OXYGENATION

Tidal volume
Pulmonary Ventilation
-Approx. 500ml of air is inspired and
Ventilation of the lungs is accomplished
expired with each breath.
through the act of breathing: inspiration
and expiration. Lung compliance
-Expansibility or stretchability of lung
Adequate ventilation depends on several tissue, plays a significant role in the
factors: ease of ventilation.
• Clear airways Lung recoil
• An intact central nervous system -The continual tendency of the lungs to
and respiratory system collapse away from the chest wall.
• An intact thoracic cavity capable -Elastic fibers in lung tissue contribute to
of expanding and contracting lung recoil, also surface tension of
• Adequate pulmonary compliance fluid lining the alveoli.
and recoil
Surfactant, a detergent-like phospholipid,
Intrapleural pressure reduces the surface tension of the fluid
Pressure in the pleural cavity lining the alveoli. When surfactant
surrounding the lungs. production is reduced, the lung
becomes stiff and the alveoli collapse.\
Is always slightly negative in
Alveolar Gas Exchange
relation to atmospheric pressure
Diffusion refers to the movement of oxygen
and carbon dioxide between the air (in
Intrapulmonary pressure the alveoli) and the blood (in the
Pressure within the lungs; Always equalize capillaries). The appropriate gas moves
with atmospheric pressure passively from an area of higher
pressure or concentration to an area of
lesser pressure or concentration
Inspiration When the pressure of oxygen is greater in the
When the diaphragm and intercostals alveoli than in the blood, oxygen diffuse
muscles contract ___ ↑ the size of the thoracic into the blood. The PO2 in the alveoli is
cavity ____ volume of the lungs ↑ ____ ↓ about is about 100mmHgm whereas the PO2
intrapulmonary pressure → then air moves. in the venous blood of the pulmonary arteries
into the lung is about 60mmHg. Therefore, PO2 diffuse
Expiration from the alveoli to the blood. By contrast
When the diaphragm and intercostal muscles PCO2 in the venous blood entering the
relax ___ the size of the thoracic cavity ↓ pulmonary capillaries is about 45mmHg,
____ volume of the lungs ↓____ whereas PCO2 in the alveoli is about
↑intrapulmonary pressure → then air moves 40mmHg, Therefore CO2 diffuse from the
out the lung blood into the alveoli.
Transport of Oxygen and Carbon Respiratory regulation
Dioxide Respiratory regulation includes
Most of O2 97% combines loosely both neural and chemical controls to
with hemoglobin as maintain the correct concentration. of
oxyhemoglobin. The remaining is O2 and CO2
dissolved and. transported in the A chemo sensitive center in the
fluid of the plasma and cells medulla oblongata is highly
Several factors affect the rate of oxygen responsive to ↑in blood CO2 or
transport from: the lungs to the tissues hydrogen ion concentration. This
Cardiac output- center can ↑ the activity of the.
inspiratory center and the rate and
• Any pathologic condition that
depth of respiration
decreases cardiac output
diminishes the amount of O2 Also, there is special neural
delivered to the tissues receptors sensitive to ↓ O2
• Number of erythrocytes and concentration. ↓ in O2
blood hematocrit concentration in carotid arteries
Excessive ↑ in the blood stimulate these receptors to
hematocrit raise the blood stimulate the respiratory. center to
viscosity, reducing the C.O and ↑ ventilation
therefore reducing O2 transport. FACTORS AFFECTING
Excessive reductions in RESPIRATORY FUNCTION
the blood hematocrit, such as A variety of factors affect adequate
occur in anemia, reduce oxygen respiratory functioning.
transport
• Exercise- • Health status
In well trained athletes, In the healthy person, the respiratory
oxygen transport can be ↑ up to system can provide sufficient O2 to meet the
20 times the normal rate, due to ↑ C. body’s needs. Diseases of the respiratory
O and to ↑ use of O2 by the cells system, can adversely affect the O2 of the
blood.

