UNIT-9

OXYGENATION

BY
RUBEQA

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 Objectives
At the end of this presentation the learner will be able to;
 Identify factors that can interfere with effective
oxygenation of body tissues.
 Describe common manifestations of altered respiratory
and cardiovascular function.
 Discuss lifespan-related changes and problems in
respiratory function and cardiovascular system.
 Describe nursing measures to ensure a patient airway.

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 Recognize the emergencies related to respiratory and
cardiovascular system.

Explain ways that caregivers can decrease the

exposure of clients to infection.

Differentiate between medical and surgical asepsis.

Apply Nursing Process and teaching plan for a client

with altered respiratory function and cardiovascular
function.

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 Oxygenation
 Oxygen, a clear, odorless gas that constitutes approximately
21% of the air we breathe, is necessary for proper
functioning of all living cells.
 The absence of oxygen can lead to cellular, tissue, and
organism death.
 Cellular metabolism produces carbon dioxide, which must
be eliminated from the body to maintain normal acid–base
balance.
 Delivery of oxygen and removal of carbon dioxide require
the integration of several systems including the
hematologic, cardiovascular, and respiratory systems.

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 The respiratory system provides the essential
first process in this integrated system, that is,
movement and transfer of gases between the
atmosphere and the blood.
 Impaired function of the system can
significantly affect our ability to breathe,
transport gases, and participate in everyday
activities.

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  Respiration is the process of gas exchange between the
individual and the environment and involves four
components:
(i) Ventilation or breathing, the movement of air in and out of
the lungs as we inhale and exhale
(ii) Alveolar-capillary gas exchange, which involves the diffusion
of oxygen and carbon dioxide between the alveoli and the
pulmonary capillaries
(iii) Transport of oxygen and carbon dioxide between the tissues
and the lungs
(iv) Movement of oxygen and carbon dioxide between the
systemic capillaries and the tissues.
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 Structure of the Respiratory System

Upper respiratory tract Lower respiratory tract

• Mouth  Trachea
• Nose &
• Pharynx  Lungs (with bronchi-
• Larynx bronchioles-alveoli-
pulmonary capillary
network and pleural
membranes)

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 Pulmonary circulation

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 Factors that can interfere with effective oxygenation of
body tissues .
• Decrease in Hbg (O2 carrying capacity)
– Anemia – s/s fatigue, decreased activity tolerance,
SOB, pallor, tachycardia
• Decreased inspired O2 concentration
• Hypovolemia
• Increase metabolic rate increases O2 demand
– Normal in pregnancy, wound healing, and exercise
as the body is building tissue
– Fever
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 Conditions Affecting Chest Wall Movement

• Pregnancy – baby pushes up against diaphragm resulting

in dyspnoea
• Obesity
• MSK abnormalities – kyphosis, lordosis, or scoliosis
• Trauma – multiple rib fractures develop into chest.
• Neuromuscular diseases – Myasthenia gravis, Guillain
Barre syndrome, poliomyelitis
• CNS – brain or spinal cord injury,
• Influence of chronic disease (COPD) influences the body
to produce more RBCs (polycythemia vera)
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 Disturbances in Cardiac Functioning

• Disturbances in conduction – Dysarrhythmias

• Altered CO
– Left-sided heart failure: decreased CO, pulmonary congestion
– Right-sided heart failure: as a result of long term left-sided
failure; congestion in systemic circulation (edema)
• Impaired valvular function – stenosis
• Myocardial ischemia
– Angina
– MI – females and elderly present differently

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 Alterations in Respiratory Function

• Hyperventilation: state of ventilation in excess

of that required to eliminate the CO2 produced
by cellular metabolism; sometimes chemically
induced (salicylate poisoning, amphetamines)
• Hypoventilation: alveolar ventilation is
inadequate to meet the body’s O2 demand or to
eliminate sufficient CO2; atelectasis
• Hypoxia: inadequate tissue oxygenation at the
cellular level; cyanosis (central vs peripheral)
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 FACTOR AFFECTING RESPIRATORY FUNCTION

Age:
 During old age certain processes affect elders such as
: infection, physical or emotional stress, surgery,
anesthesia, or other procedures.
These types of changes are seen
 Chest wall and airways become more rigid and less
elastic.
 The amount of exchanged air is decreased.
 The cough reflex and cilia action are decreased.
 Mucous membranes become drier and more fragile
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 Environment
• Altitude, heat, cold, and air pollution affect
oxygenation. The higher the altitude, the lower the
PO2 an individual breathes. As a result, the person at
high altitudes has increased respiratory and cardiac
rates and increased respiratory depth, which usually
become most apparent when the individual exercises.
• Healthy people exposed to air pollution, such as smog
or secondhand tobacco smoke, may experience
stinging of the eyes, headache, dizziness, and coughing

