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Without food……..
2-3 Weeks…….
Without water……
2-3 Days….
Without breathing…….
Only 3-5
minitues
APARNA.A
I MSc. Nursing
Oxygenation
 Oxygenation means the
delivery of oxygen to the
body’s tissues and cells
to maintain life
Process of Oxygenation
 Ventilation = the exchange of air between the
environment and the lungs
 Diffusion = the exchang...
FACTORS AFFECTING
OXYGENATION
Developmental Factors
Physiological Factors
Behavioral Factors
Life Style Factors
Medication
MEASUREMENT OF OXYGENATION
 Oxygen saturation (SO2)
 Arterial oxygen saturation (SaO2)
 Venous oxygen saturation (SvO2)...
GAS EXCHANGE: LUNGS& BLOOD
GAS EXCHANGE: BLOOD & TISSUES
OXYGEN–HAEMOGLOBIN
DISSOCIATION CURVE
VENTILATION – PERFUSION RATIO
(PULMONARY GAS VARIABILITY)
V/Q
ratio
Term Consequences
1 V-Q match Normal PaO2
>1 Dead spac...
asthma, chronic bronchitis, obstructive emphysema, fibrosis,
edema
VA/ Q↓ part alveolar ventilatory ↓
functional shunt↑>30...
(2) increased ratio of VA/Q
poor perfusion in relation to their ventilation with air
pulmonary artery embolization, DIC in...
BLOOD GAS VARIABILITY
 Arterial blood gas can vary spontaneously without
change in the clinical condition of the patient....
MEANING OF OXYGEN DEFICIENCY
 It is the condition in which the lungs cannot take in
sufficient oxygen or expel sufficient...
 In practice, respiratory failure is defined as a PaO2
value of less than 60 mm Hg while breathing or a
PaCO2 of more tha...
CAUSES OF OXYGEN INSUFFICIENCY
 Carbon monoxide inhalation
 Contact with certain chemicals
 Self-induced hypocapnia
 A...
CAUSES OF OXYGEN INSUFFICIENCY
 Acute respiratory distress syndrome.
 Exposure to extreme low pressure or vacuum
 Hangi...
Respiratory Failure
 Indicates impairment of lung’s ability to maintain
adequate oxygen and CO2 homeostasis.
Types:
 According to PaCO2
 Type 1 (Hypoxemic) respiratory failure: Associated with a
PaCO2 < 60 mmHg on air or O2 with ...
Pathophysiology
Respiratory
movement
disorder
neuro-muscular disorders
decreased strength,
myasthenia gravis
hypoxia, acid...
Hypoxia
 a condition in which the
body or a region of the
body is deprived of
adequate oxygen supply.
 Hypoxia may be
cl...
Etiological factors
Cells can switch to
anaerobic metabolism
Accumulation of acid
by products. e.g,
lactate
Imbalance in c...
Hypoxemia
 an abnormally low level of oxygen in the blood.
 specifically, it refers to oxygen deficiency
in arterial blo...
Source A-a PO2
Partial pressure of O2
in alveolar gas and
arterial blood
PvO2
Partial pressure of
venous oxygen
Hypoventil...
Hypoventilation
 Alveolar hypoventilation causes both hypoxemia and
hypercapnia as a result of a decrease in the total
vo...
V/Q abnormality
 Most of the cases hypoxemia results from V/Q
mismatch in the lungs. E.g, pneumonia, ARDS etc.
 The A-a ...
DO2/VO2 (oxygen delivery/ oxygen
uptake) imbalance
Systemic oxygen delivery is usually accompanied by an
increase in O2 ex...
Hypercapnia
 an arterial PCO2 above 46 mmHg that doesnot
represent compensation for a metabolic alkalosis.
 The causes c...
Anoxia
 A total depletion in the level of oxygen, an extreme
form of hypoxia or "low oxygen" in which there is a
complete...
Anoxia: Environmental Causes
 a lack of oxygen or the presence of other chemicals in the
air that affect the ability of b...
Anoxia: Underlining diseases/
conditions
 Amyotrophic lateral sclerosis (ALS, also known as Lou
Gehrig’s disease; a sever...
Anoxia: Other Events
 Choking
 Complications of anesthetics
 Drowning
 Drug overdose
 Low blood pressure (hypotension...
