Oxygenation
NURS 201
What will be achieved?
• A quick review of the functions of the respiratory
system
• Factors affecting oxygen delivery to cells
• Factors influencing respiratory function
• Respiratory terminologies
• Oxymeter to assess oxygenation status
• Oxygen delivery types: flow, features, and mode of
application
• Measures to be followed with a patient on oxygen
therapy
ANATOMY & PHYSIOLOGY OF RESPIRATION
The respiratory system performs its function through:
• Pulmonary ventilation: movement of air into and
out of the lungs (Ins/Exp).
• Respiratory exchange: Involves gas exchange
between the atmospheric air in the alveoli and
blood in the capillaries/ By Diffusion
• Perfusion: is the process by which oxygenated
capillary blood passes thru body tissues
Normally 1000 mls/minute of oxygen is transported from the
lungs to the periphery by the circulation. Only 25% of this is
utilized in a resting person.
OXYGEN DELIVERY TO CELLS
• Satisfactory delivery to tissues depends on a
number of factors:
 Adequate alveolar ventilation
 Diffusion from the alveoli into the pulmonary vascular
system
 Delivery of the oxygenated blood by the macro and
micro circulation to cells within tissues.
Tissue hypoxia occurs within minutes of major
failure of any of these systems.
FACTORS AFFECTING RESPIRATORY
FUNCTION
• Levels of Health: Acute & Chronic
illnesses. E.g. renal and cardiac problems,
anemia, obesity
• Developmental Considerations:
Age-related factors
• Medications: Opioids, Narcotics or
Sedatives
FACTORS AFFECTING RESPIRATORY
FUNCTION
• Lifestyle: Activity level, Smoking
• Environment: air-pollution,
environmental-pollution, occupational
hazards
• Psychological Health:
 Stress → Hyperventilation
 Anxiety → Bronchospasm
Respiratory Terminologies
• Hypoxia: condition in which an
inadequate amount of oxygen is available
to cells
• Dyspnea: difficulty breathing
• Hypoventilation: decreased rate or
depth of air movement into the lungs
Terminologies ConT’d
• Atelectasis: Incomplete lung expansion or
the collapse of alveoli
• Diffusion: is the movement of gas or particles
from areas of higher pressure or concentration
to areas of lower pressure or concentration
• Hyperventilation: condition in which there
is more than the normal amount of air entering
and leaving lungs
Assessment
• Nursing History
• Physical Assessment
• Common Diagnostic Test:

Pulse Oximeter values

Arterial Blood gases (ABGs)
Pulse Oximetry - SpO2
 The basic purpose of using Pulse
oximeter is to measure the quantity of
oxygen present in the blood.
 It emits light at dual wavelengths
from one side of the probe.
 Hemoglobin absorbs this light and
then the device measures it from the
other side.
 Normal values: 95-99%
 Clinically satisfactory: 92%
 Hypoxemia: less then 92%
Pulse Oximeter
Providing Supplemental
Oxygen
• Sources of O2 : Wall outlet or portable
cylinder or tank
• Oxygen flow rate: measured in liters per
minute (L/min) determines the amount of
O2 delivered to the patient.
• Humidification: needed when O2 is
delivered at more than 4 L/min (20% to
40% humidity)
Oxygen Piping
Oxygen Delivery Systems
1. Venturi mask
2. Face mask
3. Rebreather mask
4. Nasal cannula or
nasal prongs
Oxygen Delivery Systems
 Low flow system
 High flow system
SIMPLE FACEMASK
 It seals poorly and its large
ventilation holes allow oxygen flow
to be diluted with air
 Often used when an increased
delivery of O2 is needed for short
periods (less than12 hours)
 At an oxygen flow of 4-8 L/min,
face mask delivers 24-40 % O2
 Increasing the flow to 10 L/min
may increase oxygen concentration
to about 50 %.
NASAL CANNULA (Nasal Prongs)
o Most commonly used O2 delivery
device
o Has 2 protruding prongs placed in
patient’s nares
o It delivers O2 ranging from 2435% at 2-4 L/min
o Unpredictable amount of O2
depending on how much the patient
inhales through the mouth.
o Limit rate in Chronic lung disease
patients to minimum rate (2-3 L/min)
o A high flow rate can quickly dry
nasal mucosa (attach to humidifier)
VENTURI MASK
 This device utilizes a mechanical
venturi effect to increase oxygen flow rate
into the mask
 Delivers most precise O2
concentration
 Limits dilution of oxygen by air entering
into the mask.
 Types of venturi masks available:
-deliver 24 - 28 % oxygen at 4 L/min
-35 - 40 % oxygen at 8 L/min.
 This mask should only be used in a
clinical setting
Venturi mask
REBREATHER MASK
Partial Rebreather Mask
o A reservoir bag is added to the simple
facemask
o Reservoir collects 1/3 of patient’s
exhaled air, mixed with 100%
o
O2
Permits the conservation of O2
o When the patient breathes, much of
inhalation volume comes from the bag
o Can inhale room air thru openings in
mask
o Oxygen concentration delivered is
increased
Monitor:
o Tight seal is required
o Monitor reserve bag for slight
deflation with inspiration
Non-Rebreather Mask
• Same as the partial rebreather mask
• The two one-way valves prevent
patient from rebreathing exhaled air
• Delivers the highest concentration of
O2
Precautions for oxygen administration
• Avoid open flames in the room
• “No Smoking” sign posted
• Electrical equipment in good working order & emits
no sparks
• Avoid wearing or using synthetic fabrics (build up
static electricity)
• Avoid using oils in the area (oil may ignite
spontaneously in presence of O2)
Applied NANDA Nursing
Diagnoses
• Ineffective Airway Clearance
• Impaired Gas Exchange
• Ineffective Breathing Pattern