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Lincoln Memorial University

Caylor School of Nursing
Nursing 124/125
Summer 07
LESSON PLAN: Oxygenation

DATES: See class syllabus

TIMES: See class syllabus

OBJECTIVES: 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:

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, 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 ineffective
reponses 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 related
to oxygenation.
11. Explain how the body maintains acid-base balance.
12. Identify basic acid-base imbalances through interpretation of arterial blood gases.
13. Utilize the Roy Adaptation Model (RAM) nursing process to identify and care for
the adult with ineffective responses to oxygenation.
14. Describe respiratory care interventions and nursing implications
15. Identify nursing interventions for the patient in respiratory distress.
16. Identify the physiologic action, use, side effects, and nursing implications of the
drug classifications used in the pharmacologic management of oxygen needs.

TOPICAL OUTLINE FOR RESPIRATORY/OXYGENATION 124/125

I. Review of anatomy and physiology of the respiratory system

II. Physiology of oxygenation
A. Transport of Gases
B. Ventilation
C. Perfusion

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D. Gas Exchange
III. Factors Affecting Oxygenation
A. Levels of health
a. Developmental
b. Nutrition/hydration
c. Psychological
B. Lifestyle
C. Environmental
a. Pollution
b. Occupational hazards
IV. Prevention of Oxygenation Disorders
IV. Compromised Processes of Oxygenation
A. Hypoxemia / Hypoxia
B. Hypercapnia / Respiratory Acidosis
C. Acute Response
D. Chronic Response
E. Decompensation
V. 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
f. Wheezing
g. Clubbing of the fingers
h. Hemoptysis
3. Physical Assessment
a. Vital signs
b. General findings
c. Chest
d. Breath sounds
e. Adventitious sounds
4. Common Diagnostic and Laboratory Tests
a. Complete Blood Count (CBC)
b. Arterial Blood Gases (ABGs)
i. Acid-Base Balance
ii. pH regulatory systems

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iii. Acid-Base imbalance

iv. ABG interpretation
c. Pulse Oximetry
d. Pathogen Diagnostic Tests
i. Sputum Analysis
ii. Throat Culture
iii. Nasal Washings
iv. Thoracentesis
e. Radiologic Tests
i. Chest X-ray
ii. Chest Fluoroscopy
iii. CT Scan
iv. Lung Scintigraphy – V / Q Scan
v. Pulmonary Angiography
vi. PET Scan
f. Pulmonary Function Tests
g. Bronchoscopy

B. Analysis/Nursing Diagnosis (Ineffective airway clearance r/t thick

secretions and decrease ability to cough effectively)
a. Risk Factors/causes
b. Assessment
c. Nursing Interventions (not all inclusive)
a. Turn, cough, and deep breath
b. Incentive spirometry
c. Patient position
d. Chest physiotherapy
e. Percussion and vibration
f. Fluids as tolerated
g. Suction as needed
i. Oral airways
ii. Endotracheal tubes
iii. Tracheostomy
h. Patient teaching
i. Administer medications as ordered
d. Evaluation/outcome

C. Impaired gas exchange r/t shortness of air (pt. example and assessment)
a. Risk Factors/causes
b. Assessment
c. Nursing Interventions (not all inclusive)
a. O2 therapy
b. Humidification therapy
c. Aerosol therapy
d. Administer meds as ordered
e. Breathing retraining

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i. Abdominal breathing
ii. Pursed-lip breathing
f. Proper nutrition
g. Patient teaching
d. Evaluation /outcome

D. Ineffective breathing pattern r/t collapse lung (pt. example and

assessment)
a. Risk Factors/causes
b. Assessment
c. Nursing Interventions (not all inclusive)
a. Explain procedure and proper patient prep for chest
tube insertion
b. Gather and prepare proper equipment for chest tube
insertion
c. Observe for crepitiation (subcutaneous emphysema),
labored breathing, tachypnea, cyanosis, tracheal
deviation, or signs of hemorrhage and report to
physician
d. Monitor for infection
e. Monitor chest tube and equipment
f. Turn, cough, and deep breath
g. ROM of arm and shoulder
h. Pain control
i. Patient teaching
d. Evaluation/outcome