Carbon Dioxide • Age

At birth the fluid filled lungs drain, the PCO2
↑ and the neonate takes a first breath. The
Is transported from the cells to
the lungs in three ways. The lungs gradually expand with each subsequent
majority (65%) is carried in the breath, reaching full inflation by 2 weeks of
RBC as bicarbonate. A moderate age. Changes of aging also affect the
amount of CO2 (30%) combines respiratory system
with hemoglobin as
carbhemoglobin. Small amounts
(5%) are transported in solution in
the plasma and as carbonic acid
 • Medications 2. The surface blood capillaries must be
dilated.
Opioids are chemical agents that depress
the medullary respiratory center; as a result, S+S for acute hypoxia
the rate and depth of respirations decrease.
➢ Person appears anxious, tired, and
This occurs especially with the use of
drawn.
morphine and meperidine) Demerol
➢ Person assume sitting position, often
• Lifestyle leaning forward slightly to permit
• Environment greater expansion of the thoracic
• Stress cavity.
S+S for chronic hypoxia

ALTERATIONS IN RESPIRATORY ➢ Person appears fatigued and is

FUNCTION lethargic.
➢ Clubbed fingers and toes
a. Hypoxia is a condition insufficient
oxygen anywhere in the body, from With clubbing the base of the nail
the inspired gas to the tissue. The becomes swollen and the ends of the fingers
clinical signs box lists signs of and toes increase in size, the angle between
hypoxia. Page 1363 the nail and the base of the nail increase to
b. Hypoventilation that is inadequate more than 180 degrees.
alveolar ventilation can lead to ALTERED BREATHING PATTERNS
hypoxia
CAUSES: -breathing Patterns refers to the rate, volume,
➢ Disease of respiratory muscle- rhythm, and relative ease or effort of
➢ Drugs, or anesthesia- respiration
➢ With hypoventilation CO2 often Eupnea -Is quiet, rhythmic, and effortless
accumulates in the blood a
condition called hypercarbia or Tachypnea- Rapid rate is seen with fever,
hypercapnia metabolic acidosis, pain, and hypercapnia or
c. Hypoxemia refers to reduced oxygen hypoxemia.
in the blood and is characterized by
Bradypnea- Slow rate is seen in clients who
low PaO2 or hemoglobin saturation.
have taken drugs such as morphine,
d. Cyanosis bluish discoloration of the
metabolic alkalosis or have increased ICP)
skin, nailbeds, and a mucous
e.g., from brain injury
membrane, due to reduced
hemoglobin – oxygen saturation. Apnea- Is the cessation of breathing.
Cyanosis requires these two conditions: Hyperventilation- Is an ↑ movement of air
into and out of the lungs. The rate and depth
1. The blood must contain about 5g or
of respiration ↑ and more CO2 is eliminated
more of unoxygeneated hemoglobin
than is produced.
per 100ml of blood
One type of hyperventilation that OBSTRUCTED AIRWAY
accompanies metabolic acidosis is
kussmaul’s breathing by which the body An upper airway obstruction that is in
attempts to compensate by blowing off the the nose, pharynx, or larynx
CO2 through deep and rapid breathing.
Hyperventilation can also occur in response Causes
to stress or anxiety. ➢ F.B such as food
Abnormal respiratory rhythms create an ➢ Tongue falls back in unconscious
irregular breathing pattern. Two abnormal ➢ Collection of secretion in the
respiratory rhythms are: passageways

Cheyne – strokes respiration RESPIRATION SOUND GURGLY OR

BUBBLY
very deep to very shallow breathing
and temporary apnea Lower airway obstruction involves
partial or complete occlusion the passage in
Causes the bronchi and lungs
➢ ↑ ICP , CHF, overdose of certain Causes
drugs
➢ Accumulation of mucus or
inflammatory exudate.
Biot’s (cluster) respiration NURSING MANAGEMENT
Shallow breaths interrupted by apnea
may be seen in clients with central nervous
system disorders. Assessing

Orthopnea- Is the inability to breath except The patient’s health history is an essential
in an upright or standing position. component for assessing respiratory
functioning. Either the patient or a family
Dyspnea- Difficult or uncomfortable member can provide this information.
breathing
Nursing History

