OXYGEN INSUFFICIENCY

Presented by:
Ms. Priyanka Kumari
F.Y. M.Sc. Nursing
 Specific Objective
 Discuss factor effecting the oxygenation.
 Define oxygen insufficiency.
 Explain the etiology of oxygen insufficiency.
 List down the signs and symptoms of oxygen insufficiency.
 Explain the diagnostic evaluation of oxygen insufficiency.
 Enlist the complications of oxygen insufficiency.
 Discuss the management of patient with oxygen
insufficiency.
 Discus the nursing management of patient with oxygen
insufficiency.
Factors Affecting Oxygenation
1. Environmental Factors:

Environmental factors can influence oxygenation.

The incidence of pulmonary disease is higher in urban

areas than in rural areas.

The client’s work place may increase the risk for

pulmonary disease.
 SOURCES OF AIR POLLUTION

1.Automobiles
2.Industries
3.Domestic sources
4.Miscellaneous
 HEALTH ASPECTS

 The health effects of air pollution are both immediate and

delayed.
 Immediate effects are borne by the respiratory system,
resulting state is acute bronchitis. If the air – pollution is
intense, it may result even in immediate death by
suffocation.
2. PHYSIOLOGICAL FACTORS

 Decreased oxygen – carrying capacity

 Decreased inspired oxygen concentration
 Increased metabolic rate
3. DEVELOPMENT FACTORS

 Neonate and Infants.

 Toddlers, School age children and adolescents
 Young and middle – age adults
 Other adults
4. LIFESTYLE RISK FACTORS:

Nutritional factors.

Medications.

 Physiological health.

 Levels of health.
 Exercise.

 Smoking.

Substance abuse.
 MEANING OF OXYGEN

 A colorless, odorless gas constituting one fifth of the

atmosphere. 21% of oxygen present in the atmospheric
air.

DEFINITION OF OXYGENATION

Oxygenation is a process which occurs in the lungs to

the hemoglobin of blood, which is saturated with oxygen to
form oxyhemoglobin.
 MEANING OF OXYGEN INSUFFICIENCY :

Sufficient amount of oxygen is not getting the

organs to maintain their functions.
 ETIOLOGY

Decreased hemoglobin & oxygen carrying capacity of

blood.

Diminished concentration of inspired oxygen.

Inability of the tissue to extract oxygen from the blood.

Decreased diffusion of oxygen from the alveoli to
the blood as within pneumonia.

Poor tissue perfusion with oxygenated blood.

Impaired ventilation.
OXYGEN INSUFFICIENCY OCCURS
DUE TO SOME DISEASE
MUSCULOSKELETAL ABNORMALITIES:

Musculoskeletal impairments in the thoracic region

reduce oxygenation. Such impairments may result from
abnormal structural configuration, trauma, muscular
diseases and disease of central nervous system.
TRAUMA:
The person with multiple rib fracture
can develop a flail chest, a condition in which fractures
cause instability in part of the chest wall. The instable
chest wall allows the lung underlying the injured area to
contract on inspiration and bulge on expiration, resulting
in hypoxia.
NEUROMUSCULAR DISEASES:

Disease such as muscular dystrophy

affects oxygenation of tissue by
decreasing the client’s ability to expand
and contract the chest wall. Ventilation is
impaired and hypercapnia and
hypoxemia can occur.
CENTRAL NERVOUS SYSTEM ALTERATIONS:

Disease or trauma involving the medulla

oblongata and spinal cord may result in impaired
respiration. When the medulla oblongata is affected neural
regulation of respiration is damaged and abnormal
breathing patterns may develop.
MYOCARDIAL ISCHEMIA:

When blood supply to the myocardium from the

coronary arteries is insufficient to meet the oxygen demand
of the organ, two common manifestations of this ischemia
are angina pectoris and myocardial infarction.
 Angina pectoris is usually a transient imbalance
between myocardial oxygen supply and demand.
The pain can last for 1 to 15 minutes. Chest pain
may be left sided or substernal and may radiate to
the left or both arms and to the jaw, neck and back.
 Myocardial infraction (MI) sudden decrease in
coronary blood flow or an increase in myocardial
oxygen demand without adequate coronary
perfusion. Infarction occurs because of ischemia
and necrosis of myocardial tissue.
 HYPOVENTILATION:
It occurs when alveolar ventilation is
inadequate to meet the body’s oxygen demand or to
eliminate sufficient carbon dioxide.