Symptoms
 Bluish coloration of the lips or fingernails
 Confusion or loss of consciousness for even a brief moment
 Diz...
Treatment
 In general,
 restoring the oxygen supply, through either increasing
the amount of oxygen taken in, such as wi...
Cyanosis
 It is the appearance of a blue or
purple coloration of
the skin or mucous
membranes due to the tissues
near the...
Types of cyanosis
 Central (around the core, lips, and
tongue)
 due to a circulatory or ventilatory
problem that leads t...
Causes of central cyanosis
 1. Central Nervous System Disorders (impairing
normal ventilation)
 2. Respiratory Disorders...
Causes of peripheral cyanosis
 All common causes of central cyanosis
 Reduced cardiac output (e.g. heart
failure, hypovo...
Clubbing of fingers
 It is a deformity of
the fingers and fingernails associated with a number of
diseases, mostly of the...
Signs and symptoms
 Fluctuation and softening of
the nail bed
 Loss of the normal <165°
angle (Lovibond angle)
between t...
Diagnosis
Other conditions
 Acute asthma and COAD
 Ischemic heart disease:
 Myocardial infarction
 Congestive Heart Failure
 Sy...
HISTORY AND PHYSICAL
EXAMINATION
PFT (Pulmonary Function Test)
ABG (Arterial Blood Gas Analysis)
 ABG helps in measurement of blood for patient‘s
arterial oxygen and carbon dioxide ten...
Normal Values of ABG analysis
Measurem
ent
Normal Arterial
Values
Clinical Significance
pH 7.35-7.45 Indicates acid-base b...
ABG and oxygenation
 A low PaO2 indicates that the patient is not oxygenating
properly, and is hypoxemic.
 At a PaO2 of ...
Oximetry
 Pulse oximetry is a non-invasive method for
monitoring a patient's O2 saturation.
Working principle
Advantages
 useful in any setting where a patient's oxygenation is
unstable
 determining the effectiveness of or need fo...
Limitations
 Pulse oximetry measures solely hemoglobin
saturation, not ventilation and is not a complete
measure of respi...
 In severe anemia, the blood will carry less total oxygen,
despite the hemoglobin being 100% saturated.
 Erroneously low...
Limitations ….
 In cases of carbon monoxide poisoning, the inaccuracy
may delay the recognition of hypoxia
 Cyanide pois...
Capnography
 It is the monitoring of the
concentration or partial
pressure of carbon dioxide (CO2) in
the respiratory gas...
Principle of capnography
 CO2 absorbs infra-red
radiation.
 A beam of infra-red light is
passed across the gas
sample to...
Types of capnometry
 Colorimetric CO2
detection
 Infra red Capnography
 Modified nasal cannula
for nonintubated
patient...
Colorimetric CO2 detection
 A pH-sensitive chemical indicator is
enclosed in a plastic housing and is
connected to the ga...
Diagnostic usage:
 provides information
about CO2 production, pulmonary (lung)
perfusion, alveolar ventilation, respirato...
Other measures
 Chest Xrays and CT scan
 Sputum Studies
 Blood Studies
 Thoracentesis
 Pulmonary Angiography
 Bronch...
ACUTE CARE OF PATIENT WITH
OXYGEN INSUFFICIENCY
 Dysponea Management
 Airway Maintenance
 Mobilization of secretions
 ...
ACUTE CARE OF PATIENT WITH
OXYGEN INSUFFICIENCY
 Maintenance and Promotion of Oxygenation
 Oxygen Therapy
 Mechanical V...
OXYGEN ADMINISTRATION
Need for supplemental oxygen
 Tissues are normally hypoxic
 The tissues of human body normally operate in a low
oxygen e...
Oxygen delivery
 FiO2 : fraction of inspired oxygen
% of O2 participating in gas exchange
Natural air FiO2- 20.9% (≈ 21%)...
Low flow delivery systems
Device Reservoir capacity O2 flow (L/min) ≈FiO2 (if
TV=500ml,
RR=20/min, I:E=
1:2
Nasal Cannula ...
Methods of Oxygen Delivery
 Low flow delivery systems
 It provide variable FiO2
 e.g, Nasal prongs, face masks, and mas...
