Fundamentals of Nursing

NUR 102
Maintaining Oxygenation
Module J
Objectives
 Define terms associated with oxygenation
 Explain the physiology of oxygenation
 Explain the process of oxygenation
administration
 Explain pulse oximetry
 Explain the process of connecting a pulse
oximetry
 Identify emergency techniques for restoring
oxygenation
 Explain the process of using various
emergency techniques for restoring
oxygenation
 Explain the process of applying the nursing
process to maintaining oxygenation.
TERMS
 Afterload
 Angina pectoris
 Atelectasis
 Bronchoscopy
 Cardiac index
 Cariac output
 Cardiopulmonary rehabilitation
 Cardiopulmonary resuscitation
 Chest physiotherapy
 Chest tube
 Cyanosis
 Diaphragmatic breathing
 Diffusion
 Dyspnea
 Dysrhythmias
 Electrocardiogram (ECG)
 Expiration
 Hematemesis
 Hemoptysis
 Hemothrorax
 Humidification
 Hyperventilation
 Hypoventilation
 Hypoxia
 Incentive spirometry
 Inspiration
 Myocardial infarction (MI)
 Nasal cannula
 Nebulaizaation
 Normal Sinus Rhythm
 Orthopnea
 Peak expiratory flow rate
 Pneumothorax
 Postural drainage
 Preload
 Pursed-lip breathing
 Stroke volume
 Thoracentesis
 Ventilation
 Ventricular fibrillation
 Wheezing
Physiology of oxygenation:
1. Oxygen is required to sustain life.
2. Function of cardiac and respiratory
systems is to supply the body’s
oxygen demands.
3. Blood is oxygenation through
mechanisms of ventilation,
perfusion, and transport of
respiratory gases.
4. Depth and rate of respiration is
controlled by neural and chemical
regulators-in response to changing
tissue oxygen demands.
Cardiovascular Physiology:
 Cardiopulmonary physiology involves
delivery of deoxygenated blood (blood high
in carbon dioxide and low in oxygen), to
right side of heart and to pulmonary
circulation and oxygenated blood from
lungs to left side of heart and tissues.
 Cardiac system delivers oxygen, nutrients,
and other substances to tissues and
removes waste products of cellular
metabolism through cardiac pump,
circulatory vascular system, and integration
of other systems.
Structure and Function:

 The right ventricle pumps blood

through the pulmonary circulation.
 The left ventricle pumps blood to the
systemic circulation.
 The circulatory system exchanges
respiratory gases, nutrients, and
waste products between the blood
and the tissues.
 Myocardial Pump
 Pumping action of heart essential to
maintaining oxygen delivery.
 Coronary artery disease (CAD) and
cardiomyopathic (enlarged heart)
conditions result in diminished stroke
volume.
 Four chambers of heart fill with blood
during diastole and empty during
systole.
 Factors affecting pump include
hemorrhage and dehydration by
decreasing amount of blood ejected
from ventricles.
 Myocardial Blood Flow:
 Must supply sufficient oxygen and nutrients to
myocardium in order to maintain adequate blood flow
to pulmonary and systemic circulation.
 Blood flow through heart is unidirectional.
 There are four heart valves that ensure forward blood
flow.
 Ventricular diastole- atrioventricular (mitral and
tricuspid) valves open and blood flows from higher
pressure atria into relaxed ventricles=S1, or first heart
sound.
 After ventricular filling, systolic phase begins.
 Systolic phase- semilunar (aortic and pulmonic)
valves open and blood flows from ventricles into
aorta and pulmonary artery.
 Closure of aortic and pulmonic valves represents S2,
or second heart sound.
Respiratory Physiology

 Most cells in body obtain energy

from chemical reactions involving
oxygen and elimination of carbon
dioxide.
 Exchange of respiratory gases
occurs between environmental air
and blood.
 Three steps in process of
oxygenation:
Ventilation, perfusion, and diffusion.
 Structure and Function:
 Ventilation- process of moving gases
into and out of lungs.
 Requires coordination of muscular and
elastic properties of lung and thorax, as
well as intact innervation.
 Major inspiratory muscle of respiration
is the diaphram- innervated by phrenic
nerve, which exits spinal cord at 4th
cervical vertebra.
 Perfusion relates ability of
cardiovascular system to pump
oxygenated blood to tissues and return
de-oxygenated blood to lungs.s
Work of breathing:

