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OXYGEN INSUFFICIENCYINTRODUCTION
Oxygen insufficiency means “ deficient in oxygen”. The normal range of oxygen in the external blood should be 80-100 mm of Hg. For treating oxygen insufficiency effectively, early diagnosis and correct cause should be ruled out. The only management for oxygen insufficiency is oxygen administration.
DEFINITION
Oxygen insufficiency is a condition in which the body as a whole or a region is deprived of adequate oxygen supply. Oxygen insufficiency is a failure to provide adequate oxygen to cells of the body and to remove excess carbon dioxide from them.
ETIOLOGY
1. Decreased hemoglobin
2. High altitude
3. Inability of the tissue to extract oxygen from the blood
4. Decreased diffusion of oxygen from the alveoli to the blood
5. Poor tissue perfusion with oxygenated blood
6. Impaired ventilation
PHYSIOLOGY OF RESPIRATION
Pulmonary Ventilation: This means movement of air into and out lungs. Its main purpose is to supply fresh air.Ventilation is composed of:Inspiration- When air flows into lungsExpiration- When air moves out of lungs.
Adequate Ventilation depends upon:
• Clear airways• An intact central nervous system and respiratory
system.• An intact thoracic cavity capable of expanding and
contracting.• Adequate pulmonary compliance and recoil
Regulation of Respiration
Respiration is regulated by two mechanisms-
ChemicalNeural
Nervous system of body adjusts rate of alveolar ventilation to meet needs of body so that po2 and pco2 remain relatively constant. Control is through respiratory centre which is actually a number of groups of nerves located in medulla oblongata and pons of brain.
Cause of Oxygen insufficiency and factors affecting oxygenation
1. Developmental FactorsAt birth, fluid filled lungs drain first and pco2 rises. This causes neonate to take first breath. Lungs are gradually expanding till 2 weeks of age. Changing in age affect respiratory system of elders become especially important if system is compromised by changes such as infection, physical or emotional stress.
2. Physiological FactorsVarious diseases can exert their effect on oxygenation including disease of respiratory system like COPD, pneumonia, any tumor in respiratory system, airway obstruction etc.
3. Behavioral FactorsWhenever stress is there both physiologic and psychological responses can affect oxygenation. The person may experience light headedness, numbness, tingling of fingers, toes and around mouth. On other hand , there is release of epinephrine through sympathetic stimulation. Epinephrine causes bronchioles to dilate, increases blood flow and oxygen delivery to muscle.
4. Lifestyle FactorsPhysical activity or exercise increase the rate and depth of respiration and hence supply of oxygen in body.
Sedentary lifestyle there is lack of alveolar expansion and essential deep breathing pattern.
5. Environmental FactorsAltitude , heat, cold, and air pollution affect oxygenation .The higher the altitude lower is the pco2 a patient breathes.Air pollution can cause stinging of eyes , headache, dizziness, coughing and chocking even in healthy people.
6. MedicationCertain medications including sedatives , hypnotics and narcotics like morphine can cause respiratory depression.
Due to any factors there is reduced oxygen in body called hypoxia
Cells can switch to anaerobic metabolism
Accumulation of acid
by products e.g. lactate
Imbalance in chemical environment of cells.
Release of lysosomal enzymes
Tissues destruction
Less O2 supplied to cells
Resulting in availability of less for cellular functions.
Organelle Swelling
Destruction of tissues and organs.
Hypoxia is evident by-Cyanosis
Altered breathing patterns including tachypnea and dyspnea
Anxious faceFatigue
CO2 TRANSPORT AND EXCRETION
When CO2 combines with water, it produces Carbonic Acid & H+ ions
Stimulates respiratory centers
Increase in rate, depth of breath
Tachypnoea in order to bring back pH levels.
Because of hypoxia, there will be rise in carbonic acid levels leading to respiratory
acidosis.
But sometimes in response to hypoxia hyperventilation may occur.
