Oxygenation

1
Oxygenation
2
Oxygen Administration Needed

• Suspected acute MI or chest pain
• Acute pulmonary edema
• Pulmonary embolism
• Acute respiratory failure
• Severe trauma
• Hypoxemia
• Observable shortness of breath
• Carbon monoxide poisoning

3
Oxygen Administration May Be Needed

• Complaints of shortness of breath
• Altered respiratory rate or depth
• Flaring nostrils
• Suprasternal retractions
• Use of accessory muscles to breathe
• Orthopnea
• Acute bronchospasm
• Tachycardia or dysrhythmia
• Fever associated with respiratory tract infection
• Altered mental status, confusion, anxiety,
  agitation
• Peripheral cyanosis

4
Measuring Oxygen Therapy Outcomes

• Respiratory rate within pts normal limits
• Decreased dyspnea at rest and with exertion
• Maintenance or improvement of level of
  functioning
• Improved BS, mental status, IO, and skin color
  and temp
• Blood pressure at pts baseline
• Strong peripheral pulses
• Decreased anxiety

5
Possible Expected Outcomes for Respiratory
Conditions

• Patent airway
• Effective cough
• Clear breath sounds
• No dyspnea
• Resolution /control of underlying problem
• Respirations WNL (state expected value)
• Improved lung expansion
• No restrictions on chest wall
• Clear x-ray without atelectasis
• Tolerance and use of Chest Physiotherapy (CPT)

6
Possible Expected Outcomes for Respiratory
Conditions

• Removal of pulmonary secretions
• Sputum clear, colorless, thin
• Signs of hydration/liquefaction of secretions
• Improved activity tolerance
• ADLs
• Signs of tissue oxygenation
• Skin color
• Capillary refill

7
Cardiopulmonary Assessment Subjective

• Are you having any chest pain?
• Are you having any irregular heart beats?
• Are you having any SOB (trouble breathing, pain
  when breathing)
• Have you ever had any breathing problems in the
  past? Tell me about that time.
• Do you have a cough? Do you cough up phlegm? Do
  you wheeze?
• Have you been around anything recently that
  caused breathing problems?
• What kind of work do you do? Where?
• How often do you have colds or the flu and other
  respiratory problems in a year?

8
Cardiopulmonary Assessment Subjective

• What relieves your symptoms?
• What makes your symptoms worse?
• Have you taken medication for this?
• Have you taken drugs (street drugs)?
• Do you smoke? How many cigarettes (packs) in 24
  hours?
• Does anyone you live with or work with smoke?
• Has anyone in your family had heart disease?
  Cancer? Tuberculosis? Allergies? Asthma?
• Have you ever received a flu shot or pneumonia
  vaccine?

9
Cardiopulmonary Assessment Objective

• Inspection
• Skin color (cyanotic, pale, flushed)
• Clubbing?
• Posture
• Facial expression
• Level of consciousness
• Breathing patterns (rhythm, depth)
• Chest wall movement (retractions, asynchronous)
• Chest contour
• Respiratory rate
• Temperature
• SPO2

10
Cardiopulmonary Assessment Objective

• Palpation
• Pulse rate
• Peripheral pulses
• Auscultation
• Lung sounds (rales (crackles), rhonchi (wheezes))
• BP
• Apical pulse
• Percussion
• Resonance
• Other Data
• Lab
• X-ray
• Cultures

11
Drugs Affecting Oxygenation

• Cardiovascular System
• Glycosides digoxin, digitoxin
• Nitrates (vasodilators)- Nitroglycerine
  (Nitrobid, Nitrostat, Nitropatch, Transderm
  Nitro), Isosorbide dinitrate/mononitrate (Ismo,
  Imdur)
• Beta Blockers Propanolol
• Calcium Channel Blockers nifedipine, diltiazem
• ACE Inhibitors captopril, enalapril
• Diuretics furosemide, hydrocholorothiazide

12
Drugs Affecting Oxygenation

• Coagulation Lipids
• Anticoagulants heparin, warfarin
• Antiplatelets dypyramidole, ASA, Plavix
• Antilipemics
• Respiratory System
• Bronchodilators theophylline, albuterol
• Glucocorticoids prednisone
• Mucolytics acetylcysteine, guaifenasin
• Antihistamines benadryl
• Antitussives codeine, dextromephortham

13
Interventions

• Health Promotion
• Vaccinations,
• healthy lifestyle behavior
• environmental pollutants

14
InterventionsAcute Care

• Dyspnea Management
• Airway maintenance
• Suctioning
• Artificial airways
• Maintenance and promotion of lung expansion
• Maintenance and promotion of oxygenation
• Restoration of cardiopulmonary function
• Hydration
• Coughing techniques
• Respiratory muscle training
• Breathing exercises

15
Interventions

• Oxygen Delivery Systems
• Low flow
• Nasal cannula
• Simple face mask
• Partial rebreather mask
• Non-rebreather mask
• High flow
• Venturi mask

16
Oxygen Toxicity

• Medically induced (iatrogenic)
• Potentially fatal
• High concentration of O2 inspired for a prolonged
  time

17
Oxygen Toxicity

• Signs and Symptoms
• Dry, hacking cough
• Chest discomfort
• Numbness in the extremities
• Nausea or vomiting
• Fatigue, lethargy, or restlessness
• Dyspnea