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Chapter 39

Oxygenation

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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

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Respiratory Physiology

• Structure and function (cont'd)– Breathing: inspiration, expiration– Lung volumes and capacities– Pulmonary circulation– Respiratory gas exchange: oxygen,

carbon dioxide– Regulation of respiration

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Factors Affecting Oxygenation

• Physiological factors: cardiac– Conduction disturbances– Impaired valvular function– Myocardial hypoxia– Cardiomyopathic conditions– Peripheral tissue hypoxia

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Factors Affecting Oxygenation (cont'd)

• Physiological factors: respiratory– Hyperventilation– Hypoventilation– Hypoxia

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Factors Affecting Oxygenation (cont'd)

• Additional physiological factors– Decreased oxygen-carrying capacity– Decreased inspired oxygen

concentration– Hypovolemia– Increased metabolic rate– Conditions affecting chest wall

movement

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Factors Affecting Oxygenation (cont'd)

• Additional physiological factors– Musculoskeletal abnormalities– Trauma– Neuromuscular diseases– Central nervous system alterations– Chronic disease

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Alterations in Cardiac Functioning

• Conduction disturbances– Atrial and ventricular dysrhythmias

• Altered cardiac output– Heart failure

• Impaired valvular function

• Myocardial ischemia– Angina, MI, acute coronary

syndrome

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Alterations in Respiratory Functioning

• Hyperventilation

• Hypoventilation

• Hypoxia

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Developmental Factors

• Infants and toddlers

• School-age children and adolescents

• Young and middle adults

• Older adults

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Lifestyle Factors

• Nutrition

• Exercise

• Smoking

• Substance abuse

• Stress

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Environmental Factors

• Residence location

• Occupation

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Nursing History

• Fatigue

• Dyspnea

• Cough

• Wheezing

• Pain

• Environmental or geographical exposures

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Nursing History (cont'd)

• Respiratory infections

• Health risks

• Medications

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Assessment of Oxygenation

• Physical examination– Inspection– Palpation– Percussion– Auscultation

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Assessment of Oxygenation (cont'd)

• Diagnostic tests: blood studies– Complete blood count– Cardiac enzymes– Cardiac troponin I– Serum electrolytes– Cholesterol

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Assessment of Oxygenation (cont'd)

• Diagnostic tests: cardiac function– Electrocardiogram (ECG)– Holter monitor– Exercise stress test– Thallium stress test– Electrophysiological study (EPS)– Echocardiography– Scintigraphy– Cardiac catheterization

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Assessment of Oxygenation (cont'd)

• Diagnostic tests: ventilation studies– Pulmonary function– Peak expiratory flow rate (PEFR)– Arterial blood gases– Oximetry– Chest x-ray– Bronchoscopy– Lung scan

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Assessment of Oxygenation (cont'd)

• Diagnostic tests: ventilation studies (cont'd)– Thoracentesis– Throat cultures– Sputum specimens

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Nursing Diagnoses

• Ineffective airway clearance

• Ineffective breathing pattern

• Decreased cardiac output

• Impaired gas exchange

• Risk for infection

• Ineffective tissue perfusion

• Impaired spontaneous ventilation

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Planning

• Goals and outcomes– Client’s lungs are clear on auscultation– Client coughs productively

• Setting priorities

• Continuity of care

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Implementation: Health Promotion

• Body weight• Diet• Exercise• Stress reduction• Occupational safety• Smoke-free• Regular physical examinations

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Implementation: Health Promotion (cont'd)

• Vaccinations/immunizations– Influenza– Pneumonia

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Implementation: Acute Care

• Dyspnea management

• Airway maintenance– Mobilization of secretions– Suctioning– Artificial airways

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Implementation: Acute Care (cont'd)

• Maintenance and promotion of lung expansion– Positioning– Incentive spirometry– Chest tubes

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Implementation: Acute Care (cont'd)

• Maintenance and promotion of oxygenation: oxygen therapy– Safety precautions– Oxygen supply– Methods of oxygen delivery– Home oxygen therapy

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Implementation: Acute Care (cont'd)

• Restoration of cardiopulmonary functioning—CPR

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Implementation: Restorative Care

• Hydration

• Coughing techniques

• Respiratory muscle training

• Breathing exercises

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Evaluation

• Client care

• Client expectations