OXYGENATION

PRESENTED BY:
DELA CRUZ, CHRISTINE
JOYCE O.
FERNANDEZ, SHERNA MAE
Oxygen Hemoglobin
(oxygen-carrying red pigment)
• a clear, odorless gas that constitutes
approximately 21% of the air we Oxyhemoglobin
breathe, is necessary for proper the compound of oxygen and hemoglobin, which is
functioning of all living cells. delivered to tissues
• absence of oxygen can lead to cellular,
tissue, and organism death.
• Delivery of oxygen and removal of
carbon dioxide require the integration of
several systems including the
hematologic, cardiovascular, and
respiratory systems
• 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
 The act of oxygen diffusing from high
to low concentrations.
Oxygenation Measured by SPO2, pO2.
Eg. Alveolus to capillary. Capillary to
cell.

The act of breathing oxygen in and

Ventilation breathing carbon dioxide out.
Measured by CO2, ETCO2.
OVERVIEW OF RESPIRATORY
SYSTEM
Surfactant – lines the alveolus.
Fatty protein provides surface stability (reduces surface tension) and prevents
collapse of the alveolar structures (atelectasis)
Produced by Type 2 Pneumocytes
Lung volumes – amount of air Lung capacities – 2 or more lung
exchanged during ventilation volumes
Inspiratory Capacity
• Hyperventilation
• the rate and depth of respirations increase and
more CO2 is eliminated than is produced
• Kussmaul’s breathing – by which the body
attempts to compensate for increased
metabolic acids by blowing off acid in the
form of CO2
• Cheyne-Stokes respirations: marked
rhythmic waxing and waning of respirations
from very deep to very shallow with short
periods of apnea commonly caused by chronic
diseases, increased intracranial pressure, or
drug overdose
• Biot’s (cluster) respirations: shallow breaths
interrupted by apnea; may be seen in clients
with CNS disorders
ANATOMY AND PHYSIOLOGY OF THE CARDIOVASCULAR SYSTEM
The Heart Pericardium
a hollow, cone-shaped organ ➢ The parietal, or outermost, pericardium serves to protect the
about the size of a fist heart and anchor it to surrounding structures
➢ it is located in the Epicardium
mediastinum, between the lungs ➢ The hearts outermost layer
and underlying the sternum Myocardium
➢ Each beat of the heart pumps ➢ cardiac muscle cells that form the bulk of the heart and
about 60 contract
mL of blood, or 5 L/min. with each beat
During strenuous physical Endocardium
activity, the amount of blood ➢ lines the inside of the heart’s chambers and great vessels
pumped can double to meet
the body's increased gas
exchange needs.
A covering called the
pericardium protects the heart.
A muscular wall (septum)
separates the
heart into two halves: right and
left.
Heart Chambers
- 2 atria
- 2 ventricles

Heart Valves
➢ The valves serve to direct the flow of blood,
allowing it to move from the atria to the
ventricles, and the ventricles to the great
vessels, but preventing backflow a. Aortic Valve
(Left semilunar Valve)
b. Pulmonary Valve (Right semilunar valve)
c. Tricuspid Valve ( Right atrioventricular valve)
d. Mitral Valve ( left atrioventricular valve)
CORONARY CIRCULATION

➢ commonly known as the coronary

arteries

➢ a network of vessels that supplies

the heart with oxygen and
nourishments

➢ The coronary arteries originate at

the base of the aorta, branching out to
encircle and penetrate the myocardium.

➢ These arteries fill during ventricular

relaxation, bringing oxygen-rich blood
to the myocardium
CARDIAC OUTPUT
 Pulmonary Function Tests (PFT)

a group of tests measuring lung function 1.Body plethysmograph -

✓ Measure of diffusion capacity:

