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OXYGENATION
Paula Ruedebusch, ARNP, DNP
INTRAPLEURAL PRESSURE
Pressure in the pleural cavity surrounding the
lungs.
 Is always slightly negative in relation to atmospheric
pressure

INTRAPULMONARY PRESSURE
Pressure within the lungs
 Equal to atmospheric pressure

Tidal volume
 Approx. 500 mL of air is inspired and expired with
each breath
 Lung compliance
 Expansibility or stretchability of lung tissue, plays a
significant role in the ease of ventilation
 Lung recoil
 The continual tendency of the lungs to collapse away
from the chest wall.
 Elastic fibers in lung tissue contribute to lung recoil,
also surface tension of fluid lining the alveoli.

SURFACTANT

A detergent-like phospholipid, reduces the surface
tension of the fluid lining the alveoli. When
surfactant production is reduced, the lung becomes
stiff and the alveoli collapse.
SURFACTANT
ALVEOLAR GAS EXCHANGE

Diffusion refers to the movement of oxygen and
carbon dioxide between the air (in the alveoli) and
the blood (in the capillaries). The appropriate gas
moves passively from an area of higher pressure
or concentration to an area of lesser pressure or
concentration.
TRANSPORT OF OXYGEN AND CARBON
DIOXIDE

Most of O2 (97%) combines loosely with
hemoglobin as oxyhemoglobin. The remaining is
dissolved and transported in the fluid of the plasma
and cells.
OXYGEN TRANSPORT

Several factors affect the rate of oxygen transport from the
lungs to the tissues:
 Cardiac output
 Any pathologic condition that decreases cardiac output
diminishes the amount of O2 delivered to the tissues.
 Number of erythrocytes and blood hematocrit
 Excessive reductions in the blood hematocrit, such as
occur in anemia, reduce oxygen transport.
 Exercise
 In well trained athletes , oxygen transport can be ↑ up to
20 times the normal rate, due to ↑ C.O. and to ↑ use of
O2 by the cells.
CARDIAC OUTPUT
CARDIAC OUTPUT
RESPIRATORY REGULATION
Respiratory regulation maintains correct
concentration of O2:CO2
 Chemosensitive center in the medulla oblongata

responsive to ↑in blood CO2 or hydrogen ion
concentration.
 Can ↑ the activity of the inspiratory center and the rate
and depth of respiration.


Neural receptors
FACTORS AFFECTING RESPIRATORY
FUNCTION
Health status
 Age
 Medications
 Environment
 Stress

ALTERATIONS IN RESPIRATORY FUNCTION


Hypoxia is a condition insufficient oxygen anywhere in
the body, from the inspired gas to the tissue. The clinical
signs box lists signs of hypoxia.
Hypoventilation can lead to hypoxia.

Causes


Disease of respiratory muscle
Drugs, or anesthesia
With hypoventilation CO2 often accumulates in the blood,
a condition called hypercarbia or hypercapnia.
Hypoxemia refers to reduced oxygen in the blood and is
characterized by low PaO2 or hemoglobin saturation.
HYPOXIA

Signs and Symptoms of ACUTE hypoxia:
Person appears anxious
 Person assumes sitting position, often leaning forward
slightly to permit greater expansion of the thoracic
cavity.


Signs and Symptoms of CHRONIC hypoxia:


Person appears fatigued and is lethargic
Clubbed fingers and toes

With clubbing the base of the nail becomes swollen and the
ends of the fingers and toes increase in size, the angle
between the nail and the base of the nail increase to more
than 180 degrees.
CLUBBING
ALTERED BREATHING PATTERNS
Rate, volume, rhythm, relative ease or effort of
respiration
 Eupnea
 Tachypnea
 Bradypnea
 Apnea
 Hyperventilation
 Kussmaul’s breathing (video) 1:15



https://www.youtube.com/watch?v=TG0vpKae3Js
Cheyne-Stokes respiration (video) 2:08

https://www.youtube.com/watch?v=VkuxP7iChYY
OBSTRUCTED AIRWAY

An upper airway obstruction that is in the nose,
pharynx, or larynx

Causes:
Foreign body such as food
 Tongue falls back in unconscious
 Collection of secretion in the passageways
 Respirations sound gurgly or bubbly


