oxygenation without disorders

8/9/2019 Oxygenation Without Disorders

1/98

Julie Ann Castillo Barut RN (RP US),

MAN (on going)


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LARYNX Located above the trachea & just below the pharynx at

the root of the tongue

Commonly called the VOICE BOX

Contains 2 pairs of vocal cords, the false & true cords The opening between the true vocal cords is theGLOTTIS

GLOTTIS - Valsalva Maneuver

EPIGLOTTIS Leaf-shaped elastic structure that is attached along

one end to the top of the larynx

Prevents the food from entering the tracheo-bronchial

tree by closing over the glottis during swallowingJulie Ann Castillo Barut RN (RP US),MAN (on going)


5/98


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TRACHEA Located in front of the esophagus

Branches into the right & left mainstem bronchi at the

carinaMAINSTREAM BRONCHI Begin at the carina RIGHT BRONCHUS is slightly wider, shorter, &

more vertical than the left bronchus

Mainstream bronchi divide into 5 secondary or lobar

bronchi that enter each of the 5 lobes of the lung

The bronchi are lined with cilia which propel mucus up

& away from the lower airway to the trachea where it

can be expectorated or swallowed


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BRONCHIOLESBranch from the secondary bronchi & subdivide into small

terminal & respiratory bronchioles

Contain no cartilage & depend on the elastic recoil of the lung

for patency

Terminal bronchioles contain no cilia & dont participate in gasexchange

ALVEOLAR DUCTS & ALVEOLI- used to indicate all structures distal to the terminal bronchiole

Alveolar ducts branch from the respiratory bronchioles

Alveolar sacs which arise from the ducts contain clusters ofalveoli which are basic units of gas exchange

Cells in the walls of the alveoli secrete surfactant

- phospholipid CHON the reduces the surface tension in the

alveoli

- without surfactant the alveoli would collapseJulie Ann Castillo Barut RN (RP US),

MAN (on going)


7/98


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8/98

LUNGS Located in in the pleural cavity in the thorax

Extend from just above the clavicles to the diaphragm -

the diaphragm is the major muscle of respiration

RIGHT LUNG - is larger than the left; divided into 3 lobes:

the upper, middle & lower lobes LEFT LUNG - somewhat narrower than the right lung to

accommodate the heart ; divided into 2 lobes

Innervation of the respiratory structures is accomplished

by the PHRENICPHRENIC NERVE, VAGUS NERVE & THORACICNERVE, VAGUS NERVE & THORACIC

NERVESNERVES PARIETAL PLEURAPARIETAL PLEURA - lines the inside of the thoracic

cavity including the upper surface of the diaphragm

VISCERAL PLEURAVISCERAL PLEURA - covers the pulmonary surfaces

A thin fluid layer produced by the cells lining the pleura,

lubricates the visceral & parietal pleuraJulie Ann Castillo Barut RN (RP US),

MAN (on going)


9/98

ACCESSORY MUSCLES OFACCESSORY MUSCLES OFRESPIRATIONRESPIRATION

SCALENE MUSCLESSCALENE MUSCLES Elevate the first 2 ribsElevate the first 2 ribs

STERNOCLEIDOMASTOID MUSCLESSTERNOCLEIDOMASTOID MUSCLES Raises the sternumRaises the sternum

TRAPEZIUS & PECTORALISTRAPEZIUS & PECTORALIS

MUSCLESMUSCLES Fix the shouldersFix the shoulders


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the diaphragm descends into the abdominal cavityduring inspiration causing (-) pressure in the lungs

the (-) pressure draws the air from the area of greater

pressure (THE ATMOSPHERE)(THE ATMOSPHERE) into an area of lesser

pressure (THE LUNGS)(THE LUNGS)

In the lungs, air passes thru the terminal bronchiolesinto the alveoli to oxygenate the body tissues

At the end of inspiration, the diaphragm & intercostal

muscles relax & the lungs recoil

As the lungs recoil, pressure within the lungs becomes

greater than atmospheric pressure, causing the airwhich now contains the cellular waste products of CO2

