Chapter 39

Oxygenation

Physiology of Oxygenation

Ventilation Alveolar Gas Exchange Oxygen Transport and Delivery Cellular Respiration

Physiology of Oxygenation

Ventilation• Movement of air into and out of the lungs

- Inhalation - Exhalation

• Delivery of fresh air into the lung’s alveoli• Regulated by respiratory control centers• Hypoxemia is a decrease in blood oxygen

concentration.

Physiology of Oxygenation

Alveolar Gas Exchange• Oxygen uptake (external respiration) is the

exchange of oxygen from the alveolar space into the pulmonary capillary blood.

• Carbon dioxide diffuses from the blood to the alveolar space.

Physiology of Oxygenation

Circulation/Perfusion• The heart pumps oxygenated blood into the

arterial system, which carries it to the cells, and collects deoxygenated blood from the venous system.

Physiology of Oxygenation

Cellular Respiration (internal respiration)• Oxygen diffuses from the blood to the

tissues• Carbon dioxide moves from the tissues to

the blood.• The blood is then reoxygenated by the heart.

Process of Ventilation

The diaphragm contracts and descends, lengthening the thoracic cavity.

The external intercoastal muscles contract, lifting the ribs upward and outward.

The sternum is pushed forward, enlarging the chest from front to back.

Increased lung volume and decreased intrapulmonic pressure allows air to move from an area of greater pressure (outside lungs ) to lesser pressure (inside lungs).

The relaxation of these structures results in expiration.

Altered breathing patterns

Tachypnea(hyperventilation) Bradypnea(hypoventilation) Dyspnea Apnea Orthopnea Cyanosis Hypoxia

Factors Affecting Oxygenation

Environmental: altitude, heat and cold, air pollution

Lifestyle Factors: cigarette smoking, occupation, activity pattern

Disease Processes Exercise Emotions Narcotics

Diagnostic and Laboratory Data

Pulse Oximetry Arterial Blood Gases (ABGs) Sputum Collection Ventilatory Function Tests Lactic Acid, Hemoglobin, Hematocrit

Diagnostic and Laboratory Data

Chest X-Ray, Computerized Tomography Bronchoscopy Thoracentesis Echocardiography Electrocardiography Stress Test

Nursing Diagnosis

Primary Nursing Diagnoses• Ineffective Airway Clearance• Ineffective Breathing Patterns• Impaired Gas Exchange• Decreased Cardiac Output• Altered Tissue Perfusion

Secondary Nursing Diagnoses

Deficient Knowledge Activity Intolerance Disturbed Sleep Pattern Imbalanced Nutrition Acute Pain Anxiety

Implementation

Interventions to Promote Airway Clearance• Teach effective coughing.• Initiate postural drainage and chest

physiotherapy.• Monitor hydration.• Administer medications.

Implementation

Interventions to Promote Airway Clearance• Monitor environmental and lifestyle

conditions.• Manage artificial airways.• Suction the airway.

Suctioning an Endotracheal Tube

Implementation

Interventions to Improve Breathing Patterns• Position client properly.• Teach controlled breathing exercises.• Manage chest drainage systems.

Implementation

Interventions to Improve Oxygen Uptake and Delivery• Administer oxygen. *simple mask

*Nasal canula

*Ventori mask

*Rebreathing and Non-rebreathing mask

• Administer blood components.

Implementation

Interventions to Increase Cardiac Output and Tissue Perfusion• Manage fluid balance.• Encourage activity restrictions and

assistance with activities of daily living.• Position client properly.• Administer medications.

Implementation

Emergency Interventions• Remove airway obstruction.• Initiate cardiopulmonary resuscitation.

Implementations

Interventions to Address Associated Nursing Diagnoses• Explore lifestyle and activity

adaptations.• Encourage dietary and nutritional

modifications.• Promote comfort measures.

Precautions for Oxygen Administration

Avoid open flames in patient’s room Place no smoking signs in conspicuous places Check to see electrical equipment in room is in

good working order Avoid using oils in the area (ignite

spontaneously in oxygen)