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 Lifestyle:
• Physical exercise or activity increases the rate
and depth of respirations and hence the
supply of oxygen in the body. Sedentary
people, by contrast, lack the alveolar
expansion.
Exercise
• Physical exertion increases respiratory rate

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 Health Status :
• In the healthy person, the respiratory system
can provide sufficient oxygen to meet the
body’s needs. Diseases of the respiratory
system, however, can adversely affect the
oxygenation of the blood.

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 • Medications:
 A variety of medications can decrease the rate and depth of
respirations.
 The most common medications having this effect are:
antianxiety drugs such as diazepam (Valium) Lorazepam
(Ativan) and opioids such as morphine.
 When administering these, the nurse must carefully monitor
respiratory status, especially when the medication is begun
or when the dose is increased.
 Older clients are at high risk of respiratory depression and,
hence, usually require reduced dosages.
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 Stress and anxiety :
 When stress and stressors are encountered,
both psychological and physiological responses
can affect oxygenation. Some people may
hyperventilate in response to stress. When this
occurs, arterial PO2 rises and PCO2 falls. The
person may experience light-headedness and
numbness and tingling of the fingers, toes, and
around the mouth as a result.
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• Physiologically, the sympathetic nervous
system is stimulated and epinephrine is
released during stress. Epinephrine causes the
bronchioles to dilate, increasing blood flow
and oxygen delivery to active muscles.
Although these responses are adaptive in the
short term, when stress continues they can be
destructive, increasing the risk of
cardiovascular disease.
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 Manifestations of Altered Respiratory Function:
• Cough
• Sputum Production
• Shortness of Breath
• Chest Pain
• Abnormal Breath Sounds
• Accessory Muscle Use
• Cyanosis

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 Manifestations of Altered cardiovascular Function

• Shortness of breathing
• Nausea and fatigue
• Lightheadedness or dizziness
• Pain in arms, left shoulder,elbow,jaw /back
• Pain or pressure in chest (Angina pain)
• Pain ,numbness, weakness or coldness in legs and
arms if blood vessels are narrowed there
• Swelling of legs,ankles and feet
• Irregular beat ,fainting (valvular heart disease)
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 Conditions affecting movement of air

• The term breathing patterns refers to the rate, volume,

rhythm, and relative ease or effort of respiration. Normal
respiration (eupnoea) is quiet, rhythmic, and effortless.
 Tachypnea (rapid respirations) is seen with fevers,
metabolic acidosis, pain, and hypoxemia.
 Bradypnea is an abnormally slow respiratory rate, which
may be seen in clients who have taken drugs such as
morphine or sedatives, who have metabolic alkalosis, or
who have increased intracranial pressure (e.g., from brain
injuries).
 Apnea is the absence of any breathing
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• Hypoventilation: that is, inadequate alveolar
ventilation, may be caused by either slow or
shallow breathing, or both.
• Hypoventilation may occur because of
diseases of the respiratory muscles, drugs, or
anesthesia. Hypoventilation may lead to
increased levels of carbon dioxide
(hypercarbia or hypercapnia) or low levels of
oxygen (hypoxemia).
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• Hyperventilation is the increased movement of air
into and out of the lungs. During hyperventilation,
the rate and depth of respirations increase and more
CO2 is eliminated than is produced. One particular
type of hyperventilation that accompanies metabolic
acidosis is Kussmaul’s breathing, by which the body
attempts to compensate for increased metabolic
acids by blowing off acid in the form of CO2.
• Hyperventilation can also occur in response to stress
or anxiety
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• Orthopnea is the inability to breathe easily unless
sitting upright or standing.
• Dyspnoea:Difficulty breathing or the feeling of
being short of breath (SOB) is called dyspnea.
Dyspnea may occur with varying levels of exertion
or at rest.
• The client with dyspnea will generally have
observable (objective) signs such as flaring of the
nostrils, labored-appearing breathing, increased
heart rate, cyanosis, and diaphoresis.
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 CONDITIONS AFFECTING DIFFUSION

• Hypoxia:
• Insufficient oxygen anywhere in body
• Hypoxemia:
• Reduced level of oxygen in blood . It may be caused by conditions
that impair diffusion at the alveolar-capillary level such as pulmonary
edema or atelectasis (collapsed alveoli) or by low hemoglobin levels.
• The cardiovascular system compensates for hypoxemia by increasing
the heart rate and cardiac output, to attempt to transport adequate
oxygen to the tissues.
• If the cardiovascular system is unable to compensate or hypoxemia is
severe, tissue hypoxia results, potentially causing cellular injury or
death.