& H2O to move from the alveoli in the lungs to the

atmosphere

Expiration is a passive process

THE RESPIRATORY PROCESSTHE RESPIRATORY PROCESS


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Ventilation (breathing) is accomplished through inspiration(inhalation) when air flow into the lungs and expiration(exhalation) when air moves out of the lungs

Respiratory centers of the medulla and pons in the brain stem

control breathing The degree of chest expansion during normal breathing is

minimal and requires little energy

COPD

Pneumothorax (air in the pleural space) Hemothorax (blood

Pleural effusion (fluid) interferes with lung expansion


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Diffusion is the movement of the respiratoryprocess or other particles from an area of greaterpressure or concentration to an area of lower

pressure or concentration When the pressure of O2 is > in the alveoli than

in the blood, oxygen diffuses into the blood

When the pressure in venous blood is greater

than the pressure of CO2 in the alveoli, where itcan be eliminated with expired air


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Oxygen needs to be transported from the lungs tothe tissues, and CO2 must be transported from thetissues back to the lungs

Normally 97% of the oxygen combines looselywith Hemoglobin

It is carried to the tissues as oxyhemoglobin

The remaining oxygen is dissolved and

transported in the fluid of the plasma and cells


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1. CARDIAC OUTPUTN=5L/minuteThe amount of blood pumped by the heartAny pathologic condition that decreases cardiac output

diminishes the amount of oxygen delivered to the tissues2. NO. OF ERYTHROCYTESHematocrit is a measurement of the percentage of RBCs in the

bloodMale N= 40%-54% Female N= 37%-47%

Excessive increase in the blood Hct, raise the blood viscosity(thickness), reducing the CO and O2 transport

3. EXERCISEWell trained athletes, O2 can be inc. up to 20x the normal rate, ---

inc. cardiac output and to efficient use of O2 by the cellsJulie Ann Castillo Barut RN (RP US),

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The movement of air into or out of the lungs

The diffusion of oxygen and carbon dioxidebetween the alveoli and the pulmonarycapillaries

Transport of O2 and CO2 via the blood to andfrom the tissue cells


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1. HYPOXIA

- Hypoventilation (inadequate alveolar ventilation, canlead to hypoxia)

- CO2 accumulate in the blood- Hypercarbia/ hypercapnia

Cyanosis bluish discoloration of the skin, nail beds, andmucus membranes due to reduced hemoglobin-oxygen saturation

Clubbing of fingers late sign of hypoxia

Manifestations of hypoxia; rapid pulse, rapid shallowrespirations, dyspnea, restlessness, flaring of the nares,substernal or intercostal retractions, cyanosis


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Upper Airway Obstruction

Caused by a foreign object such as food, by thetongue blocking the oropharynx, when a person is

unconcious, or by collecting in the passageways

Lower Airway Obstruction

Partial/complete blockage of the passageways in the

bronchi and lungs (caused by bronchospasm),increased production of secretions; bronchialinflammation


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The heart, blood vessels, and blood form the majortransport system of the body.

The heart serves as the system pump, moving

blood through the vessels to the tissuesTHE HEART

hollow cone-shaped organ about the size of a fist.

3 Layers

Endocardium internal layer Myocardium cardiac muscle; contract w/ each

beat

Epicardium outer layer; enclosed by a doublelayered membrane calledpericardium


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Cardiovascular function can be altered byconditions that affect:

1. The function of the heart as a pump (cardiac

output)

2. blood flow to organs and peripheral tissues(tissue perfusion)

3.

