CARE OF CLIENTS WITH PROBLEM IN OXYGENATION BY: ROSELLE JOY C.

BALAQUIT, RN
CHEST X-RAY
• Remove all jewelry and other
metal objects from the chest area
• Assess the client's ability to inhale
and hold his or her breath
• Question women regarding
pregnancy
• Help the client get dressed after
the procedure

CARE OF CLIENTS WITH PROBLEM IN OXYGENATION BY: ROSELLE JOY C. BALAQUIT, RN

SPUTUM SPECIMEN
• Specimen obtained by expectoration or
tracheal suctioning to assist in the
identification of organisms or abnormal
cells
• Obtain an early morning sterile
specimen from suctioning or
expectoration
• Instruct the client to rinse the mouth
with water before collection
CARE OF CLIENTS WITH PROBLEM IN OXYGENATION BY: ROSELLE JOY C. BALAQUIT, RN
SPUTUM SPECIMEN
• Obtain at least 15 mL of sputum
• Instruct client to take several deep
breaths and then cough deeply to
obtain sputum
• Always collect the specimen before the
client begins antibiotic therapy
• If a culture of sputum is prescribed,
transport the specimen to the
laboratory immediately
• Assist the client with mouth care
CARE OF CLIENTS WITH PROBLEM IN OXYGENATION BY: ROSELLE JOY C. BALAQUIT, RN
 PULMONARY
ANGIOGRAPHY
• An invasive fluoroscopic procedure
in which a catheter is inserted
through the antecubital or femoral
vein into the pulmonary artery or
one of its branches
• Involves an injection of iodine or
radiopaque contrast material
• Obtain informed consent
CARE OF CLIENTS WITH PROBLEM IN OXYGENATION BY: ROSELLE JOY C. BALAQUIT, RN
• Assess for allergies to iodine,
seafood, or other radiopaque dyes
• Maintain NPO status of the client
for 8 hours before the procedure
• Monitor vital signs
• Assess results of coagulation
studies
• Instruct the client to lie still during
the procedure
CARE OF CLIENTS WITH PROBLEM IN OXYGENATION BY: ROSELLE JOY C. BALAQUIT, RN
• Instruct the client that he or she may
feel an urge to cough, flushing,
nausea, or a salty taste following
injection of the dye
• Have emergency resuscitation
equipment available
• Avoid taking BP for 24 hours in the
extremity used for the injection
• Assess insertion site for bleeding
• Monitor for delayed reaction to the dye

CARE OF CLIENTS WITH PROBLEM IN OXYGENATION BY: ROSELLE JOY C. BALAQUIT, RN

BRONCHOSCOPY
• Direct visual examination of the
larynx, trachea, and bronchi with a
fiberoptic bronchoscope
• Obtain informed consent
• Maintain NPO status for the client
form midnight before the
procedure
• Obtain vital signs
CARE OF CLIENTS WITH PROBLEM IN OXYGENATION BY: ROSELLE JOY C. BALAQUIT, RN
• Remove dentures or eyeglasses
• Prepare suction equipment
• Establish an IV access as necessary
and administer medication for sedation
as prescribed
• Have emergency resuscitation
equipment available
• Maintain the client in semi-Fowler’s
position after the procedure

CARE OF CLIENTS WITH PROBLEM IN OXYGENATION BY: ROSELLE JOY C. BALAQUIT, RN

• Assess for the return of gag reflex
• Have an emesis basin readily
available for the client to
expectorate sputum
• Monitor for bloody sputum
• Notify the physician if fever,
difficulty in breathing, or other
signs of complications occur
following the procedure
CARE OF CLIENTS WITH PROBLEM IN OXYGENATION BY: ROSELLE JOY C. BALAQUIT, RN
THORACENTESIS
• Removal of fluid or air from the
pleural space via a transthoracic
aspiration
• Obtain informed consent
• Obtain vital signs
• Prepare the client for ultrasound or
chest radiograph, if prescribed,
before the procedure
CARE OF CLIENTS WITH PROBLEM IN OXYGENATION BY: ROSELLE JOY C. BALAQUIT, RN
• Note that the client is positioned sitting
upright, with the arms and shoulders
supported by a table at the bedside
during the procedure
• If the client cannot sit up, the client is
placed lying in bed toward the
unaffected side, with the head of the
bed elevated
• Instruct the client not to cough, breath
deeply, or move during the procedure
• Apply a pressure dressing, and assess
the puncture site for bleeding
CARE OF CLIENTS WITH PROBLEM IN OXYGENATION BY: ROSELLE JOY C. BALAQUIT, RN
PULMONARY FUNCTION
TESTS
• Tests used to evaluate lung mechanics,
gas exchange, and acid-base
disturbance through spirometric
measurements, lung volumes, and
arterial blood gas levels
• Consult with the physician regarding
holding bronchodilators before testing
• Instruct the client to void before the
procedure and to wear loose clothing
CARE OF CLIENTS WITH PROBLEM IN OXYGENATION BY: ROSELLE JOY C. BALAQUIT, RN
• Remove dentures
• Instruct the client to refrain from
smoking or eating a heavy meal
for 4 to 6 hours before the test
• After the procedure, client may
resume normal diet and any
bronchodilators and respiratory
treatments that were held before
the procedure