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 Cyanosis:
 (bluish discoloration of the skin, nail beds, and mucous
membranes due to reduced hemoglobin-oxygen
saturation) may be present with hypoxemia or hypoxia.
• Adequate oxygenation is essential for cerebral
functioning. The cerebral cortex can tolerate hypoxia for
only 3 to 5 minutes before permanent damage occurs.
• Central cyanosis
• Peripheral cyanosis:

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 Measures to ensure patENT airway

 Artificial airways may be used for clients with

significant airway obstruction
 Nasal airways
 Oral airway is ( maintain the tongue away from the
posterior oropharynx in the unconscious client)
 Endo tracheal tubes(may be inserted via mouth and
are passed beyond the vocal cords into the trachea)
 Frequent cleansing and suctioning of the oral cavity
(every 2 hours) reduces discomfort and the risk of
breakdown and infection of the oral mucosa.
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 Suctioning of the airway, whether a natural or
artificial airway, may be necessary to clear
secretions the client cannot remove by
coughing.
 Client positioning to improve breathing
patterns may begin by taking cues from the
client.
 Administer Oxygen

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 LIFESPAN-RELATED CHANGES AND PROBLEMS IN
RESPIRATORY FUNCTION AND CARDIOVASCULAR
SYSTEM.

RESPIRATORY SYSTEM CVS

• Decreased cilia • Angina
• Arrhythmias
• Decreased nerve endings in • Arteriosclerosis
pharynx • Congestive heart failure
• Cough reflex blunt • CAD Due to atherosclerosis
• Decreased level of Ig A in • HTN
• Valvular heart diseases
nose and lungs
• Transient ischemic attacks (TIA) or strokes
• Senile emphysema can occur if blood flow to brain is disrupted
• Decreased elasticity of lungs • Deep venous thrombosis
• • Vericose veins
Diaphragm weakens
• Peripheral vascular disease
• Pneumonia due to lack of • Aneurysms (abnormal widening of an
immunity artery)

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 Acute Care
• Dyspnea management
• Airway maintenance
• Mobilization of pulmonary secretions
• Humidification
• Nebulization
• Chest physiotherapy (CPT)
– Postural drainage (see pages 932-933)
• Suctioning
– Oropharyngeal, nasopharyngeal, orothracheal,
nasotracheal
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• Artificial airways (for decreased LOC)
• Oral airway (displaces tongue)
• Endotracheal and tracheal airway (high risk for
infection)
• Maintenance and promotion of lung
expansion
– Positioning (turn, cough, deep breath)

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 PROCEDURES
• Chest tube insertions

• Thoracentasis

• Pleural evacuation

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 Chest tubes
• Pneumothorax – a collection of air in the pleural space; loss of
negative pressure in the intra-pleural space
• Spontaneous, or trauma
• Often caused by the rupture of an air-filled sac in the lung.
• Hemothorax – accumulation of blood and fluid in the pleural
cavity usually as a result of trauma
• Tension pneumo – air pressure builds in the pleural space,
collapsing the lung and creating a life-threatening event

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 Oxygen Therapy
• Goal
• Purpose
• Safety

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Goal - relieve hypoxia

Purpose

1. Promote lung expansion

2. Maintain patent airway
3. Mobilize secretions

1. Oxygen therapy is cheap

1. Oxygen is a medication with side effects
1. Atelectasis or oxygen toxicity
2. Dosage and concentration is important
3. Check doctor’s orders
4. Six rights of medication administration apply to oxygen as well
2. Safety – combustible (smoker with O2 running) old trapper, place signs up
1. No smoking
2. 10’ from open flames
3. Secure cylinders so they will not fall over, chained or in holders
4. Check cylinders of patients before transporting patient

3. Regulators control amount of O2 delivered

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 Methods of Delivery
• Nasal prongs /cannula

• Simple face mask

• Tracheostomy mask / collar

• AMBU Bag

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 1. Nasal cannula – up to 6L

1. Flow rates greater than 4L too drying on mucosa so add

humidification
2. Watch for skin break down over ears, nares

2. Masks
3. Simple face – short-term, concentrations of 30%-60% with
flow rate of 4-8L
4. Venturi mask – higher concentration 24%-60% with flow rate
of 4-12L

