PROMOTION OF

PHYSIOLOGIC HEALTH:
Promoting Oxygenation
!"#$%&'()*&+,-)./&0+1/&21/&20
OBJECTIVES
1. Outline the structure and function of the respiratory system.
2. Describe the processes of breathing (ventilation) and gas exchange
(respiration).
3. Explain the role and function of the respiratory system in transporting
oxygen and carbon dioxide to and from body tissues.
4. Describe the mechanisms for respiratory regulation.
5. Identify factors influencing respiratory function.
OBJECTIVES
6. Identify four major types of conditions that can alter respiratory
function.
7. Describe nursing assessments for oxygenation status.
8. Describe nursing measures to promote respiratory function and
oxygenation.
9. Explain the use of therapeutic measures such as medications,
inhalation therapy, oxygen therapy, artificial airways, airway suctioning,
and chest tubes to promote respiratory function.
10. State outcome criteria for evaluating client responses to measures
that promote adequate oxygenation.
OUTLINE OF DISCUSSION
1. Review of Anatomy and
Physiology
2. Factors affecting respiratory
function
3. Alterations in respiratory
function
4. Promoting Healthy Breathing
THE RESPIRATORY SYSTEM
§ The exchange of oxygen and carbon dioxide in
the body is essential for life.
*takes place in the lungs and at the cellular level.

§ mechanisms of respiration integration of

factors involving the;
a. nervous system
b. chemoreceptors in the cardiovascular
system
c. as well as the respiratory system.
 STRUCTURES OF THE RESPIRATORY SYSTEM
1. AIRWAYS.
§ UPPER AIRWAYS (located above the
larynx; include nasal passages, oral
cavity, and pharynx)
§ LOWER AIRWAYS (located below the
larynx; include trachea, bronchi, and
bronchioles).

FUNCTIONS:
v Humidify the air
v Warm the air
v Filter the air
STRUCTURES OF THE RESPIRATORY SYSTEM

2. LUNGS.
§ Soft, spongy, cone-shaped
organs.

§ Right lung – 3 lobes

§ left lung - 2 lobes.

Composed of tiny, thin-walled air sacks (alveoli) surrounded by an extensive network of

capillaries. ALVEOLI - involved with gas exchange.
FUNCTIONS OF THE RESPIRATORY SYSTEM

A. Ventilation.
§ Movement of air into and out of the lungs
through the process of breathing.

*Involves inhalation and exhalation.

FUNCTIONS OF THE RESPIRATORY SYSTEM

1. INHALATION:
-the intake of air into the lungs

-Expansion of the chest cavity and lungs

resulting from contraction of the diaphragm
that pulls the chest cavity downward and
contraction of the intercostal muscles that
pulls the ribs outward;

§ lung expansion causes (-) pressure that

draws air into the respiratory system.
FUNCTIONS OF THE RESPIRATORY SYSTEM

2. EXHALATION:
- the expulsion of air from the lungs

-Chest cavity and lungs return to their

original size and position when the
diaphragm and intercostal muscles relax;

§ this is a passive response that requires

no effort.
FUNCTIONS OF THE RESPIRATORY SYSTEM

RESPIRATION
-Exchange of gases that provides oxygenation of blood and
body tissues and elimination of carbon dioxide from the lungs.

§ Occurs at two levels, known as;

a. external respiration
b. internal respiration
FUNCTIONS OF THE RESPIRATORY SYSTEM

RESPIRATION.

1. EXTERNAL RESPIRATION
§ involves both bringing air into the lungs
(inhalation) and releasing air to the
atmosphere (exhalation).

2. INTERNAL RESPIRATION.
§ Involves capillary-tissue gas exchange.
 CHEMICAL CONTROL OF BREATHING
§ CHEMORECEPTORS (in carotid and aortic
bodies) – respond to changes in blood
O2.

§ send action potentials to the

respiratory center and produce an
increase in the rate and depth of
breathing
*which increases O2 diffusion from
the alveoli into the blood.
 FACTORS AFFECTING RESPIRATORY FUNCTION
1. AGE
-Developmental factors have important
influences on respiratory function.

Developmental Level
Infants (particularly premature infants).

§ Airways are narrow, small, and immature.