The composition of the blood and its ability totransport oxygen and carbon dioxide (bloodalterations)


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M.I., CHF.Infections cause damage to the heartmuscle, the heart can no longer pumpeffectively

Very irregular or excessively rapid or slowheart rates can decrease cardiac output

Abnormalities of the heart rate are known asdysrhythmias ( can be identified ECG)

Alterations in the heart structure such as CHD,infectious heart drs causes dec cardiac output


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Ischemia

lack of blood supply to tissues and organsdue to obstructed circulation

Atherosclerosis

-narrowing and obstruction of the circulatoryblood vessels (most common cause of ischemia

RISK Factors; tobacco smoking, high fat intake,obesity, sedentary lifestyle, hypertension,

uncontrolled DM


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If veins do not function properly Veins can also be inflamed , reducing blood

flow and increasing the risk of thrombus (clot)formation

The thrombus may then break loose, becomingan embolus (pleural emboli)


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When blood is unable to transport oxygen totissues, effectively , impaired tissue perfusionoccurs

Hypovolemia BP and cardiac putput fall

Hypervolemia fluid retention/ kidneyfailure; tissue ischemia


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Diseases of the CVS and RS

Medications

Stress

Anger

Type A personality

Gender

Lifestyle Environment


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SmokingSmoking Use of chewing tobaccoUse of chewing tobacco

AllergiesAllergies Frequent respiratory illnessesFrequent respiratory illnesses Chest injuryChest injury SurgerySurgery Exposure to chemicals &Exposure to chemicals & environmentalenvironmental

pollutantspollutants Family history of infectious diseaseFamily history of infectious disease Geographic residence & travel toGeographic residence & travel to foreignforeign

countriescountriesJulie Ann Castillo Barut RN (RP US),

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CHEST XCHEST X--RAY (CXR) FILMRAY (CXR) FILM(RADIOGRAPH)(RADIOGRAPH)

- information on the anatomic location & appearance

PREPRE--PROCEDURE NURSING CAREPROCEDURE NURSING CARE Remove all jewelry & other metal objects

Assess ability to inhale & hold the breath

Question regarding pregnancy of possibility of pregnancy


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Pulse Oximetry


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Detects hypoxemia

Normal SaO2 95%-100%

Below 70% life threatening


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PULSE OXIMETRYPULSE OXIMETRY- a non-invasive test that registers arterial O2 saturation

(SaO2)- NORMAL VALUE: 95%NORMAL VALUE: 95%--100%100%

- alert hypoxemia before clinical signs occurs

PROCEDUREPROCEDUREA sensor is placed: finger, toe, nose, earlobe or forehead

Dont select an extremity with an impediment to blood flow

Results lower than 91% - immediate treatment

If the SaO2 is below 85% - hypo-oxegenation If the SaO2 is 70% - life-threatening situation


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Allows continuous observation of the clientscardiac rhythm

Electrodes attached to the clients chest

Used to warn of potential problems such as avery fast or very slow heart rates


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SPUTUM SPECIMENSPUTUM SPECIMEN-- obtained by expectoration or tracheal suctioningobtained by expectoration or tracheal suctioning

-- identify organisms or abnormal cellsidentify organisms or abnormal cells

PREPRE--PROCEDURE NURSING CAREPROCEDURE NURSING CARE Determine specific purposeDetermine specific purpose Early morning sterile specimenEarly morning sterile specimen 15 ml of sputum15 ml of sputum

Rinse the mouth with water prior to collectionRinse the mouth with water prior to collection Take several deep breaths and then cough forcefullyTake several deep breaths and then cough forcefully Collect the specimen before antibioticsCollect the specimen before antibiotics


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SUCTIONING PROCEDURE INSUCTIONING PROCEDURE INOBTAINING SPUTUM SPECIMENOBTAINING SPUTUM SPECIMENAseptic technique

Hyperoxygenate Lubricate the catheter with sterile water

Tracheal suctioningTracheal suctioning: 4 inches

NasotrachealNasotracheal suctioningsuctioning: insert to induce cough reflex

Dont apply suction while inserting

Suction intermittently for 10-15 seconds Rotate and withdraw

Hyperoxygenate & deep breaths


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SPUTUM SPECIMENSPUTUM SPECIMEN

