Oxygen (O₂) is a gas. It has no taste, odor, or color. It is a basic need required for life. Death occurs within minutes if breathing stops. Brain damage and serious illness can occur without enough oxygen. Illness, surgery, and injuries affect the amount of oxygen in the body. Respiratory complications are risks after surgery.

You assist in the care of persons with oxygen needs. You must give safe and effective care.

See Body Structure and Function Review: The Respiratory System.

Body Structure and Function Review

The Respiratory System

Oxygen is needed to live. Every cell needs oxygen. Air contains about 21 percent (%) oxygen. This meets the body’s needs under normal conditions. The respiratory system (Fig. 39-1) brings oxygen (O₂) into the lungs and removes carbon dioxide (CO₂). Respiration is the process of supplying the cells with O₂ and removing CO₂ from them. Respiration involves breathing in (inhalation, inspiration) and breathing out (exhalation, expiration).

Air enters the body through the nose. The air then passes into the pharynx (throat)—a tube-shaped passage-way for air and food. Air passes from the pharynx into the larynx (voice box). Then air passes from the larynx into the trachea (windpipe).

The trachea divides at its lower end into the right bronchus and left bronchus. Each bronchus enters a lung. Upon entering the lungs, the bronchi divide many times into smaller branches (bronchioles). Eventually the bronchioles subdivide, ending up in tiny 1-celled air sacs (alveoli).

O₂ and CO₂ are exchanged between the alveoli and capillaries. Blood in the capillaries picks up O₂ from the alveoli. Then the blood is returned to the left side of the heart and pumped to the rest of the body. Alveoli pick up CO₂ from the capillaries for exhalation.

Factors Affecting Oxygen Needs

Any disease, injury, or surgery involving the respiratory or circulatory systems affects the intake and use of O₂. Body systems depend on each other. Altered function of any system (for example, the nervous, musculo-skeletal, or urinary system) affects oxygen needs. Oxygen needs are affected by:

• The circulatory system. Narrowed vessels affect blood flow. Capillaries and cells must exchange O₂ and CO₂.

• Red blood cell count. Red blood cells (RBCs) contain hemoglobin. Hemoglobin picks up O₂ in the lungs and carries it to the cells. The bone marrow must produce enough RBCs. Blood loss also reduces the number of RBCs.

• The nervous system. Nervous system diseases and injuries can affect respiratory muscles. Narcotics and depressant drugs affect the brain and slow respirations. O₂ and CO₂ blood levels also affect brain function. When O₂ is lacking, respirations increase to bring in more oxygen. When CO₂ increases, respirations increase to rid the body of CO₂.

• Aging. Respiratory muscles weaken. Lung tissue is less elastic. Strength for coughing decreases. Pneumonia (inflammation and infection of the lungs) can develop.

• Exercise. O₂ needs increase with exercise. Respiratory rate and depth increase to bring in O₂. Persons with heart and respiratory diseases may have enough oxygen at rest. However, even slight activity can increase O₂ needs. The doctor may limit activity.

• Fever. O₂ needs increase. Respiratory rate and depth increase.

• Pain. O₂ needs increase. Respirations increase to meet this need. Chest and abdominal injuries and surgeries often involve respiratory muscles. It hurts to breathe.

• Drugs. Some drugs depress the respiratory center in the brain. Respiratory depression means slow, weak respirations at a rate of fewer than 12 per minute. Respiratory arrest is when breathing stops. Narcotics (morphine, Demerol, and others) can have these effects. (Narcotic comes from the Greek word narkoun. It means stupor or to be numb.) Substance abusers are at risk for respiratory depression and respiratory arrest.

• Smoking. Smoking causes lung cancer and chronic obstructive pulmonary disease (COPD). It is a risk factor for coronary artery disease.

• Allergies. An allergy is a sensitivity to a substance that causes the body to react with signs and symptoms. Runny nose, wheezing, and congestion are common. Mucous membranes in the upper airway swell. Severe swelling can close the airway. Shock and death are risks. Pollens, dust, foods, drugs, insect bites, powders, flowers, perfumes, sprays, animals, and cigarette smoke often cause allergies.

• Pollutants. A pollutant is a harmful chemical or substance in the air or water. Examples are dust, fumes, toxins, asbestos, coal dust, and sawdust. They damage the lungs.

• Nutrition. The body needs iron and vitamins (vitamin B₁₂, vitamin C, and folate) to produce RBCs.

• Alcohol. Alcohol depresses the brain. Excessive amounts reduce the cough reflex and increase the risk of aspiration. Obstructed airway and pneumonia are risks from aspiration.

