What is clubbing a sign of?
chronic hypoxia
Low flow oxygen delivery systems
- nasal cannula
- simple oxygen mask
- non-rebreather mask
- oxymizer cannula
High flow oxygen delivery systems
- high flow nasal cannula
- venturi mask
pulmonary ventilation
movement of air into and out of the lungs
inspiration and expiration
respiration
involves gas exchange between the atmospheric air in the alveoli and blood in the capillaries through the process of diffusion
diffusion
movement of gas or particles from areas of high pressure to areas of lower pressure (or concentration)
what needs to be present in order for diffusion to occur in the lungs?
adequate surfactant
Atelectasis
collapse of alveoli
internal respiration
exchange of oxygen and CO2 between circulating blood and tissue cells
Oxygen for COPD remission
low flow nasal cannula 1-2L
Oxygen for COPD exacerbation
high flow
Gerontologic Considerations
oxygen
- less elasticity of tissues in respiratory tract + alveoli
- airways collapse more easily
- unable to maintain adequate cardiac output
- stiffening of heart valves + blood vessels
- chest is unable to stretch
- reduced power of respiratory and abd muscles
Assessment
- LOC, distress, skin color, chest diameter, breathing pattern
- auscultate breath sounds
- review diagnostic tests
Arterial Blood Gas (ABG)
- examine arterial blood to determine pressure exerted by oxygen and CO2 in the blood and blood pH
- measures the adequacy of oxygenation, ventilation, perfusion
- normal pH: 7.35-7.45
- pt must be at rest for 30 mins prior to test
CBC
- measures total number of RBCs, WBCs, values for Hct and Hgb
- wbc: 4.5-10.5
- platelets: 140,000-400,000/uL
- Hgb: varies between male and female
- Hct: varies between male and female
Electrocardiography
- electrodes are attached to chest and limbs to assess heart (12 spots)
- pt must lie still and not talk
- measures heart’s electrical activity
- used for detecting MI, heart damage, myocardial ischemia, rhythm and conduction disturbances, electrolyte imbalance, drug toxicity
Pulse Oximetry
- normal: 90-100%
- COPD: 88-92%
- measures oxygen saturation
Capnography
- measures amount of CO2 exhaled with each breath
- useful for confirming placement of advanced airways and NG tube
Thoracentesis
- puncturing chest wall and aspirating pleural fluid (used for removing extra fluid, removing pressure)
- nursing responsibilities: collecting baseline data, instructing pt not to cough or breathe deeply during procedure, monitor vitals)
Nursing interventions
r/t oxygenation
- promoting healthy lifestyle (smoking cessation, diet, exercise, monitor cholesterol + BP)
- reduce anxiety
- promoting comfort (positioning, adequate fluid intake, humidified air)
- promoting proper breathing (deep breathing exercises, incentive spirometry)
Nursing interventions cont.
r/t oxygenation
- suctioning
- maintaining oxygenation needs with meds
- positive airway pressure
- providing supplemental oxygen
- promoting/controlling coughing
Regular nasal cannula
- low flow
- 1-6 L/min
- humidifier for flow rate greater than 4 L/min to prevent drying
- check often to make sure both prongs in pts nares
Oxymizer cannula
mustache cannula
- deliver oxygen concentration 3-4x more than regular NC at same flow rate
- no humidifier due to rain out effect
- used in COPD pts
- low flow
Simple face mask
- 5-8 L/min
- 40-60% oxygen
- may use humidifier, may help liquefy thick secretion and prevent drying
- short term, low flow
- chest pain, dizziness, minor hemorrhage, respiratory disorder
