Oxygenation: Cardiovascular and Respiratory the pulmonary, hematologic, and

System cardiovascular systems.

By: Hussin, Aicel ● Specifically, the processes involved include

Ichiki, Mikka ventilation, alveolar gas exchange, oxygen

transport and delivery, and cellular
Navilla, Kim Denese respiration.
Reglos, Ella Stephanie E. ● The absence of oxygen can lead to cellular,
tissue, and organism death.

OBJECTIVES:
At the completion of this unit learners will be able
to:
1. Identify factors that can interfere with
effective oxygenation of body tissues;
2. Describe common manifestations of altered
respiratory and cardiovascular function;
3. Discuss lifespan-related changes and
problems in respiratory function and
cardiovascular system;
4. Describe nursing measures to ensure a
patient airway;
5. Recognize the emergencies related to
respiratory and cardiovascular system;
6. Explain ways that caregivers can decrease
the exposure of clients to infection; ANATOMY AND PHYSIOLOGY OF
7. Differentiate between medical and surgical RESPIRATION
asepsis; Respiration is the process of gas exchange between
8. Apply Nursing Process and teaching plan for the individual and the environment and involves
a client with altered respiratory function and following components:
cardiovascular function.
1. Pulmonary (breathing)
ventilation movement of air in
OXYGENATION and out of the lungs.
Oxygen, a clear, odorless gas that constitutes
approximately 21%of the air we breathe, is 2. Inspiration (inhalation) act of
necessary for proper functioning of all living cells. breathing in.
Oxygenation (the delivery of oxygen to the body’s
tissues and cells), is necessary to maintain life and 3. Expiration (exhalation) act of
health. breathing out.

PHYSIOLOGY OF OXYGENATION 4. External Exchange of O₂ and

respiration CO₂ between
● The delivery of oxygen to the body’s cells is alveoli and blood.
a process that depends upon the interplay of 5. Internal Exchange of O₂ and
 respiration CO₂ between blood 1. AGE
and tissue cells.
Oxygenation status can be influenced by
age. Older adults are also more susceptible
to respiratory infection because of
The Air way begins at nose and ends at terminal
decreased activity in the cilia, which
bronchioles. Air way provides a pathway for
normally are an effective defense
transport of oxygen and carbon dioxide.
mechanism. Other changes includes the
following:

Respiratory tract (Air Way) is divided into two: ● Chest wall and airways become more rigid
1. Upper and less elastic.
● Consists of
Respiratory
Tract (URT) nose, ● Decreases in muscle strength.
pharynx,
larynx and
epiglottis. ● The amount of exchanged air is decreased.

● The main ● The cough reflex and cilia action are

function is to decreased.
warm, filter
and humidify ● Mucous membranes become drier and more
inspired air. fragile.
2. Lower
● Consists of ● Decreases in muscle strength and
Respiratory
Tract (LRT) Trachea, endurance occur.
Bronchi,
bronchioles ● If osteoporosis is present, adequate lung
and lungs.
expansion may be compromised.
● Its major
● A decrease in efficiency of the immune
function are
system occurs.
conduction
of air and
● Gastroesophageal reflux disease is more
surfactant
production. common in older adults and increases the
risk of aspiration.

FACTORS AFFECTING OXYGENATION

2. ENVIRONMENT
1. Age
2. Environment Environmental factors can significantly
3. Life style affect a client’s oxygenation status.
4. Health Status Altitude, heat, cold, and air pollution affect
5. Medicatio oxygenation.
6. Stress
 agricultural employees who work with
● The higher the altitude, the lower the
moldy hay.
PO2 an individual breathes. As a result,
the person at high altitudes has 4. HEALTH STATUS
increased respiratory and cardiac rates In the healthy person, the respiratory
and increased respiratory depth, which system can provide sufficient oxygen to
usually become most apparent when the meet the body's needs. Diseases of the
individual exercises. respiratory system, however, can
adversely affect the oxygenation of the
● Healthy people exposed to air pollution, blood.
such as smog or secondhand tobacco
smoke, may experience stinging of the 5. MEDICATION
eyes, headache, dizziness, and A variety of medications can decrease
coughing. the rate and depth of respirations. The
most common medications having this
● People who have a history of existing effect are the benzodiazepine sedative-
lung disease and altered respiratory hypnotics and antianxiety drugs (e.g.,
function experience varying degrees of diazepam [Valium], lorazepam
respiratory difficulty in a polluted [Ativan], midazolam [Versed]),
environment. Some are unable to barbiturates (e.g., phenobarbital), and
perform self-care in such an narcotics such as morphine and
environment. meperidine hydrochloride (Demerol).