Nasal Prongs/
Nasal Cannula
 most common inexpensive method
 delivers a relatively low concentration of oxygen (24%
to 4...
Low flow Oxygen Mask
 The simple face mask delivers oxygen concentrations from
40% to 60% at liter flow of 5 to 8L/min re...
Face Tents
 used in clients who
cannot tolerate masks.
 provide 30% to 50% O2
concentration at a flow
rate of 4 to 8L/mi...
Non Breather Mask:
 delivers the highest oxygen concentration possible
95% to 100% by means other than intubations or
mec...
Venture Mask:
 delivers oxygen
concentration varying
from 24% to 40% or
50% at flow rate of 4 to
5 L/min.
 It has wide b...
Trans tracheal Oxygen Delivery
 used for oxygen dependent clients.
 With the method client requires less
oxygen (0.5 to ...
Methods Used In Case Of
Pediatrics
 In Case of Infants:
 Oxygen Hood: It is a rigid plastic dome that encloses on
infant...
Nurses Responsibility for
Administration of Oxygen
Hazards of Oxygen Inhalation
 Infection
 Combustion
 Drying of mucus membrane of the respiratory tract
 Oxygen toxicit...
MECHANICAL VENTILATION
 It is a positive or negative pressure breathing device
that can maintain ventilation and oxygen d...
Indications
 Continuous decrease in PaO2.
 Increase in arterial CO2 levels.
 Persistent acidosis
 thoracic or abdomina...
Types
1. Negative Pressure Ventilation:
2. Positive Pressure Ventilation:
Nursing Care of Patient on
Ventilator
NURSING MANAGEMENT OF
CLIENT WITH OXYGEN
INSUFFICIENCY
BIBLIOGRAPHY
 Paul L Mario. The ICU Book. 3rd ed. Delhi: Lippincott
publishers; 2007
 Braunwald, Kasper etal. Harrison’s...
Nursing management of patients with oxygen insufficiency
Nursing management of patients with oxygen insufficiency
Nursing management of patients with oxygen insufficiency
Nursing management of patients with oxygen insufficiency
Nursing management of patients with oxygen insufficiency
Nursing management of patients with oxygen insufficiency
Nursing management of patients with oxygen insufficiency
Nursing management of patients with oxygen insufficiency
Nursing management of patients with oxygen insufficiency
Nursing management of patients with oxygen insufficiency
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Nursing management of patients with oxygen insufficiency

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Nursing management of patients with oxygen insufficiency

  1. 1. Without food…….. 2-3 Weeks…….
  2. 2. Without water…… 2-3 Days….
  3. 3. Without breathing……. Only 3-5 minitues
  4. 4. APARNA.A I MSc. Nursing
  5. 5. Oxygenation  Oxygenation means the delivery of oxygen to the body’s tissues and cells to maintain life
  6. 6. Process of Oxygenation  Ventilation = the exchange of air between the environment and the lungs  Diffusion = the exchange of oxygen from the alveoli into the blood and CO2 in the opposite direction  Transportation= movement of oxygen, CO2, other nutrients, metabolic wastes etc in the blood.  Perfusion = the process of delivering blood to a capillary bed in its biological tissue
  7. 7. FACTORS AFFECTING OXYGENATION Developmental Factors Physiological Factors Behavioral Factors Life Style Factors Medication
  8. 8. MEASUREMENT OF OXYGENATION  Oxygen saturation (SO2)  Arterial oxygen saturation (SaO2)  Venous oxygen saturation (SvO2)  Tissue oxygen saturation (StO2  Saturation of peripheral oxygen (SpO2) HbO2 – amount of oxygenated hemoglobin Hb – total Hb in blood
  9. 9. GAS EXCHANGE: LUNGS& BLOOD
  10. 10. GAS EXCHANGE: BLOOD & TISSUES
  11. 11. OXYGEN–HAEMOGLOBIN DISSOCIATION CURVE
  12. 12. VENTILATION – PERFUSION RATIO (PULMONARY GAS VARIABILITY) V/Q ratio Term Consequences 1 V-Q match Normal PaO2 >1 Dead space ventilation Decreased PaO2 Increased PaCO2 <1 Venous admixture Decreased PaO2 Normal/ decreased PaCO2
  13. 13. asthma, chronic bronchitis, obstructive emphysema, fibrosis, edema VA/ Q↓ part alveolar ventilatory ↓ functional shunt↑>30% respiratory failure 1) type and cause of ventilation-perfusion-mismatching (1) decreased ratio of VA/Q underventilated in relation to their perfusion
  14. 14. (2) increased ratio of VA/Q poor perfusion in relation to their ventilation with air pulmonary artery embolization, DIC in lung, vessels contract, pulmonary arteritis, dead space like ventilation VA/Q↑ poor perfusion↓ respiratory failure · ·
  15. 15. BLOOD GAS VARIABILITY  Arterial blood gas can vary spontaneously without change in the clinical condition of the patient. So routine monitoring of ABG can be misleading and is not justified.
