JUDITH M. WILKINSON LESLIE S. TREASKAREN BARNETT MABLE H. SMITH
FUNDAMENTALS OFFUNDAMENTALS OFNURSINGNURSING
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Chapter 36: Chapter 36: OxygenationOxygenation
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Oxygenation
Oxygen•Atomic number: 8•Atomic mass: 16
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Pulmonary System
• Airways and lungs• Ventilation
– Movement of air into/out of the lungs
• Respiration– Exchange of
oxygen/carbon dioxide
– Alveolar capillary/capillary cell membrane
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ClickerCheck
Which diagnostic test/exam would best measure a client’s level of hypoxemia?
a.Chest x-rayb.Pulse oximeter readingc.ABGd.Peak expiratory flow rate
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ClickerCheck (cont’d)
Correct answer: C
The term “hypoxemia” means low blood oxygen level. Arterial blood gas sampling is the most direct way in which the level of oxygen in the blood can be measured.
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Factors That Influence Pulmonary Function• Life span and development (e.g.,
respiratory distress syndrome, upper respiratory infections [URIs], adolescent smoking, cardiac insufficiency)
• Environment (e.g., stress, allergies)• Lifestyle (e.g., nutrition, exercise,
substance abuse)• Medications• Smoking
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Factors That Influence Pulmonary Function (cont’d)
• Pulmonary system abnormalities (structure, airway inflammation/obstruction, alveolar-capillary membrane disorder, atelectasis)
• Pulmonary circulation abnormalities• Central nervous system abnormalities• Neuromuscular abnormalities
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Assessing Oxygenation Status
Physical examination•Breathing pattern•Respiratory effort•Pulse oximetry•Using inspection, palpation, percussion, and auscultation
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ClickerCheck
The term “Kussmaul” refers to a high-pitched, harsh, crowing inspiratory sound that occurs due to partial obstruction of the larynx.
a.Trueb.False
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ClickerCheck (cont’d)
Correct answer: B
The term for this sound of respiratory distress is “stridor.”
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Assessing Oxygenation Status
• Diagnostic testing• Arterial blood gases (ABGs)
– PO2, PCO2
• Peak flow monitoring
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Interventions for Optimal Oxygenation• Use of a mechanical ventilator• Use of chest tube
drainage systems• Administering
respiratory medications
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Interventions for Optimal Oxygenation (cont’d)
Promoting respiratory function•Immunizations/prevent URIs•Positioning: maximum lung excursion•Incentive spirometry•Aspiration precautions
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Interventions for Optimal Oxygenation (cont’d)
• Mobilizing secretions– Deep breathing
and coughing– Hydration– Chest physiotherapy
• Oxygen therapy– Cannula– Mask– Transtracheal catheter
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Interventions for Optimal Oxygenation (cont’d)
• Using artificial airways– Oropharyngeal– Nasopharyngeal– Endotracheal tubes– Tracheostomy tube
• Artificial airway patency – Suctioning
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ClickerCheck
In caring for a client with a tracheostomy, the nurse would give priority to the nursing diagnosis of
a.Risk for ineffective airway clearanceb.Anxiety related to suctioningc.Social isolation related to altered body imaged.Impaired tissue integrity
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ClickerCheck (cont’d)
Correct answer: A
While other diagnoses may be applicable, maintaining a patent airway by tending to excessive secretions is a priority.
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Think Like a Nurse
Ms. Saunders (Meet Your Patients) has adequate blood oxygen levels based on a pulse oximeter reading of 98%. Can you conclude that organ and tissue oxygenation are adequate? Explain your thinking.