45-7
Chapter 45: Oxygenation
Chapter Overview
The focus of Chapter 45 is the physiology of the respiratory system and the general factors affecting respiratory functioning. Practical suggestions for performing a comprehensive respiratory assessment are given, and expected outcomes and specific nursing strategies for implementation are described. Sample interview questions for both a general and focused respiratory history are presented, along with information on collecting data from the nursing examination. The chapter concludes with a patient care study.
Lesson Plan
· Assign Chapter 45 a week prior to the class meeting.
· Administer the quiz to assess reading comprehension.
· Use the outline below to deliver your lecture.
· Choose assignments for your students from those listed on the following page.
Lecture Outline
A. Describe the principles of respiratory physiology.
· Explain to your students how the airway is a pathway for the transport and exchange of oxygen and carbon dioxide and is divided into the upper and lower airways. Describe the organs in each airway and their main functions.
· Discuss the lungs, including their location, composition, and function. Describe the two phase of the process of ventilation (inspiration, expiration) and what occurs in each phase.
· Review the four factors that influence the diffusion of gases in the lungs. Describe how oxygen is carried in the body (via plasma and red blood cells). Discuss problems that might exist in ventilation, respiration or perfusion (hypoxia, hypoventilation).
B. Describe age-related differences that influence the care of patients with respiratory problems.
· Compare and contrast the respiratory activity of infants, children and older adults. Discuss how nursing care may be tailored to meet age-related respiratory needs. (Refer to Table 45-1: Respiratory Variations in the Life Cycle.)
C. Identify factors that influence respiratory function.
· Discuss the variables that influence respiratory functioning (levels of health, developmental consideration, medications, lifestyle, environment, and psychological health). Brainstorm with the class to identify these factors and specific nursing interventions that might help prevent or alleviate alterations in respiratory function.
D. Perform a comprehensive respiratory assessment using appropriate interview questions and physical assessment skills.
· Teach your students to use the nursing process to assess patients for respiratory functioning. Describe the respiratory component of a nursing history and how to perform a physical assessment of the respiratory system.
· Discuss the interviewing techniques and the types of information obtained in a nursing history. Brainstorm with the class to devise a list of questions tailored to meet the unique needs of individual patients (infants, children, older adults). Be sure they take into consideration the variables that affect respiratory functioning discussed in the previous section.
· Teach your students to proceed in a well-organized manner through a sequence of inspection palpation, percussion and auscultation when performing a physical assessment of the respiratory system.
· Discuss the type of sounds that may be heard upon percussion and the breath sounds that may be auscultated while listening to a complete respiratory cycle.
E. Develop nursing diagnoses that correctly identify problems that may be treated by independent nursing interventions.
· Review the common diagnostic methods (pulmonary function studies, peak expiratory flow rate, pulse oximetry, and thoracentesis), which are available to assess respiratory functioning. (Refer to Table 25-2 for further assessment data that can aid in the formation of nursing diagnoses.) Be sure your students are familiar with the tests and can describe the nurse’s role in assisting with the procedure.
· Teach your students that the etiology of the problem directs nursing interventions and the nurse must determine whether the alteration in respiratory functioning is the problem, is contributing to a different problem, or is a sign or symptom of a problem. Brainstorm with the class to develop a list of sample diagnoses for alterations in respiratory function.
F. Describe nursing strategies to promote adequate respiratory functioning, identifying their rationale.
· Review specific nursing interventions to promote adequate respiratory functioning, including, teaching about a pollution-free environment, promoting optimal function, promoting proper breathing, managing chest tubes, promoting and controlling coughing, promoting comfort, and meeting respiratory needs with medications.
· In a class discussion, discuss the effects (both active and passive) of cigarette smoking. What environmental controls are being legislated? What are the rights of smokers and nonsmokers?
· Demonstrate the breathing techniques to promote proper breathing (deep breathing, pursed-lip breathing, abdominal or diaphragmatic breathing)
· Discuss the responsibilities of the nurse when managing chest tubes.
