Chapter 49

Oxygenation
Prominent Landmarks
Major Organs
Lower Respiratory
Structure and Processes of the
Respiratory System (1 of 2)

 The function of the respiratory system is gas exchange.

 Oxygen is required for cell functioning.

 Movement of oxygen and CO2 involves integration of several body

systems.
Structure and Processes of the
Respiratory System (2 of 2)
 Oxygen from inspired air diffuses from alveoli in lungs into
blood in pulmonary capillaries.
 Carbon dioxide produced during cell metabolism builds up in
tissues and diffuses from blood into the alveoli to be exhaled.
Structure of the Respiratory
System (1 of 3)
 Upper respiratory tract
 Mouth
 Nose - Air enters - Warmed and filtered
 Pharynx
Shared pathway for air and food
Nasopharynx
Oropharynx
Structure of the Respiratory
System (2 of 3)
 Upper respiratory tract
 Larynx
Externally identified as Adam’s apple
Epiglottis is inlet.
Structure of the Respiratory
System (3 of 3)
 Lower respiratory tract
 Trachea
 Bronchi
 Bronchioles
 Alveoli - Respiratory membrane
 Pulmonary capillary network
 Pleural membranes
Upper Respiratory System

 Mouth
 Nose
 Pharynx
 Larynx
Lower Respiratory System
 Trachea
 Lungs
 Bronchi
 Bronchioles
 Alveoli
Let’s Cough

 Page1358
 Box 50-1
Definitions

Make a list – know them

Respiratory Process

 Ventilation
 Alveolar Gas Exchange
 Transport of O2 and CO2 to tissues
Ventilation
Inspiration
Expiration
Inspiration (inhalation)
Diaphragm and intercostals contract.
Thoracic cavity size increases.
Volume of lungs increases.
Intrapulmonary pressure decreases.
Air rushes into lungs to equalize pressure.
Expiration (exhalation)

 Diaphragm and intercostals relax.

 Volume of the lungs decreases.
 Intrapulmonary pressure rises.
 Air is expelled.
What is
required for
Adequate
Ventilation?
 Pulmonary Ventilation
Respiratory Centers _________________________

Intrapleural Pressure_________________________

Intrapulmonary Pressure _____________________

Tidal Volume _______________________________

Lung Compliance ___________________________

Atelectasis _________________________________

Surfactant _________________________________
 Alveolar Gas Exchange
 Diffusion of oxygen from
alveoli to the pulmonary
blood vessels
 ABG (Arterial Blood Gas)
 PO2 – 60 mm/Hg

 PCO2 – 45 mm/Hg
Transport of O2 and CO2

 O2 from lungs to
tissue

 CO2 from tissue

back to lungs
Factors Affecting O2 levels in Blood

Cardiac Output
 Number of RBC’s and Hematocrit
 Exercise

* Chronic lung conditions and CO2

 Factors that
Compromise Respirations
Infection
Stress (Physical or Emotional)
Surgery
Anesthesia
Anelgesia
Others
 Factors Affecting
Respiratory Function
 Age (changes)
 Environment
 Lifestyle
 Health Status *
 Medications
 Stress
Conditions affecting Airway

1. Partially obstructed airway indicated by low-pitched snoring

during inhalation
 Upper airway
Gurgly or bubbly sound passing obstruction
 Lower airway harder to observe
Stridor
Harsh, high-pitched sound in inspiration
Adventitious (abnormal) breath sounds

2. Completely obstructed airway

 Extreme inspiratory effort with no chest movement
Respiratory Regulation (2 of 3)

 Respiratorycenter in medulla oblongata and

pons of the brain
 Chemosensitive receptors in medulla oblongata
respond to changes in blood and hydrogen ion
concentration.
 Increased CO2 most strongly affects stimulation of
respiration.
 Nursing Interventions
 Encourage good nutrition, exercise and
immunizations
 Encourage adequate fluid intake unless cardiac
or renal involvement
 Position changes for drainage, lung expansion
and air movement
 Teach breathing techniques
 Pace Activities
 Small more frequent meals
 Avoid hot or cold temperatures
Hypoxia

Insufficient oxygen anywhere

in the body

3-5 minutes for brain

damage
What do patients look
like when they are
acutely hypoxic?

