Chapt 21 Funds---- Oxygenation

Anatomy and Physiology of Breathing

-Inspiration (breathing out) -Elasticity of lung tissue allows the lungs to stretch and fill with air. *(during
this, the dome shaped diaphragm contracts and moves downward in the thorax. Intercostal muscles
move the chest outward by elevating the ribs and sternum. This combination expands the Thoracic
cavity)*
Expiration -(breathing out)- return to resting position *(thoracic cavity decreases)*
Ventilation – movement of air in and out of lungs… *(results from pressure changes within the thoracic
cavity produced by the contraction and relaxation of respiratory muscles)*
Respiration- exchange of oxygen and carbon dioxide
External Respiration- takes place at the most distal point in the airway between alveolar-capillary
membranes
Internal Respiration- occurs at the cellular level by means of hemoglobin and body cells.
OXYGEN MOVES IN HEMOGLOBIN!

Determine quality of a clients oxygenation by collecting physical assessment data, monitoring arterial
blood gases, and using pulse oximetry.
Hypoxemia – insufficient oxygen within arterial blood
Hypoxia – inadequate oxygen at the cellular level

PHYSICAL ASSESSMENT
By monitoring clients RESPIRATORY RATE, observing the breathing pattern and effort, CHECK CHEST
SYMMETRY, and auscultating lung sounds.
Additional assessments – heart rate and BP, clients level of consciousness, color of skin, mucous
membranes, lips, and nailbeds

ARTERIAL BLOOD GASES (FROM ARTERY!)

ABG is a laboratory test using arterial blood to assess oxygenation, ventilation, and acid-base balance.
Arterial Blood is preferred for sampling because arteries have greater oxygen content than veins and are
responsible for carrying oxygen to cells.

TEST Measures Normal Abnorma Indication

pH- of blood 7.35- 7.45 <7.35 acidosis
> 7.45 alkadosis
PaO2 - partial pressure of oxygen dissolved in plasma 80-100 60-80 mm hg mild hypoxemia
40-60 moderate hypoxemia
<40 mm hg Severe Hypoxemia
>100mm hg Hyperoxygenation

PaCO2- partial pressure of carbon dioxide in plasma 35-45 <35 mm hg Hyperventilation

>45 mm hg Hypoventilation

SaO2 – percentage of hemoglobin saturated with oxygen 95-100% <95% Hypoventilation

Anemia

HCO3 – level of bicarbonate ions 22-26 <22 or >26 meq Compensation

For acid-base imbalance
PULSE OXIMETRY
Non invasive, transcutaneous technique for periodically or continuously monitoring the oxygen
saturated blood.
SPO2- abbreviation
Sustained level of LESS THAN 90% is cause for concern.
If it remains low, client needs oxygen therapy.

COMMON SIGNS OF INADEQUATE OXYGENATION

-Decreased energy….. Restlessness… Rapid Shallow Breathing… Rapid Heart Rate…Sitting up to breathe
Nasal flaring… Use of accessory muscles… hypertension… sleepiness, confusion, coma.. Cyanosis of skin
(mucous membranes in dark-skinned patients) lips, nailbeds.

PROMOTING OXYGENATION
1.—Positioning
- unless contraindicated by their condition, clients with hypoxia are placed in High Fowlers position
*(upright seated)* eases breathing by allowing abdominal organs to descend away from the diaphragm.
Orthopneic Position- seated position with the arms supported on pillows or the arm rests of a chair and
the client leans forward over the bedside table or chair back.
-position allows room for maximum vertical and lateral chest expansion and provides comfort while
resting or sleeping

BREATHING TECHNIQUES
1.. Deep Breathing- technique for maximizing ventilation. Taking in large volume of air fills alveoli to a
greater capacity, thus improving gas exchange.
Therapeutic for shallow breathers, such as those inactive or in pain.
Take in as much air possible, hold the breath briefly, and exhale slowly.

