LEC 12.2: Oxygenation

Carbon Dioxide

• Must be eliminated from the body to maintain normal acid-base balance

• Can be either removed through hematologic, cardiovascular, or respiratory methods

1. Hematologic

2. Cardiovascular

3. Respiratory

Ways Carbon Dioxide can be Removed

Hematologic

(Way Carbon Dioxide can be Removed)

• Erythrocytes/RBCs have hemoglobin which attaches with oxygen to create oxy-hemoglobin

Respiratory

(Way Carbon Dioxide can be Removed)

• Inhale oxygen and exhale carbon dioxide via ventilation

Cardiovascular

(Way Carbon Dioxide can be Removed)

• Transports oxygenated blood since heart contracts

Respiration

Process of gas exchange between the individual and environment

1. Ventilation or Breathing

2. Alveolar Gas Exchange

3. Transport of O2 and CO2 between tissues and lungs

4. Movement of O2 and CO2 between systemic capillaries and tissues

Identify the 4 Components of Respiration.

1. Pulmonary Ventilation

2. Alveolar Gas Exchange

3. Transfer of O2 and CO2

4. Systemic Diffusion

Identify the 4 Processes of the Structure & Processes of the Respiratory System.

Pulmonary Ventilation

(One of the 4 Processes of the Structure & Processes of the Respiratory System)

• Accomplished via breathing (inspiration/inhalation or expiration/exhalation)

• Depends on:

  • Clear airways

  • Intact CNS and respiratory center (medulla and pons)

  • Intact thoracic cavity

  • Adequate pulmonary compliance and recoil

• Clear airways

• Intact CNS and respiratory center (medulla and pons)

• Intact thoracic cavity

• Adequate pulmonary compliance and recoil

What does Pulmonary Ventilation depend on?

Clear Airways

(One of the factors Pulmonary Ventilation depends on)

• No obstruction, correct diameter, no narrowing, food, or allergies

Medulla & Pons

What part(s) of the brain is/are the respiratory center?

Intact CNS & Respiratory Center

(One of the factors Pulmonary Ventilation depends on)

• If the medulla and pons are hit by blunt force trauma, breathing is either decreased, altered, or even absent, resulting in the need for a ventilator

Intact Thoracic Cavity

(One of the factors Pulmonary Ventilation depends on)

• Example: pectus excavatus or a break in the ribs causes the lungs to be limited in how they expand

Adequate pulmonary compliance and recoil

(One of the factors Pulmonary Ventilation depends on)

• Pleural fluid between cavity to ease recoil

• Surfactant to create ease in lung movements

Alveolar Gas Exchange

(One of the 4 Processes of the Structure & Processes of the Respiratory System)

• Involves diffusion, which is the movement of gas from an area of greater pressure to an area of lower pressure/concentration

Diffusion

This is the movement of gas from an area of greater pressure to an area of lower pressure/concentration

Transfer of O2 & CO2

(One of the 4 Processes of the Structure & Processes of the Respiratory System)

• Hemoglobin: component of RBC responsible to attach to O2

• Oxyhemoglobin: hemoglobin with oxygen

• Factors Affecting O2 Transport Rate from Lungs to Tissues:

  • Cardiac Output

  • Number of Erythrocytes & Blood Hematocrit

  • Exercise

1. Cardiac Output

2. Number of Erythrocytes & Blood Hematocrit

3. Exercise

What are the factors affecting O2 transport rate from the lungs to tissues?

Number of erythrocytes and blood hematocrit

(Factor affecting O2 transport rate from the lungs to tissues)

• Low RBC count causes less oxygen to attach

Hematocrit

What is the ratio of RBC to entire blood flow called?

37-50%

What is the normal hematocrit levels of females?

40-54%

What is the normal hematocrit levels of males?

Exercise

(Factor affecting O2 transport rate from the lungs to tissues)

• Physical activity causes more energy consumption —> more oxygen —→ faster ventilation

Systemic Diffusion

(One of the 4 Processes of the Structure & Processes of the Respiratory System)

• Diffusion of oxygen and carbon dioxide between the capillaries and tissue and cells down to a concentration gradient similar to diffusion at the alveolar-capillary level

1. Physiological

2. Developmental

3. Lifestyle

4. Environment

What are the factors affecting oxygenation?