S+S Data should include about current and past

respiratory problems, lifestyle, presence of
➢ Person appear anxious and may cough, sputum or pain, medications for
experience SOB breathing, and presence of risk factors for
➢ Feeling of being unable to get enough impaired oxygenation status.
air
➢ Flared nostrils, skin appear dusky, ↑ P Physical Examination
➢ The nurse use 4 physical examination
techniques: Inspection, palpation,
percussion, and auscultation.
➢ The nurse first observes the rate, phase of respiration e.g., expiration
depth, rhythm, and quality of when any abnormal sound is noted.
respirations, noting the position the
Diagnostic Studies
client assumes for breathing. Also
inspects for variations in the shape of There are various diagnostic tests to assess
the thorax that may indicate respiratory status included:
adaptation to chronic respiratory
conditions. e.g., client with ➢ Sputum specimens, throat cultures,
emphysema frequently develop a visualization procedures, VBG,
barrel chest. ABG, Pulmonary function test.
➢ The nurse palpates the thorax for ➢ Pulmonary function tests measures
lung volume and capacity.
bulges, tenderness, or abnormal
movement, detect vocal fremitus. PULMONARY FUNCTION TESTS
Perform percussion posteriorly as the MEASURE THE FOLLOWING LUNG
patient pulls the shoulders forward. VOLUMES AND CAPACITIES:
Then continue with the examination
proceeding down the patient’s back, a) Tidal volume (TV):
comparing one side to the other. • the amount of air inspired and
Examine the anterior and lateral expired in a normal
thorax with the patient in a supine respiration.
position. • Normal is 500 mL.
➢ Listen carefully to the intensity and b) Inspiratory reserve volume (IRV):
quality of each sound as the chest wall • Maximum amount of air that
and underlying structures are can be inhaled over and above
percussed. a normal breath.
➢ Using the diaphragm of a • Normal is 3,100 mL.
stethoscope, move from apex to base, c) Expiratory reserve volume (ERV):
comparing one side with the other • Maximum amount of air that
side while listening to a complete can be exhaled following a
respiratory cycle, inspiration and normal exhalation.
expiration. While auscultating, ask • Normal is 1,200 mL.
the patient to breathe through an open d) Residual volume (RV):
mouth slowly because breathing • the amount of air remaining in
through the nose can produce falsely the lungs after a maximal
abnormal breath sounds. Breathing expiration.
too quickly, such as with • Normal is 1,200 mL.
hyperventilation, may cause syncope e) Total lung capacity (TLC):
and patient distress. If any abnormal • the total volume of the lungs
breath sound is detected, instruct the at maximum inflation
patient to cough and auscultate again calculated by adding the TV,
for at least two complete respiratory IRV, ERV, and RV.
cycles. Record location, change in • Normal is 6,000 mL.
breath sounds after coughing, and
 create resistance to the air flowing out
of the lungs, thereby prolonging
f) Vital capacity (VC):
exhalation and preventing airway
• the amount of air that can be
collapse by maintaining positive
exhaled after a maximal airway pressure also this tightening
inspiration. Calculated by adding abdominal muscle to exhales more
the TV, IRV, AND ERV. effectively. The client usually inhales
• Normal is 4,800 mL. to a count 3 and exhales to a count of
g) Inspiratory capacity (IC): 7
• the total amount of air that can
be inhaled following normal HYDRATION
quiet exhalation. Calculated • Adequate hydration maintains the
by adding the TV, IRV moisture of the respiratory mucous
• Normal is 3,600 mL. membranes. When the client is
h) Functional residual volume (FRV): dehydrated or when environment has
• The volume left in the lungs a low humidity, the respiratory
after normal exhalation secretions can become thick and
Calculated by adding the ERV tenacious
and RV. • Humidifiers are devices that add
• Normal is 2,400 mL. water vapor to inspired air, to prevent
SPIROMETRY- measures the amount and mucous membranes from drying and
rate of air a person breathes in order to becoming irritated and to loosen
diagnose illness or determine progress in secretions for easier expectoration
treatment.
Diagnosing
MEDICATION
Planning • A number of types of medication can
be used for clients with oxygenation
Implementing
problem
Promoting Oxygenation: Bronchodilators*
• Reduce bronchospasm, opening tight
• Deep breathing and coughing or congested airways and facilitating
• One common breathing ventilation. Route P.O, IV but the
exercise is abdominal preferred route is by inhalation
(diaphragmatic) • Side effect include ↑ P, ↑ BP, anxiety,
and pursed – lip breathing. restlessness
Advantage of this exercise
ANTI- INFLAMMATORY DRUGS such
• Abdominal breathing permits deep as glucocorticoids.
full breaths with little effort. Route: PO, IV, Inhaler
• Pursed lip breathing helps the client
Action: ↓ edema and inflammation in the
develop control over breathing, also
airways and allowing a better air exchange
LEUKOTRIENE MODIFIERS* Percussion
