Oxygen Insufficiency
Oxygen Insufficiency
INTRODUCTION
When there is an inadequate supply of oxygen to tissue its called hypoxia which causes an impairment
or reduction in partial pressure of oxygen, inadequate oxygen transport, or the inability of the tissues to
use oxygen. When the oxygen carrying capacity of the blood is reduced, it prevents the blood from
being adequately oxygenated and results in tissue death. Severe hypoxia oxygen deficiency causes
reduced human body function and brain death.
INSUFFICIENCY
It is the inability to perform properly an allotted function.
1) Pulmonary insufficiency
Insufficiency of the pulmonary valve, permitting blood to flow into the right ventricle of the heart
2) Respiratory insufficiency
Failure to adequately provide oxygen to cells of the body and to remove excess carbon dioxide from
them
APPLICATION
Acute tracheobronchitis: is an acute inflammation of the mucous membranes of the trachea and the
bronchial tree, often follows infection of the upper respiratory tract.
Pneumonia: is an inflammation of the lung parenchyma that is caused by a microbial agent.
Pulmonary tuberculosis: is an infectious disease that primarily affects the lung parenchyma.
Lung abscess: is a localized necrotic lesion of the lung parenchyma containing purulent material that
collapses and forms a cavity.
Pleurisy: is inflammation of both layers of the pleurae (parietal and visceral)
Pleural effusion: is a collection of fluid in the pleural space.
Empyema: is an accumulation of thick, purulent fluid within the pleural space, often with fibrin
development and a loculated (walled-off) area where infection is located.
Pulmonary edema: is an abnormal accumulation of fluid in the lung tissue and/or alveolar space.
Acute respiratory failure: is a fall in o2 tension (Pao2) to less than 50 mm Hg (hypoxemia) and a rise
in arterial co2 tension to greater than 50 mm Hg (hypercapnia).
Pulmonary embolism: is the obstruction of the pulmonary artery or one of its branches by a thrombus
that originates somewhere in the venous system or in the right side of the heart.
PHYSIOLOGY
Air moves in and out of the lungs for the same basic reason that any fluid, that is, a liquid or a gas,
moves from one place to another, because its pressure in one place is different from that in the other
place. Or stated differently, the existence of pressure gradient (a pressure difference) causes fluid to
move. This means that a fluid moves from the area where its pressure is higher to the area where its
pressure is lower. Under standard conditions, air in the atmosphere exerts a pressure of 760mm Hg. Air
in the alveoli at the end of one expiration and before the beginning of another inspiration also exerts a
pressure of 760 mm Hg. When atmospheric pressure is greater than pressure within the lung, air flows
down this gas pressure gradient. Then air moves from the atmosphere into the lungs. In other words,
inspiration occurs and vice-versa.
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Oxygen is supplied to and co2 is removed from cells by the circulating blood. Cells are in close contact
with capillaries whose thin walls permit easy passage or exchange of o2 and co2. The movement of co2
occurs by diffusion.
2) Respiration
After these tissue capillary exchanges, blood enters the systemic veins and travels to the pulmonary
circulation. Movement of air in and out of the airways (ventilation) continually replenishes the o2 and
removes the co2 from the airways in the lung. This whole process of gas exchange between the
atmospheric air and blood and between the blood and the cells of the body is called respiration
3) Ventilation
During inspiration, air flows from the environment into the trachea, bronchi, bronchioles and alveoli.
During expiration, alveolar gas travels the same route in reverse.
Physical factors that govern air flow in and out of the lungs are collectively referred to as the mechanics
of ventilation and include
• Air pressure variances
Air flows from a region of higher pressure to a region of lower pressure. During inspiration,
movement of the diaphragm and other muscles of respiration enlarge the thoracic cavity and thereby
lower the pressure inside the thorax to a level below that of atmospheric pressure. As a result, air is
drawn through the trachea and bronchi into the alveoli.
During normal expiration, the diaphragm relaxes and the lungs recoil, resulting in a decrease in the
size of the thoracic cavity. The alveolar pressure then exceeds atmospheric pressure and air flows
from the lungs into the atmosphere.
