Oxygenation
Chapter 39
By N.Haliyash, MD, BSN
Lecture objectives
Upon completing the lecture students will be able to:
 Define key terms related to the theme.
 Identify physiological processes related to
oxygenation.
 Describe the impact of a client’s health, age,
lifestyle and environment on tissue oxygenation.
 Identify and describe clinical outcomes of
hyperventilation, hypoventilation and hypoxemia.
 Identify nursing care interventions that promote
oxygenation.
39-2
 Most cells in the body obtain their energy
from chemical reactions involving oxygen
and the elimination of carbon dioxide.
 The exchange of respiratory gases occurs
between the environmental air and the
blood
 There are 3 steps in the process of
oxygenation:
• Ventilation; perfusion and diffusion.
39-3
Physiology of Oxygenation




Ventilation
Alveolar Gas Exchange
Oxygen Transport and Delivery
Cellular Respiration
39-4
Physiology of Oxygenation
 Ventilation
• Movement of air into and out of the lungs
- Inhalation
- Exhalation
- Work of breathing Amount of muscular energy
(work) required to accomplish ventilation.
• Delivery of fresh air into the lung’s alveoli
• Regulated by respiratory control centers
• Hypoxemia is a decrease in blood oxygen
concentration.
39-5
39-6
39-7
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.
39-8
Physiology of Oxygenation
 Oxygen Transport and Delivery
• Oxygen Transport in the Blood
- PaO2
- SaO2
39-9
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.
39-10
39-11
Circulation/Perfusion
 Key terms:
• Cardiac output Amount of blood pumped by the
heart.
- Norm 4 to 6 L/min
• Cardiac index (CI) is the adequacy of the cardiac
output for the individual
- Cardiac output ÷ BSA
- Norm 2.5 to 4 L/min/m³
39-12
• Cardiac conduction system Specialized
cells in the heart that generate and conduct
electrical impulses; consists of the sinoatrial
node, internodal pathways, atrioventricular
node, bundle of His, right and left bundle
branches, and Purkinje fibers.
39-13
39-14
 Cardiac cycle Series of electrical and
mechanical events resulting in a cycle of atrial
and ventricular contractions and relaxation.
• Systole Process of cardiac chamber emptying or
ejecting blood.
• Diastole Process of cardiac chamber filling as the
right and left ventricles relax.
 Heart failure Inability of the heart to pump
enough blood to meet the metabolic needs of
the body; often accompanied by a backup of
blood in the venous circuits (congestive heart
failure).
39-15
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.
39-16
Factors Affecting Oxygenation
 Development: Age Differences
 Environmental and Lifestyle Factors
 Disease Processes
39-17
Disease Processes
 Obstructive Pulmonary Disease
• Asthma, emphysema, and chronic
bronchitis, are collectively known as chronic
obstructive pulmonary disease (COPD), or
chronic airflow limitation.
39-18
Disease Processes
 Restrictive Pulmonary Disease
•
•
•
•
Pneumonia
Pulmonary fibrosis (scarring)
Traumatic injury to thorax
Break in pleural membrane surround lungs
 Atelectasis or alveolar collapse can be
caused by pleural defects.
39-19
Disease Processes
 Diffusion Defects
• Decrease in the efficiency of gas diffusion
from the alveolar space into the pulmonary
capillary blood
39-20
Disease Processes




Ventilation-Perfusion Mismatching
Atherosclerosis
Heart Failure
Alterations in Oxygen Uptake
39-21
Physiological Responses to
Reduced Oxygenation




Increased Oxygen Extraction
Anaerobic Metabolism
Tissue Ischemia and Cell Death
Carbon Dioxide Transport and Excretion
39-22
Assessment
 Health History
•
•
•
•
•
•
Events leading up to the problem
Duration
Methods used to alleviate symptoms
Impact on activities of daily living (ADLs)
Medical, psychosocial, and family history
Client’s knowledge level and coping abilities
39-23
Assessment
 Physical Examination
• Rate, rhythm, pattern of respirations
• Manifestations of hypoxia
- Behavior, clubbing, cyanosis, mottling
• Palpation findings related to compromised
ventilation include vocal fremitus, and
displacement of trachea.
• Percussion may reveal hyperresonance, dull
percussion tone.
39-24
Assessment
 Physical Examination
• Auscultation may reveal adventitious breath
sounds.
- Rales (crackles), wheezes (rhonchi), pleural
friction rub, stridor
• Auscultation may also reveal gallops, or
extra heart sounds, and murmurs.
39-25
Diagnostic and Laboratory Data





Pulse Oximetry
Arterial Blood Gases (ABGs)
Sputum Collection
Ventilatory Function Tests
Lactic Acid, Hemoglobin, Hematocrit
39-26
Diagnostic and Laboratory Data






Chest X-Ray, Computerized Tomography
Bronchoscopy
Thoracentesis
Echocardiography
Electrocardiography
Stress Test
39-27
Nursing Diagnosis
 Primary Nursing Diagnoses
•
•
•
•
•
Ineffective Airway Clearance
Ineffective Breathing Patterns
Impaired Gas Exchange
Decreased Cardiac Output
Altered Tissue Perfusion
39-28
Secondary Nursing Diagnoses






Deficient Knowledge
Activity Intolerance
Disturbed Sleep Pattern
Imbalanced Nutrition
Acute Pain
Anxiety
39-29
Outcome Identification
and Planning
 Expected outcomes should be
individualized to reflect the client’s
capabilities and limitations.
 Identifying desired outcomes of care is
best accomplished in small steps.
39-30
Outcome Identification and
Planning
 Outcomes may be based on
physiological parameters such as
respiration rate or arterial blood gas
values.
 Outcomes should be based upon the
assessment findings that led to the
nursing diagnoses at hand.
39-31
Implementation
 Interventions to Promote Airway
Clearance
• Teach effective coughing.
• Initiate postural drainage and chest
physiotherapy.
• Monitor hydration.
• Administer medications.
39-32
Implementation
 Interventions to Promote Airway
Clearance
• Monitor environmental and lifestyle
conditions.
• Manage artificial airways.
• Suction the airway.
39-33
Suctioning an Endotracheal
Tube
39-34
Suctioning an Endotracheal
Tube
39-35
Implementation
 Interventions to Improve Breathing
Patterns
• Position client properly.
• Teach controlled breathing exercises.
• Manage chest drainage systems.
39-36
Implementation
 Interventions to Improve Oxygen Uptake
and Delivery
• Administer oxygen.
• Administer blood components.
39-37
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.
39-38
Implementation
 Emergency Interventions
• Remove airway obstruction.
• Initiate cardiopulmonary resuscitation.
39-39
Implementations
 Interventions to Address Associated
Nursing Diagnoses
• Explore lifestyle and activity
adaptations.
• Encourage dietary and nutritional
modifications.
• Promote comfort measures.
39-40
Implementation
 Complementary Therapies
• Therapies that enhance oxygenation
include mediation, aroma therapy, Tai
Chi, Qi Gong, and Yoga.
• Herbs are often used with relaxation
techniques, exercise, and diet to
prevent disease.
39-41
Evaluation
 Based on expected outcomes that the
nurse and client have established
together.
 Success of the specific interventions may
be a matter of the degree to which the
client is or can be returned to a
satisfactory state of respiratory
functioning.
39-42
Evaluation
 When evaluating progress, it is important
to determine if each initial expected
outcome was within reasonable
expectations.
 Revision of expected outcomes,
interventions, and plan of care should be
made to reflect truly reasonable
expectations.
39-43