 Inspiration-  Expiration is
active process, passive process
stimulated by that depends on
chemical elastic recoil
receptors in properties of
aorta. lungs, requiring
little or no
muscle work.
 Lung Volume:
 Spirometry- is used to measure
to measure volume of air
entering or leaving the lungs.
 Variations in lung volumes may
be associated with health states
such as pregnancy, exercise,
obesity, or obstructive and
restrictive conditions of the lungs.
 Lung capacities- made up of two
or more lung volumes (total lung
capacity, and inspiratory and
expiratory reserve volume).
 Pulmonary Circulation:
 Primary function of pulmonary
circulation is to move blood to and
from aveolocapillary membrane for
gas exchange to occur.
 Pulmonary circulation is a reservoir
for blood so that lung can increase its
blood volume without large increases
in pulmonary artery or venous
pressures.
 Begins at the pulmonary artery, which
receives poorly oxygenated mixed
venous blood from the right ventricle.
 Oxygen Transport:
 Consists of lungs and cardiovascular
system.
 Delivery depends on amount of
oxygen entering the lungs
(ventilation), blood flow to lungs and
tissues (perfusion), rate of diffusion,
and oxygen-carrying capacity.
 Capacity of blood to carry oxygen is
influenced by the amt. of dissolved
oxygen in the plasma, amt. of
hemoglobin, and tendency of
hemoglobin to bind with O2.
Assessment

 Breathing  Diagnostic
Patterns Tests:
 Factors Pulmonary
Impairing Function Tests
Oxygenation Pulse Oximetry
Airway Maintenance:
 Humidification- process of adding
water to gas. Temperature is most
important factor affecting amt. water
vapors a gas can hold.
 Nebulization- process of adding
moisture or medications to inspired
air by mixing particles with the air.
 Chest physiotherapy-(CPT) a group
of therapies used in comb. To
mobilize pulmonary secretions.
 Nasopharyngeal suctioning- when
client is unable to clear respiratory
secretions to clear airway.
Oxygen Enhancement:

 Nursing interventions include

1. Independent nursing actions
(health promotion, prevention
behaviors), positioning, and
coughing techniques.
2. Interdependent or dependent
interventions include oxygen
therapy, lung inflation tech.,
hydration, medication admin., and
chest psysiotherapy.
Nursing Process:

 Assessment :
1. Physical examination (pain, fatigue,
smoking, dyspnea, cough,
wheezing, environment or
geographical exposures,
respiratory infections, allergies,
health risks, medications.
2. Inspection, palpation, percussion,
auscultation.
3. Diagnostic Tests
Nursing Process:
 Nursing Diagnosis:
1. Based on specific defining
characteristics and related etiology.
2. Use information gathered in
assessment to identify defining
characteristics.
3. Include: activity intolerance, risk for
activity intolerance, ineffective
airway clearance, anxiety,
ineffective breathing pattern,
decreased cardiac output, impaired
comfort, fatigue, fear, risk for
imbalanced fluid volume, impaired
gas exchange, etc.
Nursing Process:

 Implementation:
1. Health promotion (immunizations,
vaccinations), healthy lifestyle
behavior, environmental pollutants,
dyspnea management, airway
maintenance.
2. Suctioning (nasopharyngeal and
nasotracheal suctioning), artificial
airways, maintenance and
promotion of lung expansion, chest
tubes, methods of oxygen delivery.
Nursing Process:
 Evaluation:

1. Client care
2. Client expectations
Review of CPR:
*rescue breathing
1. Determine respiratory status (look, listen,
feel).
2. Call for assistance if not breathing.
3. If has pulse but no breathing, initiate
artificial airway (mouth to mouth, bag and
mask).
4. Open airway. (Head tilt, chin lift).
5. Create tight seal over mouth.
6. Give one breath every 5 seconds.
7. Reassess after one full minute.
8. Continue rescue breathing if not
breathing.