OXYGENATION

INTRODUCTION
OXYGEN

• A clear, odorless gas that constitutes approximately 21%

of the air we breathe.
• Is necessary for proper functioning of all living cells.
• Absence of oxygen can lead cellular, tissue, and organisms
death.
RESPIRATION
• It is the process of gas exchange between the individual and the environment.

• There are 4 components involved in respiration and these are the following;
1. Ventilation or breathing, the movement of air in and out of the lungs as we
inhale and exhale.
2. Alveolar-capillary gas exchange which involves the diffusion of oxygen and
carbon dioxide between the alveoli and pulmonary capillaries.
3. Transport of oxygen and carbon dioxide between the tissues and the lungs.
4. Movement of oxygen and carbon dioxide between the systemic capillaries
and the tissues.
 STRUCTURE AND PROCESSES OF THE
RESPIRATORY SYSTEM

• The structure of the respiratory system facilitates gas exchange

and protects the body from foreign matter such as particulates and
pathogens.
• The four processes of the respiratory system include pulmonary
ventilation, alveolar gas exchange, transport of oxygen and carbon
dioxide, and systematic diffusion.
STRUCTURE OF THE RESPIRATORY SYSTEM

• The respiratory system is divided structurally into the upper

respiratory system and the lower respiratory system. The mouth,
nose, pharynx, and larynx compose the upper respiratory system.
The lower respiratory system consists of the trachea, the lungs, the
bronchi, bronchioles, alveoli, pulmonary capillary network and
pleural membranes.
RESPIRATORY SYSTEM
PARTS AND FUNCTION OF THE RESPIRATORY
SYSTEM
Parts Functions
1. Mouth Also known as oral cavity and can be used to
supplement or replace the nasal cavity’s functions.
2. Nose The respiratory tract through which the air moves
and supports and protects the anterior portion of
the nasal cavity.
3. Pharynx Serves as a pathway for the movement of food from
the mouth to the esophagus.
4. Larynx Involved in breathing, producing sound and
protecting the trachea against food aspiration. It
houses the vocal chords, and manipulates pitch and
volume.
PARTS AND FUNCTION OF THE RESPIRATORY
SYSTEM
Parts Functions
5. Trachea A hollow tube connecting the larynx to the bronchi
of the lungs and providing airflow to and from the
lungs for respiration.
6. Lungs It is where the process of gas exchange takes place
7. Bronchi To ensure the passage of air from the trachea to the
bronchioles and shuttle air to and from the lungs.
8. Bronchioles Allow gas exchange with blood and carry rich air into
the lungs and carry carbon dioxide rich air out of the
lungs.
9. Alveoli To exchange oxygen and carbon dioxide molecules
to and from the bloodstream.
10. Pleural Membranes Enclose a fluid-filled space surrounding the lungs.
FOUR PROCESSES OF THE RESPIRATORY
SYSTEM

1.Pulmonary Ventilation
2.Alveolar Gas Exchange
3.Transport of Oxygen and Carbon Dioxide
4.Systematic Diffusion
PULMONARY VENTILATION
• Accomplished through the act of breathing: inspiration ( inhalation as air
flows into the lungs), and expiration (exhalation as air moves out of the
lungs).
Inspiration Expiration
• Diaphragm and Intercoastal muscles • Diaphragm and intercoastal muscles
contract relax
• Thoracic cavity size increases • Lung volume decreases
• Volume of lung increases • Intrapulmonary pressure rises
• Intrapulmonary pressure decreases • Air is expelled
• Air rushes into the lungs to equalize
pressure
ALVEOLAR GAS EXCHANGE

• It usually occurs after the alveoli are ventilated

• Pressure differences (gradient) on each side of the respiratory
membranes affect diffusion
• O2 diffusion from alveoli to pulmonary blood vessels
• CO2 diffusion from pulmonary blood vessels to alveoli
TRANSPORT OF OXYGEN AND CARBON
DIOXIDE
OXYGEN TRANSPORT
• Transported from the lungs to the tissues
• 97% of O2 combines with RBC Hgb
• Oxyhemoglobin carried to the tissues
• The remaining O2 is dissolved and transported in plasma and cells
(PO2)
TRANSPORT OF OXYGEN AND CARBON
DIOXIDE

