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Basic human need
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O2 is classified as a drug
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Must have MD order for rate and route
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Nose and nasal cavities: mm, ciliated,
vascular
Pharynx: posterior to nasal & oral cavity
Nasopharynx=air passage way, eustachian
tubes from middle ears
Trachea: 4-5in tube from larynx to bronchi.
Ciliated
Bronchial tree: air passage ways within lungs
Lungs: lobes 3=R 2=L
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Gases move in and out due to pressure in
atmosphere. Lungs stay inflated due to
pressure around them which is less than
pressure within them.
Alveolar level: sacs exchange CO2 and O2
Surfactant must be present for alveoli to
function correctly
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Diaphragm: does 80% of the work of
breathing
Intercostals
Accessory
Involuntary control of breathing: Medulla
oblongata
Voluntary control of breathing: Cerebral
cortex
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Process of moving air in & out of the lungs:
◦ Compliance
◦ Surfactant
◦ Airway resistance
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Perfusion: moving blood to & from alveolarcapillary membrane for gas exchange
◦ Pulmonary circulation
◦ Distribution
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Diffusion: > to < concentration
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Heart=pump
4 chambers-R atrium-tricuspid valve-R
ventricle-pulmonic valve-pulmonary arterylungs
Return via pulmonary veins to L atriumbicuspid valve-L ventricle-aortic valve out to
aorta
Electrical conductive system
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Impulse begins in SA node located in R atrium
(pacemaker)
Travels thru both atrium ( A=contracts)
Thru mid heart called AV node
To the Bundle of His
Down the R and L bundles
To purkinje fibers which stimulate the V to
contract
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Cerebral cortex: voluntary
Medulla oblongata: involuntary
Chemical: is based on the amount of CO2,
hydrogen, and O2 present in blood at any
given moment. Chemoreceptors in aortic
arch and carotids sense the chemical content
and adjusts rate and depth of respirations to
meet needs.
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Decreased hemoglobin: will > HR & RR
Decreased inspiration: will > HR
Hypovolemia: will > HR & RR
Increased metablolism: will > HR & RR
Chest wall movements: can decrease
ventilation yet may see > RR but more
shallow
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Pregnancy
Obesity
Musculoskeletal abnormalities
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Trauma
Muscle or musculoskeletal disease: scoliosis
CNS diseases: ALS (Lou Gehrings)
COPD, other pulmonary disorders
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Age: premature, children, elderly
Nutrition: obesity & malnutrition
Exercise: with CV fitness enhances O2
exchange
Smoking: increases HR and RR
Substance Abuse: depresses resp centers
Anxiety: increases metabolic=>>02 demand
Environmental—Smog, hi altitude, dust,etc
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Hyperventilation: ventilation in excess of that
required to maintain normal CO2 levels in
tissues. CO2 is expired in greater amounts
Hypoventilation: depressed resp rate causing
retention of CO2=hypercapnia
Hypoxia: state of inadequate oxygenation
from deficient delivery or utilization of O2 at
the cellular level.
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Rate, Rhythm, Work of breathing
Dyspnea: deals with work of breathing
Wheezing: narrowed air passages, hi-pitched
Pain: evaluate, onset, location, duration, radiation, effects
on respirations
Cough: Secretions+characteristics of
Lung sounds: bilateral chest assessment
Risk factors:family Hx of lung CA, pulmonary ds, smoking
Medical history of respiratory infections, smoking
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Maintain lung expansion
◦ Positioning
 Semi-fowlers, Fowlers, orthopneic
 Change position frequently
◦ Breathing exercises
 Pursed lip
 Diaphragmatic breathing
 Incentive spirometry
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Mobilization of pulmonary secretions:
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TCDB every 2 hours
Hydration to thin secretions
Humidify environment to moisten mm
Postural drainage & chest precussions to mobilize
secretions
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Vital signs: pulse rate, respiratory rate
Color: cyanosis, pink, dusky, ruddy
Dyspnea: the difficulty and work of breathing
Restlessness/anxiousness
Retractions
O2 saturation/ABG’s
Mental alertness/awareness
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Room air=21%
Nasal 1L=21%-24%
2L=24%-28%
3L=28%-32%
4L=32%-36%
6L=40%-44%
= max O2 level for Nasal O2
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5-6 L = 40% O2
6-7 L = 50% O2
7-10 L= 60% O2
Simple mask: 40% to 60% (varies)
Venturi mask: 24%=50% with O2 flow rate of
4L to 10L (more exact)
Non-rebreathing mask: up to 80%-90%
Partial rebreathing mask: 60-90%
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Gauge pressure(psi) X cylinder factor
(0.28)/liter flow per minute
Example:
900 X 0.28/3 liters per min
=84 min
O2 in cylinder will last 84 min
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Correct liter flow
System on then to patient
Correct positioning of cannula or mask
No smoking-signs and remove ashtrays
Avoid use of electrical equipment-avoid
sparks, razors, electric hand held games
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Must keep airway patent
Inner cannula cleaned per protocol
Suction no greater 10 seconds
Sterile technique
O2 setting per respiratory care/orders
Care of trach ties, trach dressing