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OXYGENATION

Nelia B. Perez RN MSN
PCU – Graduate School of Nursing
Respiratory

I.     Review of Respiratory System
II.    Common Manifestations
III.   Diagnostic Tests/ Procedures
IV.    Common Pharmacologic Agents
V.     Disturbances
       a. Restrictive Lung Disease
       b. COPD/ CAL
       c. Pulmonary Vascular Disease
Restrictive:
  Atelectasis
  Tuberculosis
  Pneumonia


COPD:
  Asthma
  Emphysema
  Chronic Bronchitis
Pulmonary Vascular Disease:

 Cor Pulmonale
 Pulmonary Embolism
Hematopoietic

I.    Review of the Hematopoietic System
II.   Disturbances
      a. Anemia
      b. Polycythemia Vera
      c. Bleeding Tendencies
            - DIC
            - Hemophilia
            - Thrombocytopenia
Cardiovascular

I.     Review of the Cardiovascular System
II.    Common Diagnostic Tests/ Procedures
III.   Disturbances
            a. Infection
                  - Rheumatic Heart Disease
            b. Coronary Artery Disease
                  - Atherosclerosis
                  - Arteriosclerosis
- Angina Pectoris
         - Myocardial Infarction
IV. Congestive Heart Failure
         - Right Sided Heart Failure
         - Left Sided Heart Failure
V. Congenital Heart Defects
         - Cyanotic Heart Defects
         - Acyanotic Heart Defects
RESPIRATORY SYSTEM
Oxygenation_MAN Lecture
Oxygenation_MAN Lecture
Oxygenation_MAN Lecture
Oxygenation_MAN Lecture
Measures That Promotes Adequate
Respiratory Functions:
1.   Adequate OXYGEN supply from the
     environment.
2.   Deep breathing and coughing exercises.
3.   Proper positioning
4.   Patent airway (FEMS)
5.   Adequate hydration
6.   Avoid pollutants, alcohol and smoking.
7. Chest Physiotherapy (CPT)
     * Percussion
     * Vibration
     * Postural Drainage
8. Bronchial Hygiene Measures
     * Steam Inhalation
     * Suctioning
          - Oropharyngeal
          - Nasopharyngeal
Things to Remember:SUCTIONING
Assess: AUDIBLE SECRETIONS during
          respiration
Position:
  Conscious: SEMI-FOWLER’s POSITION
  Unconscious: LATERAL POSITION
Pressure:
  Wall Unit:
     Adult:   100-120mmHg
     Child:   95-110mmHg
     Infant: 50-95mmHg
  Portable Unit:
     Adult:   10-15mmHg
     Child:   5-10mmHg
     Infant: 2-5mmHg
Appropriate Size of Catheter:
  Adult: Fr. 12-18
  Child: Fr. 8-10
  Infant: Fr. 5-8
Lubricate Catheter:
  Nasopharyngeal: water-soluble lubricant
  Oropharyngeal: Sterile water or NSS
•   Apply suction during withdrawal of the
    suction catheter (NEVER during insertion)
•   Apply suction for 5 to 10 seconds
    (maximum of 15 seconds)
•   Allow 20-30 seconds interval between each
    suction and limit suction to 5 minutes in
    total
•   Encourage patient to breathe deeply and to
    cough between suctions.
•   Assess effectiveness of suctioning
9. Incentive Spirometry
      - done to enhance deep inspiration
10. Administration of supplemental oxygen