  16. 16. MEANING OF OXYGEN DEFICIENCY  It is the condition in which the lungs cannot take in sufficient oxygen or expel sufficient carbon dioxide to meet the needs of the cells of the body. Also called pulmonary insufficiency.  Respiratory failure is a syndrome in which the respiratory system fails in one or both of its gas exchange functions: oxygenation and carbon dioxide elimination.
  17. 17.  In practice, respiratory failure is defined as a PaO2 value of less than 60 mm Hg while breathing or a PaCO2 of more than 50 mm Hg. Normal reference values :PaO2 < 60mmHg with or without PaCO2 > 50mmHg
  18. 18. CAUSES OF OXYGEN INSUFFICIENCY  Carbon monoxide inhalation  Contact with certain chemicals  Self-induced hypocapnia  A seizure which stops breathing activity  Sleep apnea  Drug overdose  central alveolar hypoventilation syndrome, or primary alveolar hypoventilation
  19. 19. CAUSES OF OXYGEN INSUFFICIENCY  Acute respiratory distress syndrome.  Exposure to extreme low pressure or vacuum  Hanging  Respiratory diseases  Drowning  Anemia  Cyanide poisoning
  20. 20. Respiratory Failure  Indicates impairment of lung’s ability to maintain adequate oxygen and CO2 homeostasis.
  21. 21. Types:  According to PaCO2  Type 1 (Hypoxemic) respiratory failure: Associated with a PaCO2 < 60 mmHg on air or O2 with normal or low PaCO2. It indicates ventilation perfusion mismatch.  Type 2 (Hypoxemic/ hypercarpnic) respiratory failure: PaO2 <60mmHg and PaCO2 > 50mmHg. It indicates alveolar hypoventilation.  `Chronic Respiratory Failure: Respiratory failure can be diagnosed by detecting a failure of acid base compensation, ie, pH<7.25  According to pathogenic mechanism  Ventilatory disorders  Gas exchange disorders  According to primary site  Central respiratory failure  Peripheral respiratory failure
  22. 22. Pathophysiology Respiratory movement disorder neuro-muscular disorders decreased strength, myasthenia gravis hypoxia, acidosis Respiratory movement ↓Depression of CNS damage of CNS drug overdose ▲ Disorders of the respiratory muscles alveolar distensibility Restrictive ventilatory disorders respiratory failure
  23. 23. Hypoxia  a condition in which the body or a region of the body is deprived of adequate oxygen supply.  Hypoxia may be classified as  generalized, affecting the whole body,  local, affecting a region of the body.