§ Central nervous system is immature, leading to impaired

breathing patterns and periods of apnea.

§ Small structures and immature immune systems

increase the risk of respiratory infections.
 FACTORS AFFECTING RESPIRATORY FUNCTION
1. AGE

• OLDER ADULTS

These types of changes are seen:

• Chest wall and airways become more rigid and less elastic.
• The amount of exchanged air is decreased.
• The cough reflex and cilia action are decreased.
• Mucous membranes become drier and more fragile.
• Decreases in muscle strength and endurance occur.
• If osteoporosis is present, adequate lung expansion may be
compromised.
• A decrease in efficiency of the immune system occurs.
• Gastroesophageal reflux disease is more common in older adults
and increases the risk of aspiration. The aspiration of stomach
contents into the lungs often causes bronchospasm by setting up
an inflammatory response.
2. Environmental Factors

a. Air quality

§ Air pollution, such as cigarette

smoke, automobile emissions,
mold spores, and radon, can
precipitate disease in
vulnerable people
§ e.g., infants, toddlers, older adults, people with heart or lung disease
ENVIRONMENTAL FACTORS cont.

b. Pulmonary allergens:
§ Allergens, such as dust, animal dander, cockroach
particles, environmental grasses, and foods such as
peanuts and gluten
§ can precipitate respiratory hypersensitivity responses
and allergies.

c. Altitude:
§ Low oxygen levels place strain on the cardiopulmonary
system
§ lead to increased ventilation, production of red blood
cells and hemoglobin, and vascularity of lungs and
body tissues.
3. LIFESTYLE FACTORS

a. Smoking tobacco and inhaling secondhand

smoke.
§ Tobacco smoke contains tars, toxins, and
nicotine; tars and toxins are known to
precipitate cancer and nicotine constricts
bronchioles.

§ Smoke also causes mucous membrane

inflammation, increases respiratory
secretions, breaks down elastin, and
decreases the numbers and efficiency of cilia
LIFESTYLE FACTORS cont.

b. Improper nutrition:
§ Inappropriate balance of proteins, carbohydrates, and
fats may reduce the immune system, impair cellular
functioning, impede tissue repair, and cause obesity.

c. Lack of exercise:
§ Sedentary lifestyle results in a depressed metabolic rate
and an inability of the cardiopulmonary system to
respond when any situation causes an increased
metabolic rate;

*regular exercise increases the heart and respiratory

rates, which helps condition the body so that the body can
better adapt to physical or emotional stressors.
Obesity.
§ A BMI more than 30 increases the risk of respiratory infections
because excess abdominal adipose tissue limits chest
expansion and gas exchange in the alveoli.

§ Sleep apnea occurs due to increased neck girth and fat deposits
in the upper airway.
Occupational hazards
§ Toxic agents include chemical fumes from cleaning products,
carbon monoxide from automobile or machine combustion,
particles from construction debris, such as asbestos, and coal
dust from coal mines.

*Toxic agents can cause chronic inflammation of the mucous

membranes of the respiratory system and lung cancer.
Substance use or abuse.
a. Alcohol and medications that depress the
respiratory center in the medulla (e.g.,
opioids, sedatives, anxiolytics, and hypnotics)
can cause hypoventilation, aspiration, apnea,
and death.

b. Stimulants, such as amphetamines and

cocaine, hallucinogens, and marijuana, also
adversely affect lung tissue, increase the risk
of aspiration, and depress respirations
PREGNANCY
§ Body metabolism increases by 15 percent and
oxygen consumption increases by 15 to 25
percent.
§ The enlarging uterus rises into the abdominal
cavity, limiting enlargement of the chest cavity
and downward movement of the diaphragm.
§ Maternal respiratory rate increases and the
mother may experience shortness of breath with
activity.
 ALTERATIONS IN
RESPIRATORY FUNCTION
 COMMON TERMINOLOGIES
§ Eupnea - Normal respiration, is quiet, rhythmic, and effortless.
§ Tachypnea - rapid respirations, is seen with fevers, metabolic acidosis, pain,
and hypoxemia.
§ Bradypnea - is an abnormally slow respiratory rate, which may
be seen in clients who have taken drugs such as morphine or
sedatives, who have metabolic alkalosis, or who have increased
intracranial pressure (e.g., from brain injuries).
§ Apnea - is the absence of any breathing.
§ Hypercarbia or Hypercapnia - increased levels of carbon dioxide
§ Hypoxemia - low levels of oxygen in the blood
§ Hypoxia - low oxygen supply in bodily tissues

The term breathing patterns refers to the rate, volume, rhythm, and
relative ease or effort of respiration.
 COMMON TERMINOLOGIES (CONT.)