Carbon Dioxide Transport

• Must be transported from tissues to the lungs
• Continually produced in the process of cell metabolism
• 65% are carried inside RBC’s as bicarbonate energy (HCO3)
• 30% combines with Hgb to carbhemoglobin
• 5% is transported in plasma as carbonic acid (H2CO3)
SYSTEMATIC DIFFUSION

• A diffusion of oxygen and carbon dioxide between capillaries and the tissues
and the cells down to a concentration gradient similar to diffusion.
• When cells consume oxygen, the partial pressure of oxygen decreases causing
it to diffuse into the cells.
• When the cell consumes more oxygen during exercise, it regulates their own
flow of oxygen because the pressure gradient increases and diffusion is
enhanced.
RESPIRATORY REGULATION

• Involves both chemical and neutral controls to maintain the

correct concentration of hydrogen ions, oxygen and carbon dioxide
in body fluids.
• The primary respiratory control center is at the medulla oblongata
and pons of the brain.
• Used for sending signals to the muscles that maintain in controlling
respiration for breathing.
FACTORS AFFECTIVE RESPIRATORY
REGULATION

1. Age
2. Environment
3. Lifestyle
4. Health Status
5. Medications
6. Stress
 AGE

• At birth, changes occur in the respiratory systems and lungs gradually

expand with each breath, reaching full inflation by 2 weeks of age.
• Changes of aging affecting the respiratory system of adults becomes
important if systems are compromised by changes such stress, infection,
etc.
• Few of these changes are seen like the amount of their exchanged air is
decreased, chest wall and airways become more rigid and less elastic.
 ENVIRONMENT

• Factors like air pollution, heat and cold can affect oxygenation in
different ways.
• Example is when people who are healthy are in an environment with
air pollution such as people who are using tobacco’s may experience
coughing and headaches
• When in higher altitudes, PO2 decreases and this causes the person
at high altitudes tend to have a high rate of increased respiratory and
cardiac arrest.
 LIFESTYLE

• People who have a healthy lifestyle such as performing physical

exercise increase the rate of their respiration hence the supply of
oxygen in the body.
• People who lack exercise involves a deep-breathing patterns and
are less likely able to respond to respiratory stressors.
 HEALTH STATUS

• A person with a high health status or a healthy person will provide

a sufficient oxygen that the body needs.
• A person with diseases in their respiratory system or having a low
health status will greatly affect the oxygenation of the blood.
 MEDICATIONS

• Some medications may decrease the rate and depth of

respirations.
• Some of these medications are antianxiety drugs, sedative-
hypnotics and benzodiazepine.
• Older clients are most prone to high respiratory oppression and
therefore they usually need dosages or medications.
 STRESS

• Stress can affect oxygenation due to psychological and physiological

responses.
• People who experience stress may hyperventilate and in result PO2
rises and PCO2 falls.
• The person may feel tingling of the fingers, legs and experience light-
headedness.
• When a person feels more stress along the way, it becomes destructive
and increasing the risk of cardiovascular disease.
ALTERATIONS IN RESPIRATORY FUNCTION

1. Patency (open airway)

2. The movement of air into or out of the lungs
3. The diffusion of oxygen and carbon dioxide between the alveoli
and the pulmonary capillaries
4. The transport of oxygen and carbon dioxide via the blood to and
from the tissue cells
CONDITIONS AFFECTING THE AIRWAY

• Two obstructions can occur anywhere between the upper and

lower respiratory passage ways
• Upper airway obstructions in the nose, larynx and pharynx can
occur if foreign objects such as food is present.
• Lower airway obstructions involves partial or complete occlusion
of the passageways in the bronchi and lungs.
CONDITIONS AFFECTING MOVEMENT OF AIR

• There are some conditions that may affect the movement of air and
the following are some examples:
1. Orthopnea- the inability to breathe easily unless sitting up or
standing
2. Dyspnea- difficulty of breathing or the feeling of being short of breath
3. Biot’s respirations- shallow breath interrupted by apnea; may be seen
in clients with CNS disorders
CONDITIONS AFFECTING DIFFUSION

