NRSG 200: Oxygenation

How does the body oxygenate blood?

Ventilation; perfusion; transport

What regulates breathing rate and depth?

Neural and chemical signals

How does the heart support oxygenation?

Maintains effective blood flow (perfusion)

What are the main functions of the respiratory system?

Deliver O2; remove CO2; maintain acid-base balance; regulate body heat; filter inhaled irritants; detect smells; assist speech production

What structures make up the upper respiratory tract?

Nasal cavity; mouth; pharynx; larynx

What structures make up the lower respiratory tract?

Trachea; bronchi; bronchioles; lungs; alveoli

What is pulmonary ventilation?

Movement of air in and out of the lungs

What is alveolar gas exchange?

Exchange of O2 and CO2 between alveoli and blood

What is oxygen transport?

O2 binds to RBCs and is carried to tissues

What is carbon dioxide transport?

CO2 carried from tissues to lungs

What is systemic diffusion?

Movement of gases between blood and tissues

What part of the brain controls breathing?

Medulla oblongata and pons

How does the respiratory center regulate breathing?

Responds to changes in O2 and CO2 levels (feedback loop)

What is the primary trigger to breathe?

Rising CO2 levels (hypercapnia)

How do low O2 levels affect breathing?

Increase breathing rate, but weaker stimulus than CO2

What role do the lungs play in acid-base balance?

Regulate pH by adjusting CO2 levels through breathing

What is hypoventilation?

Slow or shallow breathing → inadequate ventilation → CO2 retention (hypercapnia) → respiratory acidosis

What is hyperventilation?

Fast or deep breathing → excessive ventilation → CO2 loss (hypocapnia) → respiratory alkalosis

What is the normal blood pH range?

7.35-7.45

What is acidosis?

pH below 7.35

What is alkalosis?

pH above 7.45

What are physiological factors that affect oxygenation?

↓ O2-carrying capacity (anemia); ↓ inspired O2 (airway obstruction, high altitude); hypovolemia; ↑ metabolic rate (fever, infection)

What chest wall conditions affect oxygenation?

Pregnancy; obesity; trauma; neuromuscular disorders (ALS, dystrophy); CNS alterations (head injury, stroke)

What is eupnea?

Normal rate and rhythm of breathing

What is tachypnea?

Fast, shallow breathing

What is bradypnea?

Slow breathing

What is dyspnea?

Difficulty breathing

What is apnea?

Sudden cessation of breathing

What is apneustic breathing?

Prolonged gasping with short expiration

What is agonal breathing?

Gasping, labored breaths before death

What is shallow breathing?

Low depth, quiet breaths

What is air trapping?

Difficulty exhaling (common in COPD)

What is sighing?

Normal breathing interrupted by deep breaths

What is Cheyne-Stokes breathing?

Gradual increase and decrease in rate and rhythm

What is Biot's breathing?

Irregular breathing with apnea, equal depth

What is Kussmaul's breathing?

Deep, labored breathing in metabolic acidosis

What is hyperpnea?

Deep, rapid breathing (normal with exercise)

What is hypoxia?

Inadequate O2 at the tissue level

What are signs and symptoms of hypoxia?

Restlessness; apprehension; anxiety; confusion; tachypnea; dyspnea; tachycardia; cyanosis

What is cyanosis?

Bluish discoloration of skin and mucous membranes; late sign of hypoxia

What should be included in a nursing history for oxygenation?

Pain; smoking; dyspnea; cough; wheezing; environmental/occupational exposures; respiratory infections; allergies; health risks; medications

What is inspected during a respiratory assessment?

Rate; rhythm; depth; use of accessory muscles; skin color (cyanosis, pallor); chest shape (barrel, protruding, sunken; scoliosis, kyphosis)

What is palpated during a respiratory assessment?

Chest expansion symmetry; vocal vibrations; tenderness or masses

What is auscultated during a respiratory assessment?

Breath sounds

What are adventitious breath sounds?

Crackles; wheezing; rhonchi; stridor

What are crackles?

Discontinuous popping sounds caused by fluid in alveoli

What is wheezing?

High-pitched sound caused by narrowed airways

What are rhonchi?

Low-pitched sounds caused by thick airway secretions

What is stridor?

Loud, harsh sound caused by an upper airway obstruction

What are blood tests for oxygenation?

CBC; arterial blood gases (ABG)

What does a CBC check for?

Infection or anemia

What do arterial blood gases (ABGs) measure?

