SEMINARON

OXYGEN INSUFFICIENCYSENSORY DEPRIVATION

PRESENTED BY-PARBHJOT KAUR

M.Sc. (N) 1ST YEAR

OXYGEN INSUFFICIENCYINTRODUCTION

Oxygen insufficiency means “ deficient in oxygen”. The normal range of oxygen in the external blood should be 80-100 mm of Hg. For treating oxygen insufficiency effectively, early diagnosis and correct cause should be ruled out. The only management for oxygen insufficiency is oxygen administration.

DEFINITION

Oxygen insufficiency is a condition in which the body as a whole or a region is deprived of adequate oxygen supply. Oxygen insufficiency is a failure to provide adequate oxygen to cells of the body and to remove excess carbon dioxide from them.

ETIOLOGY

1. Decreased hemoglobin

2. High altitude

3. Inability of the tissue to extract oxygen from the blood

4. Decreased diffusion of oxygen from the alveoli to the blood

5. Poor tissue perfusion with oxygenated blood

6. Impaired ventilation

PHYSIOLOGY OF RESPIRATION 

Pulmonary Ventilation: This means movement of air into and out lungs. Its main purpose is to supply fresh air.Ventilation is composed of:Inspiration- When air flows into lungsExpiration- When air moves out of lungs.

Adequate Ventilation depends upon:

• Clear airways• An intact central nervous system and respiratory

system.• An intact thoracic cavity capable of expanding and

contracting.• Adequate pulmonary compliance and recoil

Regulation of Respiration

Respiration is regulated by two mechanisms-

ChemicalNeural

Nervous system of body adjusts rate of alveolar ventilation to meet needs of body so that po2 and pco2 remain relatively constant. Control is through respiratory centre which is actually a number of groups of nerves located in medulla oblongata and pons of brain.

Cause of Oxygen insufficiency and factors affecting oxygenation

 1. Developmental FactorsAt birth, fluid filled lungs drain first and pco2 rises. This causes neonate to take first breath. Lungs are gradually expanding till 2 weeks of age. Changing in age affect respiratory system of elders become especially important if system is compromised by changes such as infection, physical or emotional stress.

2. Physiological FactorsVarious diseases can exert their effect on oxygenation including disease of respiratory system like COPD, pneumonia, any tumor in respiratory system, airway obstruction etc.

3. Behavioral FactorsWhenever stress is there both physiologic and psychological responses can affect oxygenation. The person may experience light headedness, numbness, tingling of fingers, toes and around mouth. On other hand , there is release of epinephrine through sympathetic stimulation. Epinephrine causes bronchioles to dilate, increases blood flow and oxygen delivery to muscle.

4. Lifestyle FactorsPhysical activity or exercise increase the rate and depth of respiration and hence supply of oxygen in body.

Sedentary lifestyle there is lack of alveolar expansion and essential deep breathing pattern.

5. Environmental FactorsAltitude , heat, cold, and air pollution affect oxygenation .The higher the altitude lower is the pco2 a patient breathes.Air pollution can cause stinging of eyes , headache, dizziness, coughing and chocking even in healthy people.

6. MedicationCertain medications including sedatives , hypnotics and narcotics like morphine can cause respiratory depression.

Pathophysiologyof

Hypoxia

Due to any factors there is reduced oxygen in body called hypoxia

  

Cells can switch to anaerobic metabolism

Accumulation of acid

by products e.g. lactate

Imbalance in chemical environment of cells.

Release of lysosomal enzymes

Tissues destruction

Less O2 supplied to cells

Resulting in availability of less for cellular functions.

Organelle Swelling

Destruction of tissues and organs.

Hypoxia is evident by-Cyanosis

Altered breathing patterns including tachypnea and dyspnea

Anxious faceFatigue

CO2 TRANSPORT AND EXCRETION  

When CO2 combines with water, it produces Carbonic Acid & H+ ions

Stimulates respiratory centers

Increase in rate, depth of breath

Tachypnoea in order to bring back pH levels.

Because of hypoxia, there will be rise in carbonic acid levels leading to respiratory

acidosis.

But sometimes in response to hypoxia hyperventilation may occur.

 

NURSING MANAGEMENT

Assessment

Nursing Health HistoryIt includes:Exploration of present problem

Any past respiratory disease

Cough and its characteristics along with sputum

Lifestyle

Medication used for breathing.

