OXYGENATION

Prepared by:

John Gil B. Ricafort, RN

 Respiratory

III. Review of Respiratory System

IV. Common Manifestations
V. Diagnostic Tests/ Procedures
VI. Common Pharmacologic Agents
VII. Disturbances
a. Restrictive Lung Disease
b. COPD/ CAL
c. Pulmonary Vascular Disease
Restrictive:
Atelectasis
Tuberculosis
Pneumonia

COPD:
Asthma
Emphysema
Chronic Bronchitis
Pulmonary Vascular Disease:

Cor Pulmonale
Pulmonary Embolism
 Hematopoietic

III. Review of the Hematopoietic System

IV. Disturbances
a. Anemia
b. Polycythemia Vera
c. Bleeding Tendencies
- DIC
- Hemophilia
- Thrombocytopenia
 Cardiovascular

III. Review of the Cardiovascular System

IV. Common Diagnostic Tests/ Procedures
V. Disturbances
a. Infection
- Rheumatic Heart Disease
b. Coronary Artery Disease
- Atherosclerosis
- Arteriosclerosis
 - 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
RESPIRATORY SYSTEM
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.
7. Chest Physiotherapy (CPT)
* Percussion
* Vibration
* Postural Drainage
8. Bronchial Hygiene Measures
* Steam Inhalation
* Suctioning
- Oropharyngeal
- Nasopharyngeal
Things to Remember:SUCTIONING
Assess: AUDIBLE SECRETIONS during
respiration
Position:
Conscious: SEMI-FOWLER’s POSITION
Unconscious: LATERAL POSITION
Pressure:
Wall Unit:
Adult: 100-120mmHg
Child: 95-110mmHg
Infant: 50-95mmHg
Portable Unit:
Adult: 10-15mmHg
Child: 5-10mmHg
Infant: 2-5mmHg
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
• 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
9. Incentive Spirometry
- done to enhance deep inspiration
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
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
2. High flow Administration Devices
a. Venturi Mask
b. Oxygen Hood
c. Incubator / Isolette
Common Manifestations:
1. Cough
- the cardinal symptom of respiratory
problem
2. Dyspnea
- refers to difficulty on breathing
* EXERTIONAL DYSPNEA
* PAROXYSMAL NOCTURNAL
* ORTHOPNEA
3. Clinical Signs of Hypoxia
EARLY SIGNS LATE SIGNS
Tachycardia Bradycardia
Kussmaul’s Respiration Dyspnea
N/V Decreased Systolic BP
Headache Cough
Irritability Increased RBC
Memory loss Increased Hgb
Dizziness Clubbing of fingers
4. Clubbing of Fingers
5. Hemoptysis
6. Chestpain
7. Headache
8. Easy fatigability
9. Cyanosis
10. Skin flushing
11. Seizures
12. Altered level of consciousness
Common Pharmacologic Agents
1. Adrenergic (Sympathomimetic) Agents
2. Bronchodilators
3. Antibacterial
4. Corticosteroids
5. Antihistamine
6. Mucolytic, Antitussive and Expectorant
Common Procedures/ Tests
1. 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
2. Radiographic Scanning Test (X-RAY)
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)
8. Pulse Oximetry
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
13. Pulmonary Angiogram
TUBERCULOSIS
PNEUMONIA
EMPHYSEMA
BRONCHITIS
ASTHMA
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
Risk Factors for CAD
Nonmodifiable Risk Factors
Family History of CAD
Increasing Age
Gender
Race
Modifiable Risk Factors
High Blood pressure
Cigarette smoking
High Blood cholesterol levels
Diabetes Mellitus
Lack of estrogen in women
Physical inactivity
Obesity
Controlling Cholesterol
Normal Total Serum Cholesterol =
150-240mg/dl
HDL = 29-77mg/dl
LDL= 60-160mg/dl
Triglycerides= 10-190mg/dl
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

Angina Pectoris
Classifications 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
Types of Angina Pectoris
1. Stable Angina
2. Unstable Angina
3. Intractable Angina/ Refractory Angina
4. Variant Angina
5. Silent Angina
Myocardial Infarction
Cardiac 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
LDH
Normal: 100-190IU/L
Rises: 12-24 hours
Peak: 2-6 days

Trop-T
Normal: NEGATIVE
Rises: immediate
Peak: 4-24 hours
Returns to Normal: 1-3 weeks
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
Congestive Heart Failure
Classifications:
CLASSIFICATION I
Ordinary physical activity does not cause
fatigue, dyspnea, palpitations or chestpain
ASYMPTOMATIC

PROGNOSIS: Good
CLASSIFICATION II

Slight limitations on ADL’s

Patient reports no symptoms at rest but
increased physical activity will cause
symptoms

PROGNOSIS: Good
CLASSIFICATION III

Marked limitation on ADL

Patient feels comfortable at rest but less
than ordinary activity will cause symptoms

PROGNOSIS: Fair
CLASSIFICATION IV

Symptoms of Cardiac insufficiency at rest

PROGNOSIS: Poor