Oxygenation Unit Eight Ahmad Ata

Objectives  Out line the structure and function of the respiratory system.  Describe the process of breathing and gas exchange.  Explain the role and function cardiovascular system in transporting.  Identify the factors effect on respiration.  Identify the common Manifestation of impaired respiration.  List the sign of obstructive air way.  Identify and describe nursing measure to promote respiratory function.

Respiratory system

 Oxygen: a clear, odorless gas that constitutes approximately 21 percent of the air we breathe for necessary all living cell.  Respiration: is the process of gas exchange between individual and the environment.

The process of respiration involves several components: 1.Pulmonary ventilation: the movement of air between the atmosphere and alveoli of the lungs. 2.Diffusion of oxygen and carbon dioxide between alveoli and capillaries. 3.Transport of oxygen and carbon dioxide via blood to tissues. 4.Diffusion of oxygen and carbon dioxide between capillaries and cell.

Function of pulmonary system:  Ventilation: is the movement of air in and out of the lung.  Respiration: is the process of gas exchange.

Anatomy and physiology of respiratory system:  1) Upper respiratory tract:  a) Nose – made of cartilage and bone and is designed to warm, moisten, and filter air as it comes into the system.  b) Pharynx – (throat) conducts food and air; exchanges air with Eustachian tube to equalize pressure.

Cont  C) Larynx – (voice box) connects the pharynx and the trachea; made of cartilage; contains vocal cords.  D) Epiglottis – flap of tissue that covers trachea; ensures food travels down the esophagus.

Alveolar sac Alveoli

Cont  2) Lower Respiratory tract:  Trachea – (windpipe) tubular passage way for air; carries air to the lungs, C-shaped cartilage rings, divides at end.  Bronchi – pair of tubes that branch from trachea and enter lungs; have cartilage, lining is ciliated & secretes mucus.  Bronchioles – tiny tubes lacking cartilage and cilia; possess smooth muscle

 Alveoli – cup shaped structures at the end of the bronchioles that resemble bunches of grapes; are in direct contact with capillaries (gas exchange); covered with SURFACTANT that keep them from collapsing Alveoli.  Lungs – paired, cone-shaped organs that are surrounded by a pleural membrane, made of elastic tissue, and divided into lobes

Mechanics of Breathing  Inhaling (active process) – Air moves in. Why?  Gases move from an area of high pressure to low pressure  During inspiration – diaphragm pulls down and lungs expand  When lungs expand, it increase the volume, which decrease the pressure inside lungs

 Lung pressure is lower than outside pressure, so air moves in.  Exhaling (passive process) – breathing out  Diaphragm and muscles relax  Volume in lungs and chest cavity decreases, so now pressure inside increases.  Air moves out because pressure inside is HIGHER than OUTSIDE atmosphere.

Respiration:  Exchange of O2 and CO2 between alveoli and blood  Partial pressure of O2 higher in alveoli than blood so O2 diffuses into blood  Partial pressure of CO2 higher in blood than alveoli, so CO2 moves into alveoli in opposite direction and gets exhaled out

Internal respiration  Internal respiration  Exchange of O2 and CO2 between blood and tissues  Pressure of O2 higher in blood than tissues so O2 gets release into tissues.  Pressure of CO2 higher in tissue than in blood so CO2 diffused in opposite direction into blood.  CO2 Is a waste product.  O2 Is used in cellular respiration

3 Muscle Groups of Inhalation  Diaphragm: –contraction draws air into lungs –75% of normal air movement  External intercostals muscles: –assist inhalation –25% of normal air movement  Accessory muscles assist in elevating ribs: –sternocleidomastiod –serratus anterior –pectoralis minor –scalene muscles

Control of Breathing  Breathing is regulated by the rhythmicity center in the medulla and pons in brain stem.  Carotid body is sensitive to level of oxygen.  Control of Breathing  The most important factor affecting chemo sensitive center in the medulla oblogata is highly responsive increase in blood is CO2 and O2 level.   in arterial CO2 causes  in acidity of cerebrospinal fluid (CSF)  medulla  rate and depth of breathing

Pons and medulla

Factor effecting oxygenation:  Environment: high altitude leads decrease lower partial pressure and increase respiratory rate.  Exercise: physical exercise lead to increase respiratory rate.  Life style: smoking, occupation.  Health status: disease of cardiovascular disease.  Narcotics: morphine decrease respiratory rate.  Stress and anxiety.

 Respiratory alteration:  Hypoxia: is condition of insufficient oxygen anywhere in the body from the inspired gas to the tissue. Cerebral function can tolerate hypoxia for only 3 to 5 min before permanent damage.

Sign of hypoxia:  Rapid pulse.  Rapid shallow respiration.  Increase restlessness.  Flaring nares.  Cyanosis.

 Hypoventilation: inadequate alveolar ventilation can lead to hypoxia may result from disease of respiratory muscle, drug, and anesthesia.  Hypercabnia: accumulation of carbon dioxide in the blood.  Cyanosis: bluish discoloration of the skin nails beds and mucosal membrane

Altered breathing pattern:  Breathing pattern: rate, volume, rhythm, effort of respiration.  Normal respiration: (Eupnea) quite, rhythmic and effortless.  Tachypnea: rapid rate is seen with fevers, metabolic acidosis, pain and Hypercabnia.  Bradypnea: slow respiration rate, seen with narcotics and increase intracranial pressure from brain injury.

 Hyperventilation: increase movement of air into and out of the lung.  Dyspnea: difficult of breathing.  Orthopnea: in ability to breathe except in an upright position

 Obstructed air way:  Partially or completely in upper and lower respiratory tract.

Assessment  Nursing history:  Respiratory problem, cardiac problem, life style, cough and sputum.  Physical assessment:  Inspection, palpation, percussion and auscultation.  Diagnostic studies:  Sputum specimen, throat culture, arterial blood samples.  X- Ray examination.  Bronchoscopy and laryngoscopy.  Pulse oximetry: non invasive device measuring oxygen saturation.

 Sputum collected for the following reason:  Culture and sensitivity: for identify a specific microorganism.  Cytology: to identify the origin, structure, function and pathology cell.  Acid bacillus: to identify the presence of tuberculosis.

Nursing diagnosis:  Ineffective air way clearance related to accumulation of secretion.  Ineffective breathing pattern related to dyspnea.  Altered tissue perfusion related to decrease cardiac out put.  Anxiety related to ineffective air way clearance.

 Implementation:  Positioning the client to allow to maximum chest expansion.  Encourage frequent changes in position.  Encourage ambulating.  Deep breathing exercise and coughing.  Hydration to maintain moisturing of respiratory tract mucous membrane and easily to move respiratory secretion and decease incidence of infection.