OXYGENATION

DR. MARIA LOURDES CULLA – BAÑAGA RN, MAN

ASSOCIATE PROFESSOR
OBJECTIVES:
1. LIST AND DISCUSS THE MAJOR BODY STRUCTURES
2. DISCUSS FUNCTIONS RESPONSIBLE FOR PROPER OXYGENATION
3. DESCRIBE FACTORS THAT MAY ALTER ONES O2 BALANCE
4. IDENTIFY THE BEHAVIORS INDICATING NEGATIVE O2 BALANCE
5. REVIEW THE COMMON DIAGNOSTIC TEST MEDICALLY PRESCRIBED IN
ORDER TO DETERMINE THE CLIENT’S OXYGENATION STATUS
6. EXPLAIN THE MAJOR PURPOSE OF THE TESTS AND THE RELATED
NURSING RESPONSIBILITIES

Dr. MLCB
Process of Breathing

 Inspiration
• Air flows into lungs

➢ Expiration
▪ Air flows out of lungs
 Inspiration

 Diaphragm and intercostal muscle contract

 Thoracic cavity size increases
 Volume of lungs increases
 Intrapulmonary pressure decreases
 Air rushes into the lungs to equalize pressure
 Expiration

 Diaphragm and intercostal muscle relax

 Lung volume decreases
 Intrapulmonary pressure rises
 Air is expelled
10
 Gas Exchange
 Occurs after the alveoli are ventilated
 Pressure differences (gradient) on each side of the respiratory
membranes affect diffusion
▪ Alveoli:
PO2 100mmHg
PCO2 40mmHg
▪ Venous Blood
PO2 60mmHg
PCO2 45mmHg
➢ O2 diffusion from alveoli Pulmonary blood vessels
➢ CO2 diffusion from pulmonary blood vessels. Alveoli
12
 Oxygen Transport

 Transported from the Lungs to the Tissues

 97% of O2 combines with RBC Hgb
- Oxyhemoglobin carried to tissues
➢ Remaining O2, is dissolved and transported in plasma
and cells (PO2)
 Normal Oxygenation Process

 Cell environment / O2 carrying capacity

 O2 Carrying capacity of blood is expressed by:
- Red Blood Cells
- Hematocrit
% of blood that is RBCs
Men 40 – 54%
Women 37 – 50%
- Hemoglobin
11/19/2023 NRS 105.320 S2009
 Carbon Dioxide Transport

 Must be transported from tissues Lungs

 Continually produced in the process of cell
metabolism
 65% - carried inside RBCs as bicarbonate (HCO2)
 30% - combines with Hgb Carbhemoglobin
 5% - transported in plasma as carbonic acid (H2CO3)
Factors that Influence Respiratory
Function
 Age
 Environment
 Lifestyle
 Health Status
 Medications
 Stress
Common Manifestation of Impaired
Respiratory Function
 Hypoxia
 Altered breathing patterns
 Obstructed or partially obstructed airway
 Hypoxia

 Condition of insufficient oxygen anywhere in the

blood
 Rapid pulse
 Rapid, shallow respirations and dyspnea
 Increased restlessness or lightheadedness
 Flaring of nares
 Substernal or intercostal retractions
 Cyanosis
 Abnormal Respiratory Patterns

 Tachypnea ( Rapid Rate)

 Bradypnea ( abnormally slow rate )
 Apnea ( cessation of breathing )
 Kussmaul’s breathing ( labored breathing )
 Biot’ respiration (abnormal pattern of breathing
characterized by groups of quick, shallow inspirations
followed by regular or irregular periods of apnea.
Characterized by Camille Biot 1876 )
Alterations in Ease of Breathing

 Orthopnea – is the sensation of breathlessness

in a recumbent position, relieved by sitting or
standing
 Dyspnea – difficult or labored breathing
Obstructed or Partially Obstructed
Airway
 Partial Obstruction
Low pitched snoring during inhalation

➢ Complete Obstruction
Extreme inspiratory effort with no chest
movement
 Inadequate O2 Balance
 Behaviors of Negative O2 Balance
❖ Hypoventilation or Hyperventilation
❖ Stridor, audible sounds with respiration, wheezing , coughing
❖ Hypoxia
❖ Change in Mental Status
❖ Change in Vital Signs
❖ Cyanosis
❖ Decrease in GI motility
❖ Change in Renal Function
❖ Hypercapnia – From a Greek word hyper – above / too much kapnos – smoke
- also known as hypercarbia / CO2 retention
- Is a condition of abnormally elevated carbon dioxide (CO2) level in the
blood
 Nursing Responsibilities

