- trachea and lungs, with the bronchi, bronchioles,
OXYGENATION
Course Outline
 INTRODUCTION
 ANATOMY & PHYSIOLOGY OF RESPIRATORY
SYSTEM
 PROCESS OF RESPIRATORY SYSTEM
 FACTORS AFFECTING RESPIRATORY FUNCTION
 ALTERATIONS IN RESPIRATORY FUNCTION
 OXYGEN THERAPY
 OXYGEN DELIVERY SYSTEM
INTRODUCTION
Oxygen
 It is a clear, odorless gas that constitutes approximately
21% of the air we breathe.
 It is necessary for proper functioning of all living cells.
The absence of oxygen can lead to cellular, tissue, and
organism death.
 Cellular metabolism produces carbon dioxide, which
must be eliminated from the body to maintain normal
acid–base balance.
 Delivery of oxygen and removal of carbon dioxide require
the integration of several systems including the
hematologic, cardiovascular, and respiratory systems.
 Oxygen is considered a drug and must be carefully
prescribed based on individual client conditions
Respiratory
 The process of gas exchange between the individual and
the environment and involves four components:
i. Ventilation or breathing, the movement of air in
and out of the lungs as we inhale and exhale
ii. Alveolar-capillary gas exchange, which involves the
diffusion of oxygen and carbon dioxide between the
alveoli and the pulmonary capillaries
iii. Transport of oxygen and carbon dioxide between
the tissues and the lungs
iv. Movement of oxygen and carbon dioxide between
the systemic capillaries and the tissues
ANATOMY & PHYSIOLOGY OF RESPIRATORY
SYSTEM
The respiratory system is divided structurally into:
1 Upper respiratory system
- The mouth, nose, pharynx, and larynx.
2 Lower Respiratory System
alveoli, pulmonary capillary network, and pleural
membranes.
Air enters through the nose, where it is warmed, humidified,
and filtered. Inspired air passes from the nose through the
pharynx. The epiglottis opens, allowing air to move freely into
the lower airways. Below the larynx, the trachea leads to the
right and left main bronchi (primary bronchi) and the other
conducting airways of the lungs. Within the lungs, the
primary bronchi divide repeatedly into smaller and smaller
bronchi, ending with the terminal bronchioles. Together
these airways are known as the bronchial tree. After air
passes through the trachea and bronchi, it enters the
respiratory bronchioles and alveoli where all gas exchange
occurs. The alveolar and capillary walls form the respiratory
membrane (also known as the alveolar/capillary membrane)
PROCESS OF RESPIRATORY SYSTEM
Pulmonary Ventilation
 The first process of the respiratory system.
 It is accomplished through the act of breathing:
inspiration (inhalation) as air flows into the lungs and
expiration (exhalation) as air moves out of the lungs.
 Adequate ventilation depends on several factors:
1 Clear airways
2 An intact central nervous system (CNS) and
respiratory center
3 An intact thoracic cavity capable of expanding
and contracting
4 Adequate pulmonary compliance and recoil.
 In adults, approximately 500 mL of air is inspired and
expired with each breath. This is known as tidal volume.
 Lung compliance (the expansibility or stretchability of
lung tissue) tends to decrease with aging, making it
more difficult to expand alveoli and increasing the risk
for atelectasis (collapse of a portion of the lung).
 In contrast to lung compliance is lung recoil, the
continual tendency of the lungs to collapse away from
the chest wall. It is necessary for normal expiration.
 Surfactant, a lipoprotein produced by specialized
alveolar cells, acts like a detergent, reducing the surface
tension of alveolar fluid. Without surfactant, lung
expansion is exceedingly difficult and the lungs collapse.
Alveolar Gas Exchange
 The second phase of the respiratory process.
 It is the diffusion of oxygen from the alveoli and into the
pulmonary blood vessels.
 Diffusion is the movement of gases or other particles
from an area of greater pressure or concentration to an
area of lower pressure or concentration.
 When the pressure of oxygen is greater in the alveoli
than in the blood, oxygen diffuses into the blood.
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  Carbon dioxide diffuses from the blood into the alveoli,
where it can be eliminated with expired air.
Transport of Oxygen and Carbon dioxide
 The third part of the respiratory process.
 It involves the transport of respiratory gases.
 Oxygen needs to be transported from the lungs to the
tissues, and carbon dioxide must be transported from
the tissues back to the lungs.
 Normally, most of the oxygen (97%) combines loosely
with hemoglobin in the red blood cells and is carried to
the tissues.
Systemic Diffusion
 The fourth process of respiration.
