OxygenationOxygenation

Unit EightUnit Eight

Ahmad Ata Ahmad Ata

ObjectivesObjectives

Out line the structure and function of the respiratory Out line the structure and function of the respiratory system.system.

Describe the process of breathing and gas exchange.Describe the process of breathing and gas exchange. Explain the role and function cardiovascular system in Explain the role and function cardiovascular system in

transporting. transporting. Identify the factors effect on respiration.Identify the factors effect on respiration. Identify the common Manifestation of impaired respiration.Identify the common Manifestation of impaired respiration. List the sign of obstructive air way.List the sign of obstructive air way. Identify and describe nursing measure to promote Identify and describe nursing measure to promote

respiratory function.respiratory function.

Respiratory system Respiratory system

Oxygen: a clear, odorless gas that Oxygen: a clear, odorless gas that constitutes approximately 21 percent of the constitutes approximately 21 percent of the air we breathe for necessary all living cell.air we breathe for necessary all living cell.

Respiration: is the process of gas exchange Respiration: is the process of gas exchange between individual and the environment.between individual and the environment.

The process of respiration The process of respiration involves several components:involves several components:

1.1. Pulmonary ventilation: the movement of air Pulmonary ventilation: the movement of air between the atmosphere and alveoli of the lungs.between the atmosphere and alveoli of the lungs.

2.2. Diffusion of oxygen and carbon dioxide between Diffusion of oxygen and carbon dioxide between alveoli and capillaries.alveoli and capillaries.

3.3. Transport of oxygen and carbon dioxide via blood Transport of oxygen and carbon dioxide via blood to tissues.to tissues.

4.4. Diffusion of oxygen and carbon dioxide between Diffusion of oxygen and carbon dioxide between capillaries and cell.capillaries and cell.

Function of pulmonary system:Function of pulmonary system:

Ventilation: is the movement of air in and Ventilation: is the movement of air in and out of the lung.out of the lung.

Respiration: is the process of gas Respiration: is the process of gas exchange.exchange.

Anatomy and physiology of Anatomy and physiology of respiratory system:respiratory system:

1) Upper respiratory tract:1) Upper respiratory tract: a)a) Nose Nose – made of cartilage and bone and is – made of cartilage and bone and is

designed to warm, moisten, and filter air as designed to warm, moisten, and filter air as it comes into the system.it comes into the system.

b) Pharynxb) Pharynx – (throat) conducts food and air; – (throat) conducts food and air; exchanges air with Eustachian tube to exchanges air with Eustachian tube to equalize pressure.equalize pressure.

Cont Cont

C) LarynxC) Larynx – (voice box) connects the – (voice box) connects the pharynx and the trachea; made of cartilage; pharynx and the trachea; made of cartilage; contains vocal cords.contains vocal cords.

D) Epiglottis – flap of tissue that covers D) Epiglottis – flap of tissue that covers trachea; ensures food travels down the trachea; ensures food travels down the esophagus.esophagus.

Alveoli

Cont Cont

2) Lower Respiratory tract:2) Lower Respiratory tract: TracheaTrachea – (windpipe) tubular passage way for air; – (windpipe) tubular passage way for air;

carries air to the lungs, C-shaped cartilage rings, carries air to the lungs, C-shaped cartilage rings, divides at end.divides at end.

BronchiBronchi – pair of tubes that branch from trachea – pair of tubes that branch from trachea and enter lungs; have cartilage, lining is ciliated & and enter lungs; have cartilage, lining is ciliated & secretes mucus.secretes mucus.

BronchiolesBronchioles – tiny tubes lacking cartilage and cilia; – tiny tubes lacking cartilage and cilia; possess smooth musclepossess smooth muscle

AlveoliAlveoli – cup shaped structures at the end of the – cup shaped structures at the end of the bronchioles that resemble bunches of grapes; are bronchioles that resemble bunches of grapes; are in direct contact with capillaries (gas exchange); in direct contact with capillaries (gas exchange); covered with SURFACTANT that keep them covered with SURFACTANT that keep them from collapsing Alveoli.from collapsing Alveoli.

LungsLungs – paired, cone-shaped organs that are – paired, cone-shaped organs that are surrounded by a pleural membrane, made of surrounded by a pleural membrane, made of elastic tissue, and divided into lobeselastic tissue, and divided into lobes

Mechanics of BreathingMechanics of Breathing

Inhaling (active process) – Air moves in. Inhaling (active process) – Air moves in. Why?Why?