· Review nursing interventions to promote comfort (positioning, adequate fluid, humidified air, chest physiotherapy, and good nutrition).
· Teach your students the types of inhaled medication administered via nebulizer, metered dose inhaler, or dry powder inhaler. (Refer to Guidelines for Nursing Care 45-2 for information on how to use MDIs and small-volume nebulizers properly.)
· Discuss the various types of delivery systems available for administering supplemental oxygen. (Refer to Table 45-4 or a comparison of delivery systems.) Teach students the precautions for oxygen administration.
· Describe different types of artificial airways and the nurse’s role in providing care for a patient with an artificial airway in place. Discuss types of devices to assist ventilation and the proper administration of cardiopulmonary resuscitation (ABCs of basic life support).
G. Plan, implement, and evaluate nursing care related to select nursing diagnoses involving respiratory problems.
· Teach your students that everyone involved in the evaluation process needs to identify effective interventions and reasons for any failures in achieving expected outcomes. Adjustments to the nursing plan of care should then be made accordingly.
H. Critical Thinking and Blended Skills
· Assemble oxygen administration equipment (nasal cannula, nasal catheter, transtracheal catheter, oxygen masks, and tent); as well as, artificial airway equipment (oropharyngeal airway, endotracheal tube, tracheostomy tube, and cuffed endotracheal tube). Invite individual students to select a device and describe the conditions under which it is indicated, the related procedure for insertion, and priorities for nursing care. Invite the class to identify potential problems with the use of each and to strategize about nursing solutions. Ask the students to rate their own proficiency using each piece of equipment on a scale of 1 – 5 with 1 being unfamiliar with the equipment and 5 being able to use the equipment competently. Devise strategies for improving these scores for the future.
· Invite the class to identify variables in the local environment (at home, at work, and in general) that predispose to respiratory problems. What can nurses individually and collectively do to promote pollution-free environments? Brainstorm with the class!
Assignments
Practicing for NCLEX
1. Complete the first section of the Study Guide for Chapter 45.
· Multiple Choice Questions
· Alternate Items
Developing Critical Thinking and Blended Skills
2. Complete the Critical Thinking and Reflective Practice questions in Chapter 45 of the Study Guide.
Preparing for Clinical
3. Perform a nursing history on a patient with altered respiratory function. Use interview questions to identify (a) current or potential health deviations, (b) patient actions for meeting this need and their effects, (c) contributing factors, (d) use of aids to improve intake of air, and (e) effect on current lifestyle and relationships with others. Share the results of your interview with the class.
4. Role-play performing a physical assessment of the lungs and respiratory status on a partner. As your teacher is guiding you through each sequence of inspection, palpation, percussion, and auscultation, you should discuss normal and abnormal findings during each phase of the assessment.
Group Assignments
5. Your teacher will invite a respiratory therapist to demonstrate and discuss techniques, supplies, and procedures to improve oxygenation. Be prepared with a list of any questions you might want to ask regarding these procedures.
6. Take turns demonstrating and practicing the following procedures:
· Use of the incentive spirometer
· Pursed-lip breathing
· Postural drainage
· Suctioning
Writing Assignments
7. Describe the variations in the respiration process that occur in (a) infants, (b) preschool and school-aged children, and (c) the elderly.
8. Develop interview questions to assess a teenager with asthma for respiratory functioning. Write sample nursing diagnoses for this patient.
9. Research diagnostic procedures used to assess respiratory functioning and share your results with the class.
Reading Comprehension Quiz
Chapter 45
Name: ______Date: ______
1. Describe the three factors necessary for normal respiratory functioning.
2. Describe the process of pulmonary ventilation.
3. List and give an example of two factors that may affect respiratory functioning.
4. Describe deep breathing and pursed-lip breathing and why they are used to promote proper breathing.
5. Describe two oxygen delivery systems and the priority nursing interventions when using each system.