E. Potential for Aspiration (patient example)

a. Risk Factors/causes
b. Assessment
c. Nursing Interventions (not all inclusive)
a. Patient position
b. Nursing care r/t oral intake or tube feeding
c. Suction as needed
d. Patient teaching
F. Risk for Infection (patient example)
a. Risk Factors/causes
b. Assessment
c. Nursing Interventions (not all inclusive)
a. Monitor vital signs
b. Observe for manifestations of infection
c. Proper hand washing
d. Proper nutrition and fluids
e. Evaluation/outcome

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REQUIRED READINGS:

Silvestri, L. A. (2005). Saunders comprehensive review for NCLEX-RN. (3rded.).

Philadelphia: W.B. Saunders Company.

Smeltzer, S. G., & Bare, B. G. (2007). Brunner and Suddarth’s textbook of

medical – surgical nursing. (11th ed.). Philadelphia: Lippincott, Williams &
Wilkins. (Chapters 21, 23 (page 678), 24 (page 692), & 25 (pages 723-741).

Taylor, C., Lillis, C. & Lemone, P. (2005). Fundamentals of nursing: The art
and science of nursing care. (5th ed.). Philadelphia: Lippincott. Ch. 45.

REFERENCE TEXTS (see syllabus):

CLINICAL OBJECTIVES:

1. Develop a teaching/learning plan for breathing retraining 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 using an incentive spirometer.
5. Monitor and provide care for an adult requiring chest tubes and chest tube
drainage system.
6. Perform tracheal suction on an adult with a tracheostomy tube.
7. Develop teaching/learning strategies to prevent respiratory infection and
compromised responses to oxygenation.
8. Perform assessment of oxygenation status.

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INTERPRETING ARTERIAL BLOOD GASES

1) Look at arterial oxygen tension (PaO2) – PaO2 is the measure

of partial pressure (tension) of oxygen dissolved in arterial blood
plasma. It reflects 3% of total oxygen in the blood.
Does the PaO2 show hypoxemia?

2) Loo k at th e pH an d ans we r th e foll ow ing: (Is pH acid or base?)

pH < 7.35 = acidosis pH > 7.45 = alkalosis

If pH is normal but the pCO2 or HCO3- indicate imbalance, then:

pH (7.35 - 7.40) = acidosis pH (7.40 - 7.45) = alkalosis

3) Loo k at th e ar te ri al ca rb on di oi de tensi on (P aco 2)

Does the Paco2 show respiratory acidosis, respiratory alkalosis, or
normalcy? Find the value that matches the status of the pH.

-if pCO2 matches the imbalance, then the problem is respiratory

-if HCO3- matches the imbalance, then the problem is metabolic

4) Loo k at th e bica rb on at e (H CO3) an d an sw er t he f oll owin g

Does the HCO3 show metabolic acidosis, alkalosis, or normalcy?

5) Look back at the pH and answer the following:

Does the pH show a compensated or an uncompensated condition?
absent compensation (The body has done nothing to correct the
imbalance.)
- the value that doesn't match the pH is normal
- the pH is abnormal
partial compensation (The body has done something, but not
enough.))
- the value that doesn't match the pH is not normal
- the pH is abnormal
complete compensation (The body has done such a good
job that the pH is nl.)
- the value that doesn't match the pH is not normal
- the pH is normal

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DRUG CLASS ACTIONS SIDE NURSING

EFFECTS/TOXIC CONSIDERATIONS
EFFECTS
BRONCHODILATORS Relax smooth Nervousness, • Monitor VS,
Adrenergic Drugs muscles of trachea tremor, headache, lung sounds
• Terbutaline (Brethine) and bronchial tree. increased pulse, and I&O
• Isotherine (Bronkosol) increased blood • Can be given
• Albuterol (Proventil, pressure, orally
Ventolin) palpitations, N/V, • Most given by
abdominal cramps,
• Isoproterenol (Isuprel) inhalers or
sweating nebulizers
• Metaproterenol (Metaprel,
Alupent) • Teach correct
• Levalbuterol (Xopenex) use of
inhalers/nebs
• Clean
equipment
frequently
• Use
bronchodilators
first and then
• Epinephrine (short acting) steroids or
Same as above cromolyn 2nd
(if both
ordered)
• Side effects
decrease as
tolerance
develops
• Use cautiously
with
hyperthyroidis
m, DM, heart
disease

