1. Oxygenation Photos Potter & Perry, Chapters 12, 27
Anita A. Kovalsky, RN, MNEd
June Mair, RN, MSN
Mental Health:
Barbara Fickley, RN, MSN, CS
Unit 5: Caring for Clients’ Basic Human Needs
Chapter 27 Oxygenation
Chapter 12 Health Assessment and Physical Assessment
How does the anatomy and physiology of the cardiovascular and respiratory systems promote oxygenation?
What physiologic factors affect oxygenation?
How does growth and development influence oxygenation?
How do behavioral and environmental factors influence oxygenation?
What are some common alterations in cardiovascular and pulmonary functioning?
How are the critical thinking and nursing processes applied with clients having difficulty with oxygenation?
What assessment information should be obtained to determine the client's oxygenation status?
What findings are usually seen in a client who has inadequate oxygenation?
How can the nurse promote oxygenation for clients in the health promotion, acute care, and restorative care settings?
What specific measures and procedures should be implemented by the nurse to manage dyspnea, maintain a patent airway, mobilize secretions, and expand the lungs?
What should be included in client/family teaching for promotion and maintenance of oxygenation?
What safety measures should be implemented for the use of oxygen in the home?
What is the usual sequence for performing the physical exam of the respiratory system?
What are the expected and unexpected findings in a respiratory assessment?
How does the nurse report and record the findings of a respiratory assessment?
How could the nurse meet the emotional needs of a client who is having breathing problems?

2. Cardiopulmonary Physiology
Overview of anatomy and physiology of cardiovascular and respiratory system
Living cells need oxygen. Oxygen is required for maintaining life. Any condition that interferes with normal respiratory functioning must be eliminated or minimized to prevent respiratory distress which could eventually result in death.
Normal functioning of the respiratory system depends on these factors:
A cardiovascular and hematological system that can carry nutrients and wastes to and from body cells efficiently
Effective airway system to transport air to and from the lungs
An effective alveolar system in the lungs to oxygenate venous blood and to remove carbon dioxide from the blood

3. The Heart and Lungs (cont’d)
SCHEMATIC: DIRECTION OF BLOOD FLOW THROOUGH THE HEART TO LUNGS. Interrelate how the heat and lung work together to provide for adequate oxygenation. Tell students to review this on their own.
Note the heart serves as a system pump moving blood through the blood vessels to the tissues; blood along with oxygen and nutrients is transported to cells, and wastes are collected for elimination.

4. Remind students to review the anatomy and physiology of the respiratory system
Note the structures of the respiratory system: UPPER- mouth, nose, pharynx, larynx
LOWER- trachea, lungs (bronchi, bronchioles, alveoli), pulmonary capillary network and pleura.
Gas exchange refers to the intake of oxygen and the release of carbon dioxide.
There are three steps in in the process of oxygenation: ventilation , perfusion and diffusion
Ventilation – movement of air into and out of the lungs (inspiration and expiration) Breathing is the effort required for expanding and contracting the lungs. Neural and chemical regulators control respiration. See Box 27-1, p. 648.
Perfusion - blood flow to the lungs and tissues. Gases are exchanged between the air and blood via the dense network of capillaries in the respiratory areas of the lungs and the thin alveolar walls.
Diffusion – refers to the movement of oxygen and carbon dioxide between the air (in the alveoli) and the blood (in the capillaries). The gases move from an area of higher concentration to an area of lower concentration. Oxygen is transferred from the blood to tissues, and carbon dioxide is transferred from tissues to the blood to return to the alveoli to be exhaled.
Diffusion is affected by the following:
Thickening of alveolar-capillary membrane Eg. Pneumonia, pulmonary edema
Change in surface area- Eg. Removal of a lung, collapse of alveoli (atelectasis) caused by mucus, foreign body, or airway constriction
Solubility and molecular weight of the gas .Eg carbon dioxide has > solubility and diffuses more rapidly than oxygen

5. The Oxygen transport: influenced by amt
The Oxygen transport: influenced by amt. of dissolved oxygen in plasma, amt. of hemoglobin, tendency of hemoglobin to bind with oxygen.
Carbon dioxide is transported from tissues back to lungs. Carbon dioxide diffuses into red blood cells and is rapidly hydrated into carbonic acid which dissociates into hydrogen and bicarbonate ions; the bicarbonate diffuses into the plasma, the hydrogen is buffered by hemoglobin. Venous blood transports the most of the carbon dioxide.
The body’s respiratory center is a group of neurons located in the medulla oblongata and pons of the brain. This center is highly responsive to increases in blood carbon dioxide or hydrogen ion concentration. There are also chemoreceptors located outside the CNS that are sensitive to decreases in arterial oxygen concentration.
Note Box 27-1, p. 648

6. There are in the text on pg. 242
There are in the text on pg Note that assessment begins with POSTERIOR THORAX, then LATERAL THORAX, then ANTERIOR THORAX..
Figure Anterior position of lung lobes in relation to anatomical landmarks. Figure Lateral position of lung lobes in relation to anatomical landmarks. Figure Posterior position of lung lobes in relation to anatomical landmarks

7. Figure A to C, A systematic pattern (posterior-lateral-anterior) of INSPECTION is followed by auscultation

8. POSTERIOR THORAX.

12. ANTERIOR THORAX.