• Impaired diffusion can affect levels of gases in the blood like oxygen
which does not diffuse with carbon dioxide.
• Examples of conditions affecting diffusion are hypoxemia and cyanosis.
• Hypoxemia is reduced oxygen levels in the blood and may be caused by
conditions that impair diffusion.
• Cyanosis are bluish discoloration of the skin due to reduced
hemoglobin oxygen saturation.
CONDITIONS AFFECTING TRANSPORT

• When oxygen will move to the lungs and diffuses in the capillaries and
cardiovascular system, it transports the oxygen to all body tissues.
• It transports CO2 from the cells back to the lungs where it can be exhaled
out of the body.
• There are conditions that can affect transport and decrease cardiac
output
• Some of these examples are congestive heart failure or hypovolemia.
 NURSING MANAGEMENT
• Assessing • Planning • Evaluating
• Diagnosing • Implementing
 NURSING MANAGEMENT

• Assessing
 History
 Physical Examination
 Diagnostic Studies

• Nursing History
 Includes data about current and past respiratory problems.
 Data about lifestyle, presence of cough and medications of breathing.
 One example of this is the Assessment Interview.
 NURSING MANAGEMENT
• Physical Examination
 Examine using 4 techniques: inspection, palpitation, percussion and auscultation.
 The nurse observes the rate, depth and noting the position assumes for breathing .
 Inspect the different shapes of the thorax that may indicate chronic-respiratory conditions.
 Palpitation is used to detect vocal fremitus and thorax can be percussed for diaphragmatic
excursion.
 The nurse then auscultates the chest to assess the clients breathings.

• Diagnostic Studies
 Used to assess respiratory status, function and oxygenation
 Includes sputum specimens, throat cultures, visualization procedures.
 NURSING MANAGEMENT
• Arterial Blood Pressure
 An important diagnostic procedure and specimens are taken by specialty nurses, etc.
 Blood is taken directly from the radial brachial or femoral arteries or catheters placed in these
arteries.
 It is important to prevent hemorrhaging by applying pressure to the puncture site for about 5
minutes after removing the needle.

• Pulmonary Functioning Tests

 Measures lung volume and capacity.
 Clients who undergo the process does not require anesthetic and breathes into a machine.
 This test are painless but the clients need to participate in the process.
 NURSING MANAGEMENT

• Diagnosing
 Ineffective Airway Clearance- inability to clear secretions or obstructions from
the respiratory tract to maintain a clear airway.
 Ineffective Breathing Pattern- inspiration and or expiration that does not
provide adequate ventilation.
 Impaired Gas Exchange- excess or deficit in oxygenation and or carbon dioxide
elimination at the alveolar-capillary membrane.
 Activity Intolerance- insufficient physiological or psychological energy to
endure or complete required or desired daily activities.
 NURSING MANAGEMENT
• Planning
 Maintain a patent airway
 Improve comfort and case of breathing
 Maintain or improve pulmonary ventilation and oxygenation
 Improve the ability to participate in physical activities
 Prevent risks associated with oxygenation problems such as skin and tissue breakdown,
syncope, acid-base imbalances, and feelings of hopelessness and social isolation
• Planning for Home Care
 Incorporates an assessment of the client’s and family’s knowledge and abilities for self-care,
financial resources, and evaluation of the need for referral.
 Outlines a home care assessment related to the client’s oxygenation problems and needs.
 NURSING MANAGEMENT

