oxygenation

• Oxygen


  A clear, odorless gas that constitute 21% of the air we breathe. Necessary for proper functioning of all living cells.
• Respiration


  The process of gas exchange between the individual & the environment.
• Components of Respiration

  1. Ventilation or Breathing

  2. Alveolar-Capillary Gas Exchange

  3. Transport of Oxygen & Carbon Dioxide Between the Tissues & the Lungs

  4. Movement of Oxygen & Carbon Dioxide Between the Systemic Capillaries & the Tissues

  
• Pulmonary Ventilation

  1. Inspiration (Inhalation) - Air flows into the lungs

  2. Expiration (Exhalation) - Air moves out of the lungs

  
• Factors Affecting Ventilation

  • Clear Airways
  • An Intact Central Nervous System (CNS) & Respiratory Center
  • An Intact Thoracic Cavity Capable of Expanding & Contracting
  • Adequate Pulmonary Compliance & Recoil

  
• Intrapleural Pressure


  Pressure in the pleural cavity surrounding the lungs. Always slightly negative in relation to atmospheric pressure.

  
• Intrapulmonary Pressure


  Pressure within the lungs. Always equalizes with atmospheric pressure.

  
• Tidal Volume


  The lung volume representing the normal volume of air displaced between normal inhalation and exhalation when extra effort is not applied. In a healthy, young human adult, tidal volume is approximately 500 ml per inspiration.

  
• Lung Compliance


  The expansibility or stretchability of lung tissue. Plays a significant role in the ease of ventilation.

  
• Atelectasis


  Collapse of a portion of the lung.
• Lung Recoil


  The continual tendency of the lungs to collapse away from the chest wall.

  
• Surfactant


  A lipoprotein produced by specialized alveolar cells, acts like detergent, reducing the surface tension of alveolar fluid.
• Alveolar Gas Exchange


  The diffusion of oxygen from the alveoli & into the pulmonary blood vessels.

  
• Diffusion


  The movement of gases or other particles from an area of greater pressure or concentration to an area of lower pressure or concentration.
• Transport of Oxygen & Carbon Dioxide

  Involves the transport of respiratory gases. Hemoglobin is the oxygen-carrying red pigment.

  
• Factors Affecting Oxygen Transport

  • Cardiac Output
  • Number of Erythrocytes & Blood Hematocrit
  • Exercise

  
• Systemic Diffusion


  Diffusion of oxygen & CO2 between the capillaries & the tissues & cells.

  
• Factors Affecting Respiratory Function

  • Age
  • Environment
  • Lifestyle
  • Health Status
  • Medications
  • Stress
• Alterations in Respiratory Function

  • Conditions affecting the airway
  • Conditions affecting movement of air
  • Conditions affecting diffusion
  • Conditions affecting transport

  
• Upper Airway Obstruction


  Obstruction of foreign object, tongue falls back or collection of secretions.
• Conditions Affecting Movement of Air

  • Eupnea (Normal respiration: quiet, rhythmic effortless)
  • Tachypnea (Rapid respirations)
  • Bradypnea (Abnormally slow respiratory rate)
  • Apnea (Absence of breathing)
  • Hypercarbia/Hypercapnia (Increased level of carbon dioxide)
  • Kussmaul's Breathing (Deep, rapid breathing pattern)
  • Cheyne-Stokes Respirations (Rhythmic waxing & waning of respirations)
  • Biot's (cluster) respirations (Shallow breaths interrupted by apnea)
  • Orthopnea (Inability to breath easily unless in sitting upright or standing)
  • Dyspnea (Difficulty of breathing or feeling of being short of breath)

  
• Conditions Affecting Diffusion

  • Hypoxemia (Reduced oxygen levels in the blood)
  • Hypoxia (Insufficient oxygen anywhere in the body)
  • Cyanosis (Bluish discoloration of the skin, nail beds & mucous membranes due to reduced hemoglobin-oxygen saturation)

  
• Conditions Affecting Transport

  • Congestive Heart Failure (Chronic progressive condition that affects the pumping power of your heart muscle)
  • Hypovolemia (Abnormally low extracellular fluid in the body)
• Assessment

  • Nursing History
  • Physical Examination
  • Diagnostic Studies
• Pulse Oximetry

  Non-invasive method used to measure the oxygen saturation level in your blood.

  
• Normal Range for Healthy Individuals: Oxygen saturation (SpO2) typically 95-100%
• Normal Range for COPD Patients: Oxygen saturation (SpO2) above 90% is generally considered acceptable
• Nursing Diagnoses


  • Ineffective Airway Clearance
  • Ineffective Breathing Pattern
  • Impaired Gas Exchange
  • Activity Intolerance
  • Anxiety
  • Fatigue
  • Powerlessness
  • Insomia
  • Social Isolation
• Goals of Care

  • Maintain a patent airway
  • Improve comfort & ease of breathing
  • Maintain or improve pulmonary ventilation & oxygenation
  • Improve ability to participate in physical activities
  • Prevent risks associated with oxygenation problems

  
• Implementation

  • Promoting oxygenation
  • Deep breathing & coughing
  • Hydration
  • Medications
  • Incentive spirometry
  • Percussion, vibration & postural drainage
  • Mucus clearance devices
  • Oxygen therapy

  
• Humidifiers


  Devices that add water vapor to inspired air. Provide moistened air directly to the client. Prevent mucous membranes from drying & becoming irritated & to loosen secretions for easier expectoration.
• Incentive Spirometers


  Referred to as sustained maximal inspiration devices (SMIs). Measure the flow of air inhaled thru the mouthpiece.

  
• Percussion, Vibration & Postural Drainage

  1. Percussion (Forceful striking of the skin with cupped hands)

  2. Vibration (A series of quiverings produced by hands that are placed flat against the client's chest wall)

  3. Postural Drainage (The drainage by gravity of secretions from various lung segments)
• Mucus Clearance Devices


  Used for clients with excessive secretions. Produces vibrations that loosen mucus from the airway & assist its movement up the airways to be expectorated. Examples: Acapella, Cornet.
• Oxygen Therapy


  The administration of oxygen at a concentration greater than that found in the environmental atmosphere. Provides adequate transport of oxygen in the blood while decreasing the work of breathing and reducing stress on the myocardium. Oxygen concentration at room air is 21%.
• Percussion


  Forceful striking of the skin with cupped hands
• Vibration


  A series of quiverings produced by hands that are placed flat against the client's chest wall
• Postural Drainage


  The drainage by gravity of secretions from various lung segments

  
• Mucus Clearance Devices


  • Used for clients with excessive secretions such as cystic fibrosis, COPD, & bronchiectasis
  • Produces vibrations that loosen mucus from the airway & assist its movement up the airways to be expectorated
• Mucus Clearance Devices

  • Acapella
  • Cornet