2.. Incentive Spirometry- a technique for deep breathing using a calibrated device, encourages clients to
reach a goal-directed volume of INSPIRED AIR.
All are marked 100ml increments, visual cue such as elevation of lightweight balls to show how much air
the client has INHALED

3.. Pursed Lip Breathing

Form of controlled ventilation in which the client consciously prolongs the expiration phase of breathing.
This is helps remove more than usual amount of CARBON DIOXIDE.
-Especially helpful for CHROONIC LUNG DISEASES such as emphysema, which are characterized by
chronic hypoxemia and (hypercarbia – excessive levels of carbon dioxide in the blood*)
-Inhale thru nose counting to 3……. -purse lips to whistle……. -contract abdominal muscles….-exhale thru
pursed lips for count of 6 or more.

4.. DIAPHRAGMATIC BREATHING

Breathing that promotes using diaphragm rather then the upper chest muscles.
Used to increase volume of air exchanged during inspiration and expiration.

5.. Nasal Strips--- used to reduce airflow resistance by widening the breathing passageways of the nose.
-Common users of nasal strips are people with ineffective breathing as well as athletes.
-Also used to reduce or eliminate snoring
OXYGEN THERAPY
Oxygen is supplied from any one of four sources:
Wall outlet- most modern facilities supply oxygen through a wall outlet in the clients room. Outlet is
connected to a large central reservoir filled with oxygen on a routine basis.

Portable tanks- Steel cylinders that hold various volumes under extreme pressure.
2000 lbs of pressure per square inch (PSI).
-delivered with protective cap to prevent accidental force against tank outlet.
-transported and stored while strapped to a wheeled carrier.
-Tank is “cracked” before administering (technique for clearing the outlet of dust and debris. This is
done by turning the tank valve slightly to allow a brief release of pressurized oxygen) BEST TO CRACK
AWAY FROM BEDSIDE.

Liquid Oxygen unit- (expensive)

-device that converts cooled liquid oxygen to a gas by passing it through heated coils.
Ambulatory clients at home use these small, lightweight, portable unites because the allow greater
mobility inside and outside the house.
-holds 4 to 8 hours worth of oxygen.
--problems include that liquid oxygen is more expensive, unit may leak during warm weather, and frozen
moisture may occlude the outlet.

Oxygen Concentrator- (cheaper)

Collects and concentrates oxygen from room air and stores it for client use.
-to do so, it uses a substance called ZEOLITE within two absorbing chambers.
-eliminates nitrogen back into atmosphere
-eliminates need for central reservoir or use of bulky tanks that must be constantly replaced.
-used in HOME HEALTH CARE AND LONGTERM CARE FACILITIES, because of convenience and economy
-disadvantage, uses more electricity, generates heat from motor, unpleasant odor if not cleaned

EQUIPMENT USED IN OXYGEN ADMINISTRATION

1…. Flowmeter- guage used to regulate the amount of oxygen delivered to client and is attached to
oxygen source. L/min *liters per minute*
FIO2- physician prescribes concentration of oxygen *(portion of oxygen in relation to total inspired gas)
as a percentage or decimal.
-joint commission recommends oxygen be prescribed as a percentage rather then L/min.
2… Oxygen Analyzer- meaures the percentage of delivered oxygen to determine whether the client is
receiving the amount prescribed by physician.
-nurse or resp.therapist first checks % of oxygen in room air with analyzer.
-if normal, shows 21%...
-positioned near or within the device used to deliver oxygen, it should register prescribed amount
-if discrepancy- nurse adjusts flowmeter to reach the desired amount
-used most often with NEWBORNS in isolettes, children in couptents, and clients who are mechanically
ventilated.
3.. HUMIDIFIER- device that produces small water droplets and may be used during oxygen
administration because oxygen is drying the mucous membranes.
-oxygen humidified only when more than 4 L/min is administered extended period.
-When humidification desired, bottle is filled with distilled water and attached to flow meter
-must check water levels DAILY