Box 49.1
page 1283
What do patients look
like who have chronic
hypoxia?
Clubbing in the fingers of a 33-year old
female with pulmonary hypertension.
What do patients look like when
they are acutely hypoxic?
 Increased pulse
 Rapid, shallow respirations

 Restlessness and light-headedness

 Nasal Flaring

 Substernal retractions

 Cyanosis

 Usually sitting up & Leaning Forward

 Anxious

 Scared
Altered Breathing Patterns
 Eupnic – Tachypnea – Bradypnea – Apnea
-- Orthopnea -- dyspnea
 Hyperventilation - Increased rate – Stress
 Kussmaul – Met Acidosis, rapid, deep
 Cheyne Stokes – Deep with alternate
periods of apnea
 Biots – Cluster – rapid, deep with abrupt
periods of apnea
Deep Breathing and Coughing

 High Fowlers Position

 Deep Breathing and Coughing, also Expectorate

 Deep breathing and Coughing exercises – what

do you teach?
 Humidifiers and nebulizers – loosen secretions
for easier expectoration. What do you teach?
 Incentive Spirometry – Can you teach this?
Incentive Spirometer
Promoting oxygenation
 Position client for maximum chest expansion
(semi- or high Fowler’s)
 Encourage or provide frequent position
changes
 Encourage deep breathing and coughing
 Encourage ambulation
 Implement comfort measures
Deep breathing and
coughing

 Raise secretions high enough to expectorate

or swallow
 Routine exercises for clients with chronic
conditions
 Normal forceful cough
 Alternative huff coughing
Hydration

 Maintains moist mucous membranes to aid

removal of secretions
 Normal secretions thin, easily moved by
ciliary action
 When dehydrated, secretions tenacious
Humidifier
 Fluids as much as client tolerates
Medications
 Bronchodilators
 Anti-inflammatory drugs
Glucocorticoids
Leukotriene modifiers
 Expectorants/Cough suppressants
 Others that improve cardiovascular
function
Digitalis glycosides
Beta-adrenergic stimulating agents
Beta-adrenergic blocking agents
Must be monitored closely
Incentive spirometry

 Sustained maximal inspiration device (S

MI)
Improves pulmonary ventilation
Counteracts effects of anesthesia or
hypoventilation
Loosens respiratory secretions
Facilitates respiratory gaseous exchange
Expands collapsed alveoli
A, Flow-Oriented SMI
B, Volume-Oriented SMI
Home Care
Oxygenation,
Assessment and
Oxygen Safety
 Oxygen Therapy
 Safety Precautions
 Home Care
 Different Types of Oxygen
 Which ones can be used at home?
Percussion, Vibration and Postural
Drainage

 Dislodging trapped secretions

 Increases turbulence of exhaled air
 Uses Gravity for drainage
Artificial Airways Pg. 1299

 Oropharyngeal
 Nasopharyngeal – more tolerable
 Endotracheal (ET)
 Tracheostomy – Trach care

see figures & procedures in K&E

 Suctioning
 Why is sterile technique recommended
even though nasal and oral contain
multitudes of microbes?

 Important – pre-oxygenation

 Procedure Pg. 1304 Skill- 49.2

Chest Tubes and Drainage Systems

 Pneumothorax – Air collects in the

pleural space
 Hemothorax – Blood collects in the
pleural space

Normal negative pressure is lost and

must be restored for normal respirations
to resume
 Chest Tubes Pg. 1315
 Must be connected to a sealed drain or a
one-way valve that allows air or drainage
to be removed and at the same time does
not allow air to be sucked in.
 Disposable drainage systems are sterile
and closed and can have an air or water
seal.
Chest Tube
 Nursing Implications
 Monitor and maintain patency and integrity of
drainage system
 VS and O2 Saturation
 Have Rubber tipped clamps and sterile
occlusive dressing
 Observe site q4h (bleeding, drainage, odor, SQ
emphysema)
 Pain Assessment
 TCDB minimum q2h
Ineffective Airway
Clearance
Care plan
Concept Map Ineffective Airway
Clearance
 Please
Pay attention to the boxes in this chapter
Read over the equipment and procedures
learned in lab – all are testable material