1 Lincoln Memorial University Caylor School of Nursing Nursing 115 Fall 2008 UNIT IV LESSON PLAN Oxygenation DATES and TIMES See class syllabus OBJECTIVES 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Upon completion of this unit the student will be able to demonstrate in the clinical campus laboratory setting in individual and group conferences and on written materials the ability to Define and use the key terms as listed in the assigned readings Describe the structure and function of the basic life process of oxygenation Identify controls of respirations Identify the processes involved in ventilation perfusion and the transport of respiratory gases Explain how a human person s level of health age medications lifestyle and environment are stimuli that can affect oxygenation Recognize the nurse s role in the prevention of respiratory disorders Recognize physiologic indicators of acute and chronic respiratory distress Complete an assessment that identifies and includes adaptive and ineffective reponses to alterations in oxygenation Identify common diagnostic and laboratory tests regarding oxygenation and acid base balance Describe nursing implications for common laboratory and diagnostic tests related to oxygenation Utilize the Roy Adaptation Model RAM nursing process to identify and care for the adult with ineffective responses to oxygenation Describe respiratory care interventions and nursing implications Identify nursing interventions for the patient in respiratory distress Identify the physiologic action use side effects and nursing implications of the drug classifications used in the pharmacologic management of oxygen needs TOPICAL OUTLINE I Review of anatomy and physiology of the respiratory system II Physiology of oxygenation A Pulmonary Ventilation B Respiration C Perfusion D Gas transport III 08 08 Factors Affecting Oxygenation A Levels of health B Developmental considerations C Medications D Lifestyle 2 E F IV 08 08 Environmental a Pollution b Occupational hazards Psychological Utilizing the RAM Nursing Process for Clients with Oxygenation Problems A Assessment 1 History a Allergies b Immunizations c Past medical history surgeries d Present medications e Family history f Psychosocial history 2 Chief complaints a Dyspnea b Cough c Sputum production d Chest pain e Fever 3 Physical Assessment a Vital signs b General findings IPPA 4 Common Diagnostic and Laboratory Tests a Pulse oximetry b Arterial Blood Gases ABGs c Cytologic studies d Endoscopic studies e Skin tests f Radiography g Lung scan h Pulmonary function studies i Complete Blood Count CBC j Pathogen Diagnostic Tests i Sputum Analysis ii Throat Culture iii Thoracentesis B Nursing Diagnosis 1 Ineffective Airway Clearance 2 Ineffective Breathing Pattern 3 Impaired Gas Exchange 4 Impaired Spontaneous Ventilation 5 Dysfunctional Ventilatory Weaning C Planning D Implementation 1 Patient teaching re environment 2 Reduce anxiety 3 3 4 5 6 E Maintain proper nutrition Positioning Providing humidified air Promote proper breathing a Deep breathing b Incentive spirometry c Pursed lip breathing d Abdominal or diaphragmatic breathing e Coughing 7 Chest physiotherapy a Percussion b Vibration c Postural drainage 8 Suctioning overview 9 Medications a Inhaled medications 1 Purposes 2 Devices and proper usage a Metered Dose Inhaler MDI b Dry Powder Inhaler DPI b Bronchodilators c Antihistamines d Anti inflammatory 10 Supplemental oxygen a Sources and delivery b Safety precautions 11 Managing chest tubes overview 12 Artificial airways a Endotracheal tube b Tracheostomy Evaluation REQUIRED READINGS Fischbach F Dunning M 2006 Nurses quick reference to common laboratory and diagnostic tests 4th ed Philadelphia Lippincott Williams Wilkins pp 115 119 470 471 507 509 Taylor C Lillis C LeMmone P Lynn P 2008 Fundamentals of nursing The art and science of nursing care 6th ed Philadelphia Lippincott Williams Wilkins chap 45 Taylor C Lillis C LeMone P Lynn P 2008 Study guide to accompany fundamentals of nursing The art and science of nursing care 6th ed Philadelphia Lippincott Williams Wilkins Readings to coincide with above chapter 08 08 4 CLINICAL SKILLS 1 Provide teaching learning for breathing and coughing exercises 2 Provide oxygen administration nasal cannula or face mask to the adult with compromised or ineffective responses to oxygenation 3 Collect a sputum specimen 4 Provide teaching learning for use of incentive spirometer and inhalers 5 Provide patient teaching re proper breathing techniques and chest physiotherapy 6 Develop teaching learning strategies to prevent respiratory infection and compromised responses to oxygenation 7 Perform assessment of oxygenation status using subjective and objective data HANDOUTS 1 Common Diagnostic and Laboratory Tests for Assessment of Respiratory Function 2 Selected Medications Used to Improve Respiratory Function 08 08 5 COMMON DIAGNOSTIC AND LABORATORY TESTS FOR ASSESSMENT OF RESPIRATORY FUNCTIONING Arterial Blood Gas ABG and pH Analysis Measure pressure of O2 and CO2 in blood and blood pH Normal values pH 7 35 7 45 PCO2 35 45 mmHg PO2 80 100 mmHg HCO3 22 26 mEq L Purpose to assess the adequacy of the patient s oxygenation ventilation and perfusion Important points Explain procedure to patient Intra arterial puncture of either radial brachial or femoral arteries is performed and collection obtained Supplemental oxygenation is recorded on lab slip Specimen is placed on lab and sent to lab immediately Pressure is applied for 5 to 10 minutes or longer if on anticoagulants Cytologic studies Microscopic examination of sputum and its cells Purpose to determine malignancy infection or presence of pus or blood Important points Specimen to be collected in AM before breakfast if possible Approximately 1 teaspoon 5 mL required Rinse mouth before obtaining Obtain specimen after patient deep breathes and then takes deep cough Place in appropriate specimen container Label package and send to lab as soon as possible Endoscopic studies Direct visualization of a body cavity Bronchoscopy examines the larynx bronchi and trachea Purpose to examine lesions remove foreign objects drain abcesses or improve drainage assess trauma and obtain tissue samples biopsies Important points Requires informed consent Patient should be NPO for 6 to 8 hours Medication may be given prior to procedure for pain or sedation and to decrease secretions Local anesthetic spray used to numb throat Patient must not eat or drink post procedure until gag