Question

Oxygenation, Perfusion, fluid and electrolytes are concepts reflect normal physiological mechanism occurring inside the human body which may be affected by the pathological conditions and at the same time can lead to new pathological one.

Oxygenation concept and apply it on pneumonia showing the following:

1. Introduction about oxygenation concept
2. Brief introduction about pneumonia
3. Focus on the physiological changes on oxygenation associated with pneumonia in relation to:

1. Clinical S & S
2. Diagnostic measures
3. Management (medical, surgical & nursing management).

Answer 1

Answer: Oxygenation concept

• Oxygenation is the process of oxygen diffusing passively from the alveolus to the pulmonary capillary,where it binds to hemoglobin in red blood cells or dissolve into the plasma.Insufficient Oxygenation is termed hypoxemia which is differentiated from hypoxia a condition where an abnormally low oxygen content in a tissue or organ.
• Oxygen delivery is the rate of oxygen transport from the lungs to the peripheral tissues.
• Oxygen consumption is the rate at which oxygen is removed from the blood for use by the tissues.

Pneumonia: is an infection that inflames the air sacs in one or both lungs.The air sacs may fill with fluid or pus ( purulent material), causing cough with phlegm or pus,fever,chills,and difficulty breathing.A variety of organisms,including bacteria,viruses and fungi,can cause pneumonia.

Clinical Signs and Symptoms: vary from mild to severe,depending on factors such as the causative organism,age and overall health.

• Chest pain when breath or cough
• Shortness of breath
• Increased respiratory rate
• Persistent cough, may or may not be productive
• Cyanosis
• Fatigue
• Fever,headache,sweating and shaking chills,lower than normal body temperature in older adults and people with weak immune system
• Nausea,vomiting or diarrhea

Dianostic measures:

• Detailed Clinical history from the patient in adjunction with chest auscultation
• Chest X-ray
• Sputum samples
• Blood test with full blood count,WBC,blood culture and in more severe cases ABG analysis

Management:

Depends on the severity oral antibiotics or for severe cases hospitalization and treatment with Intravenous antibiotics,Oxygen therapy and chest physiotherapy

Oxygen therapy: maintaining adequate oxygen saturation levels,depending on the patient,oxygen saturation levels should be above 93%.Humidified oxygen therapy also used in order to assist the patient with expectoration.

Pulse oxymetry,and arterial blood gas levels play a major role to ensure adequate Oxygenation being achieved.Continous positive airway pressure may be indicated in hypoxic patients even receiving high flow oxygen.

Pain management: If a patient with pneumonia is in pain,their lung expansion may be compromised which may further exacerbate their condition.

Chest Physiotherapy and teach effective breathing patterns and posture to promote lung expansion and expectoration.

Hydration: Patients should be adequately hydrated and if not ensure IV fluids are commenced.Hydration is important for the expectoration of secretions and will also help with any associated hypotension.Monitoring of urinary output for fluid loss due to fever and increased respiratory rate.

Nutrition: People with severe pneumonia may also be experiencing nausea and therefore have a decreased appetite.They need a higher calorie intake to fight the infection.

Nurses need to do regular monitoring of

• Hydration and elimination
• Obsevation of vital signs including oxygen saturation
• Providing oxygen therapy as needed
• Ensure patient is position in a way that ensures adequate ventilation
• Promote rest and conservation of energy
• Pressure area care,mouth care
• Monitor and maintain nutrition
• Pain assessment and management
• Educate the patient on infection control and hand washing
• Provide reassurance to the patient