Module 2 Student Learning Outcomes:

Alteration in Oxygenation

1. Recognize components of a focused assessment that should be included when

collecting data on adults who have an alteration in oxygenation.
Smoking history, cigarette smoking greatly increases the risk for
cardiovascular disease, stroke, and cancer. Daily amount smoked, pack
years, even social smoking. Pipe smoking, Hookah, water pipe, E-cig.
Questions regarding smoking habits: how soon after waking, wake up to
smoke, is it hard not to smoke when it is prohibited, smoke when sick. What
have they tried to help quit smoking?
Passive smoke exposure: second-hand – present while someone is smoking;
third-hand – from clothes and hair
Breath sounds and respirations
Heart rate

2. Apply knowledge of anatomy, physiology, pathophysiology, nutrition, and

developmental variations when helping to plan care for adults who have alterations
in oxygenation.

3. Identify priority actions for adults who have alteration in oxygenation.

Maintain a patent airway. Oxygen therapy as needed, appropriate delivery
system and rate, humidified. Pursed lip breathing. Diaphragmatic breathing.
Orthopenic positioning (sitting up and leaning on table or knees)

4. Apply knowledge of the actions, potential side effects, and nursing implications
when administering medications to adults who have an alteration in oxygenation.
Aspiration, diminished respiratory system

5. Recognize alterations in pulse oximetry and other laboratory values related to

alterations in oxygenation.
Decreased SpO2
CBC
RBC(F 4.2-5.4 M 4.7-6.1), Hct(F 37-47 M 42-52) Hgb(F 12-16 M 14-18) –
elevated levels often in response to chronic hypoxic stated (COPD high
altitude)
Decreased levels indicated possible anemia, hemorrhage or hemolysis
WBC(5,000-10,000) – elevated levels possible acute infection or
inflammation
Decreased levels overwhelming infection, autoimmune disorder, or
immunosuppressant therapy
CBC with diff
Neutrophils (2,500-8,000/55-70%) – elevated levels possible acute bacterial
infection (pneumonia), COPD, or inflammatory conditions (smoking)
 Decreased levels indicate possible viral disease (flu)
Eosinophils(50-500/1-4%) – elevated levels indicate possible COPD, asthma,
or allergies
Decreased levels indicate pyogenic infections
Basophils(25-100/0.5-1%) – elevated levels indicate possible inflammation
(chronic sinusitis/hypersensitivity reactions)
Decreased levels may be seen in acute infection
Lymphocytes(1,000-4,000/20-40%) – elevated levels indicate possible viral
infection, pertussis, and infectious mononucleosis
Decreased levels may be seen during corticosteroid therapy
Monocytes(100-700/2-8%) – elevated levels indicate possible viral
infection, pertussis, infectious mononucleosis, and tuberculosis
Decreased levels may be seen during corticosteroid therapy
ABGs
PaO2(80-100) – elevated levels indicate possible excessive oxygen admin
Decreased levels indicate possible COPD, asthma, chronic bronchitis,
cancer of the bronchi and lungs, cystic fibrosis, respiratory distress
syndrome, anemias, atelectasis, or any other cause of hypoxia
PaCO2(35-45) – elevated levels indicate possible COPD, asthma, pneumonia,
anesthesia effects, or use of opioids (respiratory acidosis)
Decreased levels indicate hyperventilation/respiratory alkalosis
pH(7.35-7.45) – elevated levels indicate alkalosis
Decreased levels indicate acidosis
HCO3-(21-28) – elevated levels indicate possible respiratory acidosis as
compensation for a primary metabolic alkalosis
Decreased levels indicate possible respiratory alkalosis as compensation
for a primary metabolic acidosis

5. Discuss the correct use and functioning of therapeutic devices that support
oxygenation.
Incentive spirometer
FiO2 – fraction of inspired oxygen
Nasal cannula (1-6L/24-40% FiO2)
Simple Facemask (5-6L/40-60%FiO2) less than 5L does not flush CO2
Partial Rebreather Mask (6-11L/60-75% FiO2) reservoir bag should be 2/3
full
Non-Rebreather Mask (80-95% FiO2)
Venturi Mask (4-10L/24-50% FiO2)
Aerosol Mask, Face Tent, Tracheostomy Collar – (10L or >/24-100%FiO2)
T-Piece (10L or >/24-100% FiO2)
6. Describe the role of the nurse in providing quality care to adults who have an
alteration in oxygenation.