POSTPOST--PROCEDURE NURSING CAREPROCEDURE NURSING CARE

Transport specimen to lab stat

Mouth care


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BRONCHOSCOPYBRONCHOSCOPY

- visual examination of the larynx, trachea & bronchi with a

fiber-optic bronchoscope

PREPRE--PROCEDURE NURSING CAREPROCEDURE NURSING CARE Informed consent

NPO prior

Assess coagulation studies

Remove dentures or eyeglasses Prepare suction

Sedatives as Rx

Have resuscitation equipment available


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POSTPOST--PROCEDURE NURSING CAREPROCEDURE NURSING CARE V/S Fowlers position

Assess gag reflex

NPO until gag reflex returns

Monitor for bloody sputum Monitor respiratory status

Monitor for complications: bronchospasm, bronchial

perforation, crepitus, dysrhythmia, fever, hemorrhage,

hypoxemia, and pneumothorax

Notify the MD if complications occur


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PULMONARY ANGIOGRAPHYPULMONARY ANGIOGRAPHY- insertion of a flouroscopy via the antecubital or femoral

vein into the pulmonary artery

- it involves iodine or radiopaque or contrast material


Assess for allergies to iodine, seafood & dyes

NPO prior to procedure

V/S

Assess coagulation studies

Establish an IV

Administer sedation

Client must lie still during the procedureJulie Ann Castillo Barut RN (RP US),

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PULMONARY ANGIOGRAPHYPULMONARY ANGIOGRAPHYPREPRE--PROCEDURE NURSING CAREPROCEDURE NURSING CARE Urge to cough, flushing, nausea, or a salty taste

Emergency equipment available


V/S

No BP for 24 hrs in the affected extremity Monitor peripheral neurovascular status

Assess for bleeding

Monitor dye reaction


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THORACENTESISTHORACENTESISPREPRE--PROCEDURE NURSING CAREPROCEDURE NURSING CARE Informed consent

V/S

CXR or U/S prior to the procedure Assess coagulation studies

Upright

Do not to cough, breath deeply, or move during the

procedure


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POSTPOST--PROCEDURE NURSINGPROCEDURE NURSING

CARECARE V/S

Monitor respiratory status

Pressure dressing Assess site for bleeding and crepitus

Monitor for signs of PNEUMOTHORAX, AIR EMBOLISM &PNEUMOTHORAX, AIR EMBOLISM &PULMONARY EDEMAPULMONARY EDEMA


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V/S

Pressure dressing

Monitor for bleeding

Monitor for respiratory distress

Monitor for complications: pneumothorax and air emboli Prepare for CXR


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VENTILATION PERFUSION LUNG

VENTILATION PERFUSION LUNGSCANSCAN

- determines the patency of the pulmonary airways

- a radionuclide may be injected


Assess for allergies to dye, iodine, or seafood

Remove jewelry

Review breathing methods

IV access

Administer sedation

Emergency resuscitation equipment


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POSTPOST--PROCEDURE NURSINGPROCEDURE NURSING

CARECARE Monitor reaction to radionuclide

For 24 hrs following the procedure, handle body secretions carefully,

rubber gloves worn when urine is being discarded should be washed

with soap & H2O before removing, then the hands should be washedafter the gloves are removed

Instruct the client to wash hands carefully with soap and H2O for 24

hrs following the procedure


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Provides a graphic recording of the hearts electricalactivity

Detects dysrhythmias and alterations in

conduction, indicative of myocardial damage,enlargement of the heart


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SKIN TESTSSKIN TESTS

PREPRE--PROCEDURE NURSING CAREPROCEDURE NURSING CARE Determine hypersensitivity or previous reactions to skin

tests

PROCEDUREPROCEDURE Should be of excessive body hair & dermatitis

Upper 1/3 of inner surface

Circle, document the date, time and test site


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Do not to scratch

Do not wash

Assess for induration (hard swelling), erythema and

vesiculation (small blister-like elevations)


