Description and nursing considerations regarding oxygen insufficiency and sensory deprivation.

1. SEMINAR
ON
OXYGEN INSUFFICIENCY
SENSORY DEPRIVATION
PRESENTED BY-
PARBHJOT KAUR
M.Sc. (N) 1ST YEAR

2. OXYGEN INSUFFICIENCY
INTRODUCTION
Oxygen insufficiency means “ deficient in oxygen”.
The normal range of oxygen in the external blood
should be 80-100 mm of Hg. For treating oxygen
insufficiency effectively, early diagnosis and correct
cause should be ruled out. The only management for
oxygen insufficiency is oxygen administration.

3. DEFINITION
Oxygen insufficiency is a condition in which
the body as a whole or a region is deprived of
adequate oxygen supply. Oxygen
insufficiency is a failure to provide adequate
oxygen to cells of the body and to remove
excess carbon dioxide from them.

4. ETIOLOGY
1. Decreased hemoglobin
2. High altitude
3. Inability of the tissue to extract oxygen from the blood
4. Decreased diffusion of oxygen from the alveoli to the blood
5. Poor tissue perfusion with oxygenated blood
6. Impaired ventilation

5. PHYSIOLOGY OF RESPIRATION
Pulmonary Ventilation: This means movement of
air into and out lungs. Its main purpose is to supply
fresh air.
Ventilation is composed of:
Inspiration- When air flows into lungs
Expiration- When air moves out of lungs.

6. Adequate Ventilation depends upon:
•Clear airways
•An intact central nervous system and respiratory
system.
•An intact thoracic cavity capable of expanding and
contracting.
•Adequate pulmonary compliance and recoil

7. Regulation of Respiration
Respiration is regulated by two mechanisms-
Chemical
Neural
Nervous system of body adjusts rate of alveolar ventilation to
meet needs of body so that po2 and pco2 remain relatively
constant. Control is through respiratory centre which is
actually a number of groups of nerves located in medulla
oblongata and pons of brain.

8. Cause of Oxygen insufficiency and
factors affecting oxygenation
1. Developmental Factors
At birth, fluid filled lungs drain first and pco2 rises. This
causes neonate to take first breath. Lungs are gradually
expanding till 2 weeks of age. Changing in age affect
respiratory system of elders become especially
important if system is compromised by changes such as
infection, physical or emotional stress.

9. 2. Physiological Factors
Various diseases can exert their effect on oxygenation including
disease of respiratory system like COPD, pneumonia, any tumor in
respiratory system, airway obstruction etc.
3. Behavioral Factors
Whenever stress is there both physiologic and psychological
responses can affect oxygenation. The person may experience light
headedness, numbness, tingling of fingers, toes and around mouth.
On other hand , there is release of epinephrine through sympathetic
stimulation. Epinephrine causes bronchioles to dilate, increases blood
flow and oxygen delivery to muscle.

10. 4. Lifestyle Factors
Physical activity or exercise increase the rate and
depth of respiration and hence supply of oxygen
in body.
Sedentary lifestyle there is lack of alveolar
expansion and essential deep breathing pattern.

11. 5. Environmental Factors
Altitude , heat, cold, and air pollution affect
oxygenation .
The higher the altitude lower is the pco2 a
patient breathes.
Air pollution can cause stinging of eyes ,
headache, dizziness, coughing and chocking
even in healthy people.

12. 6. Medication
Certain medications including sedatives ,
hypnotics and narcotics like morphine can
cause respiratory depression.

13. Pathophysiology
of
Hypoxia

14. Due to any factors there is reduced
oxygen in body called hypoxia
Cells can switch to
anaerobic metabolism
Accumulation of acid by
products e.g. lactate
Imbalance in chemical
environment of cells.
Release of lysosomal
enzymes
Tissues destruction
Less O2 supplied to
cells
Resulting in availability of
less for cellular functions.
Organelle Swelling
Destruction of tissues
and organs.

15. Hypoxia is evident by-
Cyanosis
Altered breathing patterns
including tachypnea and dyspnea
Anxious face
Fatigue

16. CO2 TRANSPORT AND EXCRETION
When CO2 combines with water, it produces Carbonic Acid & H+ ions
Stimulates respiratory centers
Increase in rate, depth of breath
Tachypnoea in order to bring back pH levels.

17. Because of hypoxia, there will be rise in
carbonic acid levels leading to respiratory
acidosis.
But sometimes in response to hypoxia
hyperventilation may occur.