7. Identify health care education and safety needs for adults who have an alteration
in oxygenation.
Educate on equipment needed – deliver system, how to read gauges
Safety aspects and smoking cessation

8. COPD pathophysiology
Loss of lung elasticity, hyperinflation of the lungs
Increased CO2, not able to exhale it all
Inflammation of the bronchi and bronchioles
Increased incidence in heavy cigarette smokers

9. Pathophysiology of trauma related disorders

Pneumothorax – accumulation of air in the pleural space (collapsed lung)
Tension pneumothorax – Rapid developing and life threatening-rapid
accumulation of air in the pleural space as a complication of blunt
chest trauma, mechanical ventilation, closed-chest drainage, and
insertion of central venous access catheters
Results from air leak in the lung or chest wall, air forced into the chest
cavity causes a complete collapse of the affected lung * air inhaled is
not exhaled
Hemothroax – may cause hypovolemia
Simple hemothorax – blood loos of less than 1,000mL into the chest
cavity
Massive hemothorax – loss of more than 1,000mL into the chest
cavity

9. Pathophysiology of abnormal cell proliferation disorders

Head and neck cancers are usually squamous cell carcinomas, slow-growing
tumors that are curable when treated early
Laryngeal cancer
Lung cancer – leading cause of cancer related deaths, 16% 5 year survival
Most primary lung cancers arise as a result of failure of cellular
regulation in the bronchial epithelium (bronchogenic carcinomas)

10. Glucocorticoids – Stop inflammation

Oral -
Inhaled – anti-inflammatory & immune modifier
Treat: autoimmune disorders, allergies and asthma, adrenal insufficiencies,
heart failure, cancer, skin conditions (eczema, poison ivy)
Prednisone, Prednisolone, Triamcinolone, Betamethasone, Budesonide,
Cortisone
11. Methylxanthines – bronchodilator –trol
Treat: asthma, chronic bronchitis, or emphysema

12 Mast cell stabilizers – antiasthmatic, allergy, cough, & cold remedy

Treat: allergic rhinitis, conjunctivitis, anaphylaxis, asthma, autoimmune
disorders

13. Anticholinergics (inhaled) – Ipratropium, bronchodilator, allergy, cough, & cold

Remedy, COPD, asthma

14. Leukotriene modifiers – montelukast, bronchodilator, allergy, cough & cold

remedy
Treat: allergies and asthma

15. Beta 2-adrenergic agonists – salmeterol (long acting), bronchodilator

Ventolin, Proventil
Treat: Asthma, bronchitis, emphysema

16. Monoclonal antibody – omalizumab, antiasthmatic

17. Diet for patients with nutritional deficits

High calorie
High protein with limitation of empty liquids
High Vitamin and High Mineral
Wound prevention: increased calories, protein, Vitamins A and C, and
sometimes zinc

18. Nutritional supplements

High calorie
Low carbohydrate for respiratory problems
Module 2 Student Learning Outcomes:
Alteration in Integument

Recognize components of a focused assessment that should be included when

collecting data on adults who have an alteration in integument.
Nutrition and hydration, type of alteration, size and depth, pain, skin turgor,
color, history, family history, incontinent

Apply knowledge of anatomy, physiology, pathophysiology, nutrition, and

developmental variations when helping to plan care for adults who have an
alteration in integument.
Suspected Deep Tissue – skin intact, dark maroon/purple color, might have
blood blisters
Stage 1 – skin intact
Stage 2 – partial thickness, open area: abrasion or blister
Stage 3 – full thickness, can see bone or tendon, may have tunneling
Stage 4 – full thickness, undermining and tunneling, may have slough and
eschar over parts of wound
Unstageable – base is completely covered with slough and eschar

Identify priority actions for adults who have an alteration in integument.