▪ client breathes in a harmless gas for a very • Client sits in a sealed, clear
short time (one breath)
▪ the concentration of the gas in the air box that looks like a
exhaled is measured ▪ the difference in the telephone booth while
amount of gas inhaled and exhaled can help
estimate how quickly gas can travel from the breathing in and out into a
lungs into the blood
mouthpiece
•• Changes in pressure inside
the box help determine the
lung volume
 Spirometry test
measures airflow; client will breathe through a tightfitting mouthpiece and will have
nose clips
Purpose: ✓ Improve pulmonary ventilation and oxygenation
✓ Loosen respiratory secretions.
✓ Prevent or treat atelectasis by expanding collapsed.
Nursing Interventions:
Instruct client to:
a. breathe into a mouthpiece that is connected to an instrument (spirometer)
b. b. eat a light meal before the test
c. not to smoke for 4 - 6 hours before the test
d. stop using bronchodilators or inhaler
medications 6-8hrs prior
e. Inform client that
temporary shortness of breath or lightheadedness may be felt
. Peak Expiratory Flow Rate (PEFR)
Measures how fast a person can exhale
•• It is one of many tests that measure how well the airways work
•• Requires a peak expiratory flow (PEF) monitor, a small
•handheld device with a mouthpiece at one end and a scale with a
moveable indicator (usually a small plastic arrow)
•• Commonly used to diagnose and monitor lung diseases such as
asthma, chronic bronchitis, chronic obstructive pulmonary disease
(COPD), and emphysema
•• A decrease in peak flow indicates blocked or narrowed
• airways
•• A significant fall in peak flow can signal the onset of a lung disease
esp. when accompanied by persistent coughing, SOB, or wheezing
• • PEFR measurements are not as accurate as the Spirometry
Nursing Interventions:

•Inform client that repeated efforts may cause

• lightheadedness
•✓ Loosen any tight clothing that might restrict breathing
•✓ Sit up straight or stand while performing the tests
•✓ Instruct client on proper procedure to do this test:
•✓ Breathe in as deeply as possible.
• ✓ Blow into the instrument's
mouthpiece as hard and fast as
possible.
•✓ Do this 3 times, and record the highest flow rate
Arterial Blood Gases

ABG studies aid in assessing the ability of

the lungs to provide oxygen and remove
carbon dioxide and the ability of the kidneys
to reabsorb or excrete bicarbonate ions to
maintain normal body pH.
Normal Values of
ABGs
Site for Arterial Blood Gas
Extraction
• Radial Artery- first choice, most
preferable site for extraction.
• Brachial Artery- second choice
• Femoral artery- alternative
• Dorsalis pedis artery-alternative
George Kent is a 54-year-old widower with a history of chronic obstructive
pulmonary disease and was rushed to the emergency department with
increasing shortness of breath, pyrexia, and a productive cough with
yellow-green sputum. He has difficulty communicating because of his inability
to complete a sentence. One of his sons, Jacob, says he has been unwell for
three days. Upon examination, crackles and wheezes can be heard in the
lower lobes; he has tachycardia and a bounding pulse. Measurement of arterial
blood gas shows pH 7.3, PaCO2 68 mm Hg, HCO3 28 mmol/L, and PaO2 60
mm Hg. How would you interpret this?
A. Respiratory Acidosis, Uncompensated
B. Respiratory Acidosis, Partially Compensated
C. Metabolic Alkalosis, Uncompensated
D. Metabolic Acidosis, Partially Compensated
Correct Answer: B. Respiratory
Acidosis, Partially Compensated The
patient has respiratory acidosis
(raised carbon dioxide) resulting
from an acute exacerbation of
chronic obstructive pulmonary
disease, with partial compensation.
 Carl, an elementary student, was rushed to the hospital due to vomiting
and a decreased level of consciousness. The patient displays slow and
deep (Kussmaul breathing), and he is lethargic and irritable in response
to stimulation. He appears to be dehydrated—his eyes are sunken and
mucous membranes are dry—and he has a two-week history of
polydipsia, polyuria, and weight loss. Measurement of arterial blood
gas shows pH 7.0, PaO2 90 mm Hg, PaCO2 23 mm Hg, and HCO3 12
mmol/L; other results are Na+ 126 mmol/L, K+ 5 mmol/L, and Cl- 95
mmol/L. What is your assessment?