Gases move from an area of high pressure Gases move from an area of high pressure to low pressureto low pressure

During inspiration – diaphragm pulls down During inspiration – diaphragm pulls down and lungs expandand lungs expand

When lungs expand, it increase the volume, When lungs expand, it increase the volume, which decrease the pressure inside lungswhich decrease the pressure inside lungs

Lung pressure is lower than outside Lung pressure is lower than outside pressure, so air moves in.pressure, so air moves in.

Exhaling (passive process) – breathing outExhaling (passive process) – breathing out Diaphragm and muscles relaxDiaphragm and muscles relax Volume in lungs and chest cavity decreases, Volume in lungs and chest cavity decreases,

so now pressure inside increases.so now pressure inside increases. Air moves out because pressure inside is Air moves out because pressure inside is

HIGHER than OUTSIDE atmosphere.HIGHER than OUTSIDE atmosphere.

Respiration:Respiration:

Exchange of O2 and CO2 between alveoli Exchange of O2 and CO2 between alveoli and bloodand blood

Partial pressure of O2 higher in alveoli than Partial pressure of O2 higher in alveoli than blood so O2 diffuses into bloodblood so O2 diffuses into blood

Partial pressure of CO2 higher in blood than Partial pressure of CO2 higher in blood than alveoli, so CO2 moves into alveoli in alveoli, so CO2 moves into alveoli in opposite direction and gets exhaled outopposite direction and gets exhaled out

Internal respirationInternal respiration

Internal respirationInternal respiration Exchange of O2 and CO2 between blood and Exchange of O2 and CO2 between blood and

tissuestissues Pressure of O2 higher in blood than tissues so O2 Pressure of O2 higher in blood than tissues so O2

gets release into tissues.gets release into tissues. Pressure of CO2 higher in tissue than in blood so Pressure of CO2 higher in tissue than in blood so

CO2 diffused in opposite direction into blood.CO2 diffused in opposite direction into blood. CO2 Is a waste product.CO2 Is a waste product. O2 Is used in cellular respirationO2 Is used in cellular respiration

3 Muscle Groups of Inhalation3 Muscle Groups of Inhalation

Diaphragm:Diaphragm:– contraction draws air into lungscontraction draws air into lungs– 75% of normal air movement75% of normal air movement

External intercostals muscles:External intercostals muscles:– assist inhalationassist inhalation– 25% of normal air movement25% of normal air movement

Accessory muscles assist in elevating ribs:Accessory muscles assist in elevating ribs:– sternocleidomastiodsternocleidomastiod– serratus anteriorserratus anterior– pectoralis minorpectoralis minor– scalene musclesscalene muscles

Control of BreathingControl of Breathing

Breathing is regulated by the rhythmicity center in Breathing is regulated by the rhythmicity center in the medulla and pons in brain stem.the medulla and pons in brain stem.

Carotid body is sensitive to level of oxygen.Carotid body is sensitive to level of oxygen. Control of BreathingControl of Breathing The most important factor affecting chemo The most important factor affecting chemo

sensitive center in the medulla oblogata is highly sensitive center in the medulla oblogata is highly responsive increase in blood is CO2 and O2 level.responsive increase in blood is CO2 and O2 level.

in arterial CO2 causes in arterial CO2 causes in acidity of in acidity of cerebrospinal fluid (CSF)cerebrospinal fluid (CSF)

medulla medulla rate and depth of breathing rate and depth of breathing

Pons and medullaPons and medulla

Factor effecting oxygenationFactor effecting oxygenation::

Environment: high altitude leads decrease lower Environment: high altitude leads decrease lower partial pressure and increase respiratory rate.partial pressure and increase respiratory rate.

Exercise: physical exercise lead to increase Exercise: physical exercise lead to increase respiratory rate.respiratory rate.

Life style: smoking, occupation.Life style: smoking, occupation. Health status: disease of cardiovascular disease.Health status: disease of cardiovascular disease. Narcotics: morphine decrease respiratory rate.Narcotics: morphine decrease respiratory rate. Stress and anxiety.Stress and anxiety.