PULMONARY PERFUSION
Blood flow from the right side of the heart, through the
pulmonary circulation, and into the left side of the heart.

DIFFUSION
Gas movement from an area of greater to lesser
concentration through a semipermeable membrane
Respiratory function can be altered by
conditions that affect:

1. Patency (open airway)

2. Movement of air into or out of the lungs
3. Diffusion of oxygen and carbon dioxide
between the alveoli and the pulmonary
capillaries
4. Transport of oxygen and carbon dioxide via
the blood to and from the tissue cells
CONDITIONS AFFECTING THE AIRWAY
A completely or partially obstructed airway:

§ Upper airway obstruction –

-can occur when a foreign object such as food is present,
when the tongue falls back into the oropharynx when a
person is unconscious, or when secretions collect in the
passageways.
§ Lower airway obstruction
-involves partial or complete occlusion of the
passageways in the bronchi and lungs most often
due to increased accumulation of mucus or
inflammatory exudate.

§ Stridor, a harsh, high-pitched sound, may be

heard during inspiration.
 CONDITIONS AFFECTING MOVEMENT OF AIR
Hyperventilation
is the increased movement of air into and out of the lungs.
*rate and depth of respirations increase and more CO2 is eliminated
than is produced.

Kussmaul’s breathing
§ type of hyperventilation that
accompanies metabolic acidosis
§ by which the body attempts to
compensate for increased metabolic
acids by blowing off acid in the form of
CO2.
§ also occur in response to stress or
anxiety.
CONDITIONS AFFECTING MOVEMENT OF AIR
Hypoventilation - inadequate alveolar
ventilation, may be caused by either
slow or shallow breathing, or both.

§ occur because of diseases of the

respiratory muscles, drugs, or
anesthesia.

*lead to increased levels of carbon

dioxide or low levels of oxygen
 BREATHING PATTERNS

§ Cheyne-Stokes respirations: marked rhythmic

waxing and waning of respirations from very
deep to very shallow with short periods of
apnea
*commonly caused by chronic diseases,
increased intracranial pressure, or drug overdose

§ Biot’s (cluster) respirations: shallow breaths

interrupted by apnea;
§ may be seen in clients with CNS disorders.
§ Orthopnea - is the inability to breathe easily unless
sitting upright or standing.

§ Dyspnea - Difficulty breathing or the feeling of

being short of breath (SOB)

• Platypnea - is shortness of breath that is

relieved when lying down, and worsens
when sitting or standing upright
 CONDITIONS AFFECTING DIFFUSION
§ Impaired diffusion may affect levels of gases
in the blood, particularly oxygen, which does
not diffuse as readily as carbon dioxide.

§ Hypoxemia, or reduced oxygen levels in the

blood
§ caused by conditions that impair diffusion
at the alveolar-capillary level such as
pulmonary edema or atelectasis (collapsed
alveoli) or by low hemoglobin levels.

§ cardiovascular system compensates for hypoxemia by increasing the heart rate and cardiac
output, to attempt to transport adequate oxygen to the tissues.
§ If unable to compensate or hypoxemia is severe, tissue hypoxia (insufficient oxygen anywhere
in the body) results, potentially causing cellular injury or death.
§ Cyanosis (bluish discoloration of the skin,
nail beds, and mucous membranes due to BLUISH DISCOLORATION

reduced hemoglobin-oxygen saturation)

may be present with hypoxemia or hypoxia.

*Adequate oxygenation is essential for cerebral

functioning.
§ cerebral cortex can tolerate hypoxia for
only 3 to 5 minutes before permanent
damage occurs.
§ The face of the acutely hypoxic person usually appears anxious, tired, and drawn

§ usually assumes a sitting position, often leaning forward slightly to permit greater
expansion of the thoracic cavity
SIGNS OF INCREASED RESPIRATORY EFFORT.
§ Use of accessory muscles of respiration:
-- intercostal, abdominal, trapezius muscles
*to help expand the chest cavity.