A. Respiratory Acidosis, Uncompensated

B. Respiratory Acidosis, Partially Compensated
C. Metabolic Alkalosis, Uncompensated
D. Metabolic Acidosis, Partially, Compensated
Correct Answer: D. Metabolic Acidosis,
Partially, Compensated The student was
diagnosed with diabetes mellitus. The results
show that he has metabolic acidosis (low
HCO3 -) with respiratory compensation (low
CO2).
 A cigarette vendor was brought to the emergency
department of a hospital after she fell into the ground
and hurt her left leg. She is noted to be tachycardic and
tachypneic. Painkillers were carried out to lessen her
pain. Suddenly, she started complaining that she is still
in pain and now experiencing muscle cramps, tingling,
and paraesthesia. Measurement of arterial blood gas
reveals pH 7.6, PaO2 120 mm Hg, PaCO2 31 mm Hg,
and HCO3 25 mmol/L. What does this mean?
A. Respiratory Alkalosis, Uncompensated
B. Respiratory Acidosis, Partially Compensated
C. Metabolic Alkalosis, Uncompensated
D. Metabolic Alkalosis, Partially Compensated
Correct Answer: A. Respiratory Alkalosis,
Uncompensated The primary disorder is acute
respiratory alkalosis (low CO2) due to the pain
and anxiety causing her to hyperventilate.
There has not been time for metabolic
compensation.
Ricky’s grandmother has been suffering from persistent
vomiting for two days now. She appears to be lethargic
and weak and has myalgia. She is noted to have dry
mucus membranes and her capillary refill takes >4
seconds. She is diagnosed as having gastroenteritis and
dehydration. Measurement of arterial blood gas shows pH
7.5, PaO2 85 mm Hg, PaCO2 40 mm Hg, and HCO3 34
mmol/L. What acid-base disorder is shown?
• A. Respiratory Alkalosis, Uncompensated
• B. Respiratory Acidosis, Partially Compensated
• C. Metabolic Alkalosis, Uncompensated
• D. Metabolic Alkalosis, Partially Compensated
Correct Answer: C. Metabolic Alkalosis,
Uncompensated
The primary disorder is uncompensated metabolic
alkalosis (high HCO3 -). As CO2 is the strongest
driver of respiration, it generally will not allow
hypoventilation as compensation for metabolic
alkalosis.
•Mrs. Johansson, who had undergone surgery in the
post-anesthesia care unit (PACU), is difficult to arouse two hours
following surgery. Nurse Florence in the PACU has been
administering Morphine Sulfate intravenously to the client for
complaints of post-surgical pain. The client’s respiratory rate is 7
per minute and demonstrates shallow breathing. The patient does
not respond to any stimuli. The nurse assesses the ABCs
(remember Airway, Breathing, Circulation!) and obtains ABGs
STAT! Measurement of arterial blood gas shows pH 7.10, PaCO2
70 mm Hg, and HCO3 24 mEq/L. What does this mean?
A. Respiratory Alkalosis, Partially Compensated
B. Respiratory Acidosis, Uncompensated
C. Metabolic Alkalosis, Partially Compensated
D. Metabolic Acidosis, Uncompensated
Correct Answer: B. Respiratory Acidosis,
Uncompensated
The results show that Mrs. Johansson has respiratory
acidosis because of decreased pH and increased PaCO2
which means acidic in nature. Meanwhile, it is
uncompensated because HCO3 is within the normal
range.
NURSING DIAGNOSIS
INEFFECTIVE BREATHING PATTERN
➢ The state in which an individual’s inhalation
and/or exhalation pattern does not enable adequate
pulmonary inflation or emptying.

• Defining characteristics:
• ✓ dyspnea
• ✓ tachypnea
• ✓ abnormal ABG values
• ✓ cough
• ✓ respiratory depth changes
• ✓ assumption of three- point position
• ✓ pursed lip breathing
• ✓ used of accessory muscles
INEFFECTIVE AIRWAY CLEARANCE
➢ The state in which an individual is unable to clear secretions or
obstructions from the respiratory tract to maintain airway patency.

Defining characteristics:

• ✓ Abnormal breath sounds

• ✓ changes in rate and depth of respiration
• ✓ tachypnea
• ✓ effective or ineffective cough
• ✓ cyanosis
• ✓ dyspnea
IMPAIRED GAS EXCHANGE

The state in which an individual experiences a

decreased passage of oxygen and/or CO2 between
the alveoli of the lungs and the vascular system.
• Defining Characteristics:
• ✓ restless
• ✓ irritability
• ✓ inability to move secretions
• ✓ hypercapnia
• ✓ hypoxia
OTHER NURSING DIAGNOSIS
PLANNING