Altered Respiratory Function

Respiratory function involves 3 processes. Respiratory function is altered if even 1 process is affected.

• Air moves into and out of the lungs.

• O₂ and CO₂ are exchanged at the alveoli.

• The blood carries O₂ to the cells and removes CO₂ from them.

Hypoxia

Hypoxia means that cells do not have enough (hypo) oxygen (oxia). Cells cannot function properly. Anything affecting respiratory function can cause hypoxia. The brain is very sensitive to inadequate O₂. Restlessness, dizziness, and disorientation are early signs. Report the signs and symptoms in Box 39-1 at once.

Box 39-1

Altered Respiratory Function

• Hypoxia: signs and symptoms of

• Restlessness

• Dizziness

• Disorientation and confusion

• Behavior and personality changes

• Concentrating and following directions: problems with

• Anxiety and apprehension

• Fatigue

• Agitation

• Pulse rate: increased

• Respirations: increased rate and depth

• Sitting position—upright, leaning forward, hunched over a table

• Cyanosis—bluish color (cyano) to the skin, lips, mucous membranes, and nail beds

• Dyspnea

• Breathing pattern: abnormal

• Shortness of breath or complaints of being “winded” or “short-winded”

• Cough (note frequency and time of day)

• Dry and hacking

• Harsh and barking

• Productive (produces sputum) or non-productive

• Sputum (mucus from the respiratory system)

• Color—clear, white, yellow, green, brown, or red

• Odor—none or foul odor

• Consistency—thick, watery, or frothy (with bubbles or foam)

• Hemoptysis—bloody (hemo) sputum (ptysis means to spit); note if the sputum is bright red, dark red, blood-tinged, or streaked with blood

• Respirations—noisy, wheezing, wet-sounding, crowing sounds

• Chest pain (note location)

• Constant or comes and goes

• Person’s description—stabbing, knife-like, aching

• What makes it worse—movement, coughing, yawning, sneezing, sighing, deep breathing

• Vital signs: changes in

Hypoxia threatens life. All organs need O₂ to function. Oxygen is given (p. 651). The cause of hypoxia is treated.

Abnormal Respirations

Adults normally breathe 12 to 20 times per minute. Infants and children have faster rates. Normal respirations are quiet, effortless, and regular. Both sides of the chest rise and fall equally. These breathing patterns are abnormal (Fig. 39-2).

• Tachypnea—rapid (tachy) breathing (pnea). Respirations are more than 20 per minute. Fever, exercise, pain, pregnancy, airway obstruction, and hypoxemia are causes. Hypoxemia is a reduced amount (hypo) of oxygen (ox) in the blood (emia).

• Bradypnea—slow (brady) breathing (pnea). Respirations are fewer than 12 per minute. Drug over-dose and nervous system disorders are causes.

• Apnea—lack or absence (a) of breathing (pnea). It occurs in cardiac arrest and respiratory arrest. Sleep apnea is another type of apnea (Chapter 45).

• Hypoventilation—breathing (ventilation) is slow (hypo), shallow, and sometimes irregular. Lung disorders affecting the alveoli are causes. Pneumonia is an example. Other causes include obesity, airway obstruction, and drug side effects. Nervous system and musculo-skeletal disorders affecting the respiratory muscles also are causes.

• Hyperventilation—breathing (ventilation) is rapid (hyper) and deeper than normal. Causes include asthma, emphysema, infection, fever, nervous system disorders, hypoxia, anxiety, pain, and some drugs.

• Dyspnea—difficult, labored, or painful (dys) breathing (pnea). Heart disease and anxiety are causes.

• Cheyne-Stokes respirations—respirations gradually increase in rate and depth and then become shallow and slow. Breathing may stop (apnea) for 10 to 20 seconds. Drug over-dose, heart failure, renal failure, and brain disorders are causes. Cheyne-Stokes are common when death is near.

• Orthopnea—breathing (pnea) deeply and comfortably only when sitting (ortho). Causes are emphysema, asthma, pneumonia, angina, and other heart and respiratory disorders.

• Biot’s respirations—rapid and deep respirations followed by 10 to 30 seconds of apnea. They occur with nervous system disorders.

• Kussmaul respirations—very deep and rapid respirations. They signal diabetic coma.

FIGURE 39-2 Some abnormal breathing problems. (Modified from Talbot L, Meyers-Marquardt M: Pocket guide to critical care assessment, ed 3, St Louis, 1997, Mosby.)

Respiratory Tests

Respiratory problems may be acute or chronic. Report your observations promptly and accurately (see Box 39-1). The health team must take quick action to meet oxygen needs. The problem must be corrected and prevented from becoming worse.