§ Retractions:
-Intercostal, supraclavicular, and subcostal
tissues
*required to increase the depth of respirations.

§ Nasal flaring:
Widening of the nares during inhalation to
reduce resistance to airflow;
*more common in infants and young children.
SIGNS OF INCREASED RESPIRATORY EFFORT.
§ Grunting immediately before
exhalation:
-Closed glottis at the height of inspiration
keeps alveoli open to enhance gas exchange;
grunt occurs when air is expelled through the
larynx.

§ Pursed-lip breathing:
-Exhalation through the mouth with lips
positioned to create a small opening to prolong
exhalation; keeps alveoli open longer for gas
exchange and more efficiently expels trapped
air
SPUTUM
Sputum is produced when lungs are
damaged or diseased
*can give nurses important information
about the patient and his or her illness.

§ Identify whether coughing is not bringing up sputum (nonproductive

cough) or bringing up sputum (productive cough)
§ Color.
§ Clear/white: Associated with viral infections.
§ Yellow/green: Associated with bacterial
infection.
§ Black: Associated with inhalation of smoke,
soot, or coal dust.
§ Red/rust colored: Associated with the
presence of blood (hemoptysis), tuberculosis,
and pneumococcal pneumonia.
§ Pink/frothy: Associated with pulmonary edema

§ Odor: Foul smelling, associated with bacterial

infections such as pneumonia and abscesses of
the lung.
DISTINGUISHING ABNORMAL BREATH SOUNDS

Crackles (rales)
§ Air bubbling through moisture in the alveoli.
§ Not cleared by coughing.

Classified as:
1. Fine: Soft, high-pitched crackling sound
heard at height of inspiration
2. Medium: Lower-pitched, popping sound
heard during the middle of inspiration.
3. Coarse: Loud, bubbling sound heard
throughout inspiration.
Rhonchi (sonorous wheeze)
§ Mucus accumulated in large bronchi.
§ Loud, coarse, low-pitched sound heard during
inspiration and/or expiration

Wheeze (sibilant wheeze)

§ Air moving through narrowed airways.
§ High-pitched, musical sound that may be heard
throughout inspiration and expiration; more
prominent during expiration.
§ May be audible without a stethoscope
Pleural Friction Rub
§ Inflamed pleural surfaces rubbing together.
§ Low-pitched, grating sound during inspiration
and/or expiration; more prominent at height of
inspiration.
§ Heard at lateral, anterior, base of lung

Stridor
§ High-pitched crowing sound; more prominent
during inspiration.
§ Heard over larynx and trachea.
§ May be audible without a stethoscope.
§ Tracheal or laryngeal spasm
§ Partial airway obstruction
NANDA INTERNATIONAL (HERDMAN & KAMITSURU, 2014)

§ Ineffective Airway Clearance: inability to clear

secretions or obstructions from the respiratory tract
to maintain a clear airway.
§ Ineffective Breathing Pattern: inspiration and/or
expiration that does not provide adequate
ventilation.
§ Impaired Gas Exchange: excess or deficit in
oxygenation and/or carbon dioxide elimination at the
alveolar-capillary membrane.
§ Activity Intolerance: insufficient physiological or
psychological energy to endure or complete required
or desired daily activities
THE PRECEDING NURSING DIAGNOSES may also be
the etiology of several other nursing diagnoses, such as these:

§ Anxiety related to ineffective airway clearance

and feeling of suffocation
§ Fatigue related to ineffective breathing pattern
§ Fear related to chronic disabling respiratory
illness
§ Insomnia related to orthopnea and required O2
therapy
§ Social Isolation related to activity intolerance
and inability to travel to usual social activities.
PLANNING
The overall outcomes/goals for a client with
oxygenation problems are to:
§ Maintain a patent airway.
§ Improve comfort and ease of breathing.
§ Maintain or improve pulmonary ventilation and
oxygenation.
§ Improve the ability to participate in physical
activities.
§ Prevent risks associated with oxygenation problems
such as skin and tissue breakdown, syncope, acid–
base imbalances, and feelings of hopelessness
and social isolation
NURSING CARE FOR PATIENTS WITH RESPIRATORY
PROBLEMS
Vaccinations.
§ Annual flu vaccines are recommended for
all people 6 months and older.
§ Patients with chronic illnesses (heart, lung,
kidney, or immunocompromised), infants,
older adults, and pregnant women can get
very sick; thus they should be immunized.
NURSING CARE FOR PATIENTS WITH RESPIRATORY
PROBLEMS
Mobilization of Pulmonary Secretions.
§ The ability of a patient to mobilize pulmonary
secretions makes the difference between a short-
term illness and a long recovery involving
complications.