Decrease pressure, dressing changes (correct dressing type), pain
management, hydration/nutrition, humidifier, keep skin clean and dry

Apply knowledge of the actions, potential side effects, and nursing implications
when administering medications to adults who have an alteration in integument.
Diminished Respiratory System

Recognize alterations in pulse oximetry and other laboratory values related to

alterations in integument.
Serum Studies
Hgb (F 12-16 M 14-18) – elevated as a result of fluid volume loss
Hct (F 37-47 M 42-52) – elevated as a result of fluid volume loss
Urea Nitrogen (10-20) – elevated as a result of fluid volume loss
Glucose – elevated as a result of the stress response and altered uptake
across injured tissues
Electrolytes
Sodium (136-145) – Decreased; sodium is trapped in edema fluid and lost
through plasma leakage
Potassium (3.5-5.0) – Elevated as a result of disruption of the sodium
potassium pump, tissue destruction, and red blood cell hemolysis
Chloride (98-106) – Elevated as a result of fluid volume loss and
reabsorption of chloride in urine
 ABGs
PaO2 (80-100) – slightly decreased
PaCO2 (35-45) – slightly increased from respiratory injury
pH (7.35-7.45) – low as a result of metabolic acidosis
Carboxyhemoglobin (0-10) – elevated as a result of inhalation of smoke and
carbon monoxide
Other labs
Total Protein (6.4-8.3) – low; protein exudate is lost through the wound
Albumin (3.5-5.0) – low; protein is lost through the wound and through
vascular membranes because of increased permeability

Discuss the correct use and functioning of therapeutic devices that support
integument.

Describe the role of the nurse in providing quality care to adults who have an
alteration in integument.

Identify health care education and safety needs for adults who have an alteration in
integument.

Pathophysiology of trauma related disorders

Thermal – results when clothes ignite from heat or flames that electrical
sparks produce
Chemical – results from exposure to a caustic agent
Electrical burns – results when an electrical current passes through the body
and can cause severe damage, include loss of organ function, tissue
destruction with need for amputation, cardiac or respiratory arrest
Skin grafting – mesh autograph

Pathophysiology of abnormal cell proliferation disorders

Actinic keratosis – premalignant lesions
Basal cell cancer – from basal cell layer
Squamous cell cancer – cancer of epidermis
Melanoma – pigmented cancer arising from the melanin

Sulfonamides – topical drug, silver sulfadiazine (Silvadene, Thermazene)

Adheres to bacterial cell membranes inhibiting DNA synthesis and bacterial
replication
Watch for allergic reaction causing a drop in white blood cell count
Do not use if deep partial-thickness or full-thickness wounds
Monitor wounds for infection
Topical antibacterial – topical drug, nitrofurazone (Furacin)
Wide-spectrum antibacterial agent
Observe closely for signs of allergic reaction and evidence of superinfection

Topical chemotherapy – with 5-fluorouracil cream (antineoplastic) is used for

treatment of multiple actinic keratosis or for widespread superficial basal cell
carcinoma.
Action – inhibits DNA and RNA synthesis (cell-cycle) Death of rapidly
replicating malignant cells

Interferon – (antineoplastic, antiviral, antiproliferative) is used for melanomas that

are at stage III or higher
Action – interferons are proteins capable of modifying the immune response
and have antiproliferative action against tumor cells

High calorie diet

High protein diet

Enteral nutrition – start with small total strength dose and work up to full dose.
Patient remains on EN until oral intake is 66% of needs for several days

Nutritional supplements