1. Decreased Oxygen-Carrying Capacity

2. Hypovolemia

3. Decreased Inspired Oxygen Concentration

4. Increased Metabolic Rate

5. Conditions affecting chest wall movement

6. Pregnancy

7. Obesity

8. Muscular Abnormalities

9. Trauma

10. Neuromuscular Diseases

11. Central Nervous System Alteration

12. Influence of Chronic Lung Disease

What are Physiological Factors Affecting Oxygenation?

Decreased Oxygen-Carrying Capacity

(Physiological Factor Affecting Oxygenation)

• Anemic patient has a decrease of this due to low RBC levels

Hypovolemia

(Physiological Factor Affecting Oxygenation)

• Dehydration, low blood volume, causing contractility to decrease

Decreased Inspired Oxygen Concentration

(Physiological Factor Affecting Oxygenation)

• Less oxygen particle available in air, such as at high altitudes

Increased Metabolic Rate

(Physiological Factor Affecting Oxygenation)

• Constantly moving, exercising causes an increase in oxygen consumption

Conditions affecting chest wall movement

(Physiological Factor Affecting Oxygenation)

• For example, tumors on the chest wall

Pregnancy

(Physiological Factor Affecting Oxygenation)

• Two individuals consuming O2 supply

• Diaphragm is pushed up causing limited lung expansion space

Obesity

(Physiological Factor Affecting Oxygenation)

• This condition causes more consumption of oxygen

Muscular Abnormalities

(Physiological Factor Affecting Oxygenation)

• Muscles that are not functioning

Trauma

(Physiological Factor Affecting Oxygenation)

• Impact that causes ribs to break

Neuromuscular Diseases

(Physiological Factor Affecting Oxygenation)

• Guillain–Barré syndrome can significantly impact oxygenation due to nerve damage affecting breathing muscles

CNS Alteration

(Physiological Factor Affecting Oxygenation)

• Causes altered respiratory function

Influence of Chronic Lung Disease

(Physiological Factor Affecting Oxygenation)

• Emphysema, COPD, Atelectasis (Alveoli hardened)

Development

(Factor Affecting Oxygenation)

1. Fetal

2. Adult

3. Elderly

Fetal

(Developmental Stage)

• Breathe via the placenta

• When birthed, does not have fully sealed lungs

• Surfactant that is sold can be administered to a preterm baby. However, a full term baby does not need surfactant since vaginal compression/compression of the baby’s torso initiates gradual inflation of the lungs, like a balloon

Adult

(Developmental Stage)

• For this age group, the Tidal Volume is 500-1500 mL

500-1500 mL

What is the normal tidal volume for adults?

Elderly

(Developmental Stage)

• Diseases from smoking, an unhealthy lifestyle will decrease lung capacity

Conditions Affecting:

1. Airway

2. Movement of Air

3. Diffusion

4. Transport

Alterations in Respiratory Function

Conditions Affecting Airway

(Alteration in Respiratory Function)

• Either Upper airway obstruction OR Lower airway obstruction

Upper Airway Obstruction

(Conditions Affecting Airway)

• Food is the common cause and other objects, especially in children

• Secretions like sipon, hardened boogers, especially for very young children

Lower Airway Obstruction

(Conditions Affecting Airway)

• Constriction of bronchus caused by allergic reaction

Conditions Affecting Movement of Air

(Alteration in Respiratory Function)

• Includes

  • Breathing Patterns

  • Hypoxemia

  • Hypercapnia

  • Hyperventilation

  • Orthopnea

Breathing Patterns

(Conditions Affecting Movement of Air)

• Refers to the rate, volume, rhythm, and relative ease or effort of respiration

Hypoxemia

(Conditions Affecting Movement of Air)

• Low oxygen in blood

Hypercapnia

(Conditions Affecting Movement of Air)

• High Carbon Dioxide Levels in the blood

Hyperventilation

(Conditions Affecting Movement of Air)

• Example is needing a paper bag to increase carbon dioxide levels

Orthopnea

(Conditions Affecting Movement of Air)