 Nursing Assessment
- HEART
- Respiratory Assessment
- PMH Past Medical History
- LIFESTYLE
 HEART

 H – Have client describe specific location, onset

and duration of the problem
 E – Explore associated signs and symptoms
 A – Ask activities that worsen or ease the problem
 R – Rate the severity of discomfort or incapacity
 T – Talk treatments or interventions used to
alleviate the problem and their effectiveness
Nursing Measure to Promote Respiratory
Function
 Ensure a patent airway
 Positioning
 Encourage deep breathing, coughing
 Ensure adequate hydration
 Nursing Responsibilities

 Physical Assessment
- Lung auscultation and breathing pattern
- Abdominal Assessment
- Urine output
- Skin and Mucous membrane
- Heart sounds
- Circulation
- Edema
- DVT (Deep Vein Thrombosis)
 Lung Sounds
 Diminished or absent
 Crackles course and fine
- Discontinuous course bubbling
- Fine crackling sound at the middle or end of inspiration
➢ Ronchi
- A continuous sonorous sound

➢ Pleural Friction Rub

- Grating rubbing sound
 Common Test and Nursing
Responsibilities
 Measure adequacy of ventilation and gas exchange
- (CBC) Complete Blood Count Phlebotomy

- (ABG) Arterial Blood Gases. Arterial Puncture

- Pulmonary Function Test Preparation by teaching

 Common Test and Nursing
Responsibilities
 Test to determine abnormal cell growth or infection in
respiratory system:
- Sputum Culture
- Growing microorganisms from sputum
- Throat Culture
- Growth of microorganisms from throat material
 Common Test and Nursing
Responsibilities
 Test to visualize structures of respiratory system:
- Brochoscopy
- Is a procedure that lets the specialized doctor
(pulmonologist) look at the lungs and air passages using a
thin tube (bronchoscope). It passes through the nose or
mouth down to throat and into the lungs

- Chest Radiographs
- Called a Chest X – Ray (CXR), using chest film
- Is a projection radiograph of the chest used to diagnose
conditions affecting the chest, its contents and nearby
structures.
Common Test and Nursing
Responsibilities
 Thoracentesis
- Fluid
removal from the
pleural cavity with a
needle
Nursing Responsibilities

 Medications
 Incentive Spirometry
 Chest PT (Physiotherapy)
 Postural Drainage
 Oxygen Therapy
 Artificial Airway
 Airway Suctioning
 Chest Tubes
Basic Nursing Interventions

 Airway Maintenance
- Facilitate effective coughing
- Suctioning Airways
- Liquefying and mobilizing sputum
Basic Nursing Interventions

 Maintenance and
promotion of proper
lung expansion:
- Re expanding
collapsed lungs
Ex. Closed
Chest Tube Drainage
 Basic Nursing Intervention
 Improving Activity Intolerance
- Determine etiology
- Assess appropriateness of activity level
- When appropriate gradually increases activity
- Ensure the client changes position slowly
- Observe for symptoms of intolerance
- Syncope with activity ( refer to MD )
- Perform range of motion (ROM) exercise with activity
intolerance if immobile
 Basic Nursing Intervention

 Mobilization of pulmonary Secretions

- Auscultate breath sounds, monitor respiratory
patterns,
monitor ABG’s
- Position client to optimize respiration
- Pulmonary toileting
- Incentive spirometry
- Suctioning
 Basic Nursing Intervention

 Mobilization of Pulmonary Secretions

- Encourage activity and ambulation as tolerated
- Encourage increase fluid intake
- Chest Physiotherapy
- O2
- Medication as ordered
Basic Nursing Intervention

 O2 Therapy:
- Low flow
- High flow
- Humidification
- Nasal Cannula
- Simple Mask
- Non rebreathing Mask
- Partial rebreathing
 Basic Nursing Intervention

 Effective Breathing Techniques:

