1. Chapter 39
Oxygenation

2. Physiology of Oxygenation
Ventilation
Alveolar Gas Exchange
Oxygen Transport and Delivery
Cellular Respiration

3. Physiology of Oxygenation
Ventilation
Movement of air into and out of the lungs
Inhalation
Exhalation
Delivery of fresh air into the lung’s alveoli
Regulated by respiratory control centers
Hypoxemia is a decrease in blood oxygen concentration.

4. Physiology of Oxygenation
Alveolar Gas Exchange
Oxygen uptake (external respiration) is the exchange of oxygen from the alveolar space into the pulmonary capillary blood.
Carbon dioxide diffuses from the blood to the alveolar space.

5. Physiology of Oxygenation
Circulation/Perfusion
The heart pumps oxygenated blood into the arterial system, which carries it to the cells, and collects deoxygenated blood from the venous system.

6. Physiology of Oxygenation
Cellular Respiration (internal respiration)
Oxygen diffuses from the blood to the tissues
Carbon dioxide moves from the tissues to the blood.
The blood is then reoxygenated by the heart.

7. Process of Ventilation
The diaphragm contracts and descends, lengthening the thoracic cavity.
The external intercoastal muscles contract, lifting the ribs upward and outward.
The sternum is pushed forward, enlarging the chest from front to back.
Increased lung volume and decreased intrapulmonic pressure allows air to move from an area of greater pressure (outside lungs ) to lesser pressure (inside lungs).
The relaxation of these structures results in expiration.

8. Altered breathing patterns
Tachypnea(hyperventilation)
Bradypnea(hypoventilation)
Dyspnea
Apnea
Orthopnea
Cyanosis
Hypoxia

9. Factors Affecting Oxygenation
Environmental: altitude, heat and cold, air pollution
Lifestyle Factors: cigarette smoking, occupation, activity pattern
Disease Processes
Exercise
Emotions
Narcotics

10. Diagnostic and Laboratory Data
Pulse Oximetry
Arterial Blood Gases (ABGs)
Sputum Collection
Ventilatory Function Tests
Lactic Acid, Hemoglobin, Hematocrit

11. Diagnostic and Laboratory Data
Chest X-Ray, Computerized Tomography
Bronchoscopy
Thoracentesis
Echocardiography
Electrocardiography
Stress Test

12. Nursing Diagnosis Primary Nursing Diagnoses
Ineffective Airway Clearance
Ineffective Breathing Patterns
Impaired Gas Exchange
Decreased Cardiac Output
Altered Tissue Perfusion

13. Secondary Nursing Diagnoses
Deficient Knowledge
Activity Intolerance
Disturbed Sleep Pattern
Imbalanced Nutrition
Acute Pain
Anxiety

14. Implementation Interventions to Promote Airway Clearance
Teach effective coughing.
Initiate postural drainage and chest physiotherapy.
Monitor hydration.
Administer medications.

15. Implementation Interventions to Promote Airway Clearance
Monitor environmental and lifestyle conditions.
Manage artificial airways.
Suction the airway.

16. Suctioning an Endotracheal Tube

17. Implementation Interventions to Improve Breathing Patterns
Position client properly.
Teach controlled breathing exercises.
Manage chest drainage systems.

18. Implementation Interventions to Improve Oxygen Uptake and Delivery
Administer oxygen.
*simple mask
*Nasal canula
*Ventori mask
*Rebreathing and Non-rebreathing mask
Administer blood components.

19. Implementation
Interventions to Increase Cardiac Output and Tissue Perfusion
Manage fluid balance.
Encourage activity restrictions and assistance with activities of daily living.
Position client properly.
Administer medications.

20. Implementation Emergency Interventions Remove airway obstruction.
Initiate cardiopulmonary resuscitation.

21. Implementations Interventions to Address Associated Nursing Diagnoses
Explore lifestyle and activity adaptations.
Encourage dietary and nutritional modifications.
Promote comfort measures.

22. Precautions for Oxygen Administration
Avoid open flames in patient’s room
Place no smoking signs in conspicuous places
Check to see electrical equipment in room is in good working order
Avoid using oils in the area (ignite spontaneously in oxygen)