  24. 24. Etiological factors Cells can switch to anaerobic metabolism Accumulation of acid by products. e.g, lactate Imbalance in chemical environment of cells Release of lysosomal enzymes tissue destruction less O2 supplied to cells resulting in availability of less energy for cellular functions organelle swelling destruction of tissues and organs
  25. 25. Hypoxemia  an abnormally low level of oxygen in the blood.  specifically, it refers to oxygen deficiency in arterial blood
  26. 26. Source A-a PO2 Partial pressure of O2 in alveolar gas and arterial blood PvO2 Partial pressure of venous oxygen Hypoventilation Normal Normal V/Q mismatch Increased Normal DO2/VO2 Increased Decreased Causes of hypoxemia
  27. 27. Hypoventilation  Alveolar hypoventilation causes both hypoxemia and hypercapnia as a result of a decrease in the total volume of air inhaled (and exhaled) each minute.  No V/Q imbalance in the lungs, so the A-a PO2 gradient is not elevated.  Common causes include:  Brain stem respiratory depression: drugs, obesity- hypoventilation syndrome  Peripheral neuropathy: critical illness polyneuropathy, Guilian Barre Syndrome  Muscle Weakness: critical illness myopathy, hypophosphatemia, magnesium depletion, myasthenia gravis
  28. 28. V/Q abnormality  Most of the cases hypoxemia results from V/Q mismatch in the lungs. E.g, pneumonia, ARDS etc.  The A-a PO2 gradient is almost always elevated in these conditions, but elevation can be minimal in severe airway obstruction (which behave like hypoventilation)
  29. 29. DO2/VO2 (oxygen delivery/ oxygen uptake) imbalance Systemic oxygen delivery is usually accompanied by an increase in O2 extraction from capillary blood maintain constant rate of O2 uptake into the tissue. This result in a decrease in PO2 of venous blood, and it affect arterial oxygenation
  30. 30. Hypercapnia  an arterial PCO2 above 46 mmHg that doesnot represent compensation for a metabolic alkalosis.  The causes can be identified by considering the determinants of arterial PCO2 (PaCO2)  PaCO2 directly related to rate of CO2 production in the body  PaCO2 inversely related to rate of CO2 elimination by alveolar ventilation  Ie, the causes include increased CO2 production (VCO2), hypoventilation and increased dead space ventilation
  31. 31. Anoxia  A total depletion in the level of oxygen, an extreme form of hypoxia or "low oxygen" in which there is a complete lack of oxygen supply to the body as a whole or to a specific organ or tissue region.
  32. 32. Anoxia: Environmental Causes  a lack of oxygen or the presence of other chemicals in the air that affect the ability of blood to load oxygen.  These environmental effects may be caused by factors including:  Carbon monoxide  High altitude  Smoke
  33. 33. Anoxia: Underlining diseases/ conditions  Amyotrophic lateral sclerosis (ALS, also known as Lou Gehrig’s disease; a severe neuromuscular disease that causes muscle weakness and disability)  Cardiac arrest  Chronic obstructive pulmonary disease  Heart failure  Myocardial infarction  Respiratory failure  Severe asthma and allergies  Stroke
  34. 34. Anoxia: Other Events  Choking  Complications of anesthetics  Drowning  Drug overdose  Low blood pressure (hypotension)  Strangulation  Suffocation  Trauma to a tissue or organ
  35. 35. Symptoms  Bluish coloration of the lips or fingernails  Confusion or loss of consciousness for even a brief moment  Dizziness  Poor decision-making  Rapid breathing (tachypnea) or shortness of breath Serious symptoms that might indicate a life-threatening condition  Dilated pupils  Respiratory or breathing problems, such as shortness of breath, difficulty breathing, labored breathing, wheezing, not breathing, choking  Seizures and tremors  Unconsciousness or coma
  36. 36. Treatment  In general,  restoring the oxygen supply, through either increasing the amount of oxygen taken in, such as with an oxygen mask, or assistance with breathing.  Other treatment options include:  Administration of fluids and medication to increase blood pressure  Administration of medications to reduce seizure activity  Administration of medications to regulate heart function  Application of life support system
  37. 37. Cyanosis  It is the appearance of a blue or purple coloration of the skin or mucous membranes due to the tissues near the skin surface having low oxygen saturation.  Cyanosis is defined as a bluish discoloration, especially of the skin and mucous membranes, due to excessive concentration of deoxyhemoglobin in the blood caused by deoxygenation.  5.0 g/dL of deoxyhemoglobin or greater is present
  38. 38. Types of cyanosis  Central (around the core, lips, and tongue)  due to a circulatory or ventilatory problem that leads to poor blood oxygenation in the lungs. It develops when arterial saturation drops to ≤85% or ≤75%  Peripheral (only the extremities or fingers)  It is the blue tint in fingers or extremities, due to inadequate circulation. The blood reaching the extremities is not oxygen rich and when viewed through the skin a combination of factors can lead to the appearance of a blue color
  39. 39. Causes of central cyanosis  1. Central Nervous System Disorders (impairing normal ventilation)  2. Respiratory Disorders  3. Cardiac Disorders  4. Hematological disorders  5. Others
  40. 40. Causes of peripheral cyanosis  All common causes of central cyanosis  Reduced cardiac output (e.g. heart failure, hypovolaemia)  Cold exposure  Arterial obstruction (e.g. peripheral vascular disease, Raynaud phenomenon)  Venous obstruction (e.g. deep vein thrombosis)
  41. 41. Clubbing of fingers  It is a deformity of the fingers and fingernails associated with a number of diseases, mostly of the heart and lungs.
