The 

cardiovascular system consists of the heart and the blood vessels. The heart pumps oxygenated blood
through the blood vessels to the body. The cardiovascular system works in tandem with the respiratory system to
ensure tissue oxygenation.

The heart is a hollow, cone-shaped organ. It normally resides in the center of the chest in an area known as
the mediastinum and rests on the diaphragm. The size of the heart may vary; however, the average adult heart is
approximately 9 cm wide and 14 cm long.

The heart consists of four chambers. The atria are the top two smaller chambers. The ventricles are the lower two
larger chambers.

Anatomy of the heart

The wall of the heart consists of three layers: the epicardium, the myocardium, and
the endocardium.
Epicardium: the outermost of the three layers of tissue that form the heart wall. The epicardium
is the visceral portion of the serous pericardium and folds back on itself to form the parietal
portion of the serous pericardium.

 Known as the visceral pericardium

 Covers the heart’s surface
 Secretes serous fluid that helps prevent friction as the heart beats

 Myocardium: Forms the heart’s middle layer

 Composed of cardiac muscle
 Performs the work of the heart, contracting to propel blood into the next heart chamber or out into
the blood vessels of the body

 Endocardium: Forms the innermost layer

 Provides a protective lining in the chambers and valves of the heart

Flow of Blood in the Cardiovascular System: The cardiac cycle consists of three components - diastole,
systole, and the pause between the two.

Diastole occurs when the heart muscle relaxes, while systole occurs when the heart muscle contracts and
exerts pressure, forcing fluid movement within the vascular system.

The frequency of the cardiac cycle is described by the heart rate or pulse rate and is expressed as beats per
minute. The figure displays the flow of blood through the cardiovascular system.

1.The right atrium receives deoxygenated blood returning from the body through the superior and
inferior vena cava.
2. After filling, the right atrium contracts to force the tricuspid valve open, allowing blood to flow into
the right ventricle. This period, when the ventricle is relaxed and filling, is right ventricular diastole.
3. After the ventricle fills, it contracts (right ventricular systole). This causes the pressure in the right
ventricle to rise above the pressure in the pulmonary artery, forcing the pulmonic valve open. The
deoxygenated blood then passes through the pulmonic valve and into the pulmonary artery.
4. The pulmonary artery channels the blood into the lungs where it flows throughout the pulmonary
capillary system. There, red blood cells pick up oxygen and release carbon dioxide.
5. The now oxygenated blood flows into the pulmonary vein and returns to the heart through the left
atrium
6. When the left atrium is full, it contracts. This forces the mitral valve open and blood flows into the
left ventricle.
7. When the left ventricle fills, it contracts (left ventricular systole) to pump blood past the
aortic valve and into the aorta for distribution to the rest of the body.

Upper and Lower Respiratory Tracts

 The respiratory system consists of an upper respiratory tract and a lower respiratory
tract.
 The upper respiratory tract includes the nose, nasal cavity, sinuses, and pharynx. (NNSP)
 The lower respiratory tract contains the larynx, where the vocal cords are located, and
the trachea. The trachea branches into the right and left main bronchi. The bronchi
divide repeatedly into smaller tubes or bronchioles and alveolar ducts. The bronchioles
and ducts terminate in the alveoli.

1. Nasal cavity: Space behind the nose that is divided by the nasal septum
 2. Sinuses: Air filled with chambers within the skull.
3. Pharynx: Passageway through which air flows from the nose to the larynx
4. Trachea: Flexible tube about 2.5 cm in diameter and 12.5 cm long that transports air
from the pharynx and larynx to the lungs
5. Bronchi: The trachea branches into the right and left mainstem bronchi in the lungs,
which subdivide to form the bronchial tree and alveolar ducts
6. Alveoli: Small sacs surrounded by pulmonary capillaries that act as the site for oxygen
and carbon dioxide gas exchange

Overview of Oxygenation and Perfusion / 

Respiratory System
Ventilation and Oxygenation
Respiration includes two processes – ventilation and oxygenation. The movement of air into and out of
the lungs is known as ventilation.