Presenting Problems orSign and symptoms may include-

Anxiety and IrritabilityTired

Headache and DizzinessMemory loss

Nausea and vomitingOliguria / Anuria

Visual impairmentClubbing of finger

Impairment in judgment Shortness of breath

PhysicalExamination

INSPECTION

Client’s efforts at ventilationAnxious or distressed appearance

Flaring of nostrilsPosition preferences and general best configuration

Cyanosis because of poor circulation & edemaChanges in level of consciousness

ConfusionAgitation

Stupor or coma indicate ischemia of neuronal cellsHypoxia

PALPATIONDisplacement Of Trachea

Pulse Rate Clammy Skin

Ulcer In Lower Extremities

PERCUSSIONHyper resonance

Dull percussion toneChanges in the density of lungs and surrounding tissues

DIAGNOSTICSTUDIES

PULMONARY FUNCTION TEST

ARTERIAL BLOOD GAS ANALYSIS

SPUTUM STUDIES

CHEST X-RAYS & CT SCAN

BRONCHOSCOPY

THORACENTESIS

NURSINGDIAGNOSIS

1. INEFFECTIVE AIRWAY CLEARANCEMay by related to:-Obstruction of airway by the tongue.Upper airway obstruction caused by edema of larynx or glottis. Obstruction of the trachea or a bronchus by foreign body aspiration.Manifested by:-Shortness of breathUse of accessory musclesDifficulty in speakingCoughDiminished breath sound

2. INEFFECTIVE BREATHING PATTERN may be related to restrictive pulmonary disease or any major abdominal or thoracic surgery or restricted mobility.

3. IMPAIRED GAS EXCHANGE related to overall decrease in the amount of alveolar capillary surface area available for gas exchange as manifested by altered findings on ABG or Pulse oximetry.

4. DECREASED CARDIAC OUTPUT related to congestive heart failure causing pulmonary edema, heart failure or shock as manifested by cool clammy skin, weak thread pulse, low urine output and diminished level of consciousness. 

OXYGENADMINISTRATION

NEED OF OXYGEN ADMINISTRATION

Clients who have difficulty in ventilating all areas of their lungs, those whose gas exchange is impaired or

people with heart failures may require oxygen therapy to prevent hypoxia.

METHODS OF OXYGEN DELIVERY

NASAL CANNULA

FACE MASK

NON BREATHER MASK

VENTURE MASK

FACE TENTS

METHODS USED IN CASE OF INFANTS

OXYGEN HOOD

NURSING RESPONSIBILITY FOR ADMINISTRATION OF

OXYGEN

Check the nameBed number

Confirm diagnosisNeed of oxygen therapy

Asses cyanosisBreathing pattern

Monitor for result of ABGCheck that the oxygen is properly

humidified

HAZARDS OF OXYGEN INHALATION 1. Infection2. Combustion3. Drying of mucus membrane of the respiratory tract4. Oxygen toxicity: Dryness and imitation of mucus membrane

Substernal pain Nausea and vomiting

5. Atelectiasis 6. Oxygen induced Apnoea7. Retrolental Fibroplasias: Oxygen therapy may affect the eyes

Especially in infants 8. Asphyxia

Sensory deprivation

INTRODUCTION

Sensory deprivation is generally thought of as a decrease in or lack of meaningful stimuli.It results when a person experiences decreased sensory input

FACTORS AFFECTING SENSORY FUNCTION

DEVELOPMENTAL STAGEPerception of sensation is critical to the

intellectual social and physical development of the infants and

children .

STRESSDuring stress, people find their senses already overloaded and thus seek to

decrease sensory stimulation.

MEDICATION AND ILLNESSCertain medication can alter an

individual’s awareness of environmental stimuli.

e.g. Narcotics, sedatives

LIFE STYLE AND PERSONALITYLifestyle influences the quality and quantity of stimulation to which individual is accustomed.

e.g. Some people delight in constantly changing stimuli and excitement, whereas others prefer

more structured life with few changes.

CLIENT WHO ARE AT RISK OF SENSORY DEPRIVATION

1. Clients in long term care settings2. Clients who are confined to bed.3. Clients with sensory alterations (impaired vision, hearing ) 4. Clients who are depressed 5. Client with a disturbance of the nervous system.  