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 Respiratory emergencies and
Cardiovascular emergencies
Respiratory emergencies Cardiovascular emergencies

 Pneumonia  Severe hypertension

 Asthma  Chest pain
 COPD  Dysrhythmia
 Lung cancer  Cardiopulmonary arrest
 Acute pulmonary edema  Acute myocardial infarction
 Acute pulmonary hypertension  Angina pectoris
 Acute respiratory failure  Coronary congestive heart
 Aspiration pneumonia failure
 Tension pneumothorax  Coronary artery spasm
 Respiratory acidosis

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 WAYS THAT CAREGIVERS CAN DECREASE
THE EXPOSURE OF CLIENTS TO INFECTION

 hand washing.
 By applying face mask, gloves ,gowns/face shield
 Use needle cutters in ward
 Hand hygiene and cough etiquette
 The safe use and proper disposal of sharps
 Routine environmental cleaning
 Keep bed spacing
 Provide health teaching related to disease

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 Wash and bandage all cuts
 Don’t touch wound and pimples etc

 Don’t share dishes, glasses or eating utensils

 Avoid direct contact with napkins,handkerchiefs etc

 Safe practices for handling blood, body fluids,

secretions as well as excretions

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MEDICAL ASEPSIS VS SURGICAL ASEPSIS
Asepsis is the absence of microorganisms.

MEDICAL ASEPSIS SURGICAL ASEPSIS

 Also called clean technique  Also called sterile technique.

 Cleanliness (freedom from  Sterilization(freedom from all

pathogenic organisms. microorganism with spores.

 It refers to clean technique  It refers to sterilized techniques as

common medical measure use to use of mask, hand
Hand washing, clean dirty objects, scrubing,maintaining sterilized field
changing bed linens. for surgery etc.

 To reduce transmission of  Prevent introduction of any

pathogens from one person to an organism into an open wound then
other person. into body.

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 Patients are  Patients require surgery or
separated from rest taken into operation theatre
of patients by
room/ward/unit

 Antiseptic may be  Gas,radiation,chemical,au

used but no effective toclave procedures which
for some destroy microorganisms and
microorganism and their spores
spores

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Nursing Process and teaching plan for a client with
altered respiratory function and cardiovascular function.

NURSING PROCESS

Assessment: Nursing Process

 History Taking / Interviewing.

 Physical Examination.

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 Nursing Process

Assessment: (History Taking)

• Current respiratory problems

• History of respiratory diseases
• Current or past cardiovascular problems
• Life style
• Presence of Cough
• Signs of hypoxia

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 Nursing Process

Assessment:

• Sputum / (Characteristics of sputum)

• Description of sputum
• Presence of chest pain
• Presence of risk factors
• Medication history

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 Nursing Diagnosis

Primary Nursing Diagnoses

• Ineffective Airway Clearance

• Ineffective Breathing Patterns
• Impaired Gas Exchange
• Decreased Cardiac Output
• Altered Tissue Perfusion

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 Secondary Nursing Diagnoses

• Deficient Knowledge
• Activity Intolerance
• Disturbed Sleep Pattern
• Imbalanced Nutrition
• Acute Pain
• Anxiety

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 Planning

•Client maintains a patent airway.

•Client mobilizes pulmonary secretions.

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 Implementation
Implementation

1. Interventions to Promote Airway Clearance

• Teach the patient effective coughing.

• Initiate postural drainage and chest physiotherapy.
• Monitor hydration.
• Administer medications.
• Monitor environmental and lifestyle conditions.
• Manage artificial airways.
• Suction the airway.
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 Suctioning an Endotracheal Tube

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 Implementation

2. Interventions to Improve Breathing Patterns

• Position client properly.

• Teach controlled breathing exercises.

• Manage chest drainage systems.

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 Implementation
3. Interventions to Improve Oxygen Uptake and
Delivery

Administer oxygen.
• simple mask
• Nasal canula
• Venturi mask
• Rebreathing and Non-rebreathing mask

Administer blood components.

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 Implementation
4. Interventions to Increase Cardiac Output and Tissue
Perfusion

• Manage fluid balance.

• Encourage activity restrictions and assistance with
activities of daily living.
• Position client properly.
• Administer medications.

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 Implementation

Emergency Interventions

• Remove airway obstruction.

• Initiate cardiopulmonary resuscitation (CPR).

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Implementation

Interventions to Address Associated Nursing Diagnoses

• Explore lifestyle and activity adaptations.

• Encourage dietary and nutritional modifications.

• Promote comfort measures.

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 Thank you

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