Nursing 115REQUIRED READINGS:Taylor, C., Lillis, C., LeMmone, P., & Lynn, P. (2008). Fundamentals of nursing:The art and science of nursing care. (6th ed.). Philadelphia: Lippincott1Lincoln Memorial UniversityCaylor School of NursingNursing 115Fall 2008UNIT IV LESSON PLAN: OxygenationDATES and TIMES: See class syllabusOBJECTIVES: Upon completion of this unit, the student will be able to demonstrate in the clinical/campus laboratory setting, inindividual and group conferences and on written materials, the ability to:1. Define and use the key terms as listed in the assigned readings. 2. Describe the structure and function of the basic life process of oxygenation.3. Identify controls of respirations.4. Identify the processes involved in ventilation, perfusion, and the transport of respiratory gases.5. Explain how a human person’s level of health, age, medications, lifestyle, and environment are stimuli that can affect oxygenation.6. Recognize the nurse's role in the prevention of respiratory disorders.7. Recognize physiologic indicators of acute and chronic respiratory distress.8. Complete an assessment that identifies and includes adaptive and ineffectivereponses to alterations in oxygenation.9. Identify common diagnostic and laboratory tests regarding oxygenation and acid base balance.10. Describe nursing implications for common laboratory and diagnostic tests relatedto oxygenation.11. Utilize the Roy Adaptation Model (RAM) nursing process to identify and carefor the adult with ineffective responses to oxygenation.12. Describe respiratory care interventions and nursing implications 13. Identify nursing interventions for the patient in respiratory distress. 14. 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 systemII. Physiology of oxygenationA. Pulmonary VentilationB. RespirationC. PerfusionD. Gas transportIII. Factors Affecting OxygenationA. Levels of healthB. Developmental considerationsC. MedicationsD. Lifestyle08/082E. Environmentala. Pollutionb. Occupational hazardsF. Psychological IV. Utilizing the RAM Nursing Process for Clients with Oxygenation ProblemsA. Assessment1. Historya. Allergiesb. Immunizationsc. Past medical history / surgeriesd. Present medicationse. Family historyf. Psychosocial history2. Chief complaintsa. Dyspneab. Coughc. Sputum productiond. Chest paine. Fever3. Physical Assessmenta. Vital signsb. General findings (IPPA)4. Common Diagnostic and Laboratory Testsa. Pulse oximetryb. Arterial Blood Gases (ABGs)c. Cytologic studiesd. Endoscopic studiese. Skin testsf. Radiographyg. Lung scanh. Pulmonary function studiesi. Complete Blood Count (CBC)j. Pathogen Diagnostic Testsi. Sputum Analysisii. Throat Cultureiii. ThoracentesisB. Nursing Diagnosis 1. Ineffective Airway Clearance2. Ineffective Breathing Pattern3. Impaired Gas Exchange4. Impaired Spontaneous Ventilation5. Dysfunctional Ventilatory WeaningC. PlanningD. Implementation1. Patient teaching re: environment2. Reduce anxiety08/0833. Maintain proper nutrition4. Positioning5. Providing humidified air6. Promote proper breathinga. Deep breathingb. Incentive spirometryc. Pursed lip breathingd. Abdominal or diaphragmatic breathinge. Coughing7. Chest physiotherapya. Percussionb. Vibrationc. Postural drainage8. Suctioning (overview)9. Medicationsa. Inhaled medications1. Purposes2. Devices and proper usagea. Metered Dose Inhaler (MDI)b. Dry Powder Inhaler (DPI)b. Bronchodilatorsc. Antihistaminesd. Anti-inflammatory10. Supplemental oxygena. Sources and deliveryb. Safety precautions11. Managing chest tubes (overview)12. Artificial airwaysa. Endotracheal tubeb. TracheostomyE. EvaluationREQUIRED 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. 08/084CLINICAL SKILLS: 1. Provide teaching/learning for breathing and coughing exercises.2. Provide oxygen administration (nasal cannula or face mask) to the adult withcompromised 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 andcompromised 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 Function08/085COMMON DIAGNOSTIC AND LABORATORY TESTS FOR ASSESSMENT OF RESPIRATORY FUNCTIONINGArterial 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/LPurpose: 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