Respiratory alteration:Respiratory alteration:

Hypoxia: is condition of insufficient oxygen Hypoxia: is condition of insufficient oxygen anywhere in the body from the inspired gas anywhere in the body from the inspired gas to the tissue. Cerebral function can tolerate to the tissue. Cerebral function can tolerate hypoxia for only 3 to 5 min before hypoxia for only 3 to 5 min before permanent damage.permanent damage.

Sign of hypoxia:Sign of hypoxia: Rapid pulse.Rapid pulse. Rapid shallow respiration.Rapid shallow respiration. Increase restlessness.Increase restlessness. Flaring nares.Flaring nares. Cyanosis. Cyanosis.

Hypoventilation: inadequate alveolar Hypoventilation: inadequate alveolar ventilation can lead to hypoxia may result ventilation can lead to hypoxia may result from disease of respiratory muscle, drug, from disease of respiratory muscle, drug, and anesthesia. and anesthesia.

Hypercabnia: accumulation of carbon Hypercabnia: accumulation of carbon dioxide in the blood.dioxide in the blood.

Cyanosis: bluish discoloration of the skin Cyanosis: bluish discoloration of the skin nails beds and mucosal membrane nails beds and mucosal membrane

Altered breathing pattern:Altered breathing pattern:

Breathing pattern: rate, volume, rhythm, Breathing pattern: rate, volume, rhythm, effort of respiration.effort of respiration.

Normal respiration: (Eupnea) quite, rhythmic Normal respiration: (Eupnea) quite, rhythmic and effortless.and effortless.

Tachypnea: rapid rate is seen with fevers, Tachypnea: rapid rate is seen with fevers, metabolic acidosis, pain and Hypercabnia.metabolic acidosis, pain and Hypercabnia.

Bradypnea: slow respiration rate, seen with Bradypnea: slow respiration rate, seen with narcotics and increase intracranial pressure narcotics and increase intracranial pressure from brain injury.from brain injury.

Hyperventilation: increase movement of air Hyperventilation: increase movement of air into and out of the lung.into and out of the lung.

Dyspnea: difficult of breathing.Dyspnea: difficult of breathing.

Orthopnea: in ability to breathe except in an Orthopnea: in ability to breathe except in an upright position upright position

Obstructed air way:Obstructed air way: Partially or completely in upper and lower Partially or completely in upper and lower

respiratory tract.respiratory tract.

Assessment Assessment

Nursing history:Nursing history: Respiratory problem, cardiac problem, life style, cough and Respiratory problem, cardiac problem, life style, cough and

sputum.sputum. Physical assessment:Physical assessment: Inspection, palpation, percussion and auscultation.Inspection, palpation, percussion and auscultation. Diagnostic studies:Diagnostic studies: Sputum specimen, throat culture, arterial blood samples.Sputum specimen, throat culture, arterial blood samples. X- Ray examination.X- Ray examination. Bronchoscopy and laryngoscopy. Bronchoscopy and laryngoscopy. Pulse oximetry: non invasive device measuring oxygen Pulse oximetry: non invasive device measuring oxygen

saturation.saturation.

Sputum collected for the following Sputum collected for the following reason:reason:

Culture and sensitivity: for identify a specific Culture and sensitivity: for identify a specific microorganism.microorganism.

Cytology: to identify the origin, structure, Cytology: to identify the origin, structure, function and pathology cell.function and pathology cell.

Acid bacillus: to identify the presence of Acid bacillus: to identify the presence of tuberculosis.tuberculosis.

Nursing diagnosis:Nursing diagnosis:

Ineffective air way clearance related to Ineffective air way clearance related to accumulation of secretion.accumulation of secretion.

Ineffective breathing pattern related to Ineffective breathing pattern related to dyspnea.dyspnea.

Altered tissue perfusion related to decrease Altered tissue perfusion related to decrease cardiac out put.cardiac out put.

Anxiety related to ineffective air way Anxiety related to ineffective air way clearance.clearance.

Implementation:Implementation: Positioning the client to allow to maximum chest Positioning the client to allow to maximum chest

expansion.expansion. Encourage frequent changes in position.Encourage frequent changes in position. Encourage ambulating.Encourage ambulating. Deep breathing exercise and coughing.Deep breathing exercise and coughing. Hydration to maintain moisturing of respiratory Hydration to maintain moisturing of respiratory

tract mucous membrane and easily to move tract mucous membrane and easily to move respiratory secretion and decease incidence of respiratory secretion and decease incidence of infection.infection.