a. Patient will demonstrate knowledge

regarding prevention of respiratory
dysfunction.
•b. Patient’s tissues will have adequate
oxygenation.
•c. Patient will mobilize secretions.
•d. Patient will effectively cope with
changes in self-concept and lifestyle.
IMPLEMENTING
• 1. Planning for Health Promotion
• 2. Planning for Health Restoration and Maintenance
• a. Maintaining Patent Airway
• 1. Coughing techniques
• 2. Nebulization
• 3. Steam inhalation
• 4. Suctioning
•5. Chest physiotherapy(CPT)/ Chest mucus mobilization
• b. Breathing Exercises
• c. Preventing and Controlling Infection
• d. Oxygen Therapy
• e. Incentive Spirometry
• f. Appropriate pharmacologic agents
MAINTAINING PATENT AIRWAY
• 1. COUGHING EXERCISES
•➢ Assist client in a comfortable sitting position
•➢ Instruct client to lean head forward slightly while placing both
feet firmly on the ground.
•➢ Breathe in deeply using diaphragmatic breathing
Instruct to hold breath for three second while keeping the mouth
slightly open, instruct to cough out twice.
•The client should feel his diaphragm pushed upward while doing
this. The first cough should bring up the phlegm, and the second
cough should move it towards the throat.
Instruct to spit the phlegm out into a tissue. Remember to check
the colour; if the phlegm is yellow, green or brown, or has blood
in it. Allow client to rest and repeat these steps once or twice if
necessary.
2. NEBULIZATION

• a process of adding moisture or

medications to inspired air by
mixing particles of varying sizes
with air. A nebulizer uses the
aerosol principle to suspend a
maximum number of water
drops or particles of the desired
size in inspired air. Moisture
added to the RS through
nebulization improves clearance
of pulmonary secretions.
• ➢ Often used for administration
of bronchodilators and mucolytic
agents.
• ➢ The client inhales deeply and
holds each breath for a moment,
which allows for more effective
aerosol deposition into distant
portions of the airways.
 3. STEAM INHALATION
• Procedure:
•✓ Place client in semi fowler’s position.
•✓ Cover client’s eyes with wash cloth.
•✓ Check electrical device before use
•✓ Place steam inhalator in a flat, stable surface
• ✓ Place the spout 12-18 inches away from the
client’s nose or adjust the distance as necessary.
• ✓ Cover chest with a towel
•✓ Render steam inhalation for 15-20 minutes for
• effectivity
•✓ Instruct client to perform DBE and coughing exercises
• after the procedure
•✓ Provide good oral hygiene after the procedure.
• ✓ Document
 4. SUCTIONING
• Purpose:
•✓ Remove excess mucus secretions to maintain patent
• airway
•✓ Collect sputum or secretions for diagnostic testing
•Suctioning (Oropharyngeal and
Nasopharyngeal)
• . Assess indications for suctioning:
• • audible secretions during respiration
•❖ adventitious breath sounds
Suctioning (Oropharyngeal and Nasopharyngeal)

• Position:
• • conscious: Semi-Fowler’s position
• • unconscious: lateral position facing the Nurse
•Pressure of suction equipment, to prevent trauma to mucus membrane
of airways
• • Wall unit:
• ✓ Adult: 100-120 mmHg
• ✓ Child: 95-110 mmHg
• ✓ Infant: 50-95 mmHg
• • Portable unit:
• ✓ Adult 10-15 mmHg
• ✓ Child 5-10 mmHg
• ✓ Infant 2-5 mmHg
Suctioning (Oropharyngeal and
Nasopharyngeal)
•Appropriate size of sterile suction catheter, to prevent
trauma to mucus membranes of airways
• ✓ Adult Fr. 12-18
• ✓ Child Fr. 8-10
• ✓ Infant Fr. 5-8
• The following techniques are used to minimize or decrease complications:
• 1. Suction only as needed
The following techniques are used to minimize or
decrease complications:

• a. Suction only as needed.

• b. Sterile technique
• c. No saline instillation
• d. Hyperinflation
• E. Hyperventilation
• F. Hyperoxygenation
• ❖ A rule of thumb to determine suction catheter size is to double the millimeter
size of the artificial airway. For example, an artificial airway (e.g.,tracheostomy)
diameter of 8 mm × 2 = 16. A size 16 French
 TYPES OF SUCTIONING

•A. Open Method

• ➢ The traditional method of suctioning
an ETT or tracheostomy is if a client is
connected to a ventilator, the nurse
•disconnects the client from the ventilator, suctions the
• airway, reconnects the client to the
ventilator, and discards the suction
catheter.
• ➢ Wear personal protective equipment
(e.g., goggles or face shield, gown) to
avoid exposure to the client’s sputum and
the potential cost of one-time catheter
use, especially if the client requires
frequent suctioning.
Closed airway/tracheal suction system (in-line
suctioning)