• Airway resistance
Any process that changes the bronchial diameter or width affects airway resistance and alters the
rate of air flow for a given pressure gradient during respiration.
• Compliance
A measure of the elasticity, expandability and distensibility of the lungs and thoracic structures is
called compliance.
CONTROL OF RESPIRATION
• Nervous control
• Chemical control
• Mechanical control
RESPIRATORY CENTER: Lies in Medulla oblongata & Pons of the Brain Stem
Respiratory center can be divided into 3 areas on the basis of their function;
a) The medullary rhythmicity area in the medulla oblongata
b) The pneumotaxic area in the pins
c) The apneustic area also in the pons
b) Pneumotaxic area
Although the medullary rhythmicity area control the basic rhythm of the respiration, other sites in the
brain stem help coordinate the transition between inhalation and exhalation. One of these sites is the
pneumotaxic area in the upper pons, which transmits inhibitory impulses to the inspiratory area. The
major effect of these nerve impulses is to help turn off the inspiratory area before the lungs become too
full of air. In other words, the impulses shorten the duration of inhalation.
c) Apnuestic area
Another part of the brain stem that coordinates the transition between inhalation and exhalation is the
apneustic area in the lower pons. This area sends the stimulatory impulses to the inspiratory area that
activate it and prolong inhalation. The result is a long deep inhalation.
LUNG VOLUMES
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MEASUREMENT SYMBOL NORMAL DESCRIPTION
VALUE
TV 500mL THE VOLUME OF AIR INHALED AND
TIDAL VOLUME EXHALED WITH EACH BREATH.
LUNG CAPACITIES
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THE VOLUME OF AIR IN THE LUNGS
TOTAL LUNG AFTER A MAXIMUM INSPIRATION
CAPACITY TLC=TV+IRV+ERV+RV
TLC 5800ml
1. Physiological Factors
2. Developmental Factors
3. Behavioral Factors
4. Environmental Factors
1) Dyspnea
2) Cough
3) Sputum production
4) Chest pain
5) Wheezing
6) Clubbing of the fingers
7) Hemoptysis
8) Cyanosis
1) DYSPNEA
DEFINITION
Dyspnea is a condition characterized by shortness of breath or difficult or labored breathing, sometimes
accompanied by pain.
The intensity of the condition varies from mild to severe, as does the number of episodes a person with
dyspnea may experience. The condition can be extremely frightening for patients, though it is typically
not life-threatening.
CLINICAL MANIFESTATIONS
Symptoms of dyspnea can occur when a person is completely at rest as well as during periods of intense
exercise. Although shortness of breath remains the primary symptom, the following symptoms may also
accompany dyspnea:
CAUSES
Dyspnea is caused by insufficient oxygenation of the blood resulting from disturbances in the lungs,
low oxygen pressure of air, circulatory disturbances and hemoglobin deficiency.
• Cancerous Causes: Cancerous causes can include a tumor blocking the trachea or bronchus or a
tumor that prevents the lungs from fully expanding to take in enough air. People with lung
cancer commonly experience dyspnea.
• Cardiac and Pulmonary Causes: Most causes of dyspnea have roots in a cardiac or pulmonary
disorder. Cardiac or pulmonary causes include an accumulation of fluid in either the lung tissue
(pleural effusion) or around the heart itself (pericardial effusion).
DIAGNOSIS
There is no specific way to measure dyspnea, as the severity and symptoms can vary. However, in order
to form a diagnosis, a health care provider will most likely begin by giving you a physical
examination. The exam may involve an assessment of the health of your cardiac, respiratory and
renal systems. Your doctor might also check your musculoskeletal and skin status. This helps to
identify possible causes of dyspnea.
RELIEF MEASURES
Assess for airway patency and a complete respiratory assessment is performed to identify
additional sign and symptoms of respiratory distress.
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Arterial blood gas values are obtained if indicated and oxygen saturation is monitored.
The patient is placed in high fowler position.
Oxygen and medications are administered in severe cases and the patient’s response is evaluated
and documented.