Signs of Hypoxemia
   1. Increased pulse rate
   2. Rapid, shallow respiration
   3. Increased restlessness
   4. Flaring of nares
   5. Substernal or intercostal retractions
   6. Cyanosis
OXYGEN SYSTEMS:
1.   Low-flow Administration Devices
     a. Nasal Cannula (24-45% at 2-6LPM)
     b. Simple Face Mask (40-60% at 5-8LPM)
     c. Partial Rebreathing Mask
             (60-90% at 6-10LPM)
     d. Non-rebreathing Mask
             (95-100% at 6-15LPM)
     e. Oxygen Tent
2. High flow Administration Devices
   a. Venturi Mask
   b. Oxygen Hood
   c. Incubator / Isolette
Common Manifestations:
1. Cough
      - the cardinal symptom of respiratory
    problem
2. Dyspnea
      - refers to difficulty on breathing
    * EXERTIONAL DYSPNEA
    * PAROXYSMAL NOCTURNAL
    * ORTHOPNEA
3. Clinical Signs of Hypoxia
EARLY SIGNS              LATE SIGNS
    Tachycardia               Bradycardia
Kussmaul’s Respiration          Dyspnea
         N/V              Decreased Systolic BP
     Headache                    Cough
     Irritability            Increased RBC
    Memory loss              Increased Hgb
      Dizziness            Clubbing of fingers
4. Clubbing of Fingers
5. Hemoptysis
6. Chestpain
7. Headache
8. Easy fatigability
9. Cyanosis
10. Skin flushing
11. Seizures
12. Altered level of consciousness
Common Pharmacologic Agents
1.   Adrenergic (Sympathomimetic) Agents
2.   Bronchodilators
3.   Antibacterial
4.   Corticosteroids
5.   Antihistamine
6.   Mucolytic, Antitussive and Expectorant
Common Procedures/ Tests
1. Abdominal Thrust (Heimlich Maneuver)
    - a short, abrupt pressure against the
    abdomen, two fingerbreadths above the
    umbilicus, to raise the intrathoracic
    pressure.
PARTIAL: Noisy respiration, repeated
    coughing
TOTAL: Cessation of breathing, inability to
    speak
2. Radiographic Scanning Test (X-RAY)
3. Endoscopy (Bronchoscopy)
4. Chest Physiotherapy
5. Suctioning of Airway
6. Tracheostomy care
7. Pulmonary Function Test
     - Incentive Spirometry
*Tidal Volume                  (500ml)
* Residual Volume              (1200ml)
* Expiratory Reserve Volume    (1000-1200ml)
* Inspiratory Reserve Volume   (3000-
   3300ml)
8. Pulse Oximetry
9. Sputum Exam
10. Oxygen Therapy
11. Thoracentesis
12. Chest Tube (T-Tube)
   - to drain air : 2nd or 3rd ICS
   - to drain blood/ fluid: 8th or 9th ICS
13. Pulmonary Angiogram
TUBERCULOSIS
Oxygenation_MAN Lecture
Oxygenation_MAN Lecture
PNEUMONIA
Oxygenation_MAN Lecture
Oxygenation_MAN Lecture
Oxygenation_MAN Lecture
Oxygenation_MAN Lecture
EMPHYSEMA
Oxygenation_MAN Lecture
Oxygenation_MAN Lecture
Oxygenation_MAN Lecture
Oxygenation_MAN Lecture
Oxygenation_MAN Lecture
BRONCHITIS
Oxygenation_MAN Lecture
Oxygenation_MAN Lecture
Oxygenation_MAN Lecture
ASTHMA
Oxygenation_MAN Lecture
Oxygenation_MAN Lecture
Coronary Artery Diseases (CAD)
1. Atherosclerosis
      - an abnormal accumulation of lipid, or
    fatty, substances and fibrous tissues in the
    vessel wall
2. Arteriosclerosis
      - refers to hardening of the vessel walls
Oxygenation_MAN Lecture
Risk Factors for CAD
Nonmodifiable Risk Factors
  Family History of CAD
  Increasing Age
  Gender
  Race
Modifiable Risk Factors
 High Blood pressure
 Cigarette smoking
 High Blood cholesterol levels
 Diabetes Mellitus
 Lack of estrogen in women
 Physical inactivity
 Obesity
Oxygenation_MAN Lecture
Oxygenation_MAN Lecture
Controlling Cholesterol
Normal Total Serum Cholesterol =
     150-240mg/dl
HDL = 29-77mg/dl
LDL= 60-160mg/dl
Triglycerides= 10-190mg/dl
Desired levels of LDL?
< 160mg/dl for patients with one or no risk
     factors

<130mg/dl for patients with two or more risk
    factors

<100mg/dl for patients with CAD
Angina Pectoris
Classifications of Angina
Class     Activity Evoking    Limits to Activity
  I      Prolonged exertion         None
  II     Walking >2 blocks         Slight
 III     Walking <2 blocks        Marked
 IV       Minimal or Rest          Severe
Types of Angina Pectoris
1.   Stable Angina
2.   Unstable Angina
3.   Intractable Angina/ Refractory Angina
4.   Variant Angina
5.   Silent Angina
Oxygenation_MAN Lecture
Myocardial Infarction
Cardiac Enzymes
CPK
  Normal: Male: 5-35; Female: 5-25
  Rises: 4-8 hours
  Peak: ½ to 1 ½ days
  Returns to Normal: 3-4 days
LDH
  Normal: 100-190IU/L
  Rises: 12-24 hours
  Peak: 2-6 days

Trop-T
  Normal: NEGATIVE
  Rises: immediate
  Peak: 4-24 hours
  Returns to Normal: 1-3 weeks
Management:

M - morphine SO4 for pain
O - Oxygen
A – Aspirin/ ACE inhibitors (captopril)
N – Nitroglycerin
S – streptokinase ( thrombolytics )
     – should be given in 6 hrs but better
  if in 3 hrs
Oxygenation_MAN Lecture
Oxygenation_MAN Lecture
Congestive Heart Failure
Classifications:
CLASSIFICATION I
  Ordinary physical activity does not cause
  fatigue, dyspnea, palpitations or chestpain
  ASYMPTOMATIC

PROGNOSIS: Good
CLASSIFICATION II

  Slight limitations on ADL’s
  Patient reports no symptoms at rest but
  increased physical activity will cause
  symptoms

PROGNOSIS: Good
CLASSIFICATION III

  Marked limitation on ADL
  Patient feels comfortable at rest but less
  than ordinary activity will cause symptoms



PROGNOSIS: Fair
CLASSIFICATION IV

  Symptoms of Cardiac insufficiency at rest



PROGNOSIS: Poor
Oxygenation_MAN Lecture
Oxygenation_MAN Lecture

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Oxygenation_MAN Lecture

  • 1. OXYGENATION Nelia B. Perez RN MSN PCU – Graduate School of Nursing
  • 2. Respiratory I. Review of Respiratory System II. Common Manifestations III. Diagnostic Tests/ Procedures IV. Common Pharmacologic Agents V. Disturbances a. Restrictive Lung Disease b. COPD/ CAL c. Pulmonary Vascular Disease
  • 3. Restrictive: Atelectasis Tuberculosis Pneumonia COPD: Asthma Emphysema Chronic Bronchitis
  • 4. Pulmonary Vascular Disease: Cor Pulmonale Pulmonary Embolism
  • 5. Hematopoietic I. Review of the Hematopoietic System II. Disturbances a. Anemia b. Polycythemia Vera c. Bleeding Tendencies - DIC - Hemophilia - Thrombocytopenia
  • 6. Cardiovascular I. Review of the Cardiovascular System II. Common Diagnostic Tests/ Procedures III. Disturbances a. Infection - Rheumatic Heart Disease b. Coronary Artery Disease - Atherosclerosis - Arteriosclerosis
  • 7. - Angina Pectoris - Myocardial Infarction IV. Congestive Heart Failure - Right Sided Heart Failure - Left Sided Heart Failure V. Congenital Heart Defects - Cyanotic Heart Defects - Acyanotic Heart Defects
  • 13. Measures That Promotes Adequate Respiratory Functions: 1. Adequate OXYGEN supply from the environment. 2. Deep breathing and coughing exercises. 3. Proper positioning 4. Patent airway (FEMS) 5. Adequate hydration 6. Avoid pollutants, alcohol and smoking.
  • 14. 7. Chest Physiotherapy (CPT) * Percussion * Vibration * Postural Drainage 8. Bronchial Hygiene Measures * Steam Inhalation * Suctioning - Oropharyngeal - Nasopharyngeal
  • 15. Things to Remember:SUCTIONING Assess: AUDIBLE SECRETIONS during respiration Position: Conscious: SEMI-FOWLER’s POSITION Unconscious: LATERAL POSITION
  • 16. Pressure: Wall Unit: Adult: 100-120mmHg Child: 95-110mmHg Infant: 50-95mmHg Portable Unit: Adult: 10-15mmHg Child: 5-10mmHg Infant: 2-5mmHg
  • 17. Appropriate Size of Catheter: Adult: Fr. 12-18 Child: Fr. 8-10 Infant: Fr. 5-8 Lubricate Catheter: Nasopharyngeal: water-soluble lubricant Oropharyngeal: Sterile water or NSS
  • 18. Apply suction during withdrawal of the suction catheter (NEVER during insertion) • Apply suction for 5 to 10 seconds (maximum of 15 seconds) • Allow 20-30 seconds interval between each suction and limit suction to 5 minutes in total • Encourage patient to breathe deeply and to cough between suctions. • Assess effectiveness of suctioning
  • 19. 9. Incentive Spirometry - done to enhance deep inspiration
  • 20. 10. Administration of supplemental oxygen Signs of Hypoxemia 1. Increased pulse rate 2. Rapid, shallow respiration 3. Increased restlessness 4. Flaring of nares 5. Substernal or intercostal retractions 6. Cyanosis
  • 21. OXYGEN SYSTEMS: 1. Low-flow Administration Devices a. Nasal Cannula (24-45% at 2-6LPM) b. Simple Face Mask (40-60% at 5-8LPM) c. Partial Rebreathing Mask (60-90% at 6-10LPM) d. Non-rebreathing Mask (95-100% at 6-15LPM) e. Oxygen Tent