CARE OF CLIENTS WITH PROBLEM IN OXYGENATION BY: ROSELLE JOY C. BALAQUIT, RN

VENTILATION-PERFUSION
LUNG SCAN
• The perfusion scan evaluates blood
flow to the lungs
• The ventilation scan determines the
patency of the pulmonary airways and
detects abnormalities in ventilation
• A radionuclide may be injected for the
procedure

CARE OF CLIENTS WITH PROBLEM IN OXYGENATION BY: ROSELLE JOY C. BALAQUIT, RN

• Obtain informed consent
• Assess the client for allergies to dye,
iodine or seafood
• Remove jewelry around the chest area
• Review breathing methods that may be
required during testing
• Monitor client for reaction to the
radionuclide
• Instruct client that the radionuclide
clears from the body in about 8 hours

CARE OF CLIENTS WITH PROBLEM IN OXYGENATION BY: ROSELLE JOY C. BALAQUIT, RN

ARTERIAL BLOOD GASES
• Avoid suctioning before drawing the ABG
sample
• Do not turn off oxygen unless the ABG
sample is ordered to be drawn with the client
breathing room air
• Place specimen on ice
• Note the client temperature on the lab form
• Note the oxygen and type of ventilation the
client is receiving on the lab form

CARE OF CLIENTS WITH PROBLEM IN OXYGENATION BY: ROSELLE JOY C. BALAQUIT, RN

• Apply pressure to the puncture site
for 5 to 10 minutes or longer if the
client is taking anticoagulant
therapy or has a bleeding disorder
• Transport the specimen to the
laboratory within 15 minutes

CARE OF CLIENTS WITH PROBLEM IN OXYGENATION BY: ROSELLE JOY C. BALAQUIT, RN

ARTERIAL BLOOD GASES
(Allen’s Test)
• Apply direct pressure over the client’s ulnar and
radial arteries simultaneously
• While applying pressure, ask the client to open and
close the hand repeatedly; the hand should blanch
• release pressure from the ulnar artery while
compressing the radial artery and assess the color
of the extremity distal to the pressure point
• If pinkness fails to return within 6 seconds, the ulnar
artery is insufficient, indicating that the radial artery
should not be used for obtaining a blood specimen

CARE OF CLIENTS WITH PROBLEM IN OXYGENATION BY: ROSELLE JOY C. BALAQUIT, RN

NORMAL ABG
• pH – 7.35 – 7.45
• PCO2 – 35 – 45 mmHg
• HCO3 – 22 – 27 mEq/L

CARE OF CLIENTS WITH PROBLEM IN OXYGENATION BY: ROSELLE JOY C. BALAQUIT, RN

 Blood Gas
Interpretation
Blood Gases
 Important diagnostic tool
 Reveals:
1. acid-base balance
2. oxygenation status
**arterial gases only**
3. abnormalities of ventilation
Acid- base balance
• The body is designed for optimum
performance at a specific pH level
• Cell division
• Metabolism
Components of Acid- Base
Balance
pH- measures the bloods acidity
 Normal range 7.35- 7.45
 Overall H+ from both respiratory and metabolic
factors
pCO2- partial pressure of carbon dioxide in the blood
 Normal range 35-45 mmHg
 Snapshot of adequacy of alveolar ventilation
HCO3- the amount of bicarbonate in the blood
 Normal range 22- 26 or 27 mEq/L
Acid – Base Balance
Bicarbonate – carbonic acid buffer equation
(H+)(HCO3) (H2CO3) (CO2)(H2O)

It’s not that complicated!

pH 1 7 14

Acidic Neutral Alkaline

 Acid – Base Balance
• Lungs • Kidneys
• Respiratory • Metabolic
• CO2 (acid) • HCO3 ( base/alkaline)
 Making sense of it…
pH
7.35 – 7.45

