Stressors that Affect

Oxygen Needs

Oxygenation
Ventilation- air moves in & out of lungs
External respiration-exchange of O2 &
CO2 between alveoli and blood
Gas Transport- blood transports O2 &
CO2 to body cells
Internal respiration- exchange of O2 &
CO2 between blood and cells.

Checkpoint
1) T / F The pulmonary artery carries
oxygenated blood away from the lungs.

FALSE

Factors Affecting Respiration

Integrity of the airway system (ventilation)

Functioning cardiovascular system (perfusion)
Functioning alveoli (diffusion)
Functioning medulla & chemoreceptors

Ventilation- Physical movement of gases into

and out of lungs
Perfusion- passage of blood through the
pulmonary circulation. Amount of blood
flowing thru lungs effects amount of O2 &
CO2 exchanged.
Diffusion- passage of gases thru the resp.
membrane from the alveolar sac to the
capillaries and back.
Medulla- brain stem: stimulated by CO2
will cause an heart rate to blow off CO2
and this O2 levels
Chemoreceptors- sensitive to CO2 in

Pulmonary Ventilation
Inspiration- air flows into lungs
Expiration-gases flow out of lungs

According to pressure gradient Boyle

BOYLES LAW volume of gas at a constant temperature
varies inversely with the pressure FLOW from higher
pressure to lower pressure

Intrapulmonic or intra-alveolar pressure- pressure

within alveoli
(fluctuates: Inspiration 759mm Hg
Expiration 761mm Hg)

Intrapleural pressure-pressure within the intrapleural

space (always negative)
(756 mm Hg)

Note: Atmospheric Pressure = 760 mm Hg

Factors Affecting Ventilation

Lung elasticity / compliance
(ability to stretch and recoil)

Airway obstruction
Musculature condition
Neurological controls

Checkpoint
What is the name of the nerve that supplies
the diaphragm?
PHRENIC NERVE

Alveoli Gas Exchange

Air reaches alveoli
Oxygen from alveoli space moves into
pulmonary capillary (oxygen uptake)
via diffusion
Oxygen diffuses across alveoli
membranes moving from high
concentration (alveoli) to lower
concentration (pulmonary capillary)

Alveoli Gas Exchange

Surfactant- secreted by alveoli cells,
keeps surfaces moist and prevents
atelectasis
Atelectasis- incomplete lung expansion
or collapse of alveoli
Lung Compliance- elasticity of lung
tissue and flexibility of rib cage
Lung recoil- ability of lungs to recoil

Other Factors Affecting

Gas Exchange
Surface area
Thickness of tissue
Ficks Law of Diffusion:
Rate of a diffusion of gas is dependent on surface
area and thickness of the membrane

Perfusion
Transport of O2 & CO2 via
blood to tissue
Volume of blood flowing through lungs
affects amount of oxygen and gases
exchanged
Adequate blood supply and
cardiovascular functioning are needed
Oxyhemoglobin HbO2 (or SaO2)

Checkpoint
The majority of CARBON DIOXIDE
molecules are transported in the blood as:
???
BICARBONATE
HCO3

Perfusion

Rate of O2 transport depends on:

Cardiac output
Activity level
CO2 transport

Neurologic/Chemical
Controls of Respiration

Peripheral Chemoreceptors
Central Chemoreceptors
Medullary respiratory center
Spinal cord
Phrenic nerve
Diaphragm

Factors Affecting Oxygenation

Environment
Emotions
Exercise
Health
Age

Life style
Medications
Respiratory
History

Checkpoint
What is the normal respiratory rate
of a newborn?
30-60 breaths/min

Assessing Respiratory Functioning

Difficulty breathing?
SOB?
Chest pain?
Coughing? Sputum production?
Nocturnal diaphoresis
Fatigue
Sleep with 2 or more pillows?

