1. oxygenation

• Oxygenation


  Supplying oxygen to the body cells
• Oxygen


  • Needed to sustain life
• Oxygenation (supplying oxygen to the body cells)


  1. Ventilation - process of moving gases into and out of the lungs (oxygen and carbon dioxide)

  2. Diffusion - exchange of respiratory gases in the alveoli and capillaries

  3. Perfusion - ability of the cardiovascular system to pump oxygenated blood to the tissues and return deoxygenated blood to the lungs
• The exchange of respiratory gases occurs between the environment and the blood
• Respiration is the exchange of oxygen and carbon dioxide during cellular metabolism
• Airways of the lung transfer oxygen from the atmosphere to the alveoli, where the oxygen is exchanged for carbon dioxide
• Through the alveolar capillary membrane, oxygen transfers to the blood and carbon dioxide transfers from the blood to the alveoli
• Hypoventilation


  Occurs when alveolar ventilation is inadequate to meet oxygen demand of the body or eliminate sufficient carbon dioxide
• Hyperventilation


  State of ventilation in which lungs remove carbon dioxide faster than its produced cellular metabolism
• Hypoxia


  Inadequate tissue oxygenation at the cellular level
• Physiological Factors affecting oxygenation


  • Decreased Oxygen-Carrying Capacity
  • Hypovolemia
  • Decreased Inspired Oxygen Concentration
  • Increased Metabolic Rate
• Conditions Affecting Chest Wall Movement


  • Pregnancy
  • Obesity
  • Musculoskeletal Abnormalities
  • Trauma
  • Neuromuscular Diseases
  • Central Nervous System Alterations
• Alterations in Cardiac Functioning


  • Disturbances in conduction
  • Altered cardiac output
  • Impaired Valvular Function
  • Myocardial Ischemia
• Developmental Factors affecting oxygenation


  • Infants and Toddlers
  • School-Age Children and Adolescents
  • Young and Middle-Age Adults
  • Older adults
• Lifestyle Factors affecting oxygenation


  • Nutrition
  • Hydration
  • Exercise
  • Smoking
  • Substance Abuse
  • Stress
• Environmental Factors affecting oxygenation


  • Air pollution
  • Altitude
• Nursing History Assessment


  • Health Risk
  • Pain
  • Fatigue
  • Dyspnea
  • Cough
  • Allergies
  • Medications
  • Smoking
  • Respiratory Infections
• Nursing Diagnosis examples


  • Activity Intolerance
  • Decreased Cardiac Output
  • Fatigue
  • Impaired Gas Exchange
  • Ineffective Airway Clearance
  • Ineffective Breathing Pattern
  • Risk for Aspiration
• Goals and Outcomes


  • Patient's lungs are clear to auscultation
  • Patient achieves bilateral lung expansion
  • Patient coughs productively
  • Pulse oximetry (SpO2) is maintained or improved
• Health Promotion


  • Vaccinations
  • Healthy Lifestyle
  • Reducing Environmental Pollutants
• Acute Care Nursing Measures


  • Dyspnea Management
  • Airway Maintenance
  • Mobilization of Pulmonary Secretions
  • Hydration
  • Humidification
  • Nebulization
  • Coughing and Deep-Breathing Techniques
  • Chest Physiotherapy
• Dyspnea Management


  • Pharmacological measures
  • Oxygen therapy
  • Physical techniques
  • Psychosocial techniques
• Oxygen Therapy


  Also called Supplemental Oxygen - treatment that provides extra oxygen to breathe
• Oxygen Delivery Systems


  • Nasal cannula (prongs)
  • Simple face mask
  • Partial and non rebreather masks
  • Venturi mask
  • Tracheostomy Collar
• Airway Maintenance


  • Suctioning
  • Chest Physiotherapy
• Partial and non rebreather masks


  • Deliver 60%-90% FiO2 at 10-15 L/min
  • Useful for short periods
  • Delivers increased FiO2
  • Easily humidifies O2
  • Does not dry mucos membranes
  • Hot and confining
  • May irritate skin
  • Tight seal necessary
  • Interferes with eating and talking
  • Bag may twist or kink
  • Should not totally deflate
• Venturi mask


  • Delivers 24%-50% FiO2
  • Provides specific amount of oxygen with humidity added
  • Administers low, constant O2
  • Mask and added humidity may irritate skin
  • Therapy interrupted with eating and drinking
  • Specific flow rate must be followed
• Tracheostomy Collar


  Collar attaches to neck with elastic strap and can deliver high humidity and O2 via tracheostomy
• Airway Maintenance


  • Suctioning
  • Chest Physiotherapy
  • Nebulizer Therapy
• Chest Physiotherapy


  • Chest percussion
  • Vibration
• POSTURAL DRAINAGE


  Technique that involves laying/ sitting in certain positions to drain secretions from airways using gravity
• NEBULIZATION


  • Adds moisture or medications to inspired air
  • Delivers bronchodilators and mucolytic agents
• HYDRATION


  Maintains adequate hydration
• HUMIDIFICATION


  Adds moisture to inspired air
• HUFF COUGH


  • Stimulates a natural cough reflex
  • Effective for clearing central airways
• Quad Cough Technique


  • For patients without abdominal muscle control such as those with spinal cord injuries
  • Similar to abdominal thrust
• Maintenance and Promotion of Lung Expansion


  • Ambulation
  • Positioning
  • Incentive Spirometry
  • Non-Invasive Ventilation
• INCENTIVE SPIROMETRY


  • Sustained Maximal Inspiration Device (SMIs)
  • Measure the flow of air inhaled through the mouthpiece
  • Used to improve pulmonary ventilation
  • Counteract the effects of anesthesia or hypoventilation
  • Loosen respiratory secretions
  • Facilitate respiratory gaseous exchange
  • Expand collapsed alveoli
• Maintenance of Ventilation


  • Invasive-Mechanical Ventilation (Positive Pressure Ventilation)
  • Noninvasive Ventilation – (Non invasive positive-pressure ventilation) (NPPV)
• CPAP (Continuous Positive Airway Pressure)


  Fixed pressure during ventilation