Unit III. Module 4b.

Oxygenation & Pulmo Dse

Critical Care Course
Nursing Education and Training Division

Unit III. Body System Functions and Management

Module 4b
Concept of Oxygenation and Common Pulmonary Disorders

Organizing Principle
Oxygen is essential to life. The delivery of oxygen to body cells is a process that depends on the interplay of the pulmonary,
hematologic and cardiovascular system. The respiratory system provides the essential first process in this integrated system, that is
movement and transfer of gases between the atmosphere and the blood. Impaired function of the system can significantly affect our
ability to breathe, transport gases, and participate in everyday activities. Clients with compromised oxygenation status need careful
assessment and thoughtful nursing care to achieve an adequate and comfortable level of oxygenation function

Objectives
1. Discuss the breathing/respiration process
2. Define oxygenation, respiration and ventilation
3. Enumerate factors influencing oxygenation
4. Discuss relationship between perfusion and oxygenation
5. Identify signs and symptoms indicating imbalance in oxygenation

Underlying Concepts
1. Role of Hemoglobin in Oxygen Transport
2. Hypoxemia vs Hypoxia
3. oxygen therapy

Learning Content and Resources

Process of Respiration
 Unit III. Module 4b. Oxygenation & Pulmo Dse
Gas Exchange Process

Definition of Terms:

• Oxygenation - delivery of oxygenation to tissue/cells to maintain body functions

• Respiration- act of inhaling and exhaling air to transport oxygen to the alveoli

• Ventilation- actual exchange of oxygen and carbon dioxide or the process by which air moves in and out of the lungs

• Perfusion- process by which the cardiovascular system pumps blood throughout the lungs

Role of Hemoglobin in Gas Exchange

• Hemoglobin is a protein that is made up of 4 peptide chains

• Each peptide chain contains 1 heme (iron) to which oxygen binds

• The body’s demand for oxygen is affected by activity, metabolic status, temperature, and level of anxiety
• The ability of Hemoglobin to move the oxygen to the tissues depends on a number of factors, such as oxygen supply,
ventilatory effectiveness, nutrition, cardiac output, hemoglobin level, smoking, drug use, and underlying disease.
 Unit III. Module 4b. Oxygenation & Pulmo Dse

Hypoxemia and Hypoxia

• Hypoxemia- is a condition where arterial oxygen tension or partial pressure of oxygen (PaO2) is below normal (<80 mmHg).
Therefore, Hypoxemia is the inadequate supply of oxygen in the arterial blood. 
• Hypoxia- the reduction of oxygen supply at the tissue level, which is not measured directly by a laboratory value, but by pulse
oximetry and SpO2
• Generally, the presence of hypoxemia suggests that hypoxia exist
• Hypoxemia is the most common cause of hypoxia
• Hypoxemia can be caused by breathing air at pressures less than atmospheric pressure, such as at high altitudes or in an
enclosed space with inadequate ventilation.
• If a patient hypoventilates, the level of oxygen in the alveoli will fall, and the level of carbon dioxide will increase. Hypoxemia
occurs because less oxygen is moved into the pulmonary blood flow
• Examples of conditions that cause hypoxemia:
- Asthma
- COPD
- Heart Failure
- Pleural Effusions
- Pneumonia
- Pneumothorax
- Pulmonary Edema
- Pulmonary Embolism
• Presence of symptoms depends on the patient’s age, presence of disease process, level of health, and presence of chronic illness
• Early signs of hypoxia
- anxiety
- confusion
- restlessness
• As hypoxia worsens, patient’s vital signs, activity tolerance and level of consciousness decrease

Oxygen Therapy
• a means to provide oxygen according to target saturation rates to achieve normal or near normal oxygen saturation levels for
acute and chronically ill patients
• tissue oxygenation is dependent on optimal or adequate delivery of oxygen to tissues
• increasing the concentration of inhaled oxygen is an effective method of increasing the partia; pressure of oxygen in the blood
and correcting hypoxemia
• 2 types of oxygen delivery system
- low flow: nasal cannula, face mask
- high flow: rebreather mask, venturi mask

Management of Hypoxia
• Deep breathing and coughing techniques
• Positioning the patient/Raising the head of bed
• Oxygen Therapy
• Oral Suctioning
• Pain relief
• Pharmacological management: bronchodilators, mucolytics and steroids
 Unit III. Module 4b. Oxygenation & Pulmo Dse
Other Resources
oxygen transport
• https://www.youtube.com/watch?v=CdEOQUy_FSw

gas exchange
• https://www.youtube.com/watch?v=WzrN6sJ1i_g

Oxygen delivery system

• https://www.youtube.com/watch?v=4OUEPvcAyRM
• https://www.youtube.com/watch?v=LGxV9mHqXP0

COPD, Pneumonia and Respiratory Failure

Objectives:
At the end of this module, participants are expected to:
1. Define COPD, Pneumonia, and Respiratory failure
2. List the types/ classification of each pulmonary disorders
3. Discuss the mode of transmission and pathophysiology of each pulmonary disorders
4. Enumerate clinical manifestations each pulmonary disorders
5. Discuss nursing and medical management for each pulmonary disorders

Pneumonia

Definition:
• An infection in one or both lungs that causes inflammation in the alveoli or air sacs
• The alveoli is filled with pus or fluid which makes oxygen intake more difficult
• Inflammation and consolidation of lung tissue due to infectious agent