• Difficulty breathing when lying down, common to asthmatic patients

Conditions Affecting Diffusion

(Alteration in Respiratory Function)

• Includes

  • Hypoxemia

  • Hypoxia

Hypoxemia

(Conditions Affecting Diffusion)

• Low oxygen blood levels

Hypoxia

(Conditions Affecting Diffusion)

• Low oxygen levels in the tissues

Conditions Affecting Transport

(Alteration in Respiratory Function)

• Conditions that decrease cardiac output like

  • Heart failure

  • Hypovolemia

Heart failure

(Conditions Affecting Transport)

• No blood or less pumping out of heart

Hypovolemia

(Conditions Affecting Transport)

• Low blood volume

1. Current Respiratory Problem

2. History of Respiratory Disease

3. Lifestyle

4. Presence of Cough

5. Presence of Chest Pain

6. Presence of Risk Factors

7. Medical History

What should be included in assessment of Oxygenation?

Current Respiratory Problem

(Should be included in assessment of Oxygenation)

• Does patient have SOB, tachypnea, bradypnea?

History of Respiratory Disease

(Should be included in assessment of Oxygenation)

• Pneumonia induced by what?

Lifestyle

(Should be included in assessment of Oxygenation)

• Does the patient participate in Smoking? Active exercise?

Presence of Cough

(Should be included in assessment of Oxygenation)

• Observe the ___ reflex of the patient

• Auscultate

• Is it productive or nonproductive? Color? Odor? Viscosity?

Presence of Chest Pain

(Should be included in assessment of Oxygenation)

• Or is it referred pain?

Presence of Risk Factors

(Should be included in assessment of Oxygenation)

• Based on patient’s history

Medical History

(Should be included in assessment of Oxygenation)

• If patient is asthmatic, know what medication they used: bronchodilators? corticosteroids? sedatives?

1. Maintaining airway clearance and effective gas exchange

2. Promote Effective Breathing

3. Medications

4. Specific measures for oxygenation problem

5. Referrals

6. Community Support

Home Care Oxygenation

Maintaining Airway Clearance & Effective Gas Exchange

(Home Care Oxygenation)

• No smoking

• Teach proper coughing techniques.

• Monitor sputum changes.

• Encourage fluids (unless contraindicated)

• Proper use of nebulizers and inhalers.

Promote Effective Breathing

(Home Care Oxygenation)

• Encourage Deep breathing exercises

Medications

(Home Care Oxygenation)

• Bronchodilators, careful with using cough suppressants — expectorants are better since they expel secretions

Specific measures for oxygenation problem

(Home Care Oxygenation)

• Includes nebulization, ventilation

Referrals

(Home Care Oxygenation)

• Where can the patient purchase oxygen tanks? ventilators? Available RTs?

Community Support

(Home Care Oxygenation)

• Use local programs and agencies for help.

• Sit and stand straight for better lung expansion.

• Exercise regularly.

• Breathe through the nose.

• Avoid smoking and secondhand smoke.

• Avoid chemicals and pesticides.

• Properly ventilate homes.

• Support pollution control.

Ways to Promote Healthy Breathing

1. Positioning

2. Encouraging or providing frequent changes in positioning

3. Encouraging deep breathing and coughing

4. Encouraging ambulation

5. Implementing measures that promote comfort, such as giving pain meds

6. Humidifiers

7. Vibration

8. Postural Drainage

Nurse Interventions to Maintain Normal Respirations of the Client

Humidifiers

Devices that add water vapor to inspired air to loosen secretions; can moisten airway

Vibration

Series of vigorous quivering produced by hands that are placed flat against client’s chest wall

Postural Drainage

Drainage by gravity of secretions from various lung segments

Oxygen Therapy

Medical administration of supplemental oxygen is considered to be a process similar to that of administering medications and requires similar nursing actions

1. Nasal Cannula

2. Face Mask

3. Face Tent

How can oxygen therapy be administered?

Nasal Cannula

For low flow oxygen (0.5 - 3 L)

Face Mask

For 4-6 L of oxygen

Face Tent

For high flow oxygen

• Usually for infants

• Should never be given directly on the face of an infant since it may cause blindness