Janna Wickham RN MSN
Lake Sumter Community College
Nursing Foundation
January 2013
Learning Objectives
Safe, Effective Care Environment
 Describe physiological processes affecting the client's
ventilation, perfusion, and exchange of respiratory
gases
 Assess the client’s oxygenation status
Health Promotion and Maintenance
 Develop nursing interventions that promote
oxygenation
 Describe the impact of a client's level of health, age,
lifestyle, and environment on tissue oxygenation
Physiological Integrity
 Interpret diagnostic testing related to oxygenation,
breathing, circulation, and gas exchange
Systems Involved in Oxygenation
 Pulmonary
 Respiration
 Circulatory
 Perfusion
 Musculoskeletal
 Ventilation
 Neurological
 Ventilation
Lungs-Lower- considered sterile
 Right- 3 lobes
 Left- 2 lobes
 Mediastinum- separates right from left
 Alveoli
 Alveoli-capillary membrane
 Gas Exchange
 Surfactant
 Pleura
 Pleural Space
Gas Exchange
Functions of Pulmonary System
 Ventilation
 Respiration
 Oxygenation
 Hypoxemia (blood)
 Perfusion
 Hypoxia
Pulmonary Ventilation
 Inhalation
 Diaphragm contracts
 Exhalation
 Diaphragm
 Hyperventilation
 Hypoventilation
 Lung Compliance
 Conditions that reduce lung compliance



Edema
Scar tissue
Loss of surfactant
 Lung elasticity
 Loss of elasticity results in lungs that inflate but air is
trapped
 Airway resistance
 Small changes can cause increased airway resistance
Respiration
 External Respiration
 Alveolar-Capillary Membrane
 Diffusion
 Conditions that slow or reduce gas exchange
 Internal Respiration
How is Breathing Controlled
 Respiratory Center
 Brainstem
 Feedback system



Chemoreceptors in the medulla, aorta, and carotid arteries
Blood pH, O2 levels, and CO2 levels
Lung receptors provide feedback
Cardiovascular
 Deoxygenated blood flows into the right atrium
 Pulmonary circulation
 Alveolar-capillary membrane external gas exchange
occurs
 Oxygenated blood flows from the lungs to the left side
of the heart of out into the arterial circulation
 Blood Flow Song
Heart
 Sinoatrial Node
 60-100
 Atrio-ventricular Node
 40-60
 Ventricular
 <40
Vascular System
 Arteries
 Arterioles
 Capillaries- one cell thick
 Veins
 Venules
Oxygen Transport
 Requires adequate
 Cardiac output
 Circulation
 Effective regulation of cardiovascular system
 Hemoglobin-reservoir for oxygen
 97% of blood oxygen is bound to hemoglobin
 3% of oxygen is dissolved
 Carbon Dioxide
 Dissolves into plasma for diffusion into the alveoli
Autonomic Nervous System
 Regulates Cardiovascular Function
 Sympathetic
 Parasympathetic
Brain Stem Center
 Baroreceptors
 Heart

Aortic arch
 Blood vessels

Carotid artery
 Chemoreceptors
 Blood pH
 Oxygen
 Carbon dioxide levels
Factors Affecting Oxygenation
 Developmental factors
 Lifestyle factors
 Environment
 Stress
 Medications
Stop
Developmental
 Preterm infants surfactant system is not fully developed putting
them at risk for respiratory distress syndrome- atelectasis
 Infant airways are small and this puts them at risk for
obstruction from mucous, edema, foreign objects
 Toddlers are at risk for URI because of tonsils and adenoids are
relatively large. Preschool introduces infectious agents. Still at
risk for choking.
 Age/Older Adults
 Reduces lung expansion
 Less alveolar inflation
 Less effective cough
 Declining immune system
 Diminished ability to increase ventilation
Lifestyle
 Smoking
 Sedentary lifestyle
 Nutrition
 Fat
 Sugar
 Pregnancy
 Occupational Hazards
 Obesity
 Substance Abuse
Environment
 Stress
 Catecholamine - SNS
 Suppressed immune system
 Release of cortisol
 Allergic Reactions
 Asthma –allergic reaction in the bronchioles of the lungs
 Air Quality
 Altitude
 Low oxygen levels can cause hypoxemia and hypoxemia
 Heat and Cold
Nursing history
 fatigue
 dyspnea
 cough
 wheezing
 pain
 environmental exposures
 respiratory infections
 risk factors
 medications
Examination
 Lung
 Heart
 Circulatory Function
 Ventilation and oxygenation studies
 Pulmonary Function Tests
 Arterial Blood Gas Tests
 pO2
 Arterial blood range 80-100mmHg
 Venous 40 mmHg
 pCO2 35-45 mm Hg
 Pulse Oximetry
 Capnography
 Peak Flow Monitoring
Lung Volume
and Capacity
Diagnostics
 Visualizing Respiratory system
 Chest x-ray
 Bronchoscopy
 Lung scan
 Basic cardiac monitoring
 lead placement
 cardiac cycle/wave form
Alterations in Oxygenation
 Hypoxemia
 Hypoxia
 Hypercarbarbia
 Hypocarbia
Pulmonary Causes
 Structural Abnormalities
 Airway Inflammation/Obstruction
 Alveolar-capillary membrane disorders
 Atelectasis
 Pulmonary Embolism
 Pulmonary Hypertension
Cardiovascular Causes
 Heart Failure
 Cardiomyopathy
 Cardiac Ischemia
 Dysrhythmias
 Valve Abnormalities
 Anemia
 CO poisoning
 Peripheral Vascular Disease
Promote Optimum Respiratory Function
 Immunization/ Screening
 Influenza, pneumonia, tuberculosis
 Prevent URI
 Position for maximum ventilation
 Teach/Assist with Incentive Spirometer
 Implement Aspiration Precautions
Mobilization of pulmonary secretions
 Hydration
 Humidification
 Nebulization
 Chest physiotherapy
 chest percussion
 vibration
 postural drainage
 CPR
 Pharmacotherapy
Artificial Airway Management
 Oropharyngeal
 Nasopharnygeal
 Endotracheal
 Tracheostomy
 Care
 Maintaining placement
 Suctioning
Mechanical Ventilation
 Acute
 Long term
Chest Tubes
 Purpose to remove air or fluid from the pleural space
to reestablish negative pressure
 Flow of air or fluid is in one direction
 Water sealed
Promotion of oxygenation
 Oxygen therapy
 safety precautions
 Methods of oxygen delivery
 nasal cannula
 nasal catheter
 transtracheal
 masks
Home Oxygen Therapy
 compressed gas cylinders
 liquid oxygen systems
 concentrators
Breathing exercises
 pursed-lip breathing
 diaphragmatic breathing
Promote Optimum Circulation
 Promote Venous Return
 Ambulation
 Positioning
 ROM
 Compression devices
 Prevent Clot Formation
 CPR
Pharmacotherapy
Nursing Diagnosis
 Pulmonary
 Ineffective Airway Clearance
 Ineffective Breathing Pattern
 Impaired Gas Exchange
 Impaired Spontaneous Ventilation
 Dysfunctional Ventilatory Weaning Response
 Risk for Aspiration
Nursing Diagnosis
 Cardiac
 Decreased Cardiac Output
 Ineffective Tissue Perfusion
 Risk for Shock
 Ineffective coping
 Anxiety
 Pain
 Risk for Activity Intolerance