Oxygenation
Elizabeth Bruderle
Villanova University

Oxygenation

Highest priority in Maslow’s Hierarchy

Nurse’s Role:

Understand cardiopulmonary A&P
Assess oxygenation status of patient
Patient education
Provide oxygen therapy safely
Restore cardiopulmonary function: CPR

Cardiovascular System: transports oxygen and carbon dioxide to and from lungs, cells, and tissues.

Normal function depends on: effective pumping action of heart, competent valves, adequate coronary circulation, intact electrical system, sufficient cardiac output, competent peripheral circulation

Respiratory System: maintains oxygen and carbon dioxide at normal levels in circulating blood:

Arterial oxygen (Po2) = 80-100 mmHg (dissolved in plasma)

Arterial carbon dioxide (Pco2) = 35-45 mmHg (dissolved in plasma)

Oxygen saturation (SaO2) = 95-100%
(% hemoglobin saturated with oxygen)

Oxygenation: depends on Mechanical and Chemical factors

Ventilation: process by which air moves in and out of the lungs

Ventilatory effort affected by:

Lung compliance
Airway resistance
Use of accessory muscles

Diffusion: movement of molecules from higher to lower concentration

Perfusion: circulation of blood through tissue

Transport of Oxygen and Carbon Dioxide: 3% plasma, 97% Hgb.

CNS regulation: Medulla and Chemoreceptors in aortic arch and carotids

Additional Factors:

Physiologic
Developmental
Behavioral/Lifestyle
Environmental

Alterations in Oxygenation:

Hyper/Hypoventilation
Hypoxemia
Hypoxia

Assessment: Cardiorespiratory systems

History: review 2104

Specific symptoms
Fatigue
Dyspnea
Cough
Cyanosis

Physical exam: review 2104
Vital signs, IPPA

Auscultating Breath Sounds:

Tracheal: over trachea
Bronchial: over manubrium
Bronchovesicular: over main bronchus
(trachea splits at sternal ridge)
Vesicular: over most areas of both lungs

Anatomy: Anterior, Posterior, Lateral
Anteriorly apices extend 1.5” above clavicle; bases at 6th rib MCL & 8th rib MAL
Posteriorly apices at T1; bases at T10 on expiration and T12 on inspiration
 

Diagnostic Tests

Sputum specimens: C&S, acid-fast bacilli (AFB), cytology

Oximetry: continuously measures % of hemoglobin saturated with oxygen.

Non-invasive: called cutaneous, ear, or pulse oximetry

Sensor measures amount of light absorbed by oxygenated hemoglobin

Nursing Interventions

Goals: increase activity tolerance, maintain lung expansion, mobilize secretions, maintain patent airway, promote tissue oxygenation, restore cardiopulmonary function

Interventions can be dependent, independent, and/or interdependent

 

Specific Strategies

Breathing Exercises

Deep breathing/coughing
Pursed-lip breathing
Diaphragmatic breathing

Chest Physiotherapy

Postural drainage
Percussion and Vibration

Incentive Spirometry

Oxygen Therapy: Prescriptive devices

Safety concerns: combustible

Low-flow devices: amount of oxygen varies with patient’s breathing (patient entrains room air)

Nasal Cannula: 1-6 liters (flow rate); 24-40% conc.

Simple Face Mask: 5-l0 liters; 40-60%; use for less than 12 hours

Reservoir masks: use for 24 hrs. or less in patients who need at least 50% conc.

Partial Rebreather: 6-15 liters, 70-90% (valves removed)

Non-Rebreather: delivers highest concentration of oxygen, 60-100%, at 6-15 liters (valves closed during inhalation; open during exhalation)

High flow device: delivers a set concentration of oxygen

Venturi mask/air entrainment mask:

Mixes oxygen with room air: keep side ports open

Delivers most precise concentrations of oxygen (24, 28, 30, 35, 40, and 50%) at 4-10 liters

used for patients with COPD

Artificial Airways

Oropharyngeal/Nasopharyngeal Airway: used in a patient who is breathing spontaneously.

Purposes:

Keep tongue clear of airway
Allow for suctioning of secretions

Guidelines:

Use size 4 or 5 for an adult
Do not tape in place
Position patient on side when in place

Metrology Review

Order reads:

1 L D5W q. 6 h.
1. How many cc will infuse in 24 hours?
2. How many cc will infuse per hour?
3. How many gtts will infuse per minute?
Drip factor is 10

Order reads:

Decadron 1.5 mg. po qid
Recommended dose: 0.2mg/kg/24h
Child weighs 66 lb.
Is the ordered dose safe?
 

Order reads:

Rocephin 2 G IM q 12 h
Label reads: Add 7.2 ml sterile water for concentration of 1000 mg/ml
How many ml will you give?
By what route?