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Chapter 40: Oxygenation
Cardiovascular Physiology
Structure and function
Myocardial pump Myocardial blood flow Coronary artery circulation Systemic circulation Blood flow regulation: cardiac output, preload, afterload, contractility Conduction system
Respiratory Physiology
Structure and function
Breathing: inspiration, expiration Lung volumes and capacities Pulmonary circulation Respiratory gas exchange: oxygen, carbon dioxide Regulation of respiration (Box 40-1: Physiological Processes of Oxygenation)
Factors Affecting Oxygenation
Physiological factors
Decreased oxygen-carrying capacity Decreased inspired oxygen concentration Hypovolemia Increased metabolic rate
Factors Affecting Oxygenation (cont'd)
Conditions affecting chest wall movement Musculoskeletal abnormalities Pregnancy Obesity Trauma Neuromuscular diseases Central nervous system alterations Chronic disease
Alterations in Cardiac Functioning
Conduction disturbances
- Atrial and ventricular dysrhythmias
Altered cardiac output
Impaired valvular function
Myocardial ischemia
- Angina, MI, acute coronary syndrome Alterations in Respiratory Functioning
Hyperventilation
Hypoventilation
Hypoxia
Developmental Factors
Infants and toddlers
School-age children and adolescents
Young and middle adults
Older adults
Lifestyle Factors
Nutrition
Exercise
Smoking
Substance abuse
Stress
Environmental Factors
Residence location
Occupation
Assessment of Oxygenation (cont'd)
Diagnostic tests: Pulmonary
(box 40-6)
Pulmonary function test Peak expiratory flow rate (PEFR) Arterial blood gases Oximetry Chest x-ray Bronchoscopy Lung scan Assessment of Oxygenation (cont'd)
Diagnostic tests: pulmonary
Thoracentesis Throat cultures Sputum specimens Nursing Diagnoses
Ineffective airway clearance
Ineffective breathing pattern
Impaired gas exchange
Impaired spontaneous ventilation
Decreased cardiac output
Ineffective tissue perfusion
Risk for infection
Planning
Setting priorities
Continuity of care
Goals and outcomes
Client’s lungs will remain clear to auscultation Client’s cough will be productive
Implementation: (Health Promotion)
Body weight
Diet
Exercise
Stress reduction
Occupational safety
Smoke-free
Regular physical examinations
Vaccinations/immunizations
Influenza Pneumonia Implementation: (Acute Care)
Dyspnea management
Airway maintenance
Mobilization of secretions Humidification Nebulization Chest Physiotherapy Suctioning (oral, NT, ET, trach) Artificial airways Implementation: (Acute Care -cont'd)
Maintenance and promotion of lung expansion
Positioning (table 40-7) Incentive spirometry (fig 40-13) Chest tubes (fig 40-14) Implementation: (Acute Care -cont'd)
Maintenance and promotion of oxygenation: oxygen
therapy
Safety precautions Oxygen supply Methods of oxygen delivery (table 40-8) Home oxygen therapy
