Oxygenation, Perfusion, and Cardiovascular function

Oxygenation

The process of adding oxygen to the body, essential for cellular function.

Perfusion

The process by which oxygenated blood passes through body tissues.

Pulmonary ventilation

The movement of air into and out of the lungs (inspiration and expiration).

Alveoli

Small air sacs in the lungs where gas exchange occurs.

Surfactant

A substance that reduces surface tension in the alveoli, preventing collapse.

Visceral pleura

The membrane lining the lungs.

Parietal pleura

The membrane lining the thoracic cavity.

Diaphragm

A muscle that contracts during inhalation to expand the thoracic cavity.

Mediastinum

The central compartment of the thoracic cavity, containing the heart and other structures.

Gas Exchange (Respiration)

• Refers to the intake of oxygen and release of carbon

dioxide

• Made possible by respiration and perfusion

• Occurs via diffusion (movement of oxygen and

carbon dioxide between the air and blood)

• Happens at alveoli

Oxyhemoglobin

A complex formed when oxygen binds to hemoglobin in red blood cells for transport throughout the body.

Hypoxia

An inadequate amount of oxygen available to cells.

Dyspnea

Difficulty breathing.

Hypoventilation

Decreased rate or depth of air movement into the lungs.

Myocardial ischemia

Reduced blood flow to the heart muscle.

Dysrhythmia

Abnormal heart rhythm that can affect blood flow, potentially causing complications.

Angina

Chest pain caused by reduced blood flow to the heart.

Myocardial infarction

A heart attack, caused by blockage of blood flow to the heart.

Respiratory Activity in the Infant

• Lungs are transformed from fluid-filled structures to

air-filled organs.

• The infant’s chest is small, airways are short, and

aspiration is a potential problem.

• Respiratory rate is rapid and respiratory activity is

primarily abdominal.

• Synthetic surfactant can be given to the infant to

reopen alveoli.

• Crackles heard at the end of deep respiration are

normal.

Respiratory Activity in the Child

• Some subcutaneous fat is deposited on the chest

wall, making landmarks less prominent.

• Eustachian tubes, bronchi, and bronchioles are

elongated and less angular.

• The average number of routine colds and infections

decreases until children enter daycare or school.

• Good hand hygiene and tissue etiquette are

encouraged.

• By the end of late childhood, the immune system

protects from most infections.

Respiratory Functioning in the Older Adul

• Bony landmarks are more prominent due to loss of

subcutaneous fat.

• Kyphosis contributes to appearance of leaning

forward.

• Barrel chest deformity may result in increased

anteroposterior diameter.

• Tissues and airways become more rigid; diaphragm

moves less efficiently.

• Older adults have an increased risk for disease,

especially pneumonia

Nursing History

• Usual patterns of respiration

• Medications

• Health history

• Recent changes

• Lifestyle and environment

• Cough or sputum

• Pain or dyspnea

• Fever or fatigue

Pulmonary function tests

Tests that measure how well the lungs are working.

Tidal volume (TV)

The amount of air inhaled and exhaled in one breath.

Vital capacity (VC)

The total amount of air exhaled after a deep breath.

Forced Vital Capacity

The total amount of air that can be forcibly exhaled after taking the deepest breath possible.

Forced expiratory volume (FEV)

The amount of air that can be forcibly blown out in one second.

Total lung capacity (TLC)

The total amount of air the lungs can hold.

Residual volume (RV)

The amount of air left in the lungs after a maximal exhalation.

Peak expiratory flow rate (PEFR)

The highest speed of expiration.

Cyanosis

A bluish discoloration of the skin due to lack of oxygen.

Physical Assessment of the Respiratory System

• Inspect for general appearance, color (cyanosis,

pallor), structural abnormalities of the chest,

respiratory rate, rhythm and depth

• Palpate for temperature, chest expansion,

tenderness, masses, pulsations

• Percuss to assess the position of the lungs, density

of lung tissue

• Auscultate breath sounds

Bronchovesicular breath sounds

medium pitch and sound during

expiration, heard over the upper anterior chest and

intercostal area

Bronchial breath sounds

High-pitched sounds primarily heard over the trachea.

Vesicular breath sounds

Low-pitched, soft sounds during expiration heard over most of the lungs.

Wheezes

Continuous, musical sounds produced by air passing through narrowed airways constricted by

swelling, narrowing, secretions, or tumorsin the bronchi and bronchioles, often associated with conditions such as asthma or COPD. Classified as sibilant or sonorous.

Crackles

Intermittent sounds occurring when air moves through airways containing fluid. Classified as fine, medium, or coarse

Bronchodilators

Medications that open narrowed airways.

Nebulizers

Devices that disperse fine particles of liquid medication into the respiratory tract.

Meter-dose inhalers

Devices that deliver a controlled dose of medication with each compression.

Dry powder inhalers

breath-activated delivery of medications inhaled powdered medications directly into the lungs.

Nasal cannula

A device used to deliver supplemental oxygen through the nostrils.