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CHEST PHYSIOTHERAPY (CPT)CHEST PHYSIOTHERAPY (CPT)

NURSING CARENURSING CARE Best time - morning upon arising, 1 hr before meals or 2-3hrs after meals

Stop if pain occurs

Provide mouth care


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CONTRAINDICATIONS OFCONTRAINDICATIONS OFCHESTPHYSIOTHERAPY (CPT)CHESTPHYSIOTHERAPY (CPT)

respiratory distress

Hx of fractures

Chest incisions


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POSTURAL DRAINAGEPOSTURAL DRAINAGE- use of the gravity

NURSING CARENURSING CARE Position the client Best time A.M. upon arising, 1 hr before meals, 2-3 hrs

after meals

Stop if cyanosis or exhaustion occurs

Maintain position 5-20 mins after Provide mouth care after the procedure


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CONTRAINDICATIONS OFCONTRAINDICATIONS OFPOSTURAL DRAINAGEPOSTURAL DRAINAGE Unstable V/S

Increased ICP

CLIENT INSTRUCTIONS FORCLIENT INSTRUCTIONS FORINCENTIVE SPIROMETRYINCENTIVE SPIROMETRY Use the lips to form seal around the mouth piece

Inspire deeply Hold inspiration for a few seconds

Forcefully exhale

Avoid the use of spirometry at mealtimes

- it may cause nausea


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OXYGEN (OOXYGEN (O22) ADMINSITRATION) ADMINSITRATION

NURSING CARENURSING CARE

V/S

OXYGEN IN USEOXYGEN IN USE sign

Humidify the O2


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NASAL CANNULA (NASAL PRONGS)NASAL CANNULA (NASAL PRONGS)- flow rates of 1-6L/min; 24% (at 1L/min) to 44%

(at 6L/min)

- flow rates higher than 6L/min dont significantly increaseoxygenation

NOTE: Client who retains CONOTE: Client who retains CO22 should never receive Oshould never receive O22 at ratesat rates

higher than 2higher than 2--3 L/min unless on a mechanical ventilator3 L/min unless on a mechanical ventilator

- effective O2 concentration can be delivered to both nose

breathers & mouth breathers with the use of a nasalcannula


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FFII0022 DELIVERED VIADELIVERED VIANASAL CANNULANASAL CANNULA

24% at 1L/min

28% at 2L/min

32% at 3L/min

36% at 4L/min

40% at 5L/min 44% at 6L/min


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Add humidification

Monitor humidifier

Assess RR Assess the mucosa

- high flow rates have a drying effect & increase

mucosal irritation

Assess the skin integrity

- O2 tubing can irritate the skinProvide water-soluble jelly


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SIMPLE FACE MASKSIMPLE FACE MASK

- 40%-60% for short term O2 therapy or to deliver O2 in an

emergency

- minimal flow rate of 5L/min - to prevent the rebreathing of

exhaled air

NURSING CARENURSING CARE Be sure the mask fits

Provide skin care

- pressure & moisture under the mask may cause skin

breakdown

Monitor for aspiration- the mask limits the clients ability to clear the mouth esp if

vomiting occurs

Provide emotional support to decrease anxiety in the client

who feels claustrophobicJulie Ann Castillo Barut RN (RP US),MAN (on going)


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NONNON--REBREATHER MASKREBREATHER MASK- 90%

- most frequently deteriorating respiratory status requiring

intubation- has a one-way valve between the mask & reservoir and

two flaps over the exhalation ports

- entire quantity of O2 from the reservoir bag

- the flaps prevent room air from entering thru the

exhalation ports


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NONNON--REBREATHER MASKREBREATHER MASKFFIOIO22 DELIVERED: 60% to 100%DELIVERED: 60% to 100% FFIOIO22 at a liter flow that maintainsat a liter flow that maintains

the bag 2/3 fullthe bag 2/3 full


Remove the mucus or saliva from the mask

Assess the client

Ensure the valve & flaps are functional Valves should open during expiration & close during

inspiration

Monitor for kinks & twisting


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HIGHHIGH--FLOW OXYGEN DELIVERY SYSTEMFLOW OXYGEN DELIVERY SYSTEM

- 24% to 100% at 8-15L/min

- high-flow systems include the Venturi mask, aerosol

mask, face tent, tracheostomy collar, and T-piece

- deliver a consistent and accurate O2 concentrationVENTURI MASKVENTURI MASK

- give accurate O2 concentration

- an adapter is located between the bottom of the mask &

the O2 source

- the adapter contains holes of different sizes that allowonly specific amounts of air to mix with the O2