Oxygen, carbon dioxide, and blood pH

What is a skin test for oxygenation?

TB skin test

What does a TB skin test detect?

Exposure to tuberculosis

What is an x-ray test for oxygenation?

Chest x-ray

What does a chest x-ray show?

Lung fields, fluid, masses, or consolidation

What are invasive tests for oxygenation?

Thoracentesis; bronchoscopy

What does thoracentesis do?

Removes fluid from the pleural space

What does bronchoscopy allow?

Direct visualization of the airway

What are noninvasive tests for oxygenation?

SaO2; pulmonary function test (PFT); CT scan; MRI

What does SaO2 measure?

Oxygen saturation of hemoglobin

What does a pulmonary function test (PFT) measure?

Lung volume and airflow

What are specimen tests for oxygenation?

Sputum culture; sputum AFB

What does a sputum culture identify?

Organisms causing respiratory infection

What does sputum AFB detect?

Tuberculosis bacteria

What health promotion strategies support oxygenation?

Vaccinations; healthy lifestyle; environmental awareness

What vaccinations promote respiratory health?

Influenza vaccine; pneumococcal vaccine; COVID-19 vaccine

What lifestyle habits promote oxygenation?

Good nutrition; regular exercise; avoiding smoking and substance use; stress management

What environmental factors should patients be aware of for oxygenation?

Air pollution; occupational exposures (dust, asbestos, mold, chemicals)

What are desired outcomes for patients with oxygenation problems?

Maintain patent airway; achieve normal respiratory rate and depth; maintain adequate oxygen saturation; demonstrate effective coughing and secretion clearance; report decreased dyspnea during activity

What interventions promote lung expansion?

Ambulation; upright or semi-Fowler's positioning; incentive spirometry; coughing and deep breathing; chest tubes

How does ambulation support lung expansion?

Encourages lung inflation and secretion clearance

How does upright or semi-Fowler's positioning help?

Increases lung expansion and oxygenation

What does incentive spirometry encourage?

Deep breathing to expand alveoli

What do coughing and deep breathing exercises do?

Promote secretion clearance and improved ventilation

What is the purpose of chest tubes?

To remove air and fluid from the pleural space

What is oxygen therapy?

Delivers extra O₂ to improve oxygen saturation and breathing when natural respiration is insufficient

What are methods of oxygen delivery?

Nasal cannula; Simple mask; Non-rebreather mask; Venturi mask

What oxygen flow is used with a nasal cannula?

Low O₂ (1-6 L/min) for mild hypoxia

What oxygen flow is used with a simple mask?

Moderate O₂ (6-10 L/min)

What oxygen flow is used with a non-rebreather mask?

High O₂ (up to 15 L/min) for severe hypoxia

What is unique about a Venturi mask?

Delivers precise O₂ concentration

What safety precautions are required with oxygen therapy?

No smoking; avoid open flames; use "Oxygen in Use" signs; check electrical equipment; keep oxygen cylinders secured

Why should patients avoid petroleum-based products with oxygen therapy?

They are flammable

What should be monitored during oxygen therapy?

Skin integrity around ears and face; oxygen saturation

What nursing supports are used in dyspnea management?

Airway support and anxiety support

What type of oxygen is used to ease breathing in dyspnea?

Humidified O₂

What medications are used for dyspnea management?

Bronchodilators

What helps mobilize pulmonary secretions in dyspnea management?

Chest physiotherapy (CPT) and postural drainage

What is the purpose of chest physiotherapy (CPT)?

Loosens mucus

What is the purpose of postural drainage?

Uses positioning to remove secretions

What is oropharyngeal/nasopharyngeal suctioning used for?

When a client cannot clear secretions

What is orotracheal/nasotracheal suctioning used for?

When a client cannot cough or swallow

What is tracheal suctioning used for?

For clients with an endotracheal tube or tracheostomy

What is the purpose of an artificial airway?

To maintain airway patency when the patient cannot do so independently

What are types of artificial airways?

Oral airway; endotracheal tube; tracheostomy tube

What is the purpose of an oral/nasopharyngeal airway?

Prevents obstruction by keeping the tongue clear of the pharynx

When is an oral/nasopharyngeal airway appropriate?

For unconscious patients only

What is the purpose of an endotracheal tube?

Short-term airway management and mechanical ventilation

What is the purpose of a tracheostomy tube?

Long-term airway management and mechanical ventilation