Low flow

1–2 L/min = 24–28%

3–5 L/min = 32–40%

6 L/min = 44%

High flow

Maximum flow 60 L/min

10 L/min = 65%

15 L/min = 90%

Simple Mask

Low flow

5–8 L/min = 40–60% (5 L/min is minimum setting)

Non-rebreather mask

Low flow

10–15 L/min = 80–95%

Venturi mask

A type of mask that delivers a precise concentration of oxygen.

High flow

4–6 L/min = 24–40%

FI02

Fraction of Inspired Oxygen, the percentage of oxygen in the air that is inhaled.

Chest physiotherapy

A treatment to help clear mucus from the lungs.

Synthesized surfactant

Medications used to reopen alveoli in infants.

Larynx

The voice box; it is involved in breathing, sound production, and protecting the trachea.

Trachea

The windpipe, a passage that connects the larynx to the lungs.

Bronchi

The branches of the trachea that lead into the lungs.

Alveolar-capillary membrane

The membrane that separates alveolar air from blood in the capillaries.

Internal respiration

The exchange of gases between the blood and body cells.

External respiration

Gas exchange between the lungs and blood.

Facilitated diffusion

The process by which gases move through the alveolar-capillary membrane.

Environmental considerations

Factors such as air quality that affect respiratory health.

Clinical manifestations of respiratory distress

Signs such as increased respiratory rate, use of accessory muscles, and altered mental status.

Abdominal breathing

A type of breathing that involves the diaphragm rather than the chest.

Active inspiration

The process of taking in air, aided by muscles such as the diaphragm.

Passive expiration

The process of exhaling air without active muscle contraction.

Excursion

The movement of the diaphragm during breathing.

Oropharyngeal airway

An artificial airway inserted through the mouth.

Nasopharyngeal airway

An artificial airway inserted through the nose.

Tracheostomy tube

A tube inserted into the trachea through a surgical opening in the neck.

Endotracheal tube

A flexible tube inserted into the trachea through the mouth or nose to maintain an open airway.

Nursing Skills to Support Respiration

• Tracheal suctioning

• Assisting ventilation with mechanical ventilator

• Clearing an obstructed airway

• Administering cardiopulmonary resuscitation

Chest tube

A tube inserted into the pleural space to drain fluid or air.

• Assist with insertion and removal of the chest tube.

• Monitor the patient’s respiratory status and vital

signs.

• Check the dressing.

• Maintain the patency and integrity of the drainage

system.

Electrocardiography

A diagnostic procedure that records the electrical activity of the heart over a period of time.

Arterial blood gas

A test that measures the levels of oxygen and carbon dioxide in the blood, as well as the blood's pH, providing insights into respiratory and metabolic status.

Spirometry

A test that measures the amount of air a person can breathe in and out.

Capnography

A method of monitoring the concentration of carbon dioxide in exhaled air.

Cardiac biomarkers

Substances released into the blood when the heart is damaged.

Cough suppressants

Medications that decrease coughing.

Expectorants

Medications that help clear mucus from the airways.

Antihistamines

Medications that block the effects of histamine, often used for allergies.

Leukotriene receptor antagonists

Medications used to manage asthma and allergic rhinitis.

Mucolytic agents

Medications that thin and loosen mucus in the airways, making it easier to expel.

Corticosteroids

Medications that reduce inflammation and suppress the immune response, commonly used in respiratory disorders such as asthma.

Incentive spirometry

A device used to encourage deep breathing and improve lung function, particularly after surgery or during respiratory illness.

Pursed-lip breathing

A breathing technique that helps improve oxygenation and reduce shortness of breath by prolonging exhalation.

Diaphragmatic breathing

A breathing exercise that uses the diaphragm to increase lung capacity and improve oxygenation by allowing deeper breaths.

Precautions for Oxygen Administration

Avoid open flames in the patient’s room.

• Place “no smoking” signs in conspicuous places.

• Check to see that electrical equipment in the room is

in good working order.

• Avoid wearing and using synthetic fabrics (builds up

static electricity).

• Avoid using oils in the area (oils ignite

spontaneously in oxygen)

Oxygenation

The delivery of oxygen to body cells and removal of carbon dioxide.

Cardiopulmonary system

System that integrates the respiratory and cardiovascular systems.

Patent airway

An unobstructed airway necessary for adequate oxygenation.

Effective ventilation

Proper movement of air into and out of the lungs.

Alveolar-capillary gas exchange

Process where oxygen and carbon dioxide are exchanged between alveoli and blood.

Hypoxemia

Low oxygen levels in arterial blood.

Hypoxia

Inadequate oxygen at the tissue level.

Ischemia

Insufficient blood flow to tissue, leading to lack of oxygen.

Upper airway

Includes the nose, pharynx, larynx, and epiglottis.

Lower airway

Includes the trachea, bronchi, bronchioles, and terminal bronchioles.

Cilia

Hair-like structures that move mucus and debris upward.

Goblet cells

Cells that secrete mucus in the respiratory tract.

Surfactant

Substance that reduces surface tension in the alveoli.

Atelectasis

Collapse of alveoli leading to reduced gas exchange.

Pulmonary ventilation

Movement of air into and out of the lungs.

Inspiration

Active process of drawing air into the lungs.

Expiration

Passive process of expelling air from the lungs.

Respiratory muscle strength

Strength of muscles involved in breathing.