• Implementing
 Examples of nursing intervention to facilitate pulmonary ventilation are:
 Ensuring a patent airway, positioning, encouraging deep breathing and coughing, and
ensuring adequate hydration.
• Promoting Oxygenation
 Changing position frequently, ambulating, and exercising usually maintains a good ventilation
and gas exchange.
 Examples of nursing intervention that may help to maintain normal respiration are:
 Encouraging ambulation, encouraging deep breathing and coughing, encouraging or
providing frequent changes in position.
 NURSING MANAGEMENT
• Deep Breathing and Coughing
 Can be facilitated by encouraging deep-breathing exercises and coughing to remove secretions
from the airways.
 Clients with conditions that increase secretions like cystic fibrosis and chest surgery require
encouragement to cough and breathe deeply.
 People with chronic obstructive disease requires specialized breathing exercises for their
pulmonary rehabilitation.
• Hydration
 Consistent hydration maintains the moisture of the respiratory mucous membrane.
 Fluid intake should be as great as the client can tolerate.
 Humidifiers are devices that add water vapor to inspired air.
 Their purpose is to prevent mucous membranes from drying and becoming irritated and to
loosen secretions for easier expectoration.
 NURSING MANAGEMENT
• Medications
 The following can be used to clients with oxygenation problems:
 Bronchodilators- anti inflammatory drugs, expectorants, and cough suppressants are
some medications that may be used to treat respiratory problems
 Sympathomimetic drugs and xanthines, reduce bronchospasm, opening tight or
congested airways and facilitating ventilations.
 Expectorants help “break up” mucus, making it more liquid and easier to expectorate.
 Other medications can be used to improve oxygenation by improving cardiovascular
function.
 Beta-adrenergic blocking agents such as propranolol affect the sympathetic nervous
system to reduce the workload of the heart.
 NURSING MANAGEMENT

• Incentive Spirometers
 Also known as sustained maximal inspiration devices, measure the flow of air
inhaled through the mouthpiece and are used to:
 Improve pulmonary ventilation.
 Counteract the effects of anesthesia or hypoventilation.
 Loosen respiratory secretions.
 Facilitate respiratory gaseous exchange.
 Expand collapsed alveoli.
 NURSING MANAGEMENT
• Percussion, vibration and postural drainage.
 - performed according to primary care provider's order by nurses, respiratory therapists, physical therapists or an
interdisciplinary team of these health care team members.
• Percussion (clapping)
 is forceful striking of the skin with cupped hands.
 mechanical cups and vibrators are also available.
• To percuss a client's chest, follow these steps:
 Cover the area with a towel or gown to reduce discomfort.
 Ask the client to breath slowly and deeply to promote relaxation.
 Alternately flex and extend the wrist rapidly to slap the chest.
 Percuss when each lung segment for 1 to 2 minutes.
 should produce a hollow, popping sound.
 avoided over the breast sternum, spinal column and kidneys.
 NURSING MANAGEMENT
• Vibration
 a series of vigorous quivering's produced by hands that are placed flat against the client's chest wall.
 it is used after percussion to increase the turbulence of the exhaled air and thus loosen thick secretions.
• To vibrate the client's chest, the nurse should follow these steps:
 Place hands, palms down, on the chest area to be drained, one hand over the other with the fingers
together and extended.
 Ask the client to inhale deeply and exhale slowly through the nose or pursed lips.
 During exhalation, tense all the hand and arm muscles, and using mostly the heel of the hand, vibrate
(shake) the hands, moving them downward.
 Stop vibrating when the client inhales.
 Vibrate during five exhalations over one affected lung segment.
 After each vibration, encourage the client to cough and expectorate secretions into the sputum container.
 NURSING MANAGEMENT
• Postural Drainage
 is the drainage by gravity of secretions from various lung segments.
 Secretions that remain in the lungs or respiratory airways promote bacterial
growth and subsequent infection.
• Sequence for PVD
 Positioning
 Percussion
 Vibration
 Removal of secretions by coughing or suction (Each position is assumed for 10-15
minutes)
 NURSING MANAGEMENT
• Mucus Clearance Devices
 used for clients with excessive secretions such as cystic fibrosis, COPD, and
bronchiectasis.
 Example: Flutter MCD - small, handheld device with a hard plastic mouthpiece at one
end and a perforated cover at the other end.
• Oxygen Therapy
 is indicated for clients who have hypoxemia due to the reduced ability for diffusion of
oxygen through the respiratory membrane, hyperventilation, or substantial loss of lung
tissue due to tumors or surgery.
• Oxygen is supplied in two ways:
 Portable systems (cylinders or tanks)
 Wall outlets
 NURSING MANAGEMENT
• To use an oxygen wall-outlet system, carry out these steps:
 Attach the flow meter to the wall outlet, exerting from pressure. The flow meter
should be in the off position.
 Fill the humidifier bottle with distilled or tap water in accordance with agency
protocol. This can be done before coming to the bed-side. Some humidifier
bottles come prefilled by the manufacturer.
 Attach the prescribed oxygen tubing and delivery device to the humidifier.
 Regulate the flow meter to the prescribed level. The line for the prescribed low
rate should be in the middle of the ball of the flow meter.
 Safety precautions are essential during oxygen therapy because it does facilitate
combustion. It is important to teach clients about this aspect of oxygen therapy.
 NURSING MANAGEMENT