 HYPOXIA:
Hypoxia is inadequate tissue oxygenation
at the cellular level. This can result from a deficiency in
oxygen delivery or oxygen utilization at the cellular level.
CYANOSIS:
Blue discoloration of the skin and mucous
membrane caused by the presence of de-saturated
hemoglobin in capillaries, is a late sign of hypoxia.
CEREBRAL PALSY:
Cerebral palsy is a non-progressive neurological
disorder that is present from birth and usually involves motor
function.
SYNCOPE:

 Temporary loss of consciousness, feeling faint. It may

indicate decreased cardiac output, fluid deficit or defects
in cerebral perfusion. Syncope frequently occurs as a
result of postural hypotension.
DIAGNOSIS EVALUATION OF THE
PATIENT THAT WHO IS HAVING
OXYGEN INSUFFICIENCY
HISTORY COLLECTION:

Nursing history should focus on the client’s

ability to meet oxygen needs. History for cardiac function
includes pain, dyspnea, fatigue, peripheral circulation,
cardiac risk factors, presence of past or current conditions.
PHYSICAL EXAMINATION
MEASUREMENT NORMAL CLINICAL SIGNIFICANCE
RANGE
Tidal volume (Vt) 500 ml Decreased in restrictive lung
Volume of air inhaled or disease and older client.
exhaled per breath.
Residual volume (Rv) Increase in clients with COPD and
Volume of air left in 1000 – older clients due to decreased
lungs after a maximal 1200 ml respiratory muscle mass, strength,
exhalation. elastic recoil and chest wall
compliance.
Functional residual Increased in clients, with COPD
capacity 2000 – and older clients due to decreased
Volume of air left in 2400 ml respiratory muscle mass, strength,
lungs after a normal elastic recoil and chest wall
exhalation. compliance.
MEASUREMENT NORMAL CLINICAL SIGNIFICANCE
RANGE
Vital capacity 4500 – 4800 Decreased in pulmonary
Volume of air ml edema atelectasis and
exhaled after a changes associated with a
maximal inhalation giving.

Total lung 5000 – 6000

capacity(TLC) ml Decreased in restrictive
Total volume of air lung disease increase in
in lungs following a obstructive lung disease.
maximal inhalation
 ARTERIAL BLOOD GAS:
Measures the hydrogen concentration
partial pressure of carbon dioxide, partial pressure of
oxygen, oxygen concentration.
SPIROMETRY:
Spirometry measure, the volume of
air in liters exhaled or inhaled by a patient over
time.
 PULSE OXIMETRY

 CHEST X – RAY:

Usually posterior-anterior and lateral films are

taken to adequately visualize all of the lung fields.
Radiography of the thorax is used to observe the lung field
for fluid (pneumonia), masse (lung cancer), other abnormal
process.
 MANAGEMENT

POSITION
BREATHING EXERCISES DEEP BREATING
EXERCISES:

When hypoventilation occur a decreased

amount of air enters and leaves the lungs. However
deep – breathing exercises can be used to
overcome hypoventilation.
ABDOMINAL AND PURSED LIP BREATHING-

 Assume comfortable semi-sitting position in a bed

or chair or a lying position in bed with one pillow.

 Flex your knees to relax the muscle of abdomen.

 Place one or both hands on your abdomen just

below the ribs.
 Breath in deeply through the nose keeping the mouth closed.

 Concentrate on feeling or skin and tighter the abdomen

muscle breathing out to enhance effective exhalation.

 If indicated, cough two or more time during exhalation.

 Use this exercise whenever feeling short of breath and

increase gradually to 5 – 10 minutes a day.
NEBULISATION:

 Nebulization is a process of adding moisture or

medication to inspired air by mixing particle of varying
sizes with air.
Purpose
To relieve respiratory insufficiency due to
bronchospasm.
To correct the underlying respiratory disorder
responsible bronchospasm.
 To liquefy and remove retained thick secretion form the
lower respiratory tract.

 To reduce inflammatory and allergic response in the upper

respiratory tract.

 To correct humidity deficit.

CHEST PHYSIOTHERAPY

 Chest physiotherapy is a group of therapies used in

combination to mobilize pulmonary secretion.

 These therapies include postural drainage, chest

percussion and vibration.

 Chest physiotherapy should be followed by productive

coughing and suctioning of the client who has a decreased
ability to cough.
 Positional drainage is use of positioning technique
that draw secretions form specific segments of the
lungs and bronchi into the trachea.

