NURSING

Module Four: Oxygenation and Perfusion

Module Objectives:

Upon completion of this module, learner will be able to:

1) Analyze processes that impact oxygenation and perfusion

3) Appraise common signs and symptoms of altered oxygenation and perfusion

4) Describe diagnostics, treatment modalities, and nursing intervention relevant to altered perfusion

5) Explore the pathophysiologic reasons for clinical manifestations and management of alterations in oxygenation and perfusion

Required readings and resources:

Sorenson, M., Quinn, L., & Klein, D. (2019). Pathophysiology: Concepts of human disease. Pearson Education.

Pages 422 – 423; and pages 532 – 533.

Read chapters 17 – 27 focusing on sections as needed for your Health Alteration Analysis and substantive additions

Optional Resources:

Take a look in the Additional Resources Specific to Pathophysiology folder in the course shell and search for topics related to oxygenation and perfusion

David Woodruff, MSN, RN-BC, CNS, CNE has published a number of excellent presentations on youtube. I am no longer linking them into specific modules as they are nearly or more than ten years old, and most are lengthy. However, if you want more detail on a specific concept, go to youtube and enter David Woodruff in the search bar. His videos are excellent in explaining pathophysiology

Alilia Medical Media is a valuable Youtube channel with lots and lots of excellent and short videos. I have not watched all of them, but what I have watched are excellent. Here is the link
https://www.youtube.com/c/Alilamedicalmedia/videos

Osmosis is another Youtube channel I have found valuable. Again, I have not watched all of them, but what I have seen has been good. As an example, I was challenged trying to understand the cytokine storm we heard much about during COVID. Osmosis has a video (just over 10 minutes long) that helped me. Here is the link to Osmosis
https://www.youtube.com/c/osmosis/videos

The Khan Academy has a lot of engaging videos. Those I have viewed are high quality and accurate. I find this site a little more challenging to navigate than Alilamedicalmedia or Osmosis. You can start your investigation at
https://www.khanacademy.org/

‘Crash Course’ videos on Youtube can provide a nice overview before you get started reviewing professional evidence based resources. Go to youtube and then in the search bar, enter ‘crash course pathophysiology’.

Items due:

Health Alteration Analysis –
Ischemic Stroke

Substantive Additions to the Health Alteration Analysis to two peers

Please see the course calendar for due dates
. See the Health Alteration folder (found under content) for guidance.
Note: a video overview, examples, and a template are available in that folder. See the grading rubric in the syllabus appendices (the
identical grading rubric is copied below for your convenience)

Appendix B. Health alteration analysis rubric

Students will develop two health alteration analyses over the semester. Choose one of the topics included in the appropriate discussion forum. If you have a health alteration you wish to address that fits with the concepts being studied and is not listed, please email Ruth. I am looking for succinct responses that demonstrate understanding.
More detail is not always better. I want you to ‘drill down’ to the essential information and share that with your peers. You may not be able to find the specific ‘why’ in a textbook – this will require you to understand essential information and

make meaningful connections
.

Students will make a substantive addition to two different alterations other than the one addressed in their initial post. Will address a minimum of three health alterations (one primary post, two substantive additions)

For more guidance, and an example, go to the Health Alteration Analysis folder under Content Health alteration analysis rubric
– 30 points possible

4: Relevant lab tests/diagnostics

Accurate. Includes crucial labs and diagnostics. (1 point)

Accurate. Some crucial labs/diagnostics not included.

(

0.5 points)

Inaccurate, incomplete.

(0 points)

5. Physiologic cause of alterations in labs/diagnostics

Accurate. Explains physiologic cause (they

‘why’) of alterations. Makes meaningful connections.

(1 point)

Physiologic ‘why’ incomplete(

0.5 points)

Inaccurate. Incomplete. (0 points)

6. Expected essential nursing interventions (include dependent and independent)

Accurate. Includes all crucial, expected interventions.

(2 points)

Most, but not all crucial interventions included

(1 point)

Inaccurate. Incomplete. (0 points)

7. Rationale for interventions from physiologic perspective

Accurate. Explains the physiologic ‘why’ for interventions. Makes meaningful connections.

(3 points)

Accurate. Physiologic ‘why’ is incomplete. Some, but not all connections made.

(1.5 points)

Inaccurate. Incomplete. Meaningful connections lacking. (0 points)

8:

Prevention

(incorporate lifestyle and social determinants as

appropriate)

Addresses prevention strategies. Consider
bothpotential social determinants and potential lifestyle considerations. Makes meaningful connections

(2 points)

Prevention considered
OR social determinants considered.

(1 point)

Inaccurate. Incomplete. (0 points)

9. Priorities for Safety

/ Potential

Complications

Addresses priorities for safety. Addresses potential complications.

(2 points)

Priorities to safety
OR potential complications addressed (but not both) (1 point)

Inaccurate. Incomplete. (0 points)

10: Evidence based/ writing quality

Accesses and integrates at least two
professional

evidence-based sources (see criteria p. 6 of syllabus) per APA style. Sources developed for the lay person will
not count as professional evidence. Minimal direct quotations. Fewer than five writing mechanics / APA style errors. Flows clearly and logically.

(2 points)

Multiple or lengthy direct quotations. References included, but do not meet criteria for professional evidence based sources. Five – ten writing mechanics / APA errors. (1 points)

More than 10 writing mechanics /APA errors. No evidence to support post.