  42. 42. Signs and symptoms  Fluctuation and softening of the nail bed  Loss of the normal <165° angle (Lovibond angle) between the nail bed and the fold (cuticula)  Increased convexity of the nail fold  Thickening of the whole distal (end part of the) finger (resembling a drumstick)  Shiny aspect and striation of the nail and skin
  43. 43. Diagnosis
  44. 44. Other conditions  Acute asthma and COAD  Ischemic heart disease:  Myocardial infarction  Congestive Heart Failure  Syncope
  45. 45. HISTORY AND PHYSICAL EXAMINATION
  46. 46. PFT (Pulmonary Function Test)
  47. 47. ABG (Arterial Blood Gas Analysis)  ABG helps in measurement of blood for patient‘s arterial oxygen and carbon dioxide tensions. Elevated levels of CO2 indicate inadequate alveolar ventilation.
  48. 48. Normal Values of ABG analysis Measurem ent Normal Arterial Values Clinical Significance pH 7.35-7.45 Indicates acid-base balance PCO2 35-45 mm of Hg Indicates adequacy of alveolar ventilation, represents respiratory component of acid- base balance. HCO3 22-26 mEq/l Bicarbonate level; indicates metabolic component of acid- base balance PaO2 80-100 mm of Hg Partial pressure of oxygen; represents oxygen dissolved in plasma SO2 96%-98% Saturation of hemoglobin with oxygen
  49. 49. ABG and oxygenation  A low PaO2 indicates that the patient is not oxygenating properly, and is hypoxemic.  At a PaO2 of less than 60 mm Hg, supplemental oxygen should be administered.  At a PaO2 of less than 26 mmHg, the patient is at risk of death and must be oxygenated immediately  The carbon dioxide partial pressure (PaCO2) is an indicator of CO2 production and elimination  for a constant metabolic rate, the PaCO2 is determined entirely by its elimination through ventilation  A high PaCO2 (respiratory acidosis, alternatively hypercapnia) indicates underventilation (or, more rarely, a hypermetabolic disorder), a low PaCO2 (respiratory alkalosis, alternatively hypocapnia) hyper- or overventilation.
  50. 50. Oximetry  Pulse oximetry is a non-invasive method for monitoring a patient's O2 saturation.
  51. 51. Working principle
  52. 52. Advantages  useful in any setting where a patient's oxygenation is unstable  determining the effectiveness of or need for supplemental oxygen  used to detect abnormalities in ventilation.  Simple to use and the provide continuous and immediate oxygen saturation values  Portable pulse oximeters are also useful for mountain climbers and athletes whose oxygen levels may decrease at high altitudes or with exercise.
  53. 53. Limitations  Pulse oximetry measures solely hemoglobin saturation, not ventilation and is not a complete measure of respiratory sufficiency.  It is not a substitute for blood gases checked in a laboratory, because it gives no indication of base deficit, carbon dioxide levels, blood pH, or bicarbonate (HCO3 -) concentration.
  54. 54.  In severe anemia, the blood will carry less total oxygen, despite the hemoglobin being 100% saturated.  Erroneously low readings may be caused by hypoperfusion of the extremity being used for monitoring incorrect sensor application; highly calloused skin; or movement (such as shivering), especially during hypoperfusion.  Pulse oximetry also is not a complete measure of circulatory sufficiency
  55. 55. Limitations ….  In cases of carbon monoxide poisoning, the inaccuracy may delay the recognition of hypoxia  Cyanide poisoning gives a high reading, because it reduces oxygen extraction from arterial blood.  Methemoglobinemia characteristically causes pulse oximetry readings in the mid-80s.  The only noninvasive method allowing continuous measurement of the dyshemoglobins is a pulse CO- oximeter. It provides clinicians a way to measure the dyshemoglobins carboxyhemoglobin and methemoglobin along with total hemoglobin.