 It is the diffusion of oxygen and carbon dioxide between
the capillaries and the tissues and cells.
 As cells consume oxygen, the partial pressure of oxygen
in the tissues decreases, causing the oxygen at the
arterial end of the capillary to diffuse into the cells.
 Carbon dioxide from metabolic processes accumulates
in the tissues and diffuses into the capillaries where the
partial pressure of carbon dioxide is lower.
FACTORS AFFECTING RESPIRATORY FUNCTION
AGE
 The respiratory system is compromised by age-related
changes such as infection, physical or emotional stress,
surgery, anesthesia, or other procedures.
 These types of changes are seen:
o Chest wall and airways become more rigid and
less elastic.
o The amount of exchanged air is decreased.
o The cough reflex and cilia action are decreased.
o Mucous membranes become drier and more
fragile.
o A decrease in efficiency of the immune system
occurs.
o Gastroesophageal reflux disease is more
common in older adults and increases the risk of
aspiration
ENVIRONMENT
 Altitude, heat, cold, and air pollution affect oxygenation.
 People at high altitudes have increased respiratory and
cardiac rates.
 Healthy people exposed to air pollution may experience
stinging of the eyes, headache, dizziness, and coughing
LIFESTYLE
 Physical exercise or activity increases the rate and depth
of respirations and hence the supply of oxygen in the
body.
 Sedentary people lack the alveolar expansion and deep-
breathing patterns of people with regular activity and
are less able to respond effectively to respiratory
stressors.
 Certain occupations predispose an individual to lung
disease (asbestosis in asbestos workers, anthracosis in
coal miners, and organic dust disease in farmers, etc.).
HEALTH STATUS
 In the healthy person, the respiratory system can
provide sufficient oxygen to meet the body’s needs.
 Diseases of the respiratory system, however, can
adversely affect the oxygenation of the blood.
MEDICATIONS
 A variety of medications can decrease the rate and
depth of respirations.
 The most common medications having this effect are
the benzodiazepine sedativehypnotics and antianxiety
drugs and opioids such as morphine.
 When administering these, the nurse must carefully
monitor respiratory status, especially when the
medication is begun or when the dose is increased.
 Older clients are at high risk of respiratory depression
and, hence, usually require reduced dosages.
STRESS
 When stress and stressors are encountered, both
psychological and physiological responses can affect
oxygenation.
 Some people may hyperventilate in response to stress.
The person may experience light-headedness and
numbness and tingling of the fingers, toes, and around
the mouth as a result.
 Epinephrine (released during stress) causes the
bronchioles to dilate, increasing blood flow and oxygen
delivery to active muscles.
ALTERATIONS IN RESPIRATORY FUNCTION
Respiratory function can be alter by conditions that affect:
 Patency (open airway)
 The movement of air into or out of the lungs
 The diffusion of oxygen and carbon dioxide between the
alveoli and the pulmonary capillaries
 The transport of oxygen and carbon dioxide via the
blood to and from the tissue cells.
Conditions Affecting the Airway
 Partial obstruction of the upper airway passages is
indicated by a low-pitched snoring sound during
inhalation.
 Complete obstruction is indicated by extreme
inspiratory effort that produces no chest movement and
an inability to cough or speak.
 Lower airway obstruction is not always as easy to
observe. Stridor, a harsh, high-pitched sound, may be
heard during inspiration.
Conditions Affecting Movement of Air
 The term breathing patterns refers to the rate, volume,
rhythm, and relative ease or effort of respiration.
 Normal respiration (eupnea) is quiet, rhythmic, and
effortless.
 Tachypnea (rapid respirations) is seen with fevers,
metabolic acidosis, pain, and hypoxemia.
 Bradypnea is an abnormally slow respiratory rate.
 Apnea is the absence of any breathing.
 Hypoventilation is an inadequate alveolar ventilation
that may be caused by either slow or shallow breathing,
or both.
 Hypoventilation may lead to increased levels of carbon
dioxide (hypercarbia or hypercapnia) or low levels of
oxygen (hypoxemia).
 Hyperventilation is the increased movement of air into
and out of the lungs. During hyperventilation, the rate
and depth of respirations increase and more CO2 is
eliminated than is produced.
 Cheyne-Stokes respirations is a marked rhythmic waxing
and waning of respirations from very deep to very
shallow with short periods of apnea.
 Biot’s (cluster) respirations are shallow breaths
interrupted by apnea; may be seen in clients with CNS
disorders.
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  Orthopnea is the inability to breathe easily unless sitting
upright or standing.