(0 points)

Example

Health Alteration: Anaphylaxis

Summary in three to seven sentences

Anaphylaxis is a rapid and severe type I hypersensitivity reaction (Sorenson et al., (2019). It is an

acute and often dramatic reaction to an allergen such as some foods, drugs, insect venom, or

vaccinations

(Reber, et al., 2017).

When a person is sensitized to an allergen, IgE binds to mast cells

and basophils. In a subsequent exposure, the offending allergen causes degranulation of the mast

cells and basophils. Destruction of these cells releases chemical mediators such as histamine,

prostaglandins, leukotrines, and cytokines, at first locally. Soon the chemical mediators travel through

the blood stream and can rapidly impact both ventilation and perfusion (Reber, et al.)

Assessment

(this does not need to be in complete sentences if using template)

Expected signs and symptoms What is happening physiologically to contribute to

these signs and symptoms?

Difficulty breathing, chest tightness

(Sorenson, et al., 2019)

Chemical mediators cause bronchial smooth muscle

contraction

(Khan &

Kemp, 2011)

Itching (Khan & Kemp, 2011) Histamine is released into subcutaneous tissue

(Khan & Kemp, 2011)

Falling blood pressure, can progress to shock

(Sorenson, et al., 2019)

Chemical mediators cause vasodilation- vascular

smooth muscle dilates (Sorenson, et al., 2019)

Angioedema – subcutaneous edema as fluid

shifts from the vascular space (Bethel,

2013).

Chemical mediators cause increases in vascular

permeability

(Bethel, 2013).

Tachycardia

(Bethel, 2013).

Attempts to compensate for falling blood pressure

Feelings of doom and anxiety; cyanosis,

dizziness, headache. Can progress to seizures.

(Bethel, 2013).

Hypoxia secondary to bronchospasm and

limited cerebral perfusion (Bethel, 2013).

Skin is cool and clammy (Bethel,

2013).

Blood is shunted to vital organs and away from the

skin (Bethel, 2013).

Tachypnea, wheezing stridor

(Sorenson, et al., 2019)

Laryngeal edema

Abdominal cramps, nausea, diarrhea

(Sorenson, et al., 2019)

Constriction of smooth muscles of the GI tract

Diagnosis

Lab value or diagnostic test utilized Abnormal /normal findings

No single diagnostic test can identify

anaphylaxis. It is typically diagnosed by the

rapid onset of severe respiratory or

cardiovascular symptoms after exposure or

ingestion of an allergen

(Reber, et al., 2017).

Serum IgE level May or may not be elevated – elevation is typically

associated with antigen – antibody reactions (Khan &

Kemp, 2011)

Management

Possible/expected intervention measures What happens physiologically

Maintain a patent airway

(Bethel, 2013).

To allow for oxygenation of tissues

Ephinephrine

(Dalal &

Grujic, 2022)

Non selective adrenergic agonist to relax

smooth muscle and cause vasoconstriction

(Dalal & Grujic, 2022)

Oxygen therapy (Bethel,

2013).

To reduce/prevent hypoxia

Crystalloids or colloid intravenous fluids

(Bethel, 2013).

To restore vascular volume, prevention of

circulatory collapse

Inhaled bronchodilators

(Brasted & Ruppel 2016)

Dilate bronchioles, improve oxygenation

Antihistamines

(Brasted & Ruppel 2016)

To prevent further release of histamine

(Brasted & Ruppel 2016)

Systemic cortiocosteroids

(Brasted & Ruppel 2016)

Blunt the delayed inflammatory response that may

occur several hours after the initial event

(Brasted & Ruppel 2016)

Norepinephrine

(Dalal & Grujic, 2022)

Sympathomimetic that acts on smooth muscle

to constrict blood vessels and so restore blood

pressure and increase cardiac output (Dalal &

Grujic, 2022)

Prevention

(include lifestyle and social determinants as applicable)

Primary prevention is preferable to treatment. Nursing can prevent by taking careful histories,

specifically asking about prior drug reactions or sensitivities to other substances or foods. Nurses can

educate individuals/families to read food and other labels carefully.

Secondary prevention: Individuals at high risk should carry epi-pens and be educated on appropriate

use

(Brasted & Ruppel, 2016)

.

Epi-pens can be very expensive (Drugs.com, 2022). Nursing can connect those who need assistance

and assist in obtaining appropriate resources.

When you give an injection, especially if it is an antibiotic, make sure the person stays in the clinical or

emergency department for at least 30 minutes afterwards so you can assess for signs of a reaction

(Brasted & Ruppel, 2016)

Priorities for safety

Again, if a person is at risk, education on prevention and emergency management are essential.

Nursing must be prepared to prioritize and act quickly to maintain a patent airway and prevent

anaphylactic shock and circulatory collapse (Khan & Kemp, 2011).

When the person starts to improve, fluid may shift back from the tissue into the vascular space.

Fluid volume overload could occur (Bethel, 2013)

Health Alteration: _____________________

Summary in three to six sentences

Assessment

(this does not need to be in complete sentences if using template)

(add or subtract rows as needed)

Expected signs and symptoms What is happening physiologically to contribute to

these signs and symptoms?

Diagnosis

Lab value or diagnostic test utilized Abnormal /normal findings

Management

Possible/expected intervention measures What happens physiologically

Prevention

(include lifestyle and social determinants as applicable)

Priorities for safety

References: (You will note in my example addressing anaphyaxis that some of these are older

than seven years. For this course, if you find a valuable dated resource that you want to use,

email Ruth and ask about appropriateness. Some pathophysiologic concepts do not change.