Respiratory Metabolic

CO2=Acidosis HCO3=Acidosis

CO2=Alkalosis HCO3=Alkalosis
 Interpretation: 4 steps

• Normal Values
– pH 7.35 – 7.45
– pCO2 35 – 45 mmHg
– HCO3 22 – 26 or 27 mEq/L

• Evaluate each component as Acid or Base

1) Evaluate pH and determine acidosis or
alkalosis
7.35 7.40 7.45

Acid Normal Base

Acidosis Alkalosis
2) Evaluate pCO2 (respiratory)

35 40 45

Base Normal Acid

3) Evaluate HCO3 (metabolic)

22 24 26

Acid Normal Base

4) Determine which regulatory system is
responsible for the imbalance by checking
to see which component matches the pH.
– If pH and pCO2 match = respiratory

– If pH and HCO3 match = metabolic

 ABG Analysis
pH pCO2 HCO3
Resp. A A N
Acidosis (<7.35) (>45) (22-26/27)
Resp. B B N
Alkalosis (>7.45) (<35) (22-26/27)
Metabolic A N A
Acidosis (<7.35) (35-45) (<22)
Metabolic B N B
Alkalosis (>7.45) (35-45) (>26/27)
Compensation
• When an acid – base imbalance exists, over time the
body attempts to compensate.
practice…
pH pCO2 HCO3
A A N Respiratory Acidosis
7.26 55 23
B N B Metabolic Alkalosis
7.54 43 39
N N N Normal
7.39 41 25
B B N Respiratory Alkalosis
7.51 29 24
Metabolic Acidosis
A N A
7.29 40 17
A A A Mixed Acidosis
7.28 61 18
 Understanding Compensation

• Uncompensated – the alternate system has

not attempted to adjust (remains within
normal range), and the pH remains abnormal
• Example
– pH 7.30 A
– pCO2 60 A
– HCO3 25 N
Uncompensated Respiratory
Acidosis
• Partial Compensation – the alternate
system is trying to create a balanced
environment and bring the pH back within
normal limits, but hasn’t yet succeeded.
• Example
– pH 7.34 A
– pCO2 59 A
– HCO3 28 B
Partially Compensated
Respiratory Acidosis
• Fully Compensated – the alternate
system has adjusted enough to restore
balance and normalize the pH
• Example
–pH 7.36 N (but slightly A)
–pCO2 58 A
–HCO3 31 B
Compensated Respiratory
Acidosis
pH pCO2 HCO3
Metabolic Alkalosis partially
B A B compensated
7.51 49 40
A A N Respiratory Acidosis uncompensated
7.29 53 22

N B A
Metabolic Acidosis fully compensated

7.37 25 18
N A B Respiratory Acidosis fully compensated

7.35 65 28
B B A
Respiratory Alkalosis partially
compensated
7.46 22 20
Respiratory Acidosis partially
A A B compensated
7.34 52 27

BLOOD GAS INTERPRETATION: ROSELLE JOY C. BALAQUIT, RN

PULSE OXIMETRY
• Is a noninvasive test that registers the
oxygen saturation of the client’s
hemoglobin
• The capillary oxygen saturation is
recorded as a percentage
• The normal value is 96% to 100%
• A pulse oximeter reading can alert the
nurse to hypoxemia before clinical
signs occur
CARE OF CLIENTS WITH PROBLEM IN OXYGENATION BY: ROSELLE JOY C. BALAQUIT, RN
PULSE OXIMETRY
• A sensor is placed on the client’s finger, toe,
nose, ear lobe or forehead to measure
oxygen saturation, which then is displayed
on a monitor
• Do not select an extremity with an
impediment to blood flow
• Results lower than 91% necessitate
immediate treatment
• If the oxygen saturation is lower than 85%,
oxygenation to body tissues is compromised;
if less than 70% it is life threatening
CARE OF CLIENTS WITH PROBLEM IN OXYGENATION BY: ROSELLE JOY C. BALAQUIT, RN
LUNG BIOPSY
• A percutaneous lung biopsy is
performed to obtain tissue for
analysis by culture or cytological
examination
• A needle biopsy is done to identify
pulmonary lesions, changes in
lung tissue, and the cause of
pleural effusion
CARE OF CLIENTS WITH PROBLEM IN OXYGENATION BY: ROSELLE JOY C. BALAQUIT, RN
• Obtain informed consent
• Maintain NPO status of the client before the
procedure
• Inform client that a local anesthetic will be
used but a sensation of pressure during
needle insertion and aspiration may be felt
• Apply a dressing to the biopsy site and
monitor for drainage or bleeding
• Monitor for signs of respiratory distress, and
notify the physician if they occur
• Prepare client for chest radiography if
prescribed
CARE OF CLIENTS WITH PROBLEM IN OXYGENATION BY: ROSELLE JOY C. BALAQUIT, RN