• Oxygen Delivery Systems

 low-flow and high-flow systems are available depends on the client's need, comfort and
developmental considerations.
• Low-flow systems
 deliver oxygen via small-bore lubbing.
 Example: Nasal Cannulas, Face Masks, Oxygen Tents, Transtracheal catheters
• High-flow system
 supply all the oxygen required during ventilation in precise amounts, regardless if the client's
respirations.
 Example: Verturi mask with large-bore tubbing
 NURSING MANAGEMENT
• Nasal Cannula
 is the most common and inexpensive device used to administer oxygen.
 it is easy to apply and does not interfere with the client's ability to eat or talk.
 it delivers a relatively low concentration of oxygen (24%-45%) at flow rates of 2
to 6 L/min.
 NURSING MANAGEMENT
• Face Mask
 covers the client's nose and mouth that may be used for oxygen inhalation.
 some have reservoir bags to provide higher oxygen concentration to the client.

• Variety of oxygen mask are:

 Simple face mask - delivers oxygen concentration from 40%-60% at liter flows of 5-8 L/min.
 Partial rebreather Mask - delivers oxygen concertration of 40%-60% at liter flows of 6-10 L/min.
 Nonbreather mask - delivers oxygen concertration of 95%-100% at liter flows of 10-15 L/min.
 Verturi Mask - delivers oxygen concertration of 24%-40% or 50% at liter flows of 4-10 L/min.
 NURSING MANAGEMENT

• Face tent
 can replace oxygen masks when masks are poorly tolerated by clients.
 frequently inspect the client's facial skin for dampness or chafing, and dry and
treat as needed.
 NURSING MANAGEMENT

• Transtracheal Catheter
 is placed through a surgically created tract in the lower neck directly into the trachea.
 once the tract has matured, the client removes and cleans the catheter two to four times per
day.
 NURSING MANAGEMENT
• Noninvasive Positive Pressure Ventilation
 It is used for the delivery of air or oxygen under pressure without the need for an invasive
tube such as an endotracheal tube or tracheostomy tube.
 Most common treatment for OSA is positive pressure ventilation
 Positive pressure ventilation- a mask fitted over the clients nose during sleep to provide air
under pressure during inhalation and exhalation.
• Artificial Airways
 Inserted to maintain a patent air passage for clients whose airways have become obstructed.
 Patent airway is necessary so air can flow to and from the lungs.
 NURSING MANAGEMENT
• Oropharyngeal and Nasopharyngeal Airways
 Used to keep the upper air passages open when secretions or the tongue may obstruct them.
 Oropharyngeal airways stimulate the gag flex and used for clients with altered levels of consciousness.

• Oropharyngeal Airways
 To insert the airway:
1. Place the client in a supine or semi-Fowler’s position.
2. Apply clean gloves.
3. Hold the lubricated airway by the outer flange, with the distal end pointing up or curved upward.
4. Open the client’s mouth and insert the airway along the top of the tongue.
5. When the distal end of the airway reaches the soft palate at the back of the mouth, rotate the airway 180
degrees downward, and slip it past the uvula into the oral pharynx.
6. If not contraindicated, place the client in a side-living position or with the head turned to the side to allow
 NURSING MANAGEMENT