Assessment
Nursing Health HistoryIt includes:Exploration of present problem
Any past respiratory disease
Cough and its characteristics along with sputum
Lifestyle
Medication used for breathing.
Presenting Problems orSign and symptoms may include-
Anxiety and IrritabilityTired
Headache and DizzinessMemory loss
Nausea and vomitingOliguria / Anuria
Visual impairmentClubbing of finger
Impairment in judgment Shortness of breath
INSPECTION
Client’s efforts at ventilationAnxious or distressed appearance
Flaring of nostrilsPosition preferences and general best configuration
Cyanosis because of poor circulation & edemaChanges in level of consciousness
ConfusionAgitation
Stupor or coma indicate ischemia of neuronal cellsHypoxia
PALPATIONDisplacement Of Trachea
Pulse Rate Clammy Skin
Ulcer In Lower Extremities
PERCUSSIONHyper resonance
Dull percussion toneChanges in the density of lungs and surrounding tissues
PULMONARY FUNCTION TEST
ARTERIAL BLOOD GAS ANALYSIS
SPUTUM STUDIES
CHEST X-RAYS & CT SCAN
BRONCHOSCOPY
THORACENTESIS
1. INEFFECTIVE AIRWAY CLEARANCEMay by related to:-Obstruction of airway by the tongue.Upper airway obstruction caused by edema of larynx or glottis. Obstruction of the trachea or a bronchus by foreign body aspiration.Manifested by:-Shortness of breathUse of accessory musclesDifficulty in speakingCoughDiminished breath sound
2. INEFFECTIVE BREATHING PATTERN may be related to restrictive pulmonary disease or any major abdominal or thoracic surgery or restricted mobility.
3. IMPAIRED GAS EXCHANGE related to overall decrease in the amount of alveolar capillary surface area available for gas exchange as manifested by altered findings on ABG or Pulse oximetry.
4. DECREASED CARDIAC OUTPUT related to congestive heart failure causing pulmonary edema, heart failure or shock as manifested by cool clammy skin, weak thread pulse, low urine output and diminished level of consciousness.
NEED OF OXYGEN ADMINISTRATION
Clients who have difficulty in ventilating all areas of their lungs, those whose gas exchange is impaired or
people with heart failures may require oxygen therapy to prevent hypoxia.
NURSING RESPONSIBILITY FOR ADMINISTRATION OF
OXYGEN
Check the nameBed number
Confirm diagnosisNeed of oxygen therapy
Asses cyanosisBreathing pattern
Monitor for result of ABGCheck that the oxygen is properly
humidified
HAZARDS OF OXYGEN INHALATION 1. Infection2. Combustion3. Drying of mucus membrane of the respiratory tract4. Oxygen toxicity: Dryness and imitation of mucus membrane
Substernal pain Nausea and vomiting
5. Atelectiasis 6. Oxygen induced Apnoea7. Retrolental Fibroplasias: Oxygen therapy may affect the eyes
Especially in infants 8. Asphyxia
INTRODUCTION
Sensory deprivation is generally thought of as a decrease in or lack of meaningful stimuli.It results when a person experiences decreased sensory input
DEVELOPMENTAL STAGEPerception of sensation is critical to the
intellectual social and physical development of the infants and
children .
STRESSDuring stress, people find their senses already overloaded and thus seek to
decrease sensory stimulation.
MEDICATION AND ILLNESSCertain medication can alter an
individual’s awareness of environmental stimuli.
e.g. Narcotics, sedatives
LIFE STYLE AND PERSONALITYLifestyle influences the quality and quantity of stimulation to which individual is accustomed.
e.g. Some people delight in constantly changing stimuli and excitement, whereas others prefer
more structured life with few changes.
CLIENT WHO ARE AT RISK OF SENSORY DEPRIVATION
1. Clients in long term care settings2. Clients who are confined to bed.3. Clients with sensory alterations (impaired vision, hearing ) 4. Clients who are depressed 5. Client with a disturbance of the nervous system.
