OXYGENATION

Overview of Anatomy and Physiology

Presented by:
Hanako Sasaki-Aranilla, RN
 Learning Objectives:
• Oxygenation vs. Ventilation
• Review of Structures and Functions of
Respiratory System
• Mechanics of Breathing
• Normal Oxygenation Process
• Gas exchange
 Oxygenation vs. Ventilation
Oxygenation Ventilation
• Process by which oxygen • Process by which air moves
diffuses from inspired air in and out of the lungs
into the blood, then to the
tissues. • Inflow and outflow of air
between the atmosphere
and the lung alveoli
CO2 and/or O2 = need for more
ventilation
RESPIRATORY SYSTEM
 FUNCTIONS OF THE RESPIRATORY
SYSTEM
• To provide O2 to and eliminate CO2 from
the cells of the body.
• Filters, warms, moisten inspired air
• Produces sound
• Contains receptors for smell
• Helps regulate blood pH
ANATOMY OF RESPIRATORY SYSTEM
• STRUCTURAL • FUNCTIONAL
CLASSIFICATION CLASSIFICATION
• Upper respiratory tract • Conducting portion
• Lower respiratory tract • Respiratory portion
 • UPPER RESPIRATORY TRACT
NOSE
• Externally visible
part of the
respiratory system
• FUNCTIONS:
• Airway
• Moisten & warms
air
• Filters air
• Resonating center
for speech
• Olfaction
 NASAL • UPPER RESPIRATORY TRACT
CAVITY
• Anterior region:
• Enclosed by the external
nose
• Posterior region:
• More central within the
skull
• The nasal cavity has:
• A floor
• A roof
• A midline or septal wall
• A lateral wall
 NASAL • UPPER RESPIRATORY TRACT
CAVITY
• 3 General Regions:
• Nasal Vestibule
• Lined by skin and contains
hair follicles
• Respiratory Region
• Rich in vascular supply,
lined by respiratory
epithelium
• Olfactory Region
• Small, at the apex, lined by
olfactory epithelium
 NASAL • UPPER RESPIRATORY TRACT
CAVITY
• Lateral Wall:
1. Superior Meatus
• Posterior ethmoid sinuses
2. Middle Meatus
• Maxillary
• Frontal
• Anterior Ethmoid
3. Inferior Meatus
• Nasolacrimal duct
4. Sphenoethmoidal recess
• Sphenoid
 PARANASAL • UPPER RESPIRATORY TRACT
SINUSES
• Cavities in the cranial
bones
• FUNCTIONS:
• Lighten the skull
• Produce mucus
• Resonance to the voice
• Warm and moisten air
• Protect the brain from
frontal trauma
 MAXILLARY • UPPER RESPIRATORY TRACT
SINUS
• Pyramidal in shape
• Paired and symmetrical
• Located within the body of
the maxilla, behind the
skin of the cheek
Capacity=30ml

• Drains to the middle

meatus of the nasal cavity
• Most commonly infected
 FRONTAL • UPPER RESPIRATORY TRACT
SINUS
• Contained within frontal
bone
• Separated from each other
by a bony septum

• Drains to the middle

meatus of the nasal cavity
 SPHENOID • UPPER RESPIRATORY TRACT
SINUS
• Located at the
approximate center of the
skull above the
nasopharynx.
• Superior border: Sella
turcica

• Drains to the
sphenoethmoidal recess
 ETHMOID • UPPER RESPIRATORY TRACT
SINUS
• Contained within ethmoid
bone, between the nose
and the orbit
• DRAINAGE:
• Anterior: middle meatus
• Posterior: superior meatus