1) COUGH
DEFINITION
A forceful and sometimes violent expiratory effort preceded by a preliminary inspiration.
Cough results from irritation of the mucus membrane anywhere in the respiratory tract.
CLINICAL SIGNIFICANCE
Cough may indicate serious pulmonary disease. The nurse needs to evaluate the character of the cough.
Dry cough-----a cough unaccompanied by sputum production.
Moist cough--- a cough accompanied by production of mucus or exudates.
3) SPUTUM PRODUCTION
A patient who coughs long enough almost invariably produces the sputum.
CLINICAL SIGNIFICANCE
A profuse amount of purulent sputum (thick and yellow, green or rust-colored) or a change in
color of the sputum probably indicates the bacterial infection.
Thin, mucoid sputum frequently results from viral bronchitis.
A gradual increase of sputum over time may indicate the presence of chronic bronchitis or
bronchiectasis.
Pink-tinged mucoid sputum suggests a lung tumor.
Profuse, frothy, pink material, often welling up into the throat, may indicate pulmonary edema.
Foul-smelling sputum and bad breath point to the presence of a lung abcess, bronchiectasis or an
infection caused by anaerobic organisms.
RELIEF MEASURES
If the sputum is too thick for the patient to expectorate, it is necessary to decrease its viscosity
by increasing its water content through adequate hydration (drinking water) and inhalation of
aerolized solutions, which may be delivered by any type of nebulizer.
Adequate oral hygiene.
Stop smoking.
2) CHEST PAIN
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Chest pain or discomfort may be associated with pulmonary or cardiac disease. Chest pain associated
with pulmonary conditions may be sharp, stabbing and intermittent or it may be dull, aching and
persistent. The pain is usually felt on the side where the pathologic process is located.
CLINICAL SIGNIFICANCE
Chest pain may occur with pneumonia, pulmonary embolism with lung infarction and pleurisy. It also
may be a late symptom of bronchogenic carcinoma.
RELIEF MEASURES
Analgesic medications
NSAIDs
A regional anesthetic block may be performed to relieve extreme pain.
3) WHEEZING
Wheezing is often the major finding in a patient with bronchoconstriction or airway narrowing. It is
heard with or without a stethoscope, depending on its location. Wheezing is a high-pitched, musical
sound heard mainly on expiration.
RELIEF MEASURES
Oral or inhalant bronchodilator medications
It is a sign of lung disease found in patients with chronic hypoxic conditions, chronic lung infections
and malignancies of the lung. This finding may be manifested initially as sponginess of the nailbed and
loss of the nailbed angle.
7) HEMOPTYSIS
DEFINITION
It is defined as expectoration of blood from the respiratory tract.
It is a symptom of both pulmonary and cardiac disorders. The onset is usually sudden, and it may be
intermittent or continuous.
9) CYANOSIS
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DEFINITION
Cyanosis is the bluish coloration of the skin and is a very late indicator of the hypoxia.
The condition is caused by a deficiency of o2 and an excess of co2 in the blood. Hence, the presence or
absence of the cyanosis is determined by the amount of unoxygenated hemoglobin in the blood.
Cyanosis appears when there is 5g/dLof unoxygenated Hb.
TREATMENT
To remove the underlying cause
Artificial respiration together with oxygen inhalation.
DEFINITION
Respiratory failure is a sudden life-threatening deterioration of the gas exchange function of the lung. It
exists when the exchange of o2 for co2 in the lungs cannot keep up with the rate of oxygen
consumption and co2 production by the cells of the body.
Acute Respiratory failure is defined as a fall in o2 tension (Pao2) to less than 50 mm Hg (hypoxemia)
and a rise in arterial co2 tension to greater than 50 mm Hg (hypercapnia).
PATHOPHYSIOLOGY
Common causes of ARF can be classified into 4 categories:
d) Other causes
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In the post-operative period, especially after thoracic or abdominal surgery, inadequate
ventilation and respiratory failure may occur because of several factors like due to the effects of
the anesthetic agents, analgesics and sedatives, which may effect respiration leading to
hypoventilation.