Lower airway obstruction involves partial or
complete occlusion the passage in the bronchi and
lungs

Causes:
Accumulation of mucus or inflammatory exudate
 Malignancy
 Foreign Body

NURSING MANAGEMENT

Health History







Current and past respiratory problems
Lifestyle
Cough?
Sputum or pain?
Meds
Risk factors for impaired O2 status
Physical Exam
Inspection
 Palpation
 Percussion
 Auscultation

PHYSICAL EXAM

The nurse use 4 physical examination techniques:


Observes:


Inspection, palpation, percussion, and auscultation.
the rate, depth, rhythm, and quality of respirations,
noting the position the client assumes for breathing.
Inspects:

Also inspects for variations in the shape of the thorax
that may indicate adaptation to chronic respiratory
conditions. e.g., client with emphysema frequently
develop a barrel chest.
CHEST SHAPE VARIATIONS
AVERAGE RESPIRATORY RATES:
*INFANTS: ABOUT 30 BREATHS PER MINUTE
*PRESCHOOLER: AROUND 25 BREATHS PER MINUTE
*ADOLESCENTS & ADULTS: 12- 18 BREATHS PER MINUTE
HYPOXEMIA VS. HYPOXIA
Hypoxemia = low levels of oxygen in blood
Can cause:
 Hypoxia = low levels of oxygen in body tissues

SYMPTOMS OF HYPOXIA
Although they can vary from person to person, the
most common hypoxia symptoms are:
 Changes in the color of your skin, ranging from blue to
cherry red
 Confusion
 Cough
 Fast heart rate
 Rapid breathing
 Shortness of breath
 Sweating
 Wheezing

CYANOSIS
 Cyanosis
bluish discoloration of the skin,
nailbeds, and a mucous membranes, due
to reduced hemoglobin – oxygen
saturation.
IMPAIRED OXYGENATION

Can be life-threatening
 Mild to severe
 Diseases, injuries
 Frightening, frustrating
ASSESSMENT: WHAT DO YOU HEAR?
NORMAL BREATH SOUNDS

Normal breath sounds are the inspiratory and
expiratory sounds heard through the chest wall of a
healthy individual
http://www.easyauscultation.com/cases?coursecaseorder=1&coursei
d=201
AIRWAY PATENCY

Nursing priority with:
Patient status changes
 Facial/dental surgery
 Upper respiratory tract obstruction
 Emergency Situations

AIRWAY PATENCY

Swollen tongue:

Definitely an airway
issue since it affects
ventilation!
AIRWAY PATENCY

When edema and swelling of the trachea occur in
response to a virus, bacterium, or other irritant, the
airway is further narrowed
OXYGENATION
Hemoglobin is the oxygen-carrying molecule within
the red blood cells (RBCs)
 No RBCs or hemoglobin = NO OXYGEN!
 Pulse oximeter measures percentage of oxygen
attached to hemoglobin

OXYGEN SATURATION
Pulse oximeter is used to measure the percentage
of oxygen attached to hemoglobin
 Part of normal vital signs

NURSING REMINDERS

When assessing a patient, determine if the patient
is:
Short of breath and/or in respiratory distress
 Just finishing physical activity or exertion
 Wearing the pulse ox properly and it is turned on
 Comfortable only when in tripod position?

TRIPOD BREATHING POSITION

Leaning forward with the hands on the knees
TEST YOURSELF!

What is the first thing you do when someone has
difficulty breathing?
1. Have them raise their feet
 2. Sit them up in a high upright position
 3. Give them water to drink
 4. Take their blood pressure

QUESTIONS?