7. The oropharynx may be suctioned as needed by inserting the suction catheter alongside the airway
8. Remove and discard gloves.
9. Perform hand hygiene.
10. Do not tape the airway in place; remove it when the client begins to cough or gag.
11. Provide mouth care at least every 3 to 4 hours, keeping suction available at the bedside.
12. As appropriate for the clients condition, remove the airway every 8 hours to assess the mouth and
provide oral care. Reinsert the airway immediately.
 NURSING MANAGEMENT
7. The oropharynx may be suctioned as needed by inserting the suction catheter alongside the airway
8. Remove and discard gloves.
9. Perform hand hygiene.
10. Do not tape the airway in place; remove it when the client begins to cough or gag.
11. Provide mouth care at least every 3 to 4 hours, keeping suction available at the bedside.
12. As appropriate for the clients condition, remove the airway every 8 hours to assess the mouth and
provide oral care. Reinsert the airway immediately.
• Nasopharyngeal airways
 Inserted through the nares, terminating in the oropharynx.
 NURSING MANAGEMENT

• Endotracheal Tubes
 Most commonly inserted in client who have had general anesthetics.
 Used for people in emergency situations where mechanical ventilation is required.
 The tube may have an air-filled cuff to prevent air leakage around it.
 NURSING MANAGEMENT

• Tracheostomy
 Is an opening into the trachea through the neck.
 A tube is usually inserted through this opening and an artificial airway is created.
 It is performed using one of the two techniques namely the traditional open surgical method or via a
percutaneous insertion.
 Percutaneous insertion- it can be done at the bedside in a critical care unit.
 Open surgical technique- done in an operating room where surgical incision is made in the trachea just
below the larynx.
 NURSING MANAGEMENT
• Suctioning
 Is used when clients are having a hard time handling their secretions or an artificial airway is in place,
suction is necessary to clear air passages.
 Is the aspiration of secretions through a catheter connected to a suction machine or wall suction outlet.
 Oropharyngeal and nasopharyngeal suctioning removes secretions from the upper respiratory tract.
• Suctioning used in different ages
 Infants- a bulb syringe is used to remove secretions from an infant’s nose or mouth.
 Children- A catheter is used to remove secretions from an older child’s mouth or nose.
 Older adults- often have cardiac or pulmonary disease, this increasing their susceptibility to hypoxemia
related to suctioning.
 NURSING MANAGEMENT
• The following techniques are used to minimize or decrease these implications:
 Suction only as needed- should be performed only when indicated and not on a fixed schedule.
 Sterile technique- Infection in the lower respiratory system can occur during tracheal suctioning so
nurses use this technique to prevent complications along the process.
 No saline instillation- instilling normal saline into the airway is a routine part of the suctioning
procedure. But in later research, it says, saline instillation may cause effects such as hypoxemia and
increased risk of pneumonia.
 Hyperinflation- involves giving the clients breaths that are greater than the tidal volume set on the
ventilator.
 Hyperventilation- involves increasing the number of breaths the client is receiving.
 Hyperoxygenation- the best technique to avoid suction related to hypoxemia and can be done with a
manual resuscitation bag.
 NURSING MANAGEMENT

• Chest Tubes and Drainage Systems

 Chest tubes may be inserted into the pleural cavity to restore negative pressure and drain collected fluid
or blood.
 Hemothorax- accumulation of blood in the pleural space
 Chest tubes for the pneumothorax are often placed in the upper anterior thorax, whereas chest tubes
used to drain blood and fluid are placed in the lower lateral chest wall.
 When the chest tubes are inserted they must be connected with a sealed drainage system that allows
air and fluid to be removed from the chest cavity.
 Sterile disposable drainage systems- used to prevent outside air from entering the chest tube.
 NURSING MANAGEMENT
• Evaluation
 Using goals and desired outcomes identified in the planning stage of the nursing process.
 The nurses collects data to evaluate the effectiveness of interventions.
 If the outcomes are not reached, the nurse, client and support person need to explore the reasons
before modifying the care plan.

• Few examples of questions that needs to be considered are the following:

 What is the client’s perception of the problem?
 Has the client been exposed to an upper respiratory infection that is affecting breathing?
 Do other factors need to be considered, such as the client’s psychological stress level?
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