• Use correct
concentration
• Double check
dosage with
another nurse
• Given sub Q
for asthma, etc
Methylxanthine drugs Irritability, • Relaxes
• Theophylline (oral) restlessness, smooth
insomnia, muscles; CNS

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headache, stimulant, acts

dizziness, like caffeine
palpitations, • Give with food
tachycardia, to decrease GI
hypotension, N/V, effects
anorexia, flushing, • Therapeutic
diuresis range 10 - 20
• Aminophylline (IV) mcg/ml
• Hold med if
Same as above level >20, call
MD
• Don’t give with
other
methylxanthine
drugs
• Multiple drug
interactions,
check
compatibility
• May be used as
a respiratory
stimulant for
infantile apnea

ANTI-INFLAMMATORY Decrease Euphoria, • Minimal side

AGENTS inflammation of the insomnia, increased effect with
• Beclomethasone (Vanceril) airway allowing for blood pressure, inhaled steroids
• Metamethasone better exchange of CHF, edema, • Monitor K+
• Triamcinolone (Azmacort) air during increased appetite, levels
respiration weight gain, GI • Monitor blood
• Flusinolide (Aerobid)
irritation, peptic glucose
o Above meds
ulcer, delayed
inhaled • Use cautiously
wound healing,
in patients with
osteoporosis,
active
cataracts,
infections
glaucoma,
increased glucose, • Monitor
decreased K+, patients for s/s
• Solumedrol (IV) moon face, of infection
decreased growth in • Monitor daily
children, muscle weights; report
weakness, excessive
decreased weight gain
resistance to • Reduce dosage
infection. gradually; do

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not abruptly
discontinue
(will have
rebound effect)
• Rinse mouth
after use; clean
inhaler daily/
assess for oral
candidiasis
• Not a treatment
for acute
wheezing or
bronchospasm
• Use
bronchodilators
first if both are
ordered
MUCOLYTIC AGENTS (inhaled) Helps to liquefy • Also used to
• Acetylcystiene and thin treat
(Mucomyst) mucous/secretions. acetaminophen
• Domase alfa (Pulmozyme) Aids in better overdose
removal of • Primarily used
secretions. for treatment of
cystic fibrosis
EXPECTORANTS Liquefy bronchial . • Frequently in
• Guiafenesin (Robitussin) secretions and OTC
• Iodide preparations increase amount of preparations
excretion in the • Taste bad; take
respiratory tract with juice, etc.
ANTI-TUSSIVE AGENTS Act on cough Sedation, • Monitor for
• Narcotic (may contain center in brain to constipation, respiratory
codeine) suppress cough respiratory depression
reflex. Use with suppression.
irritating,
• Non-narcotic – noncongestive,
dextromethorphan non-productive
o Tessalon cough.

Soothe respiratory
tract and reduces
cough reflex at its
source

ANTIHISTAMINES Block the effects of Drowsiness, drying • Assess allergy

• Benadryl histamine at effects of mouth symptoms

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• Atropine peripheral H1 and mucous • Monitor BP

receptor sites and membranes. CNS and pulse
have drying effects depression if used • Assess lung
and antipruretic with ETOH or sounds
(itching) effects. other sedatives. • Maintain fluid
Used for intake
symptomatic relief
• Safety
of allergic rhinitis,
precautions
conjunctivitis, and
because it may
urticaria. May also
cause
be used as an
drowsiness
adjunctive therapy
to anaphylactic • Teach to avoid
reactions – relief of use of ETOH
lower respiratory and other CNS
conditions such as depressants
bronchoconstriction • Frequent oral
and bronchospacms hygiene or
chew sugarless
gum to combat
dry mouth.
• DO NOT give
if client has
glaucoma

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