• Lamina papyracea
 • UPPER RESPIRATORY TRACT
PHARYNX
• 3 REGIONS:
• Nasopharynx
• -the nose and mouth
connected by an isthmus
• Pharyngeal tonsils
• Eustachian tube
• Oropharynx
• Soft palate---epiglottis
• Laryngopharynx
• -epiglottis---esophagus
 • UPPER RESPIRATORY TRACT
LARYNX
• “VOICEBOX”
• C4-C6 vertebrae
• 9 cartilages
• “Adam’s apple”
• Cricothyroidotomy
• FUNCTIONS:
• Vocalizations
• Airway
• Switching mechanism
• -closed during swallowing
• -open during breathing
• LOWER RESPIRATORY TRACT
TRACHEA
• Windpipe
• Divides to form the
primary bronchi
• C-shaped hyaline
cartilage
• Carina-cough reflex
• Lined with ciliated
mucosa
• LOWER RESPIRATORY TRACT PRIMARY
BRONCHI
• Formed by division
of the trachea
• Enters the lungs
trough the “hilum”
• Right Bronchus:
• -shorter, straighter
• -3 branches
• Left Bronchus:
• -2 branches
• LOWER RESPIRATORY TRACT
LUNGS
• Apex: near clavicle
• Base: diaphragm
• Each lung divided
into lobes by
fissures
• Right Lung:
• 3 lobes- fissures?
• Left Lung:
• -2 lobes-fissures?
• Each lung has 10
bronchopulmonary
segments.
 RESPIRATORY TREE DIVISIONS
• Primary Bronchi
• Lobar Bronchi
• Segmental Bronchi
• -bronchopulmonary
segment
• Bronchioles
• Terminal Bronchioles
• -smallest airway
without alveoli
FUNCTIONAL DIVISION
• LOWER RESPIRATORY TRACT
BRONCHIOLES
• Intralobular airways
diameters 1mm or
less
• Terminal
bronchioles: last
part of air
conducting system
• Respiratory
bronchioles:
participates in gas
exchange
• LOWER RESPIRATORY TRACT
ALVEOLI
• Saclike evaginations
from the
respiratory
bronchioles,
alveolar ducts, and
alveolar sacs.
• Gas exchange
 RESPIRATORY MEMBRANE or
BLOOD-AIR BARRIER
• Components:
• -alveolar epithelium
• -capillary endothelium
• -their fused basement
membranes
• Function: ?
 MECHANICS OF BREATHING
PULMONARY VENTILATION
• Completely mechanical process
• Depends on the volume changes in the
thoracic cavity
TWO PHASES
Inspiration-air flows into the lungs
Expiration-air flows out of the lungs
Normal RR in adults=?
MUSCLES OF RESPIRATION
 INSPIRATION
• Diaphragm CONTRACTS
and moves
DOWNWARD
• External intercostals
CONTRACT and move
ribcage UPWARD
• Lung Volume=increased
• Air flows in
 EXPIRATION
• Largely, PASSIVE process
• Diaphragm RELAXES
and returns to DOME
shape
• External intercostals
RELAX
• Lung Volume=decrease
• Air flows OUT
 SURFACTANT
• Secreted by Type II alveolar cells
• Phospholipid,cholesterol,surfactant proteins
• Coats entire inner alveolar surface
• Reduces tendency of lungs to collapse
• QUESTIONS:
• AOG start of surfactant production?
• Associated condition due to lack of
surfactant?
CIRCULATORY SYSTEMS IN THE LUNGS
• The lung has two separate blood supplies:
• PULMONARY CIRCULATION
• -uptake of O2 and removal of CO2 from the
body
• BRONCHIAL CIRCULATION
• -supply O2 to lung tissue
 PULMONARY
CIRCULATION
• Begins in the Right
Atrium of the heart.
• Review pathway

• Receives 100% of
blood flow.
• Low pressure 9-
24mmHg
• Thin walls with little
smooth muscle
 BRONCHIAL
CIRCULATION
• Arises from aorta
• Part of systemic
circulation
• Receives about 2%
of Left ventricular
output
• High pressure
• Perfuses the upper
respiratory tract
 CENTRAL CONTROL OF RESPIRATION
• CNS-brainstem
• -main control center
• 2 systems:
• AUTOMATIC CONTROL
• Medullary rhythmicity-medulla oblongata
• Pneumotaxic area-upper pons
• Apneustic area-lower pons “apneusis”?
• VOLUNTARY CONTROL-cerebral cortex
GAS EXCHANGE
 GAS EXCHANGE
• Occurs in the alveoli after ventilation

• Gas movement throughout the respiratory

system occurs predominantly via?
 PRESSURE GRADIENTS
ALVEOLI VENOUS BLOOD
• PO2 100mmHg • PO2 60mmHg
• PCO2 40mmHg • PCO2 45mmHg

• O2 diffusion from alveoli • CO2 diffusion from

• to pulmonary blood vessels
• pulmonary blood vessels • To
• Alveoli
OXYGEN TRANSPORT
 OXYGEN TRANSPORT
• Carried in blood in two forms:
• 1. Dissolved O2=3%
• -transported in plasma and cells (PaO2)

