NURSING MISC Respiratory Chapters 27-28; 30-32 Neurologic Control of Ventilation

Respiratory Chapters 27-28; 30-32 Fall 2017 Shannon Muhlenkamp, MSN, RN, CCRN Neurologic Control of Ventilation •Central chemoreceptors (medulla)- CO2 in the CSF •Peripheral chemoreceptors (aortic arch)- to PaO2 •COPD switches control to peripheral receptors. Arterial Saturation of Oxygen (SaO2) •Partial Pressure is the pressure exerted in the mixture of gases (proportional to the amount) •Oxygen dissolves in the plasma (free) or combines/saturates Hgb (oxyhemoglobin) •Pulse Oximetry •PaO2 compared to SaO2 Hypoxemia • Hypoxemia - ↓ in arterial oxygen in blood What does the respiratory rate do to compensate for hypoxemia? What would that do to the ABG? • Hypoxia- Decrease in the oxygen supply to the tissues (paO2 70; paO2 60 for COPD) • Inadequate oxygen supply or cardiac output • Adequacy of sat monitors Oxygen Therapy • Indications: – Early- ↑RR, pattern, Restlessness, confusion, tachycardia – Rise PaO2 to baseline • Oxygen toxicity (Greater than 50% or 48 hrs) COPD Patients – Stimulus for respiration is ↓ serum oxygen – ↑ oxygen levels → ↓ respirations – Sleepy, decrease BP, sats 92% Oxygen Therapy (p. 515/566; Chart 1) • Nasal cannula:24-44%; high-flow nasal cannula • Simple mask:40-60%; Cause claustrophobia • Venturi mask: 24-50% Most precise, best for COPD pts • Partial-rebreathing mask: 60-80% • Non-rebreathing mask: 80-100% • Aerosol/Face tents- Humidified oxygen 100% • Trach collars; T-pieces • Oxygen Safety: • No smoking signs, Clean, skin, flammable material, upright, away from heating sources