§ Nursing interventions promoting removal of

pulmonary secretions assist in achieving and
maintaining a clear airway and help to promote lung
expansion and gas exchange.
NURSING CARE FOR PATIENTS WITH RESPIRATORY
PROBLEMS
Hydration.
§ Maintenance of adequate systemic hydration
keeps mucociliary clearance normal.

§ Excessive coughing to clear thick, tenacious

secretions is fatiguing and energy depleting.
§ best way to maintain thin secretions is to
provide a fluid intake of 1500 to 2500
mL/day unless contraindicated by cardiac or
renal status.
 NURSING CARE FOR PATIENTS WITH RESPIRATORY
PROBLEMS
Humidification - is the process of adding water to gas.
§ Temperature is the most important factor affecting the
amount of water vapor a gas can hold.
§ Relative humidity is the percentage of water in the gas.
§ Air or oxygen with a high relative humidity keeps the
airways moist and loosens and mobilizes pulmonary
secretions.
§ Humidification is necessary for patients receiving oxygen
therapy at greater than 4 L/min (check agency protocol).
§ It might be necessary to add humidification at lower
oxygen concentrations if the environment is dry and
arid.
NURSING CARE FOR PATIENTS WITH
RESPIRATORY PROBLEMS
Nebulization - adds moisture or medications
to inspired air by mixing particles of varying
sizes with the air.
• Aerosolization suspends the maximum
number of water drops or particles of the
desired size in inspired air.
• moisture added through nebulization
improves clearance of pulmonary
secretions.
• used for administration of bronchodilators
and mucolytic agents
NURSING CARE FOR PATIENTS WITH
RESPIRATORY PROBLEMS
Chest physiotherapy (CPT) is a group of therapies for
mobilizing pulmonary secretions.
Chest physiotherapy may be implemented by a
respiratory therapist.

a. Postural drainage: Place the patient sequentially in a

variety of positions so that it permits gravity to drain
secretions from all lobes of the lungs.
b. Percussion: Strike the chest wall using cupped hands
to generate sounds and slight negative pressure that
loosen secretions
c. Vibration: Apply vibrations to the chest wall with the
hands or a vibrator to loosen secretions;
POSITIONS FOR POSTURAL DRAINAGE
PROMOTE LUNG EXPANSION
§ Have the patient assume a
position that allows the
diaphragm to contract without
pressure from abdominal
organs and permits thoracic
excursion

§ such as semi-Fowler, high-Fowler,

or orthopneic (tripod) position.
PROMOTE LUNG EXPANSION
§ Encourage an intake of air in which the abdomen expands
on deep inhalation and abdominal muscles tighten on
exhalation (diaphragmatic [abdominal] breathing) to
increase the amount of air entering and exiting the lungs.

§ Encourage the patient to exhale through the mouth with

the lips positioned to create a small opening (pursed-lip
breathing) to prolong exhalation.

§ Doing so keeps alveoli open longer for gas exchange and

more efficiently expels trapped air.

§ This is a beneficial breathing technique for patients with

obstructive airway diseases, such as emphysema, asthma,
and chronic bronchitis.
PROMOTE LUNG EXPANSION

§ Encourage use of an incentive spirometer

10 times every hour to help prevent
atelectasis and reexpand collapsed
alveoli;

§ device promotes deep breaths by

providing a visual goal to progressively
increase the volume of breaths
Suctioning Techniques.
• Suctioning - is necessary when patients are unable to
clear respiratory secretions from the airways by
coughing or other less invasive procedures.