  • 22. 2. High flow Administration Devices a. Venturi Mask b. Oxygen Hood c. Incubator / Isolette
  • 23. Common Manifestations: 1. Cough - the cardinal symptom of respiratory problem 2. Dyspnea - refers to difficulty on breathing * EXERTIONAL DYSPNEA * PAROXYSMAL NOCTURNAL * ORTHOPNEA
  • 24. 3. Clinical Signs of Hypoxia EARLY SIGNS LATE SIGNS Tachycardia Bradycardia Kussmaul’s Respiration Dyspnea N/V Decreased Systolic BP Headache Cough Irritability Increased RBC Memory loss Increased Hgb Dizziness Clubbing of fingers
  • 25. 4. Clubbing of Fingers
  • 26. 5. Hemoptysis 6. Chestpain 7. Headache 8. Easy fatigability 9. Cyanosis 10. Skin flushing 11. Seizures 12. Altered level of consciousness
  • 27. Common Pharmacologic Agents 1. Adrenergic (Sympathomimetic) Agents 2. Bronchodilators 3. Antibacterial 4. Corticosteroids 5. Antihistamine 6. Mucolytic, Antitussive and Expectorant
  • 28. Common Procedures/ Tests 1. Abdominal Thrust (Heimlich Maneuver) - a short, abrupt pressure against the abdomen, two fingerbreadths above the umbilicus, to raise the intrathoracic pressure. PARTIAL: Noisy respiration, repeated coughing TOTAL: Cessation of breathing, inability to speak
  • 29. 2. Radiographic Scanning Test (X-RAY)
  • 30. 3. Endoscopy (Bronchoscopy) 4. Chest Physiotherapy 5. Suctioning of Airway 6. Tracheostomy care 7. Pulmonary Function Test - Incentive Spirometry *Tidal Volume (500ml) * Residual Volume (1200ml) * Expiratory Reserve Volume (1000-1200ml) * Inspiratory Reserve Volume (3000- 3300ml)
  • 32. 9. Sputum Exam 10. Oxygen Therapy 11. Thoracentesis 12. Chest Tube (T-Tube) - to drain air : 2nd or 3rd ICS - to drain blood/ fluid: 8th or 9th ICS
  • 55. Coronary Artery Diseases (CAD) 1. Atherosclerosis - an abnormal accumulation of lipid, or fatty, substances and fibrous tissues in the vessel wall 2. Arteriosclerosis - refers to hardening of the vessel walls
  • 57. Risk Factors for CAD Nonmodifiable Risk Factors Family History of CAD Increasing Age Gender Race
  • 58. Modifiable Risk Factors High Blood pressure Cigarette smoking High Blood cholesterol levels Diabetes Mellitus Lack of estrogen in women Physical inactivity Obesity
  • 61. Controlling Cholesterol Normal Total Serum Cholesterol = 150-240mg/dl HDL = 29-77mg/dl LDL= 60-160mg/dl Triglycerides= 10-190mg/dl
  • 62. Desired levels of LDL? < 160mg/dl for patients with one or no risk factors <130mg/dl for patients with two or more risk factors <100mg/dl for patients with CAD
  • 63. Angina Pectoris Classifications of Angina Class Activity Evoking Limits to Activity I Prolonged exertion None II Walking >2 blocks Slight III Walking <2 blocks Marked IV Minimal or Rest Severe
  • 64. Types of Angina Pectoris 1. Stable Angina 2. Unstable Angina 3. Intractable Angina/ Refractory Angina 4. Variant Angina 5. Silent Angina
  • 66. Myocardial Infarction Cardiac Enzymes CPK Normal: Male: 5-35; Female: 5-25 Rises: 4-8 hours Peak: ½ to 1 ½ days Returns to Normal: 3-4 days
  • 67. LDH Normal: 100-190IU/L Rises: 12-24 hours Peak: 2-6 days Trop-T Normal: NEGATIVE Rises: immediate Peak: 4-24 hours Returns to Normal: 1-3 weeks
  • 68. Management: M - morphine SO4 for pain O - Oxygen A – Aspirin/ ACE inhibitors (captopril) N – Nitroglycerin S – streptokinase ( thrombolytics ) – should be given in 6 hrs but better if in 3 hrs
  • 71. Congestive Heart Failure Classifications: CLASSIFICATION I Ordinary physical activity does not cause fatigue, dyspnea, palpitations or chestpain ASYMPTOMATIC PROGNOSIS: Good
  • 72. CLASSIFICATION II Slight limitations on ADL’s Patient reports no symptoms at rest but increased physical activity will cause symptoms PROGNOSIS: Good
  • 73. CLASSIFICATION III Marked limitation on ADL Patient feels comfortable at rest but less than ordinary activity will cause symptoms PROGNOSIS: Fair
  • 74. CLASSIFICATION IV Symptoms of Cardiac insufficiency at rest PROGNOSIS: Poor