19. Assessment
Nursing Health History
It includes:
Exploration of present problem
Any past respiratory disease
Cough and its characteristics along with sputum
Lifestyle
Medication used for breathing.

20. Presenting Problems or
Sign and symptoms may include-
Anxiety and Irritability
Tired
Headache and Dizziness
Memory loss
Nausea and vomiting
Oliguria / Anuria
Visual impairment
Clubbing of finger
Impairment in judgment
Shortness of breath

22. INSPECTION
Client’s efforts at ventilation
Anxious or distressed appearance
Flaring of nostrils
Position preferences and general best configuration
Cyanosis because of poor circulation & edema
Changes in level of consciousness
Confusion
Agitation
Stupor or coma indicate ischemia of neuronal cells
Hypoxia

23. PALPATION
Displacement Of Trachea
Pulse Rate
Clammy Skin
Ulcer In Lower Extremities
PERCUSSION
Hyper resonance
Dull percussion tone
Changes in the density of lungs and surrounding tissues

24. DIAGNOSTIC
STUDIES

25. PULMONARY FUNCTION TEST
ARTERIAL BLOOD GAS ANALYSIS
SPUTUM STUDIES
CHEST X-RAYS & CT SCAN
BRONCHOSCOPY
THORACENTESIS

26. NURSING
DIAGNOSIS

27. 1. INEFFECTIVE AIRWAY CLEARANCE
May by related to:-
Obstruction of airway by the tongue.
Upper airway obstruction caused by edema of larynx or glottis.
Obstruction of the trachea or a bronchus by foreign body
aspiration.
Manifested by:-
Shortness of breath
Use of accessory muscles
Difficulty in speaking
Cough
Diminished breath sound

28. 2. INEFFECTIVE BREATHING PATTERN may be related to
restrictive pulmonary disease or any major abdominal or thoracic
surgery or restricted mobility.
3. IMPAIRED GAS EXCHANGE related to overall decrease in
the amount of alveolar capillary surface area available for gas
exchange as manifested by altered findings on ABG or Pulse
oximetry.
4. DECREASED CARDIAC OUTPUT related to congestive
heart failure causing pulmonary edema, heart failure or shock as
manifested by cool clammy skin, weak thread pulse, low urine
output and diminished level of consciousness.

29. OXYGEN
ADMINISTRATION

30. NEED OF OXYGEN
ADMINISTRATION
Clients who have difficulty in ventilating all areas of
their lungs, those whose gas exchange is impaired or
people with heart failures may require oxygen therapy
to prevent hypoxia.

31. METHODS OF OXYGEN DELIVERY
NASAL CANNULA

32. FACE MASK

33. NON BREATHER MASK

34. VENTURE MASK

35. FACE TENTS

36. METHODS USED IN CASE OF
INFANTS
OXYGEN HOOD

37. NURSING RESPONSIBILITY
FOR ADMINISTRATION OF
OXYGEN
Check the name
Bed number
Confirm diagnosis
Need of oxygen therapy
Asses cyanosis
Breathing pattern
Monitor for result of ABG
Check that the oxygen is properly
humidified

38. HAZARDS OF OXYGEN INHALATION
1. Infection
2. Combustion
3. Drying of mucus membrane of the respiratory tract
4. Oxygen toxicity: Dryness and imitation of mucus membrane
Substernal pain
Nausea and vomiting
5. Atelectiasis
6. Oxygen induced Apnoea
7. Retrolental Fibroplasias: Oxygen therapy may affect the eyes
Especially in infants
8. Asphyxia

39. Sensory deprivation

40. INTRODUCTION
Sensory deprivation is generally thought of as a
decrease in or lack of meaningful stimuli.
It results when a person experiences decreased sensory
input

41. FACTORS AFFECTING
SENSORY FUNCTION

42. DEVELOPMENTAL STAGE
Perception of sensation is critical to the
intellectual social and physical
development of the infants and
children .

43. STRESS
During stress, people find their senses
already overloaded and thus seek to
decrease sensory stimulation.

44. MEDICATION AND ILLNESS
Certain medication can alter an
individual’s awareness of
environmental stimuli.
e.g. Narcotics, sedatives

45. LIFE STYLE AND PERSONALITY
Lifestyle influences the quality and quantity of
stimulation to which individual is accustomed.
e.g. Some people delight in constantly changing
stimuli and excitement, whereas others prefer
more structured life with few changes.

46. CLIENT WHO ARE AT RISK OF SENSORY DEPRIVATION
1. Clients in long term care settings
2. Clients who are confined to bed.
3. Clients with sensory alterations (impaired vision, hearing )
4. Clients who are depressed
5. Client with a disturbance of the nervous system.