CLINICAL SIGNS

PHYSICAL BEHAVIOURExcessive yawning

DrowsinessSleeping.

ESCAPE BEHAVIOUR

EatingExercisingSleepingRunning away from deprivedenvironment.

COGNITIVE BEHAVIOUR CHANGES

Decreased Attention SpanDifficulty In ConcentratingDecreased Problem SolvingImpaired MemoryPeriodic DisorientationGeneral ConfusionNocturnal ConfusionDecreased Task Performance

PERCEPTUAL CHANGES

1.Inaccurate perception of: Sight SoundTasteSmellBody PositionsCoordination Equilibrium

2. Palpitations3. Hallucinations4. Delusions

AFFECTIVE BEHAVIOUR CHANGES

1. Anxiety 2. Fear3. Anger 4. Panic5. Rapid Mood Changes 6. Crying7. Depression 8. Apathy

NURSING MANAGEMENT

ASSESSMENT

1.Nursing history2.Mental status examination3.Physical examination4.Identification of clients at risk5.Social background

NURSINGDIAGNOSIS

1. Disturbed sensory perception.

2. Risk for injury related to disturbedsensory perception, like hearing

impairment, visual impairment etc

3. Risk for impaired skin integrity(altered tactile stimulation)

NURSINGDIAGNOSIS

4. Impaired verbal communicationrelated to altered level of

consciousness or impaired hearing

5. Self care deficit related to visualimpairment, diminished perception.

6. Social isolation related to impairedvision, hearing, memory etc.

PLANNING

1.Care of clients independent of setting.2. Maintain the function of existing senses3. Develop an effective communication mechanism4. Prevent injury5. Reduce social isolation6. Perform activities of daily living activities independently and safely

IMPLEMENTATION 

Promoting healthy sensory functionHealthy sensory function can be promoted with environmental stimuli that provide appropriate sensory input.

Adjusting environmental stimuliThe client functions best when the environment is similar to that of the individual's ordinary life.

Preventive sensory deprivationEncourage sensory functionPromote the use of other sensesCommunicate effectivelyEnsure client safetyVisual StimulationColourful SheetsCardsPicturesFlowers

Auditory Stimulation

T.V.

Radio

Computer

Caring And Orienting

Communication

Reading Material To Client

Call By Name

Tactile Stimulation

Backrubs

Turning And Repositioning

Hair Brushing

Combing

Gentle touch

Olfactory StimulationOral HygieneCare Of DenturesFoods Of Different ColourTemperature Served AttractivelyHome FoodsPleasurable AromasSmelling Food Before Serving It

Cognitive InputOrient The Patient To EnvironmentEncourage In Self CareDiscuss Current EventsEmotional OutputEncourage Client To Share Fears, Concerns And PerceptionsReassure Client

Impaired Vision

Orient the client to the arrangementof room furnishings.

Good lightening in room.

Assist with ambulation.

Impaired Hearing

Assess the client frequently

Hearing aids

Call person by name

Television, Radio may be helpful

Impaired Olfactory SenseKeep gas stoves and heaters in a good working order

Ask the client to assess the fragrances of different things.

Impaired Tactile SenseThe clients with impaired sense of touch may not be aware of hot temperature, which can cause-

• Burns• Pressure ulcers

Therefore the temperature adjustment of water should be done before bathing.

Confused ClientThis is most commonly seen in older people.

Promote orientation to time, place, person and situation.

Unconscious Client

1. Listen carefully to support person’s concerns. 2. Maintain the schedule each day. 3. Touch and stroke the unconscious client.4. Encourage family members to talk to andtouch the client as though the client were conscious.5. Call the patient by name.

EVALUATION

Using the measurable desired outcomes developed during the planning stage as a guide , the

nurse collects data needed to judge whether client goals and outcomes have been achieved . If outcomes are not achieved , the nurse and the client, and support people if appropriate need to explore the reason before modifying

care plan.

REFERENCESBasheer SP et al. “ A concise textbook of advanced nursing practice”. Published by EMMESS Medical publishersPage No. 198-207280-283Available on URL: https://en.wikipedia.org/wiki/Sensory_deprivationhttp://www.scribd.com/doc/154283938/Oxygen-Insufficiency#scribd