  56. 56. Capnography  It is the monitoring of the concentration or partial pressure of carbon dioxide (CO2) in the respiratory gases  It is usually presented as a graph of expiratory CO2 plotted against time, or, less commonly, but more usefully, expired volume.  The plot may also show the inspired CO2  Direct monitor of the inhaled and exhaled concentration or partial pressure of CO2, and an indirect monitor of the CO2 partial pressure in the arterial blood
  57. 57. Principle of capnography  CO2 absorbs infra-red radiation.  A beam of infra-red light is passed across the gas sample to fall on a sensor. The presence of CO2 in the gas leads to a reduction in the amount of light falling on the sensor, which changes the voltage in a circuit.
  58. 58. Types of capnometry  Colorimetric CO2 detection  Infra red Capnography  Modified nasal cannula for nonintubated patients  Transcutaneous PCO2
  59. 59. Colorimetric CO2 detection  A pH-sensitive chemical indicator is enclosed in a plastic housing and is connected to the gas stream between the endotracheal tube and the anesthesia circuit. The pH sensitive indicator changes color when exposed to C02. The color varies between expiration and inspiration, as C02 level increases or decreases. The color changes from purple (when exposed to room air or oxygen) to yellow (when exposed to 4% C02). The response time of the device is sufficiently fast to detect changes of C02 breath-by breath.1 However, this device is not very sensitive when CO2 output is low as is during CPR. Easy cap II is a an example of such pH sensitive indicator devices.
  60. 60. Diagnostic usage:  provides information about CO2 production, pulmonary (lung) perfusion, alveolar ventilation, respiratory patterns, and elimination of CO2 from the anesthesia breathing circuit and ventilator.  used to measure carbon dioxide production, a measure of metabolism.  Capnography in emergency medical services:  assessment and treatment of patients in the prehospital environment.  verifying and monitoring the position of an endotrachael tube or a blind insertion airway device.
  61. 61. Other measures  Chest Xrays and CT scan  Sputum Studies  Blood Studies  Thoracentesis  Pulmonary Angiography  Bronchoscopes
  62. 62. ACUTE CARE OF PATIENT WITH OXYGEN INSUFFICIENCY  Dysponea Management  Airway Maintenance  Mobilization of secretions  Humidification  Nebulization  Chest Physiotherapy  Postural Drainage  Suctioning  Maintenance and promotion of lung expansion  Positioning  Incentive Spirometry  Chest tubes in case of pneumothorax/ hemothorax
  63. 63. ACUTE CARE OF PATIENT WITH OXYGEN INSUFFICIENCY  Maintenance and Promotion of Oxygenation  Oxygen Therapy  Mechanical Ventilation  Restoration of Cardiopulmonary Function  Cardiopulmonary Resuscitation  Restoring and Continuing Care  Hydration  Coughing and Breathing Exercise  Respiratory Muscle Training
  64. 64. OXYGEN ADMINISTRATION
  65. 65. Need for supplemental oxygen  Tissues are normally hypoxic  The tissues of human body normally operate in a low oxygen environment  Tolerance to arterial hypoxemia  Severe clinical hypoxemia due to pulmonary insufficiency are tolerated without evidence of inadequate oxygenation
  66. 66. Oxygen delivery  FiO2 : fraction of inspired oxygen % of O2 participating in gas exchange Natural air FiO2- 20.9% (≈ 21%) = .21 So supplemental oxygen should have high FiO2 than atmospheric air, ie, > 0.21 upto 1 Typically it is maintained below 0.5 even in ventilator
  67. 67. Low flow delivery systems Device Reservoir capacity O2 flow (L/min) ≈FiO2 (if TV=500ml, RR=20/min, I:E= 1:2 Nasal Cannula 50ml 1 0.21- 0.24 2 0.24-0.28 3 0.28-0.34 4 0.34-0.38 5 0.38-0.42 6 0.42-0.46 Oxygen face mask 150-250ml 5-10 0.40-0.60 Mask-reservoir bag 750-1250ml Partial rebreather 5-7 0.35-0.75  nonrebreather 5-10 0.40-1.0
  68. 68. Methods of Oxygen Delivery  Low flow delivery systems  It provide variable FiO2  e.g, Nasal prongs, face masks, and mask with reservoir.  High flow oxygen masks  It provide complete control of the inhaled gas mixture and deliver a constant FiO2 regardless of changes in the ventilatory pattern
  69. 69. Nasal Prongs/ Nasal Cannula  most common inexpensive method  delivers a relatively low concentration of oxygen (24% to 45%) at flow rate of 2-6L/min  delivers a constant flow of oxygen to the nasopharynx and oropharynx, which act as an oxygen reservoir (average capacity = 50ml, or anatomical dead space)  As the O2 flow rate increases from 1-6L/min, the FiO2 increases from 0.24 to 0.46
  70. 70. Low flow Oxygen Mask  The simple face mask delivers oxygen concentrations from 40% to 60% at liter flow of 5 to 8L/min respectively.  The partial rebreather mask delivers oxygen concentrations of 60% to 90% at liter flow of 6 to 10L/min, respectively.  Mask with reservoir bags: In re breather mask the oxygen reservoir bag that is attached allows the client to re breath about first third of the exhaled air in conjunction with oxygen. Thus it increases FiO2 by recycling expired oxygen. Reservoir increases capacity by 600-1000ml
  71. 71. Face Tents  used in clients who cannot tolerate masks.  provide 30% to 50% O2 concentration at a flow rate of 4 to 8L/min.