47. CLINICAL SIGNS

48. PHYSICAL BEHAVIOUR
Excessive yawning
Drowsiness
Sleeping.

49. ESCAPE
BEHAVIOUR
Eating
Exercising
Sleeping
Running away from deprived
environment.

50. COGNITIVE BEHAVIOUR CHANGES
Decreased Attention Span
Difficulty In Concentrating
Decreased Problem Solving
Impaired Memory
Periodic Disorientation
General Confusion
Nocturnal Confusion
Decreased Task Performance

51. PERCEPTUAL CHANGES
1.Inaccurate perception of: Sight
Sound
Taste
Smell
Body Positions
Coordination
Equilibrium
2. Palpitations
3. Hallucinations
4. Delusions

52. AFFECTIVE BEHAVIOUR CHANGES
1. Anxiety 2. Fear
3. Anger 4. Panic
5. Rapid Mood Changes 6. Crying
7. Depression 8. Apathy

54. ASSESSMENT
1.Nursing history
2.Mental status examination
3.Physical examination
4.Identification of clients at risk
5.Social background

55. NURSING
DIAGNOSIS
1. Disturbed sensory perception.
2. Risk for injury related to disturbed
sensory perception, like hearing
impairment, visual impairment etc
3. Risk for impaired skin integrity
(altered tactile stimulation)

56. NURSING
DIAGNOSIS
4. Impaired verbal communication
related to altered level of
consciousness or impaired hearing
5. Self care deficit related to visual
impairment, diminished perception.
6. Social isolation related to impaired
vision, hearing, memory etc.

57. PLANNING
1.Care of clients independent of setting.
2. Maintain the function of existing senses
3. Develop an effective communication mechanism
4. Prevent injury
5. Reduce social isolation
6. Perform activities of daily living
activities independently and safely

58. IMPLEMENTATION
Promoting healthy sensory function
Healthy sensory function can be promoted with environmental
stimuli that provide appropriate sensory input.
Adjusting environmental stimuli
The client functions best when the environment is similar to that
of the individual's ordinary life.

59. Preventive sensory deprivation
Encourage sensory function
Promote the use of other senses
Communicate effectively
Ensure client safety
Visual Stimulation
Colourful Sheets
Cards
Pictures
Flowers

60. Auditory Stimulation
T.V.
Radio
Computer
Caring And Orienting
Communication
Reading Material To Client
Call By Name
Tactile Stimulation
Backrubs
Turning And Repositioning
Hair Brushing
Combing
Gentle touch

61. Olfactory Stimulation
Oral Hygiene
Care Of Dentures
Foods Of Different Colour
Temperature Served Attractively
Home Foods
Pleasurable Aromas
Smelling Food Before Serving It
Cognitive Input
Orient The Patient To
Environment
Encourage In Self Care
Discuss Current Events
Emotional Output
Encourage Client To Share Fears,
Concerns And Perceptions
Reassure Client

62. Impaired Vision
Orient the client to the arrangement
of room furnishings.
Good lightening in room.
Assist with ambulation.

63. Impaired Hearing
Assess the client frequently
Hearing aids
Call person by name
Television, Radio may be helpful

64. Impaired Olfactory
Sense
Keep gas stoves and heaters in a
good working order
Ask the client to assess the
fragrances of different things.

65. Impaired Tactile Sense
The clients with impaired sense of touch may
not be aware of hot temperature, which can
cause-
• Burns
• Pressure ulcers
Therefore the temperature adjustment of water
should be done before bathing.

66. Confused Client
This is most commonly seen in older people.
Promote orientation to time, place, person and
situation.

67. Unconscious Client
1. Listen carefully to support
person’s concerns.
2. Maintain the schedule each
day.
3. Touch and stroke the
unconscious client.
4. Encourage family members to
talk to and
touch the client as though the
client were conscious.
5. Call the patient by name.

68. EVALUATION
Using the measurable desired outcomes
developed during the planning stage as a guide , the
nurse collects data needed to judge whether client goals
and outcomes have been achieved . If outcomes are not
achieved , the nurse and the client, and support people if
appropriate need to explore the reason before modifying
care plan.

69. REFERENCES
Basheer SP et al. “ A concise textbook of
advanced nursing practice”. Published by
EMMESS Medical publishers
Page No. 198-207
280-283
Available on URL:
https://en.wikipedia.org/wiki/Sensory_depriv
ation
http://www.scribd.com/doc/154283938/Oxy
gen-Insufficiency#scribd