3. LIFESTYLE When administering these, the nurse

must carefully monitor respiratory
Physical exercise or activity increases status, especially when the medication
the rate and depth of respirations and is begun or when the dose is increased.
hence the supply of oxygen in the body. Older clients are at high risk of
Sedentary people, by contrast, lack the respiratory depression and, hence,
alveolar expansion and deep-breathing usually require reduced dosages.
patterns of people with regular activity.
6. STRESS
Clients who are exposed to dust, animal
dander, asbestos, or toxic chemicals in When stress and stressors are
the home or workplace are at increased encountered, both psychological and
risk for alterations in oxygenation. physiological responses can affect
oxygenation. Some people may
● Silicosis is seen more often in sandstone hyperventilate in response to stress.
blasters and potters than in the rest of When this occurs, arterial PO2 rises and
the population. PCO2 falls. The person may experience
light-headedness and numbness and
● Asbestosis in asbestos workers. tingling of the fingers, toes, and around
the mouth as a result.
● Anthracnosis in coal miners. Physiologically, the sympathetic
nervous system is stimulated and
● Organic dust disease in farmers and epinephrine is released during stress.
Epinephrine causes the bronchioles to
 dilate, increasing blood flow and Bradypnea Abnormal slowness of
oxygen delivery to active muscles. breathing.
Although these responses are adaptive
Hypoxia Low oxygen level in tissues
in the short term, when stress continues
they can be destructive, increasing the Hypercarbia Accumulation of CO2 in the
risk of cardiovascular disease. blood.
Hypoxemia Reduced oxygen in the
MAINTAINING HEALTHY OXYGENATION blood.

Encourage clients to: Tachycardia Heart rate over 100bpm

1. Leave windows open for ventilation instead Bradycardia Heart rate below 60bpm.
of using an air conditioner or humidifier.
2. Wear a mask when working with hazardous Life Span Consideration Changes
materials, such as asbestos. Respiratory Rate
3. Limit physical exertion if it causes shortness New born: 40-80 cpm
of breath. Infant: 30 cpm
4. Refrain from smoking. Preschooler: 25 cpm
5. Change filters on furnaces, heaters, and Adult: 12-20 cpm
range hoods as recommended by Heart Rate
manufacturer. New born : 80-200 bpm
Common Manifestations Of Altered Infant- :80-150 bpm
Respiration and Cardiovascular Function Preschooler-Adult : 60-100 bpm
Blood pressure
Apnea Temporary cessation of Newborn -3 days: 65/40mmHg
breathing. After one month: 90/55 mmHg
Adult: 120/80 mmHg
Dyspnea Difficulty in breathing. Eg.
SOB
Life Span Considerations Problems
Eupnea Normal breathing. 12 to 20 Premature infant:
cpm. Lack of surfactant ( A substance in alveoli
which keeps the lungs wet and prevents
Hyperpnoea Increased rate and depth of
collapse).
breathing.
Infants & Toddlers:
Hyperventilation Increased pulmonary Risk of upper respiratory tract infections due
ventilation leading to low to exposure to other children and second
blood level of CO2. hand smoke.
Risk of airway obstruction also.
Hypoventilation Decreased pulmonary School Age Children & Adolescents:
ventilation leading to Respiratory infections and respiratory risk
increased blood level of factors such as second hand smoke &
CO2. cigarette smoking. Can lead to
Orthopnea Dyspnea that occurs when a cardiopulmonary disease if continues.
person is lying down. Young & Middle age adults:

Tachypnea Accelerated respiration.

 Multiple cardiopulmonary risk factors due to Assessment
unhealthy diet, lack of exercise, stress, drugs History Taking/ Interviewing
& smoking. Physical Examination:
Older Adults: Current respiratory problems
Body systems undergo changes throughout History of respiratory diseases
the aging process, eg, atherosclerosis which Current respiratory problems
Current or past cardiovascular problems
leads to increased BP.
Life style
Respiratory system changes—thoracic cage
Presence of Cough
changes—eg, barrel chest—decreased Signs of hypoxia
ventilation. Sputum
Presence of Chest pain
Respiratory Emergencies Nursing Diagnosis
● Hypoxia Primary Nursing Diagnosis:
● Hypoventilation:  Ineffective Airway Clearance
● Hypercarbia  Ineffective Breathing Pattern
● Hypoxemia  Impaired Gas Exchange
● Tachypnea:  Decreased Cardiac Output
● Hypoventilation  Altered Tissue Perfusion
● Bradypnea Secondary Nursing Diagnosis:
● Dyspnea  Deficient Knowledge
Signs of Hypoxia  Activity Intolerance
● Rapid pulse  Disturbed Sleep Pattern
● Rapid, shallow respiration &  Imbalanced Nutrition
dyspnea  Acute Pain
● Increased restlessness  Anxiety
● Flaring of nares Planning
● Substernal/Intercostal retractions.  Client maintains a patent airway.
● Cyanosis  Client mobilizes pulmonary
Cardiac Emergencies secretions.
● Cardiac Arrest (the abrupt loss of Implementation
heart function, breathing and 1. Interventions to Promote Airway
Clearance
consciousness.
● Teach the patient effective coughing.
● Myocardial infarction (MI)
● Initiate postural drainage and chest
(permanent damage to the heart physiotherapy.
muscle.) ● Monitor hydration.
● Congestive Heart Failure: (heart ● Administer medications.
failure is a condition in which the ● Monitor environmental and lifestyle
heart can't pump enough blood to conditions.
meet the body's needs. Heart failure ● Manage artificial airways.
does not mean that your heart has ● Suction the airway.
stopped or is about to stop working.
It means that your heart is not able to
pump blood the way it should.) Implementation
● Disturbances of Cardiac Rhythm 1. Interventions to Promote Airway Clearance
(Arrhythmias). ● Teach the patient effective coughing.
Nursing Process ● Initiate postural drainage and chest
physiotherapy.
 ● Monitor hydration. ● Initiate cardiopulmonary resuscitation
● Administer medications. (CPR).
● Monitor environmental and lifestyle Interventions to Address Associated Nursing
conditions. Diagnoses
● Manage artificial airways. ● Explore lifestyle and activity adaptations.
● Suction the airway. ● Encourage dietary and nutritional
modifications.
Suctioning an Endotracheal Tube ● Promote comfort measures.
Asepsis
● Asepsis is the absence of microorganisms.
● Medical asepsis uses practices to reduce the
number, growth, and spread of
microorganisms. Medical asepsis is also
referred to as "clean technique".
● Surgical asepsis, or sterile technique,
consists of those practices that eliminate all
microorganisms and spores from an object
or area.