 It starts with inspiration (inhalation) triggered by impulses generated in the respiratory center of

the brain.
 The impulses travel through the phrenic nerve, which stimulates the diaphragm to move
downward, and the intercostal nerve, which stimulates the intercostal muscles along the ribs to
contract.
 These movements cause the chest cavity to expand, thus decreasing the pressure within
the alveoli of the lungs during inspiration (interalveolar pressure). Atmospheric pressure is then
higher than the interalveolar pressure, causing air to move into the respiratory tract and the
lungs to fill with air.
 The reversal of air movement is called expiration. During expiration, or exhalation, the
diaphragm relaxes, the chest and lung tissues recoil, and interalveolar pressures increases,
causing air to be forced out of the lungs.

External Respiration, Internal Respiration, and Cellular Respiration

Oxygenation involves intake of air and gas exchange in the lungs, transport of oxygen via the blood, and
utilization of oxygen by the body tissues. In the lungs, oxygen diffuses across alveolar walls into
pulmonary capillaries. This exchange of gases between the lungs and blood is called external
respiration.

This oxygen then dissolves in the blood plasma or binds itself to the hemoglobin in red blood cells. The
oxygen-enriched blood then travels to the body’s tissues, where tissue perfusion occurs. The exchange
of gases between the blood and tissues is called internal respiration.
Cellular respiration occurs when the cells use the oxygen for metabolism, releasing carbon dioxide in
the process.

SUMMARY
The cardiovascular and respiratory systems work together to ensure tissue perfusion and
oxygenation.

The right atrium of the heart receives deoxygenated blood from the body and the right ventricle
pumps it to the lungs for oxygenation. The left atrium receives the oxygenated blood from the
lungs and the left ventricle pumps it to the rest of the body. This entire cycle is called a cardiac
cycle. It is comprised of systole, diastole, and the intermediate pause.

Respiration involves the upper and lower respiratory tracts. Ventilation is the movement of air
into (inspiration) and out (expiration) of the lungs. Oxygenation is the complex process of intake,
delivery, and utilization of oxygen by the tissues. External respiration involves the exchange of
gases between the lungs and the blood. Internal respiration involves the exchange of gases by the
cells and tissues; and cellular respiration occurs when cells oxidize food molecules (e.g.,
glucose) to release energy. Carbon dioxide is released as a byproduct of the process.

Nursing Diagnosis and Planning Related to Oxygenation and Perfusion / 

Introduction

Knowledge of common and applicable nursing diagnoses and how to plan care based on the
concurrent assessment data are fundamental to effective patient care.

Diseases of the respiratory and cardiovascular systems are what we usually think of when
considering nursing diagnoses that are related to alterations of oxygenation and perfusion. However,
diseases of many other body systems also can result in oxygenation and perfusion alterations. For example, a
patient with severe kidney disease accumulates body water, which can lead to heart failure and fluid in the
lungs—oxygenation and perfusion problems. It should not be surprising then that nursing diagnoses
associated with oxygenation and perfusion alterations are commonly found in a wide variety of nursing care
plans.

After completing this lesson, you should be able to:

 Identify nursing diagnoses related to oxygenation and perfusion
Discuss measurable patient-centered goals related to oxygenation and perfusion

Selecting and Individualizing Nursing Diagnoses Related to Oxygenation

and Perfusion
Nursing diagnoses for patients with decreased oxygenation and perfusion should reflect the patient’s
precise health alterations. The specific manner in which any patient’s illness manifests and progresses
will have unique aspects based on individual patient factors such as age, general physical and mental
health, and previous medical and surgical history. Individualizing a patient’s nursing diagnosis requires
accurate and thorough assessment data collection and appropriate data clustering. Failure to truly
individualize the nursing diagnoses can lead to unnecessary or potentially harmful interventions .