 Coughing or suctioning normally removes secretion

from the trachea.
SUCTIONING:

The suctioning technique includes oropharyngeal

and nasopharyngeal suctioning. Oro-tracheal and naso-
tracheal suctioning should perform after suctioning of the
oropharynx trachea, by using a rounded – tipped catheter.
OXYGEN THERAPY:

Oxygenation by applying an oxygen mask

Nasal catheter
Oxygen tent
Oxygen therapy in the home
 NURSING MANAGEMENT

 Nursing care plan of patient with oxygen insufficiency

according to prioritize the problem on the basis of:
 Ineffective Airway clearance:

May be related to:

Obstruction of airway by the tongue.

Upper airway obstruction caused by edema of larynx or

glottis.
Obstruction of trachea or a bronchus by foreign body
aspiration.

Partial occlusion of the bronchi and bronchioles by

infection.

Occlusion of the more distal airways by association

with emphysema.
Goal:

To promote airway clearance.

To maintain a patent airway.

Nursing intervention:

Teach effective coughing:

Effective coughing should be preceded by slow, deep
breaths.
Assisting the client to a sitting position.

Provide oral care.

Assess the sputum produced by coughing, noting the

amount, color and odor.

Initiate postural drainage and chest physiotherapy.

Monitor hydration status of the client.

Administer the prescribed medication.

Monitor environment and lifestyle conditions.

Introduce artificial airways in case where

obstruction cannot be removed. (nasal airways,
oral airways)
 Ineffective breathing pattern:
May be related to:

Restricted pulmonary disease or CNS disorder or

thoracic surgery.

Any major abnormal or thoracic surgery or whose

mobility is restricted.
Neuromuscular disease that can weaken the
respiratory muscles.

Abnormal curvature like alteration of spine.

Goal:

To promote lung expansion.

To improve breathing pattern.

Intervention:

To provide proper positioning.

Teach controlled breathing exercises.
Introduced chest drainage system.
Impaired gas exchange:
May be related to:

Ventilation perfusion mismatching.

Widespread shunting as with atelectasis and

pneumonia.
 Goal:
To improve oxygen uptake and delivery.

 Intervention:
Administer oxygen to the client.
Decreased cardiac output:
This may be related to

 CHF causing pulmonary edema, heart failure or

shock.

Goal:

 To maintain a normal cardiac output.

Intervention:
Manage fluid balance by:

Limited sodium and reduced fluid intake in case of CHF.

Give diuretics.

Maintaining daily weight and intake output.

Monitoring electrolyte balance if the client is receiving

 CURRENT TREND

“Comparison of Mask Oxygen Therapy and High-Flow

Oxygen Therapy after Cardiopulmonary Bypass in Obese
Patients”
 By- Mazlum Sahin.
 Background
 To clarify the efficiency of mask O2 and high-flow
O2 (HFO) treatments following cardiopulmonary bypass
(CPB) in obese patients.
 Methods

During follow-up, oxygenation parameters including

arterial pressure of oxygen (PaO2), peripheral oxygen
saturation (SpO2), and arterial partial pressure of carbon
dioxide (PaCO2) and physical examination parameters
including respiratory rate, heart rate, and arterial pressure
were recorded respectively. Presence of atelectasis and
dyspnea was noted. Also, comfort scores of patients were
evaluated.
 Results:

Mean duration of hospital stay was 6.9 ± 1.1 days in the

mask O2group, whereas the duration was significantly
shorter (6.5 ± 0.7 days) in the HFO group (p= 0.034).
The PaO2values and SpO2 values were significantly
higher, and PaCO2 values were significantly lower in
patients who received HFO after 4th, 12th, 24th, 36th, and
48th hours. In postoperative course, HFO leads patients to
achieve better postoperative FVC (p < 0.001).
Conclusion:

Our study demonstrated that HFO following CPB in

obese patients improved postoperative PaO2, SpO2, and
PaCO2 values and decreased the atelectasis score,
reintubation, and mortality rates when compared with mask
O2.
Oxygen is very essential
component for living things so as a
nurse it is fundamental to assess
the level of oxygen in body, and if
it is less than necessary action
should be taken.
Bibliography
 Suzanne .C. Smeltzer, Brenda Bare (2004) “Brunner &
Suddarth’s text book of medical surgical nursing”
published by Lippincott Williams and wilkins 10th
edition. Page no 577, 600,601.
 Potter and Perry (2005) “Fundamental of nursing”
Elsevier Publisher, 6th edition. Page no 1068 – 1071.
 Navdeep Kaur Brar, HC Rawat (2017) “Textbook of
Advanced Nursing Practice” JAYPEE Publications 1st
edition. Page no 317-334.
 https:/www.ncbi.nlm.nih.gov > pubmed.