2. Interventions to Improve Breathing Patterns

● Position the client properly.
● Teach controlled breathing exercises.
● Manage chest drainage systems.
Decrease the Exposure of Clients to infection.
3. Interventions to Improve Oxygen Uptake and
Delivery

Administer oxygen:

● simple mask
● Nasal cannula
● Venturi mask
● Rebreathing and Non-rebreathing mask

Administer blood components.

4. Interventions to Increase Cardiac Output and

Tissue Perfusion
● Manage fluid balance.
● Encourage activity restrictions and
assistance with activities of daily living. Ways That Can Decrease The Exposure Clients
● Position the client properly. To Infection
● Administer medications. Standard Precaution:
Emergency Interventions ● Hand washing
● Remove airway obstruction. ● Use of personal protective equipment
 ● Appropriate handling of patient care
equipment and soiled linen Types of Oxygen Delivery
● Prevention of needlestick/sharp injuries
● Environmental cleaning and spills- Nasal Cannula/Nasal Prongs
management ● Flow rate up to 6L/min
● Appropriate handling of waste ● Unable to determine exact concentration
● Comfortable-allows patient to eat, drink talk
Oxygen Therapy ● Can still be used if patient' mouth breathing
● is the administration of oxygen at a ● Delivers 02 into the patient's nostrils by way
concentration greater than that found in the of two small plastic prongs
environmental atmosphere. ● Delivers low concentration of 02 (24% to
45%) at flow rates of 2-6 L/min
Goal:
● Is to provide adequate transport of oxygen in
the blood while decreasing the work of
breathing and reducing stress on the
myocardium.
● To prevent Hypoxia
Oxygen administration: Face Masks
● Oxygen therapy is prescribed by the
physician who specifies the concentration,
method of delivery and liter flow per
minute. The concentration is of more
importance than the liter flow per minute.
● Face masks that cover the client's nose and
mouth may be used for oxygen inhalation.
● Exhalation ports on the sides of the masks
allowed exhaled carbon dioxide to escape.

Simple Face Masks

● delivers oxygen concentrations from 40% to

Indications for Oxygen Therapy 60% at liters flows of 5 - 8 L/minute,
respectively.
Humidifiers
Prevent mucous membranes from drying and Partial Rebreather Masks
becoming Irritated and loosens secretions for easier
expectoration. Oxygen passing through water picks
up water vapor before it reaches the client The
oxygen passes through sterile distilled water or tap
water and then along a line to the device through
which the moistened oxygen is inhaled (e.g. a
● delivers oxygen concentrations of 60% to
Cannula, Nasal Catheter, or Oxygen Mask).
90% at liter flows of 6 to 10 L/ minute,
 respectively. The oxygen reservoir bag that
is attached allows the client to rebreathe
about the first third of the exhaled air in
conjunction with oxygen.

Non Rebreather Masks

● An OPA is a device usually made of plastic
● It is inserted into patient's mouth and into
back of throat
● Helps to maintain an open airway for
breathing/ resuscitation
● Use OPA's only on unconscious patients
● It delivers the highest oxygen concentration who DON'T have a gag reflex
possible - 95% to 100% - by means other
than intubation or mechanical ventilation at
liter flows of 10 - 15 L/ minute, respectively.

Venturi Masks

Suctioning
● The venturi masks deliver oxygen
concentrations varying from 24% to 40% or
50% at liter flows of 4 to 10 L/minute. It is
often used with air-entrainment nebulizers to
provide humidification and oxygen therapy.
● NEVER suction for longer than 15 seconds
at a time
● NEVER suction as you are inserting the
Face Tents (Face Shield)
catheter, place the suction tip in the patients
mouth before starting suction

Nurses Responsibilities
● The nurse should explain the reason and the
objective for the therapy
● The nurse should know the proper care of
and administration of oxygen
● Instruct the patient and family the methods
for administering oxygen
Artificial Airways ● Demonstrate safe and appropriate use of
Oropharyngeal Airways oxygen and oxygen device
● Identify to patient and family the signs and
symptoms indicating the need for oxygen