 Difficulty breathing or the feeling of being short of
breath (SOB) is called dyspnea.
Conditions Affecting Diffusion
 Hypoxemia is reduced oxygen levels in the blood.
 If hypoxemia is severe, tissue hypoxia (insufficient
oxygen anywhere in the body) is the result, potentially
causing cellular injury or death.
 Cyanosis is the bluish discoloration of the skin, nail beds,
and mucous membranes due to reduced hemoglobin-
oxygen saturation.
 The cerebral cortex can tolerate hypoxia for only 3 to 5
minutes before permanent damage occurs.
OXYGEN THERAPY
 The medical administration of supplemental oxygen is
considered a process similar to that of administering
medications and requires similar nursing actions.
 Supplemental oxygen is indicated for clients who have
hypoxemia, hyperventilation, or substantial loss of lung
tissue due to tumors or surgery.
 Oxygen therapy is prescribed by the primary care
provider, who specifies the concentration, method of
delivery, and depending on the method, liter flow per
minute (L/min).
 When administering oxygen as an emergency measure,
the nurse may initiate the therapy, and then contact the
primary care provider for an order.
 Oxygen is supplied in two ways in health care facilities: by
portable systems (cylinders or tanks) and from wall
outlets.
 Oxygen administered from a cylinder or wall-outlet system
is dry. Dry gases dehydrate the respiratory mucous
membranes.
 Humidifiers prevent mucous membranes from drying and
becoming irritated and loosen secretions for easier
expectoration.
 Very low liter flows (e.g., 1 to 2 L/min by nasal cannula) do
not require humidification.
Oxygen Safety
 Prominently display a “NO SMOKING” sign on the
patient’s door.
 Inspect all electrical equipment in the immediate vicinity
of the patient.
 Do not allow the patient to use an electric razor.
 Avoid using woolen blankets
 Take special precautions with patients in oxygen tent (do
not comb hair or allow electric call bells to be operated in
a closed tent)
OXYGEN DELIVERY SYST EM
CANNULA
 The nasal cannula (nasal prongs) is the most common
and inexpensive device used to administer oxygen.
 Easy to apply and does not interfere with the client’s
ability to eat or talk.
 It delivers a relatively low concentration of oxygen (24%
to 45%) at flow rates of 2 to 6 L/min.
 Above 6 L/min, the client tends to swallow air and the
FiO2 is not increased.
 Limitations of the plain nasal cannula include inability to
deliver higher concentrations of oxygen, and that it can
be drying and irritating to mucous membranes.
FACE MASK
 Most masks are made of clear, pliable plastic that can
be molded to fit the face.
 They are held to the client’s head with elastic bands. ▪
Exhalation ports on the sides of the mask allow exhaled
carbon dioxide to escape.
 Some masks have reservoir bags, which provide higher
oxygen concentrations to the client. A portion of the
client’s expired air is directed into the bag.
 A variety of oxygen masks are marketed:
1. The simple face mask delivers oxygen
concentrations from 40% to 60% at liter flows of 5
to 8 L/min, respectively.
2. The partial rebreather mask delivers oxygen
concentrations of 40% to 60% at liter flows of 6 to
10 L/min, respectively. The partial rebreather bag
must not totally deflate during inspiration to avoid
carbon dioxide buildup.
3. The nonrebreather mask delivers the highest
oxygen concentration possible—95% to 100%—by
means other than intubation or mechanical
ventilation, at liter flows of 10 to 15 L/min.
4. The Venturi mask delivers oxygen concentrations
varying from 24% to 40% or 50% at liter flows of 4
to 10 L/min. The Venturi mask has wide-bore tubing
and color-coded jet adapters that correspond to a
precise oxygen concentration and liter flow.
 Initiating oxygen by mask is much the same as initiating
oxygen by cannula, except that the nurse must find a
mask of appropriate size. Smaller sizes are available for
children.
 Limitations of masks include difficulty in achieving a
proper fit and poor tolerance by some clients who may
complain of feeling hot or “smothering.”
SIMPLE MASK
PARTIAL REBREATHER M ASK
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NONREBRETHER MASK

VENTURI MASK

FACE TENT
 Face tents can replace oxygen masks when masks are
poorly tolerated by clients.
 Face tents provide varying concentrations of oxygen, for
example, 30% to 50% concentration of oxygen at 4 to 8
L/min.
 Frequently inspect the client’s facial skin for dampness
or chafing, and dry and treat as needed.
 As with face masks, the client’s facial skin must be kept
dry.

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