The structure of a nursing diagnosis statement accommodates individualization in the second (related to)
and third (as evidenced by) parts of the statement. The information included in these two parts is based on
data collected during the assessment phase of the nursing process
Impaired Gas Exchange:
 Patient diagnosed with emphysema
 SpO2 90%
 Adventitious breath sounds bilaterally
 Respiratory rate 26 breaths/min and shallow
 Speaks in short sentences
Ineffective Airway Clearance:
Ineffective airway clearance related to
bronchoconstriction, increased production of mucus, as
evidenced by thick sputum, prolonged coughing
incidents, adventitious breath sounds, and complaint of
dyspnea.
An example of patient assessment data that would
support this nursing diagnosis:
 Patient diagnosed with pneumonia
 Decreased bilateral breath sounds in lower
lungs
 Cough with thick, green sputum
Ineffective peripheral tissue perfusion related to
decreased oxygen levels in the blood, as evidenced by
fatigue with exercise and cyanosis.
An example of patient assessment data that support this
nursing diagnosis:
 Patient sitting in wheelchair with oxygen in
place
 Report of fatigue with ambulation
 SpO2 with oxygen 92%, without oxygen 82%
ICNP:
 Impaired Gas Exchange
o Supporting Data: SpO2 of 90%
on 2 L of oxygen via nasal
cannula, patient complaints of
difficulty breathing.
 Impaired Breathing
o Supporting Data: Ineffective
movement of air into and out
of the lungs, difficulty
breathing with activity and at
rest, use of pursed-lip
breathing.
 Impaired Cardiac Output
o Supporting Data: Decreased
pumping ability of the heart,
decreased activity tolerance.
Planning: Goal statement
 Patient will maintain SpO2 at 92% or
greater by the end of the shift.
 Patient's lungs will be clear to
auscultation within 24 hours.
 Patient will maintain SpO2 at 92% or
greater with activity within 48 hours.
 Patient will report decreased fatigue
during hospitalization.
 Patient's extremities will be pink and
warm to touch after supplemental
oxygen is applied.
 Patient will verbalize an increase in
psychological and physical comfort
within 8 hours.
Patient's respirations will return to a range
between 16 breaths/min and 20 breaths/min
after pain medication is administered before
cardiac catheterization.
Implementation
1.Simple face mask: Simple face masks do not have
reservoir bags.
 Allows room air to be inspired with the
oxygen delivered
 Every increase of 1 L/min of oxygen relates to
approximately a 5% increase in oxygen
concentration delivered. Examples include:
 5 L/min = 40%
 6 L/min = 45%
 7 L/min = 50%
 8 L/min = 55%
 higher than 8 L/min = 60%

2.Partial Rebreather mask: Partial rebreather masks

are a type of reservoir mask
 Allow some of the exhaled air to enter the
reservoir.
 Rebreathing exhaled air, which contains
carbon dioxide, acts as a stimulus for some
patients, i.e., COPD.

3.Non breather mask:

 Non-rebreather masks are a type of reservoir

mask.
 One-way valve does not allow any exhaled air to
enter the reservoir bag.
 Additional one-way valves allow air to be exhaled
through the mask, however no room air can be
inhaled through the valves.
 Flow rates should be higher than 10 L/min to
maintain bag inflation.
 Flow rates and percent oxygen values range from:
o 10 L/min to 15 L/min = 60% to 100% (10
L/min needed to maintain reservoir
inflation)

4.Venturi mask:
 Venturi masks ensure accuracy of the oxygen
concentration delivered.
 Often used with patients that retain CO2,
such as COPD patients.
 Color-coded adaptors or a dial, with
corresponding liters-per-minute setting
listed, can be attached to the mask.
 The dial setting specifies the concentration of
 oxygen that will be delivered to the patient.
 4 to 12L/min = 24 to 60%