CLINICAL MANIFESTATIONS
And finally,
• Respiratory arrest
NURSING DIAGNOSIS
1) Impaired gas exchange and airway clearance related to excessive mucus production,
retained secretions and inflammation.
GOAL: To maintain patent airway.
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4) Anxiety related to feeling of suffocation.
GOAL: To reduce anxiety.
I. DIAGNOSTIC EVALUATIONS
• PULSE OXIMETRY
It is a non-invasive method of continuously monitoring the o2 saturation of hemoglobin. A probe or
sensor is attached to the fingertip, forehead, earlobe or bridge of the nose. The sensor detects changes in
oxygen saturation levels by monitoring high signals generated by the oxieter and reflected by blood
pulsing through the tissue at the probe. Normal SpO2 values are 98% to 100%. Values less than 85%
indicate that the tissues are not receiving enough oxygen.
• CULTURES
Throat cultures may be performed to identify organisms responsible infection in the respiratory tract.
Nasal swabs may also be performed for the same purpose.
• SPUTUM STUDIES
Sputum is obtained to identify pathogenic organisms and to determine whether malignant cells are
present.
• IMAGING STUDIES
Chest X-ray
Computed tomography
Magnetic resonance imaging
Fluoroscopic studies
Pulmonary angiography
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• ENDOSCOPIC PROCEDURES
Bronchoscopy
Thoracoscopy
• THORACENTESIS
• BIOPSY
OXYGEN INHALATION
Patient with respiratory dysfunctions are treated with oxygen inhalations to relieve anoxemia or
hypoxemia. The normal amount of oxygen in the arterial blood should be in the range of 80 to 100 mm
Hg. If it falls below 60mm Hg, irreversible physiologic effects may occur. Thus, it is urgent to correct
anoxemia promptly.
• Anemia
It is the deficiency of either quality or quantity of the red corpuscles in the blood giving rise to the
symptoms of anoxemia.
• Diseases or conditions in the alveoli of the lungs that interfere with the exchange of oxygen
across the alveolar-capillary membranes e.g., atelectasis, pneumonectomy, thoracoplasty etc.
• Poisoning
Poisoning with chemicals or that alter the tissue’s ability to utilize oxygen, e.g. cyanide poisoning.
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• Patients who are critically ill
• Asphyxia
It is a condition in which there is a lack of oxygen supply to the lungs leading to unconsciousness
caused by blocking of the air passages by foreign bodies, drowning, electrical shock, strangulation,
inhalation of poisonous gases etc.
a) Infection
The use of contaminated equipment can spread infection in the patient. The causative
organisms may be present in such places as catheters, tracheostomy or endotracheal tubes,
humidifying water and masks.
b) Combustion (fire)
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Oxygen itself does not burn, but it supports combustion. Hence, fire is potential hazard when
oxygen is administered.
e) Atelectasis
Collapse of the alveoli develops as a result of increased oxygen concentrations in the
inspired air.
f) Retrolental fibroplasias
The hazards of the oxygen therapy may affect the eyes. Retrolental fibroplasias is noted in
premature infants who have a high concentration of oxygen inhalation. The infants exposed
to high oxygen concentrations which cause an oxygen tension of 200mmHg or more in the
blood will develop fibrotic changes behind the lens which impairs light penetration to the
retina. The eyes of the adult may also be damaged by the oxygen administration. Ulceration,
odema, visual impairment etc. may result from the toxic effects of oxygen on the cornea and
the lens of the adult.
g) Asphyxia
Patients receiving oxygen inhalation by means of masks and closed tents must be protected
from the danger of asphyxia resulting from unexpected and unobserved depletion of oxygen
cylinders.
REFRENCES
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1. Brunner-Suddharth, Textbook of Medical-Surgical nursing, Edition
10th, Published by Lippincott
P: 463-586
SEMINAR ON
OXYGEN INSUFFICIENCY
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SUBMITTED BY: SUBMITTED TO:
Ms. Amandeep Kaur Ms. N. Juneja
M.Sc. Nursing Principal
Roll No. 1 ACON, Mukatsar
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