- Position for maximal respiratory function
- Pursed lip breathing
- Diaphragmatic or abdominal breathing
 Basic Nursing Intervention
 Stress and Anxiety Reduction:
- Remove pertinent cause of anxiety at that moment
a. Help client gain control over respiration
b. Reassure client not in immediate danger
- Chronic Clients
a. Exacerbations and remissions
b. Goal is to reduce general level of anxiety
c. Learn to control episodes of anxiety to improve
quality of life
- desensitization program
- guided mastery
Administration of Prescribed
Medications
 Expectorants
 Mucolytic
 Bronchodilator
 Cough Suppressants
 Corticosteroids
 Antihistamines
 Antibiotic
 Vasoconstritors
 Adequate O2 Balance

 Behaviors of Negative O2 balance Cardio

Vascular Disease
- Arterial
- Venous
- Impaired Tissue Perfusion
 Adequate O2 Balance

 Behaviors of Negative O2 Balance. CV

- Restlessness, dizziness, syncope, bradycardia, decrease
urine
- Cold and Clammy skin, Cyanosis, Slow Capillary refill
- Decreased Cardiac Output
Common Tests and Nursing
Responsibilities
 (CBC) Complete Blood Count – is a blood test
used to evaluate overall health and detect a wide
range of disorders including anemia, infection,
and leukemia
 Lipid Profile – Usually includes the levels of total
cholesterol, high density lipoprotein (HDL)
cholesterol, Triglycerides and the calculated low
density lipoprotein (LDL) cholesterol
Common Tests and Nursing
Responsibilities
 Coagulation Studies - Measure blood’s ability to
clot. Test can help to asses the risk of excessive
bleeding or developing clots ( thrombosis)
somewhere in blood vessels
 EKG / ECG – Is a medical test that detects cardiac
(Heart) abnormalities by measuring the electrical
activity generated by the heart as it contracts
 Common Tests and Nursing
Responsibilities
 Angiography - or arteriography, is a medical imaging technique used
to visualize the inside, or lumen of blood vessels and organs of the body
with particular interest in the arteries, veins and the heart chambers.
This is traditionally done by injecting a radio – opaque contrast agent
into the blood vessel and imaging using X-ray based techniques such as
fluoroscopy.
 Doppler Blood Flow Studies – also known as Vascular flow studies. It
uses sound waves to measure the flow of blood through a blood vessel.
The results are shown on a computer screen in lines called Waveforms
Basic Nursing Interventions
 Cardiovascular
Modify Risk Factor
- Diet
- Exercise
- Co – morbidities
Preventing Vasoconstriction
- Positioning
- Cold Temperature
- Nicotine
Basic Nursing Interventions

➢ Cardiovascular
Prevent Complications
- Risk DVT
- Position Changes
- Early Ambulation
- Obstruction Removal
- Bypass Surgery
 Basic Nursing Interventions

 Cardiovascular
Promoting Rest
- Schedule rest periods
- Assistance with (ADL’s) Activity of daily living
- Monitor vitals with activity
- Place items ex. Call light
- Quiet environment, decrease stimuli
 Basic Nursing Interventions

 Cardiovascular
Positioning to improve (CO) Cardiac Output
- Position semi high fowlers decrease
venous return and preload, decrease preload
Decrease risk of heart congestion
 Basic Nursing Interventions

 Cardiovascular
Avoiding Valsalva Maneuver
- Teach client to avoid valsalva maneuver
a. Hold breath while turning or moving in bed Assist
b. Bearing down during (BM) Bowel movement Stool
softeners and diet
 Basic Nursing Interventions

 Cardiovascular
Avoid Stimulants
- Avoid appetite suppressants, cold , coffee, tea and
chocolate
Maintaining Fluid Balance
- Assess fluid status, monitor I &O, assess breath sounds,
(JVD) jugular vein distention, pitting edema in dependent
areas, fluid and Na+ restriction and electrolyte
monitoring
Basic Nursing Interventions

 Cardiovascular
Increase O2 Supply
- Administer O2
- Educate Client NO SMOKING
- Position to facilitate breathing
 Basic Nursing Interventions

 Dietary Control
- Assess nutritional status
- Consider a dietician referral to assess nutritional
needs
related to clients
 Basic Nursing Interventions

 Weight Control
Evaluate the client’s physiological status in relation to
condition
- More than body requirements
- Less than body requirements
Administration of Prescribed
Medications
 Cardiovascular
- Anti Coagulants
- Vasodilator Medications
- Inotropic Medications
- Anti Dysrhythmics
- Anti Hypertensives
God bless !!!!