Types of Pneumonia
According to areas involved:
1. Lobar Pneumonia - affects section/lobe of a lung
2. Bronchopneumonia - affects patches throughout both lungs. Characterized by patchy foci of consolidation (pus in
many alveoli and adjacent air passages) scattered in one or more lobes of one or both lungs.

lobar pneumonia bronchopneumonia

According to Etiology/ Environment:

 Unit III. Module 4b. Oxygenation & Pulmo Dse
1. Community Acquired
2. Hospital Acquired
3. Ventilator Acquired (VAP)
4. Pneumonia in the immunocompromised host

According to Causative Organism:

1. Bacterial - Streptococcus pneumonia, staphylococcus aureus, haemophilous influenza, klebsiella pneumonia,
2. Viral- corona virus, influenza virus
3. Fungal - histoplasmosis
4. Parasitic - pneumocystiis carinii

According to the cause:

1. Aspiration pneumonia
2. Chemical Pneumonia

Risk Factors:
• Age
• Smoking
• Pollution
• Prolong bed rest
• Chronic Illnesses
• Environmental factors - residence, crowded areas

General signs and symptoms:

• Fever
• Cough
• Pleuritic chest pain
• Loss of appetite
• Rapid shallow breathing
• Fatigue

*** Read on Pneumonia pathophysiology

COPD (Chronic Obstructive Pulmonary Disease)

Definition:
• Is a disease state characterized by airflow limitation that is not fully reversible
• In COPD, less air flows in and out of the airways because of one or more of the following:
The airways and air sacs lose their elastic quality
The walls between many of the air sacs are destroyed
The walls of the airways become thick and inflamed
The airways make more mucus than usual, which tends to clog
• Smoking is the primary risk factor. The numerous irritants found in cigarette smoke stimulate excess mucus production and
coughing, destroy ciliary production and lead to inflammation of bronchial and alveolar walls.

Pathophysiology:
 Unit III. Module 4b. Oxygenation & Pulmo Dse
• Smoking and other airway irritants cause neutrophils, T- Lymphyocytes and other inflammatory cells to accumulate in the
airways. Once activated, this trigger an inflammatory response in which an influx of molecules navigate to the site in an
attempt to destroy and remove inhaled foreign debris.
• Under normal circumstances, the inflammatory response in useful and leads to healing. In COPD, repeated exposure to
airway irritants perpetuates an ongoing inflammatory response. Over time, this process causes structural and physiologic
lung changes that get progressively worse.
• As inflammation continues, the airways constrict becoming excessively narrow and swollen that leads to excess mucus
production and poorly functioning cilia, which makes airway clearance more difficult.

Hallmark Symptoms of COPD:

• Chronic productive cough
• Wheezes
• Dyspnea

Other signs and symptoms:

• Chest tightness
• Weight loss
• Fatigue
• Barrel Chest appearance- chronic hyperinflation leads to loss of lung elasticity

2 Classification of COPD:
1. Bronchitis
2. Emphysema

Bronchitis - results from inflammation of the bronchi. It occurs if the lining of the bronchial tubes is constantly irritated and inflamed
causing long term cough and mucus. It is defined as the presence of cough and sputum production for at least 3 months

Chronic Bronchitis is characterized by:

• An increased in size and number of submucus glands in the large bronchi, which increase mucus production
• An increased in the the number of goblet cells which also secrete mucus
• Impaired ciliary function which reduce mucus clearance

Emphysema- enlargement of air spaces distal to the terminal bronchioles with destruction of their walls of the alveoli. As the alveoli
are destroyed, the alveolar surface area in the contact with the capillaries deceases

Management goal of patient with COPD:

• Smoking cessation
• Improve ventilation
• Facilitate removal of bronchial secretions
• Reduce complications
• Slow progression of disease

Respiratory Failure

Defintion:
• A clinical condition when the respiratory system fails to maintain its main function
• Abnormal physiologic process that prevents adequate gas exchange
• PaO2 value of less than 60 mmHg or a PaCO2 of more than 50 mmHG
 Unit III. Module 4b. Oxygenation & Pulmo Dse

Respiratory Distress - increased work of breathing/ breathing becomes difficult/ respiratory effort
Respiratory Arrest - absence of breathing

Types of Respiratory Failure

• Type 1 - hypoxemic respiratory failure
• Type 2 - hypercapnia respiratory failure
• Type 3 - prerioperative respiratory failure
• Type 4 - shock

Type 1 Type 2 Type 3 Type 4

Oxygenation Failure Ventilatory Failure Patients who are intubated and

Failure of oxygen exchange
Hypoxia without Hypercapnia
Ex: pneumonia, pulmonary
edema
PaO2 low
PaCO2 normal or low
ventilated in the process of
Failure to exchange or remove resuscitation, or a respiratory
carbon dioxide failure associated with shock
It occurs in the perioperative
state (ex. Cardiogenic,
Hypoxia without Hypercapnia period secondary to
hypovolemic, septic.. ).
development of atelectasis
Ex: COPD, Gullain Barre Hypoperfusion of respiratory
either from pain, anesthesia or
Syndrome, muscles results in respiratory
narcotic drugs
muscle fatigue
PaO2 low
PaCO2 high

Other resources:

https://www.youtube.com/watch?v=dzJNabJAPaE

https://www.youtube.com/watch?v=2nBPqSiLg5E

https://www.youtube.com/watch?v=nUGK8hKDpEg