The doctor may order a chest x-ray to detect lung changes. If necessary, other complex tests are ordered. You may be involved in pulse oximetry and sputum specimens. Assist with other tests as directed by the nurse.

Pulse Oximetry

Pulse oximetry measures (metry) the oxygen (oxi) concentration in arterial blood. Oxygen concentration is the amount (percent) of hemoglobin containing O₂. An agency may use 1 of these terms.

• Pulse oximetry or pulse ox

• O₂ saturation or O₂ sat

• SpO₂ (saturation of peripheral oxygen)

Measurements are used to prevent and treat hypoxia. The normal range is 95 to 100%. For example, if 97% of all hemoglobin (100%) carries O₂, tissues get enough oxygen. If only 90% contains O₂, tissues do not get enough oxygen. As low as 85% may be normal for persons with some chronic diseases.

A sensor attaches to a finger, toe, earlobe, nose, or forehead (Fig. 39-3). Light beams on 1 side of the sensor pass through tissues. A detector on the other side measures the amount of light passing through the tissues. With this information, the oximeter measures the O₂ concentration.

FIGURE 39-3 A, A pulse oximetry sensor is attached to a finger. The device displays the O₂ concentration and pulse. B, A pulse oximetry sensor for children. (B, From Covidien ©2015. All rights reserved. Used with permission of Covidien.)

A good sensor site is needed. Avoid swollen sites and sites with skin breaks. If blood flow to fingers or toes is poor, then the earlobe, nose, and forehead sites are used.

Bright light, nail polish, fake nails, and movements affect measurements.

• Place a towel over the sensor to block bright lights.

• Remove nail polish or use another site.

• Do not use a finger site if there are fake nails.

• Use the earlobe if the person has movements from shivering, seizures, or tremors.

• Do not measure blood pressure on the side of a finger site. Blood pressure cuffs affect blood flow.

Oxygen concentration is often measured with vital signs. The pulse rate may be displayed on the pulse oximeter along with the oxygen concentration. Report and record measurements according to agency policy.

Oximeter alarms are set for continuous monitoring. An alarm sounds if:

• O₂ concentration is low.

• The pulse rate is too fast or slow.

• Other problems occur.

See Focus on Children and Older Persons: Pulse Oximetry.

See Delegation Guidelines: Pulse Oximetry, p. 646.

See Promoting Safety and Comfort: Pulse Oximetry, p. 646.

See procedure: Using a Pulse Oximeter, p. 646.

Focus on Children and Older Persons

Pulse Oximetry

Children

Different sensors may be used for children (see Fig. 39-3, B). The sensor is attached to the sole of the foot, palm of the hand, toe, or earlobe. If the child moves a lot, the earlobe is a better site.

Delegation Guidelines

Pulse Oximetry

To assist with pulse oximetry, you need this information from the nurse and the care plan.

• What site to use

• How to use the equipment

• What sensor to use

• What type of tape to use (if needed)

• The person’s normal range of SpO₂

• Alarm limits for SpO₂ and pulse rate (if set)

• When to do the measurement

• What pulse site to use: apical or radial

• How often to check the site for continuous monitoring (usually every 2 hours)

• What observations to report and record:

• The date and time

• The SpO₂ and display pulse rate

• Apical or radial pulse rate

• What the person was doing at the time

• Oxygen flow rate (p. 654) and the device used (p. 653)

• Reason for the measurement: routine, continuous monitoring, or condition change

• When to report observations

• What patient or resident concerns to report at once:

• An SpO₂ below the alarm limit (usually 95%)

• A pulse rate above or below the alarm limit

• The signs and symptoms listed in Box 39-1

Promoting Safety and Comfort

Pulse Oximetry

Safety

The person’s condition can change quickly. Pulse oximetry does not lessen the need for good observations. Observe for signs and symptoms of hypoxia and altered respiratory system function (see Box 39-1).

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Tags: Mosbys Textbook for Nursing Assistants

Apr 13, 2017 | Posted by admin in NURSING | Comments Off

Hypoxia

Abnormal Respirations

Pulse Oximetry

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Nurse Key

Fastest Nurse Insight Engine

Oxygen Needs

Oxygen Needs

Key Abbreviations

Factors Affecting Oxygen Needs

Altered Respiratory Function

Respiratory Tests

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Nurse Key

Fastest Nurse Insight Engine

Oxygen Needs

Key Abbreviations

Factors Affecting Oxygen Needs

Altered Respiratory Function

Hypoxia

Abnormal Respirations

Respiratory Tests

Pulse Oximetry

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