Assessing Respiratory Functioning

Respiratory Hx
includes:
Allergies
Medications
Medical Hx

Smoking
Lifestyle /
Activity Level
Stressors
Recent exposures
Developmental
level

Assessing Respiratory Functioning

Patient states difficulty breathing: you
can assess by using PQRST
P- provokes
Q- quality
R- region/radiation
S- severity scale
T- timing

Assessing Respiratory Functioning

Respiratory Rate:
Tachypnea R>24
Bradypnea R<10
Apnea
Respiratory Depth:
Deep - diaphragmatic
Shallow

Assessing Respiratory Functioning

Respiratory Rhythm:
Regular even and symmetrical
Cheyne-Stokes
Kussmauls
Biots (ataxic without rhythm)
Apneustic breathing (gasping)

Assessing Respiratory Functioning

Respiratory Quality:

No difficulty- Eupneic/ Unlabored

Dyspnea
Orthopnea
Retractions
Use of accessory muscles

Auscultation:
Vesicular
Bronchial
Bronchovesicular

Assessing Respiratory Functioning

Cough:
Nonproductive
Productive
Sputum
Hemoptysis
Breath sounds

Adventitious
Sounds:
Crackles:

fine,medium,coarse

Wheeze:
sibilant,sonorous

Stridor
Stertor
Pleural friction rub

Respiratory Assessment Review

Oxygen delivery method correctly applied
Obtain a pulse oximetry reading (norm is
>95%)
Check Vital Signs ?T ?P ?R
Auscultate the pts lungs
Note changes in skin and mucosa color
Assess capillary refill

Checkpoint
What are some other elements of a
respiratory assessment not yet
mentioned?
Neurological state
Color
Nail clubbing
AP vs Transverse Diameter
Barrel Chest?

Assessing Respiratory Functioning

Diagnostic tests:
Sputum
Nose/throat cultures
CBC (complete blood count)
ABG (arterial blood gases)
CXR (chest x ray)
PFT (pulmonary function tests)
Pulse Oximetry
http://www.oximeter.org/pulseox/principles.htm
Other: Scopes, CT, MRI, PET

Alterations:Respiratory Functioning

Hypoxia
Hypoxemia
Hyperventilation
Hypercapnia

Obstructed
airway
Foreign body
obstruction
(FBO)

Nursing Interventions
Independent

Airway maintenance
Positioning
Deep breathing & coughing
Pursed-lip breathing
Abdominal/diaphragmatic breathing
Hydration
Teaching of health habits

Nursing Interventions
Collaborative/Dependent

Incentive spirometry
Percussion/postural drainage
Suctioning
Oxygen therapy
Medications

Nursing Interventions
Collaborative/Dependent

Oxygen Therapy
Indications
Sources- wall outlet or portable tank
Monitor pulse oximetry
Methods- cannula, mask, venturi
mask, tent/isolette,BiPAP, CPAP

Administering Oxygen Therapy

Flow rate
Humidification
Hydration
Positioning
Safety precautions
Document
MD order required

Oxygen Safety Precautions

Signs: No smoking. Oxygen in use.
Remove matches, lighters and cigarettes.
Remove and store electrical equipment to
avoid sparks. Ground electrical equipment.
Avoid materials that generate static
electricity
Avoid use of volatile, flammable materials,
such as alcohol.
Know location & use of fire extinguishers
& alarms.

Nursing Interventions

Medications
Nebulizer Tx
Cough suppressants
Mucolytic: expectorants
Bronchodilators
Corticosteroids

Documentation
Routine Nurses Note

Date
Time
LOC
Rate
Depth

Rhythm
Breath sounds
(auscultated)
Quality
Color

Nursing Diagnosis

Ineffective airway clearance

Risk for aspiration
Ineffective breathing pattern
Impaired gas exchange
Risk for suffocation
Ineffective tissue perfusion; cardiopulmonary
Impaired spontaneous ventilation
Dysfunctional ventilatory weaning response

Checkpoint
Select a priority nursing diagnosis for the
following scenario:
88 y.o. female with pneumonia who has a
non-productive cough, R= 24, course
crackles upon auscultation. She is weak,
undernourished and fatigued.
Ineffective airway clearance

Checkpoint
Select a priority nursing diagnosis for the
following scenario:
A patient with hx of emphysema with
decreased PO2, increased CO2 levels who
is dyspneic and restless.
Impaired Gas Exchange

Checkpoint
Select a priority nursing diagnosis for the
following scenario:
A patient admitted to the ER post MVA with
notable blood loss, BP= 80/50, P=120,
R=22
Ineffective Tissue Perfusion;
Cardiopulmonary

Summary: Oxygenation
Oxygenation based on
ventilation/perfusion/diffusion of
oxygen
Various factors effect oxygenation
Assessment includes respiratory Hx,
clinical exam, diagnostic tests
Interventions include airway
maintenance /proper breathing/ oxygen
therapy/meds