  72. 72. Non Breather Mask:  delivers the highest oxygen concentration possible 95% to 100% by means other than intubations or mechanical ventilation, at liter flow of 10 to 15L/min.
  73. 73. Venture Mask:  delivers oxygen concentration varying from 24% to 40% or 50% at flow rate of 4 to 5 L/min.  It has wide bore tubing and color coded jet adaptors that correspond to a precise oxygen concentration and liter flow
  74. 74. Trans tracheal Oxygen Delivery  used for oxygen dependent clients.  With the method client requires less oxygen (0.5 to 2L/min) as all of flow is delivered to lungs directly.  Special Consideration: The nurse keeps the catheter patent by injection 1.5 ml of normal saline with it, moving a cleaning rod in and out and then re- injecting, 5ml of saline twice or thrice a day.
  75. 75. Methods Used In Case Of Pediatrics  In Case of Infants:  Oxygen Hood: It is a rigid plastic dome that encloses on infant‘s head  It provides precise oxygen levels and high humidity.  In Case of Children:  Oxygen Tent: It is made up of rectangular, clear, plastic canopy with outlets that connect to an oxygen source.  Flow rate is adjusted at 10 to 15 L/min after flooding the tent for 5 minutes. At a rate of 15L/minuets.
  76. 76. Nurses Responsibility for Administration of Oxygen
  77. 77. Hazards of Oxygen Inhalation  Infection  Combustion  Drying of mucus membrane of the respiratory tract  Oxygen toxicity  Atelectiasis  Oxygen induced Apnoea  Retrolental Fibroplasias  Asphyxia
  78. 78. MECHANICAL VENTILATION  It is a positive or negative pressure breathing device that can maintain ventilation and oxygen delivery for a prolonged period.
  79. 79. Indications  Continuous decrease in PaO2.  Increase in arterial CO2 levels.  Persistent acidosis  thoracic or abdominal surgery, drug overdose, neuromuscular disorders, inhalation injury, COPD, multiple trauma, shock, multisystem failure, and coma  A patient with apnea, which is not readily reversible
  80. 80. Types 1. Negative Pressure Ventilation: 2. Positive Pressure Ventilation:
  81. 81. Nursing Care of Patient on Ventilator
  82. 82. NURSING MANAGEMENT OF CLIENT WITH OXYGEN INSUFFICIENCY
  83. 83. BIBLIOGRAPHY  Paul L Mario. The ICU Book. 3rd ed. Delhi: Lippincott publishers; 2007  Braunwald, Kasper etal. Harrison’s Principles of Internal Medicine.15th ed. USA:McGraw Hills Publishers;2001  Chintamani. Lewis’s Medical Surgical Nursing.1st ed. India: Mosby’s Publishers;2011  Joyce M. Black, Jane Hokason Hawks. Medical Surgical Nursing. 8th ed. India: Saunders publishers;2010  Patricia Potter, Anne Griffin Perry. Fundamentals of Nursing. 6th ed. New Delhi: Elsevier Publications;2006

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