• 2. O2 bound to Hemoglobin=97%
• oxyhemoglobin-primary transport mechanism
of O2
 ERYTHROCYTE
• Erythros=RED
• Biconcave disc
• Central pallor 1/3
• Enucleated=mature
• Large surface-volume
ratio= diffusion area
• Survival= ? days
 FUNCTIONS OF RBC
• Transport Hemoglobin—O2 carrier—tissue =
tissue oxygenation
• Contain carbonic anhydrase=CO2 transport
• Acid base buffer
 O2 carrying capacity of blood
• Average # of RBC
– Male- 5.2M/uL
– Female- 4.7M/uL
• Hematocrit-% of blood that is RBC
– Male- 40-54%
– Female- 37-50%
• Hemoglobin
– Male- 15 g/dL
– Female- 14 g/dL
 HEMOGLOBIN
• Major transport
molecule for O2
• O2 saturation
• 1 g Hb=1.34 ml O2
• Gives RED pigment
• A protein with
• 2 major components:
• -4 non protein heme
groups
• -globin (protein portion)
 CARBON DIOXIDE TRANSPORT
• CO2 produced at rate • 65% carried inside RBCs
200ml/min as bicarbonate HCO3-
• Normal Respiratory • 30% combined with
exchange ratio= 0.8 Hgb-
• Ratio of expired CO2 to carbaminohemoglobin
O2 uptake • 5% transported in
plasma as carbonic acid
 COMMON MANIFESTATIONS OF
IMPAIRED RESPIRATORY FUNCTION
• Hypoxia
• Altered Breathing patterns
• Obstructed or partially obstructed airways
 TISSUE HYPOXIA
• Decrease in the amount • Hypoxemic hypoxia
of O2 delivered to the • -blood not able to pick up
tissues enough O2 from the
• Signs and symptoms? atmosphere
• Anemic hypoxia
• -not enough Hgb
• Circulatory hypoxia
• -blockage in a circulation
to an area
• Histotoxic hypoxia
• -O2 getting to tissues but
cannot be utilized
 ALTERED BREATHING PATTERNS
• Tachypnea
• Bradypnea
• Apnea
• Kussmaul’s
• Cheyne-Stoke’s
• Biot’s
 ERYTHROPOESIS
• Red blood cell
production
• Bone marrow
• Erythropoetin=
synthesized in the ?

• Epoetin alfa
 ACID-BASE BALANCE
• Acid is defined as any substance that adds H+
to body fluids
• Alkali is defined as any substance that
removes H+ to body fluids

• QUESTION:
• 2 body systems maintaining acid-base
balance?
Relationship between H+ and pH
 RESPIRATORY COMPONENT OF
ACID-BASE BALANCE
• Normally, breathing removes CO2 as fast as it
forms:

• LARGE LOADS OF ACID STIMULATE

BREATHING!
• -----Respiratory Compensation--------
 ABG Analysis
• One of the first test ordered to assess
respiratory status because it helps evaluate
gas exchange in the lungs.
• Indications:
• Respiratory failure
• Ventilated patients
• Sleep studies
• Patient’s with organ failures
 ABG ANALYSIS
• SITE: ? Preferred
• Less common:
• Dorsalis pedis and posterior tibialis

• AVOID! Artery without collateral supply

• Perform Allen’s Test
 STEPS IN ABG INTERPRETATION
• 1. The first value a nurse should look at is the
pH to determine if the patient is in the normal
range, above, or below.
• If a patient’s pH > 7.45, the patient is in
alkalosis.
• If the pH < 7.35, then the patient is acidosis.
 STEPS IN ABG INTERPRETATION
• 2. Next, examine the PaCO2. This will
determine if the changes in the blood gas are
due to the respiratory system or metabolically
driven.
 STEPS IN ABG INTERPRETATION
• 3. Remember ROME!

• Respiratory Opposite -- In respiratory

disorders, the pH and CO2 arrows move in
opposite directions.
• Metabolic Equal -- In metabolic disorders, the
PH and CO2 arrows will move in the same
direction.
 PRACTICE!
• Question 1.
• You are called to see a 54 year old lady on the ward.
She is three days post-cholecystectomy and has been
complaining of shortness of breath. Her ABG is as
follows:
• pH: 7.49 (7.35-7.45)
• pO2: 7.5 (10–14)
• pCO2: 3.9 (4.5–6.0)
• HCO3: 22 (22-26)
• BE: -1 (-2 to +2)
• Other values within normal range
 PRACTICE!
• Question 2.
• A 64 year old gentleman with a history
of COPD presents with worsening shortness of
breath and increased sputum production.
• pH: 7.21 (7.35-7.45)
• pO2: 7.2 (10–14)
• pCO2: 8.5 (4.5–6.0)
• HCO3: 29 (22-26)
• BE: +4 (-2 to +2)
• Other values within normal range
 PRACTICE!
• Question 3.
• A 21 year-old woman presents feeling acutely lightheaded
and short of breath. She has her board exams next week.
• pH: 7.48 (7.35-7.45)
• pO2: 12.1 (10–14)
• pCO2: 3.5 (4.5–6.0)
• HCO3: 22 (22-26)
• BE: +2 (-2 to +2)
• Other values within normal range
 PRACTICE!
• Question 4.
• A 67 year-old man with a history of peptic ulcer disease
presents with persistent vomiting.
• pH: 7.56 (7.35-7.45)
• pO2: 10.7 (10–14)
• pCO2: 5.0 (4.5–6.0)
• HCO3: 31 (22-26)
• BE: +5 (-2 to +2)
• Other values within normal range
 PRACTICE!
• Question 5.
• A seventeen year-old girl presents to the emergency department
after an argument with her boyfriend. He says that she took lots of
tablets. She denies this. You persuade her to let you do an ABG:
• pH: 7.15 (7.35-7.45)
• pO2: 11.0 (10–14)
• pCO2: 3.2 (4.5–6.0)
• HCO3: 9 (22-26)
• BE: -18 (-2 to +2)
• Other values within normal range