oxygenation
TRANSCRIPT
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OXYGENATIONPrepared by:
John Gil B. Ricafort, RN
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Respiratory
I. Review of Respiratory SystemII. Common ManifestationsIII. Diagnostic Tests/ ProceduresIV. Common Pharmacologic AgentsV. Disturbances
a. Restrictive Lung Diseaseb. COPD/ CALc. Pulmonary Vascular Disease
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Restrictive:AtelectasisTuberculosisPneumonia
COPD:AsthmaEmphysemaChronic Bronchitis
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Pulmonary Vascular Disease:
Cor Pulmonale
Pulmonary Embolism
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Hematopoietic
I. Review of the Hematopoietic SystemII. Disturbances
a. Anemiab. Polycythemia Verac. Bleeding Tendencies
- DIC- Hemophilia- Thrombocytopenia
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Cardiovascular
I. Review of the Cardiovascular SystemII. Common Diagnostic Tests/ ProceduresIII. Disturbances
a. Infection - Rheumatic Heart Disease
b. Coronary Artery Disease- Atherosclerosis- Arteriosclerosis
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- Angina Pectoris
- Myocardial Infarction
IV. Congestive Heart Failure
- Right Sided Heart Failure
- Left Sided Heart Failure
V. Congenital Heart Defects
- Cyanotic Heart Defects
- Acyanotic Heart Defects
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RESPIRATORY SYSTEM
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Measures That Promotes Adequate Respiratory Functions:
1. Adequate OXYGEN supply from the environment.
2. Deep breathing and coughing exercises.
3. Proper positioning
4. Patent airway (FEMS)
5. Adequate hydration
6. Avoid pollutants, alcohol and smoking.
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7. Chest Physiotherapy (CPT)
* Percussion
* Vibration
* Postural Drainage
8. Bronchial Hygiene Measures
* Steam Inhalation
* Suctioning
- Oropharyngeal
- Nasopharyngeal
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Things to Remember:SUCTIONING
Assess: AUDIBLE SECRETIONS during respiration
Position:
Conscious: SEMI-FOWLER’s POSITION
Unconscious: LATERAL POSITION
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Pressure:
Wall Unit:
Adult: 100-120mmHg
Child: 95-110mmHg
Infant: 50-95mmHg
Portable Unit:
Adult: 10-15mmHg
Child: 5-10mmHg
Infant: 2-5mmHg
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Appropriate Size of Catheter:
Adult: Fr. 12-18
Child: Fr. 8-10
Infant: Fr. 5-8
Lubricate Catheter:
Nasopharyngeal: water-soluble lubricant
Oropharyngeal: Sterile water or NSS
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• Apply suction during withdrawal of the suction catheter (NEVER during insertion)
• Apply suction for 5 to 10 seconds (maximum of 15 seconds)
• Allow 20-30 seconds interval between each suction and limit suction to 5 minutes in total
• Encourage patient to breathe deeply and to cough between suctions.
• Assess effectiveness of suctioning
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9. Incentive Spirometry - done to enhance deep inspiration
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10. Administration of supplemental oxygen
Signs of Hypoxemia
1. Increased pulse rate
2. Rapid, shallow respiration
3. Increased restlessness
4. Flaring of nares
5. Substernal or intercostal retractions
6. Cyanosis
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OXYGEN SYSTEMS:1. Low-flow Administration Devices
a. Nasal Cannula (24-45% at 2-6LPM)b. Simple Face Mask (40-60% at 5-8LPM)c. Partial Rebreathing Mask
(60-90% at 6-10LPM)d. Non-rebreathing Mask
(95-100% at 6-15LPM)e. Oxygen Tent
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2. High flow Administration Devices
a. Venturi Mask
b. Oxygen Hood
c. Incubator / Isolette
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Common Manifestations:1. Cough
- the cardinal symptom of respiratory problem
2. Dyspnea- refers to difficulty on breathing
* EXERTIONAL DYSPNEA* PAROXYSMAL NOCTURNAL * ORTHOPNEA
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3. Clinical Signs of HypoxiaEARLY SIGNS
Tachycardia
Kussmaul’s Respiration
N/V
Headache
Irritability
Memory loss
Dizziness
LATE SIGNS
Bradycardia
Dyspnea
Decreased Systolic BP
Cough
Increased RBC
Increased Hgb
Clubbing of fingers
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4. Clubbing of Fingers
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5. Hemoptysis
6. Chestpain
7. Headache
8. Easy fatigability
9. Cyanosis
10. Skin flushing
11. Seizures
12. Altered level of consciousness
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Common Pharmacologic Agents1. Adrenergic (Sympathomimetic) Agents
2. Bronchodilators
3. Antibacterial
4. Corticosteroids
5. Antihistamine
6. Mucolytic, Antitussive and Expectorant
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Common Procedures/ Tests1. Abdominal Thrust (Heimlich Maneuver)
- a short, abrupt pressure against the abdomen, two fingerbreadths above the umbilicus, to raise the intrathoracic pressure.