• These medications suppress -Sometimes called clapping,
the effects of Leukotriene on is forceful striking of the skin with
the smooth muscle of the cupped hands. Percussion can
respiratory tract. mechanically dislodge tenacious
• Leukotriene cause secretions from the bronchial walls.
bronchoconstriction, mucous Cupped hands trap the air against the
production, edema of the chest
respiratory tract
EXPECTORANTS* Vibration
• Help breakup mucus, making -is a series of vigorous
it more liquid and easier to quivering produced by hands that are
expectorate. placed flat against the client’s chest
E.g., Guaifenesin wall
• When frequent or prolonged
coughing interrupts sleep, a Postural drainage
cough suppressant such as - Is the drainage by gravity of
codeine secretions from various lung
segments. A wide variety of positions
is necessary to drain all segments of
DIGITALIS GLYCOSIDES ACT
the lungs. The lower lobes require
DIRECTLY ON THE HEART TO
drainage most frequently because the
upper lobes drain by gravity
• improve the strength of
contraction and slow the
heart rate OXYGEN THERAPY
Clients who have difficulty
BETA-ADRENERGIC ventilating all areas of their lungs,
BLOCKING AGENTS those whose gas exchange is
e.g., Propranolol* impaired, or people with heart failure
• Affect the sympathetic may benefit from oxygen therapy to
nervous system to reduce the prevent hypoxia.
workload of the heart
Oxygen delivery systems
Incentive spirometry The choice of system
- Measure the flow of air depends on the client’s oxygen
inhaled through the mouthpiece needs, comfort, and developmental
Percussion, Vibration, and Postural considerations.
drainage 1. Cannula (nasal prongs)
Advantage:
• Does not interfere with the
client’s ability to eat or to talk.
It also is relatively
 comfortable, permits some
freedom of movement and is • Face tent Can replace oxygen
well tolerated by the client. masks when masks - are
• It delivers a relatively low poorly tolerated by clients.
concentration of O2 (24% to Face tents provide varying
45%) at flow rates of 2 to 6 L concentrations of O2, for
/min. Above 6 L/min the example, 30% to 50%
client tends to swallow air and concentration of oxygen at 4
the Fio2 is not increased to 8 L/min
Disadvantage:
• Inability to deliver higher ARTIFICAL AIRWAYS
concentrations of O2, and it - Are inserted to maintain a
. can be drying and irritating to patent air way passage for clients
mucous membranes whose airway has become or may
become obstructed.
2. Face mask
• Simple face mask delivers O2 FOUR COMMON TYPES OF
concentrations from 40% to AIRWAYS ARE:
60% at flow rates of 5 to 8
L/min 1. Oropharyngeal and
• Partial rebreather mask nasopharyngeal airways
delivers O2 concentrations of • 1 are used to keep the
60% to 90% at liter flows of 6 upper air passage open
to 10 L/min when they may become
• The partial rebreather bag obstructed by secretions
must not totally or the tongue
deflateNduring inspiration to • Oropharyngeal airways
avoid carbon dioxide buildup stimulate the gag reflex
• Nonrebreather mask delivers and are only used for
the highest oxygen clients with altered levels
concentration possible 95% to of consciousness (e.g.,
100% at liter flows of 10 to 15 general anesthesia,
L/min. One-way bag valves overdose, or head injury
on the mask and between the
reservoir bag and the mask 2. Endotracheal tubes
prevent the room air and the • use for clients who have -
client’s exhaled air from 2 general anesthetics or
entering the bag so only the for those in emergency.
oxygen in the bag is inspired situations where
• Venturi mask delivers mechanical ventilation is
oxygen concentration varying required
from 24% to 40% or 50% at
liter flows of 4 to 10 L/min.
 CHEST TUBES AND DRAINAGE
SYSTEMS
Tracheostomy If the thin, double layered pleural
• Clients who need long membrane is disrupted by lung
term - 3 airway support disease, surgery, or trauma, the
may have a tracheostomy negative pressure between the pleural
• Tracheostomy is an layers may be lost. The lung then may
opening into the trachea be collapses. Chest tubes may be
through the neck inserted into the pleural cavity to
restore. negative pressure and drain
collected fluid or blood
SUCTIONING
• Is aspirating secretions MANAGING CHEST TUBES
through a catheter connected Patients with fluid (pleural effusion),
to a suction machine or wall blood (hemothorax) or air
suction outlet (pneumothorax) in the pleural space
require a chest tube to drain these
Indication of suction substances and allow the compressed
1. Signs of respiratory distress lung to expand. Once inserted, the
• The client unable to cough up tube is secured with a suture and tape,
and expectorate secretions covered with an airtight dressing, and
2. Dyspnea, bubbling, rattling breath attached to a drainage system that
sounds, poor skin color, ↓ oxygen may or may not be attached to.
saturation levels suction

Complications:
o hypoxemia
o trauma to the airway
o nosocomial infection
o cardiac dysrhythmia

The following techniques are used

to minimize or decrease these
complications:
o Hyperinflation
o Hyperoxygenation