- the adapter allows selection of the amount of O2 desired


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VENTURI MASKVENTURI MASKFFIOIO22 DELIVERED: 24% to 55%DELIVERED: 24% to 55% FFIOIO22 with flow rates of 4with flow rates of 4--10L/min10L/min

NURSING CARENURSING CARE Monitor closely to ensure an accurate flow rate eep the orifice for the Venturi adapter open uncovered to

ensure adequate oxygen delivery

Ensure the mask fits snugly & that tubing is free of kinks

Monitor mucous membranes


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FACE TENTFACE TENT

- fits over the clients chin, with top extending halfway

across the face

- the O2 concentration varies

- useful for the client who has facial trauma or burns

because it is not tightAEROSOL MASKAEROSOL MASK

- used for the client who has thick secretions

TRACHEOSTOMY COLLAR OR TTRACHEOSTOMY COLLAR OR T--PIECEPIECE- the tracheostomy collar can be used to deliver high

humidity & the desired O2 to the client with a

tracheostomy

- a special adapter, called T-piece can be used to deliver

any desired FIO2 to the client with a tracheostomy,

laryngectomy or endotracheal tube


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Face te t

er s l as


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FACE TENT, AEROSOL MASK, TRACHEOSTOMYFACE TENT, AEROSOL MASK, TRACHEOSTOMY

COLLAR & TCOLLAR & T-- PIECEPIECEFFIOIO22 DELIVERED: 24% to 100%DELIVERED: 24% to 100% FFIOIO22 with flow rates of at leastwith flow rates of at least

10L/min10L/min

NURSING CARENURSING CARE Change to nasal cannula during meals

Empty condensation Monitor water in the canister & change the aerosol water

container as needed

eep the exhalation port in the T-piece open

Position the T-piece so that it does not pull on the

tracheostomy or endotracheal tube- it may cause erosion of the skin at the tracheostomy

insertion site


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A. Endotracheal Tube

Purpose:

1. Tracheal Suctioning2. Positive Pressure Breathing

Nsg. Care:1. Humidify air

2. Suction PRN

3. NGT

4. Promote Communication

5. Confirm placement

6. Monitor the cuffJulie Ann Castillo Barut RN (RP US),

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NSG. CARE:

1. Asepsis2. No sedative

3. Suction PRN

4. Hemostats

5. NGT, TPN & Oral nutrition

6. Wash the stoma7. Tub bath

8. Avoid swimming

9. Weaning


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Anti-emboli stockings preventsdegrees of immobility


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a combination of oral resuscitation , whichsupplies O2 to the lungs and external cardiacmassage which is intended to reestablish

cardiac function and blood circulation


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A cardiac arrestis the cessation of cardiac function; heartstops beating. Within 20 to 40 seconds of a cardiac arrest, thevictim is clinically dead. After 4-6 min irreversoble braindamage occur

ARes irat ry arrestis the cessation of breathing itoften occur follo ing a cardiac arresr


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Maintaining a patent airway with breath soundclear and absence of dyspnea

Demonstrating behaviors to improve airwayclearance

Demonstrating improved ventilation andadequate oxygenation of tissues by ABGswithin the clients normal range and by freesmptoms of respiratory distress

Establishing a normal/ effective respiratory

distress Be free of cyanosis and other signs and

symptoms of hypoxia


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CONTINUING CARE


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Nurse provides client education regarding:

Behaviors and lifestyle changes to regain andor maintain appropriate weight

Identifying interventions to prevent or reduce

risk of infections Verbalization of condition or disease process

and treatment

Identification of relationship of current signs/

symptoms to the disease process andcorrelation of these with causative factors


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CONTINUING CARE


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Ph 7.35 7.45

ph acidosis ( H ion conc.)

ph alkalosis( H ion conc.)