• ➢ The suction catheter attaches to the

ventilator tubing and the client does not
need to be disconnected from the
ventilator. The nurse is not exposed to any
secretions because the suction catheter is
enclosed in a plastic sheath.
• ➢ The catheter can be reused as many
times as necessary until the system is
changed
ARTIFICIAL AIRWAYS
➢ Artificial airways are inserted to maintain a patent air passage for clients whose airways
have become or may become
obstructed
Four Types of Airways:
• a. Oropharyngeal-➢ stimulate the gag reflex and are only used for clients with altered
levels of consciousness
• ➢ used during general anesthesia, overdose incident, or head injury
• b. Nasopharyngeal
• ➢ used to keep the upper air passages open when secretions or the tongue may obstruct them (e.g.,
in a client who is sedated, is semicomatose, or has an altered level of consciousness)
• ➢ low risk of complications
• ➢ nasopharyngeal airway should be well lubricated with water soluble gel prior to inserting
• c. Endotracheal tubes (ETTs)-➢ are most commonly inserted in clients who have had
general anesthetics or for those in emergency situations where mechanical ventilation is required
• ➢ inserted by an anesthesiologist, primary care provider, certified registered nurse anesthetist
(CRNA), or respiratory therapist with specialized education
• ➢ It is inserted through the mouth or the nose and into the trachea, using a laryngoscope as a guide
The tube terminates just superior to (above) the bifurcation of the trachea into the bronchi
• ➢ The tube may have an air-filled cuff to prevent air leakage around it because an ETT passes
through the epiglottis and glottis, the client is unable to speak while it is in place
• . Tracheostomy-airway support due to a temporary or permanent condition
• ➢ An opening into the trachea through the neck. A tube is usually inserted through this opening
and an artificial airway is created
Tracheostomy

• Two Techniques:
• a. The traditional open surgical
method ➢ done in an operating
room where a surgical incision is
made in the trachea just below
the larynx
• b. The percutaneous method ➢
can be done at the bedside in a
critical care unit
• ➢ A curved tracheostomy tube is
inserted to extend through the
stoma into the trachea
•
 5. CHEST PHYSIOTHERAPY (CPT)

• Chest physiotherapy- a group of therapies in combination to

mobilize pulmonary secretions.
•• Is based on the premise that mucus can be shaken from the
walls of the airways and helped drain form the lungs.
•• CPT should be followed by productive coughing and suctioning
of the client who has decreased ability to cough.
•• CPT is recommended for clients who produce greater than 30
ml of sputum per day or have evidence of atelectasis by CXR
exam.
• Includes:
• a. Chest percussion
• b. Vibration
• c. Postural Drainage
 NUTRITION

EXERCISE
LIFESTYL
SMOKING
E FACTOR
SUBSTANCE ABUSE

STRESS
 MEDICATIONS
A. Bronchodilators -Bronchodilators, anti-inflammatory drugs, expectorants, and
cough suppressants are some medications that may be used to treat respiratory
problems. including sympathomi-metic drugs and xanthines, reduce bronchospasm,
opening tight or congested airways and facilitating ventilation.
b. Anti-inflammatory drugs - such as glucocorticoids, can be given orally,
intravenously, or by inhaler, work by decreasing the edema and inflammation in the
airways and allowing a better air exchange
c. Leukotriene Modifiers -suppress the effects of leukotrienes on the smooth muscle
of the respiratory tract. Leukotrienes cause bronchoconstriction, mucous production,
and edema of the respiratory tract.
d. Expectorants - help “break up” mucus, making it more liquid and easier to
expectorate. Ex: Guaifenesin
e. Cough Suppressant - When frequent or prolonged coughing interrupts sleep
codeine may be prescribed.
f.Digitalis Glycosides - act directly on the heart to improve the
strength of contraction and slow the heart rate

g. Beta-Adrenergic Stimulating Agents - such as dobutamine similarly

increase cardiac output, thus
improving O2 transport

h. Beta-adrenergic - blocking agents such as propranolol affect the

sympathetic nervous system to reduce the workload of the heart
➢ These drugs, however, can negatively affect people with
asthma or COPD because they may constrict airways by
blocking beta-2 adrenergic receptors.