1. Oropharyngeal or nasopharyngeal suctioning - is

used when the patient is able to cough
effectively but unable to clear secretions by
expectorating.
2. Orotracheal or nasotracheal suctioning - is
necessary when a patient with pulmonary
secretions is unable to manage secretions by
coughing and does not have an artificial airway
present
OXYGEN DELIVERY SYSTEMS
Oxygen therapy - is widely available and used
in a variety of settings to relieve or prevent
tissue hypoxia.

§ Goal: is to prevent or relieve hypoxia by

delivering oxygen at concentrations greater
than ambient air (21%).

§ Oxygen is a medical gas and should be

used in accordance with federal, state, and
local regulations.
§ Place the mask securely over the nose and mouth with the
elastic straps above the ears.
§ Ensure the flow rate is ≥5 L/minute to prevent carbon
dioxide accumulation in the mask.
§ Switch to a nasal cannula when eating.
OXYGEN IS SUPPLIED IN 2 WAYS
1. Portable Systems (Cylinders or Tanks)

2. Wall-outlet System
qPlace “No Smoking: Oxygen in Use” sign.
qAvoid use of oils, greases, alcohol and
acetone near the client.
qAvoid materials that generate static electricity.
qMake sure that the electric devices are in
good working condition.

***Hazards of O2 Therapy
§ Oxygen toxicity
§ Vision difficulties in newborns (premature)
§ Place the nasal prongs curved downward into the
nares with the elastic straps wrapped around the ears
and the slider under the chin.
§ Assess for dryness of the nasal mucosa.
§ Humidify oxygen if the flow rate is >3 L/minute.
§ Flood the reservoir with oxygen before attaching the
mask to the patient.
§ Ensure that the reservoir does not collapse during
inhalation; a higher flow rate is required if this occurs.
§ Flood the reservoir with oxygen before attaching the
mask to the patient.
§ Ensure that the reservoir remains half full during
inhalation; if not, a higher flow rate is required.
§ Delivers oxygen to the nose and mouth via a clear, flexible mask
with a valve and tubing attached between the mask and the
oxygen tubing.
§ Interchangeable color-coded valves permit a specific mix of room
air and oxygen to deliver a precise percentage of oxygen.
§ Exhaled air is discharged through ports on the side of the mask
to keep carbon dioxide buildup to a minimum.
§ Liter flow: Depends on valve being used.
§ FIO2: 24% to 60%, depending on color-coded valve used.
§ Most patients do not feel claustrophobic.
§ High levels of humidity can be used.
§ Monitor pulse oximetry routinely because the percentage
of oxygen delivered is not precise.
Rationale: It will cause damage to
the mucous membrane
TYPES OF ARTIFICIAL AIRWAYS
Guedel Airway

-is for a patient with a decreased level of

consciousness or airway obstruction
§ aids in removal of tracheobronchial secretions.
§ places a patient at high risk for infection and
airway injury.
TYPES OF ARTIFICIAL AIRWAYS
Tracheostomy
§ Insertion of a tube into the
trachea through an incision in
the neck.

Endotracheal
§ Insertion of tube into the
trachea through the mouth or
nose (intubation).
MEDICATIONS THAT AFFECT THE RESPIRATORY
SYSTEM
§ Sympathomimetics (beta-adrenergic
agonists) - Stimulate beta receptors
to dilate bronchioles
§ Example: albuterol, salbutamol

§ Leukotriene receptor antagonists - Inhibit

leukotriene synthesis or activity;
Minimize inflammation and edema.
§ Example: montelukast
§ Inhaled and nasal route steroids -
Decrease inflammatory response and
edema
§ Example: Budesonide, fluticasone

§ Mucolytics are medicines taken orally

that may loosen sputum, making it easier
to cough it up.
§ Example: Acetylcysteine
§ Expectorants - Increase volume and
decrease viscosity of respiratory secretions
in trachea and bronchi.
§ Example: guaifenesin (Robitussin)

§ Antitussives - Suppress cough reflex.

§ Example: dextromethorphan (DM)
References:
 THANKS! Reference:
● Kozier, et al. Kozier & Erb's Fundamentals of Nursing,
Prof. VinzPearson Acena, 10th MAN,
Edition RN, RM

OLFU- Valenzuela Campus

CREDITS: This presentation template was created by

Slidesgo, including icons by Flaticon, and infographics
& images by Freepik