BUFFER SYSTEM:Bicarbonate : Carbonic acid

HCO3 : CO3

Strong base : Weak acid20 : 1


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A. Respiratory System: CO2 (acid)

Metabolic acidosis (Lungs) excrete CO2

Metabolic alkalosis (Lungs) retain CO2

B. Renal or Metabolic System: H ion(acid) ; HCO3(base)

Respi. acidosis (Kidney) excrete H+ ; retain HCO3

Respi. alkalosis (Kidney) retain H+ ; excrete HCO3

Normal ABG Values:

Ph : 7.35 7.45 SaO2 95%-100%PCO2 : 35 45 mgHG

HCO3 : 22-26 meq/L

PO2 : 80-100 mgHg

Base excess : (+2 or 2)


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SITE: Radial Artery

TEST: Allens Test

Ph - acidosis alkalosis

PCO2 - alkalosis acidosis

HCO3 - acidosis alkalosis


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1. Assess ph, PCO2 & HCO3

2. Identify imbalance. If ph is normal use 7.4

7.4 acidosis

7.4 alkalosis3. Identify if compensated or uncompensated

uncompensated- if one component is normal & the other is

abnormal

compensated if both PCO2 & HCO3 are abnormal in

opposite directions4. If compensated, identify if partially or fully

partially if ph is abnormal

fully - if ph is normal


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YOU CAN MAKE IT, OUR GOALISTO TAKE IT ONE TIME.

GOODLUCK & MAY GOD BLESS

YOU ALL

BY: Julie Ann C. Barut, RN (USA, RP)

INSTRUCTOR


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MAN (on going)

PULMONARY FUNCTION TESTPULMONARY FUNCTION TEST(PFTs)(PFTs)

- include a number of different tests used to evaluate lung mechanics,

gas exchange, & acid-base disturbance thru spirometric

measurements, lung volumes, and arterial blood gases

PREPRE--PROCEDURE NURSING CAREPROCEDURE NURSING CARE Determine if an analgesic that may depress the respiratory function is

being administered

Consult with MD regarding holding bronchodilators prior to testing

Instruct the client to void prior to procedure and to wear loose clothing

Remove dentures

Instruct the client to refrain from smoking or eating a heavy meal for 4-

6 hrs prior to the test


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POSTPOST--PROCEDURE NURSINGPROCEDURE NURSINGCARECARE Resume normal diet and any bronchodilators &

respiratory treatments that were held prior to the

procedure


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ARTERIAL BLOOD GASES (ABGs)ARTERIAL BLOOD GASES (ABGs)- measure the dissolved O2 & CO2 in the arterial blood and renal acid-

base state & how well the O2 is being carried to the body

- the ventilation scan determines the patency of the pulmonaryairways and detects abnormalities in ventilation

- a radionuclide may be injected for the procedure

PREPRE--PROCEDURE NURSING CAREPROCEDURE NURSING CARE Perform Allens test prior to drawing radial artery specimens Have the client rest for 30 mins prior to specimen collection

Avoid suctioning prior to drawing ABGs

Dont turn off O2 unless the ABGs are ordered to be drawn at room air


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POSTPOST--PROCEDURE NURSING CAREPROCEDURE NURSING CARE Place the specimen on ice

Note the clients temperature on the laboratory form

Note the O2 & type of ventilation that the client is receiving on the

laboratory form

Apply pressure on the puncture site for 5-10 mins & longer if the clientis on anticoagulant therapy or has bleeding disorder

Transport the specimen to the laboratory within 15 mins

oxygenation without disorders

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