum culture
• growing microorganisms from sputum
• Throat culture
• growth of microorganisms from throat material
45. Common Tests and Nursing Responsibilities
• Tests to visualize structures of
respiratory system:
•
•
Bronchoscopy
Chest radiographs
52. Basic Nursing Interventions
•Improving Activity Tolerance:
• Determine etiology
• Assess appropriateness of activity level
• When appropriate gradually increase activity
• Ensure the client changes position slowly
• Observe for symptoms of intolerance
• Syncope with activity
• refer to MD
• Perform ROM exercises with activity intolerance if
is immobile
58. Basic Nursing Interventions
• Effective Breathing Techniques
• Position for maximal respiratory function
• Pursed lip breathing
• Diaphragmatic or abdominal breathing
59. Basic Nursing Interventions
Stress and anxiety reduction:
• Remove pertinent cause of anxiety at that moment
- help client gain control over respiration
- reassure client not in immediate danger
• Chronic clients
• exacerbations and remissions
• goal is to reduce general level of anxiety
• learn to control episodes of anxiety to improve quality
of life
• desensitization program
• guided mastery
61. Basic Nursing Interventions
• Physical Exercise health teaching
Activity and rest -- a priority!
Activity stimulates respiratory function
Rest conserves energy and reduces metabolic demand
• MD’s treatment plan
• guidelines for activity
• may simply call for activity as tolerate.
•
•
prioritize activities
arrange need items conveniently
• Provide emotional support and encouragement
• gradually increase activity
• Simplify daily life
• Work at a steady state
• Conserve energy
66. Basic Nursing Interventions
•Cardiovascular
- Prevent
complications
• Promoting rest
•Risk DVT
•Position changes
•Early ambulation
•Obstruction removal
•Bypass surgery
•Schedule rest periods
•Assistance with ADL’s
•Monitor Vitals with activity
•Place items, i.e. call light,
water pitcher, strategically
•Quiet environment,
decrease stimuli
67. Basic Nursing Interventions
Cardiovascular
• Positioning to improve
CO
• Avoiding Valsalva
maneuver
-
•
- Position semi to high
fowlers-> decrease venous
return and preload, decease
preload-> decreases risk of
heart congestion
Teach client to avoid
valsalva maneuver
- Hold breath while
turning or moving in
bed-> assist
- Bearing down during
BM-> stool softeners
and diet
71. Basic Nursing Interventions
• Dietary control
• Assess nutritional status
• Consider a dietician referral to assess
nutritional needs related to clients
• Chronicity of CAL and CAD and nutrition
72. Basic Nursing Interventions
•Weight control
• Evaluate the client’s physiological status in relation
to condition
• More than body requirements
• Less than body requirements