PARTIAL: Noisy respiration, repeated coughing
TOTAL: Cessation of breathing, inability to speak
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2. Radiographic Scanning Test (X-RAY)
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3. Endoscopy (Bronchoscopy)
4. Chest Physiotherapy
5. Suctioning of Airway
6. Tracheostomy care
7. Pulmonary Function Test
- Incentive Spirometry
*Tidal Volume (500ml)
* Residual Volume (1200ml)
* Expiratory Reserve Volume (1000-1200ml)
* Inspiratory Reserve Volume (3000-3300ml)
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8. Pulse Oximetry
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9. Sputum Exam
10. Oxygen Therapy
11. Thoracentesis
12. Chest Tube (T-Tube)
- to drain air : 2nd or 3rd ICS
- to drain blood/ fluid: 8th or 9th ICS
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13. Pulmonary Angiogram
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TUBERCULOSIS
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PNEUMONIA
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EMPHYSEMA
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BRONCHITIS
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ASTHMA
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Coronary Artery Diseases (CAD)1. Atherosclerosis
- an abnormal accumulation of lipid, or fatty, substances and fibrous tissues in the vessel wall
2. Arteriosclerosis
- refers to hardening of the vessel walls
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Risk Factors for CADNonmodifiable Risk Factors
Family History of CAD
Increasing Age
Gender
Race
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Modifiable Risk Factors
High Blood pressure
Cigarette smoking
High Blood cholesterol levels
Diabetes Mellitus
Lack of estrogen in women
Physical inactivity
Obesity
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Controlling CholesterolNormal Total Serum Cholesterol =
150-240mg/dl
HDL = 29-77mg/dl
LDL= 60-160mg/dl
Triglycerides= 10-190mg/dl
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Desired levels of LDL?< 160mg/dl for patients with one or no risk
factors
<130mg/dl for patients with two or more risk factors
<100mg/dl for patients with CAD
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Angina PectorisClassifications of Angina
Class Activity Evoking Limits to Activity
I Prolonged exertion None
II Walking >2 blocks Slight
III Walking <2 blocks Marked
IV Minimal or Rest Severe
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Types of Angina Pectoris1. Stable Angina
2. Unstable Angina
3. Intractable Angina/ Refractory Angina
4. Variant Angina
5. Silent Angina
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Myocardial InfarctionCardiac Enzymes
CPK
Normal: Male: 5-35; Female: 5-25
Rises: 4-8 hours
Peak: ½ to 1 ½ days
Returns to Normal: 3-4 days
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LDHNormal: 100-190IU/LRises: 12-24 hoursPeak: 2-6 days
Trop-TNormal: NEGATIVERises: immediatePeak: 4-24 hoursReturns to Normal: 1-3 weeks
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Management:
M - morphine SO4 for pain
O - Oxygen
A – Aspirin/ ACE inhibitors (captopril)
N – Nitroglycerin
S – streptokinase ( thrombolytics )
– should be given in 6 hrs but better if in 3 hrs
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Congestive Heart FailureClassifications:
CLASSIFICATION I
Ordinary physical activity does not cause fatigue, dyspnea, palpitations or chestpain
ASYMPTOMATIC
PROGNOSIS: Good
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CLASSIFICATION II
Slight limitations on ADL’s
Patient reports no symptoms at rest but increased physical activity will cause symptoms
PROGNOSIS: Good
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CLASSIFICATION III
Marked limitation on ADL
Patient feels comfortable at rest but less than ordinary activity will cause symptoms
PROGNOSIS: Fair
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CLASSIFICATION IV
Symptoms of Cardiac insufficiency at rest
PROGNOSIS: Poor
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