COGNITIVE BEHAVIOUR CHANGES
Decreased Attention SpanDifficulty In ConcentratingDecreased Problem SolvingImpaired MemoryPeriodic DisorientationGeneral ConfusionNocturnal ConfusionDecreased Task Performance
PERCEPTUAL CHANGES
1.Inaccurate perception of: Sight SoundTasteSmellBody PositionsCoordination Equilibrium
2. Palpitations3. Hallucinations4. Delusions
AFFECTIVE BEHAVIOUR CHANGES
1. Anxiety 2. Fear3. Anger 4. Panic5. Rapid Mood Changes 6. Crying7. Depression 8. Apathy
ASSESSMENT
1.Nursing history2.Mental status examination3.Physical examination4.Identification of clients at risk5.Social background
NURSINGDIAGNOSIS
1. Disturbed sensory perception.
2. Risk for injury related to disturbedsensory perception, like hearing
impairment, visual impairment etc
3. Risk for impaired skin integrity(altered tactile stimulation)
NURSINGDIAGNOSIS
4. Impaired verbal communicationrelated to altered level of
consciousness or impaired hearing
5. Self care deficit related to visualimpairment, diminished perception.
6. Social isolation related to impairedvision, hearing, memory etc.
PLANNING
1.Care of clients independent of setting.2. Maintain the function of existing senses3. Develop an effective communication mechanism4. Prevent injury5. Reduce social isolation6. Perform activities of daily living activities independently and safely
IMPLEMENTATION
Promoting healthy sensory functionHealthy sensory function can be promoted with environmental stimuli that provide appropriate sensory input.
Adjusting environmental stimuliThe client functions best when the environment is similar to that of the individual's ordinary life.
Preventive sensory deprivationEncourage sensory functionPromote the use of other sensesCommunicate effectivelyEnsure client safetyVisual StimulationColourful SheetsCardsPicturesFlowers
Auditory Stimulation
T.V.
Radio
Computer
Caring And Orienting
Communication
Reading Material To Client
Call By Name
Tactile Stimulation
Backrubs
Turning And Repositioning
Hair Brushing
Combing
Gentle touch
Olfactory StimulationOral HygieneCare Of DenturesFoods Of Different ColourTemperature Served AttractivelyHome FoodsPleasurable AromasSmelling Food Before Serving It
Cognitive InputOrient The Patient To EnvironmentEncourage In Self CareDiscuss Current EventsEmotional OutputEncourage Client To Share Fears, Concerns And PerceptionsReassure Client
Impaired Vision
Orient the client to the arrangementof room furnishings.
Good lightening in room.
Assist with ambulation.
Impaired Hearing
Assess the client frequently
Hearing aids
Call person by name
Television, Radio may be helpful
Impaired Olfactory SenseKeep gas stoves and heaters in a good working order
Ask the client to assess the fragrances of different things.
Impaired Tactile SenseThe clients with impaired sense of touch may not be aware of hot temperature, which can cause-
• Burns• Pressure ulcers
Therefore the temperature adjustment of water should be done before bathing.
Confused ClientThis is most commonly seen in older people.
Promote orientation to time, place, person and situation.
Unconscious Client
1. Listen carefully to support person’s concerns. 2. Maintain the schedule each day. 3. Touch and stroke the unconscious client.4. Encourage family members to talk to andtouch the client as though the client were conscious.5. Call the patient by name.
EVALUATION
Using the measurable desired outcomes developed during the planning stage as a guide , the
nurse collects data needed to judge whether client goals and outcomes have been achieved . If outcomes are not achieved , the nurse and the client, and support people if appropriate need to explore the reason before modifying
care plan.
REFERENCESBasheer SP et al. “ A concise textbook of advanced nursing practice”. Published by EMMESS Medical publishersPage No. 198-207280-283Available on URL: https://en.wikipedia.org/wiki/Sensory_deprivationhttp://www.scribd.com/doc/154283938/Oxygen-Insufficiency#scribd