BATAAN PENINSULA STATE UNIVERSITY

COLLEGE OF NURSING AND MIDWIFERY

City of Balanga 2100 Bataan
PHILIPPINES

OXYGENATION

Oxygenation is a basic human need.

Breathing is synonymous with life. Respiratory system replenishes body’s Oxygen supply and eliminates
waste from the blood in the form of Carbon Dioxide.
Respiration. The process of gaseous exchange between the individual and the environment.

I. THE AIRWAYS
Upper Airways Lower Airways (Tracheobronchial Tree)
1. Nasal Cavity 1. Trachea
2. Pharynx 2. Right and left main stem bronchi
3. Larynx 3. Segmental bronchi
4. Sub-segmental bronchi
5. Terminal bronchi

Functions
Upper Airways Lower Airways
1. Transport of gases to lower airways 1. Clearance Mechanism
2. Protection of lower airway from foreign • Cough
matter • Muco-ciliary system
3. Warming, filtration and humidification of • Macrophages
inspired air. • Lymphatics
2. Immunologic Responses
• Cell – mediated immunity in alveoli.
3. Pulmonary protection in injury.
• Respiratory epithelium
• Muco-ciliary system.

Nostrils or Nares – openings of the nose on the face area. Each leads to a cavity called Vestibule.
Vibrissae – hair that lines the vestibule, filter foreign objects.
Paranasal sinuses – open areas within the skull, lined with mucous membrane, help in phonation. The
different sinuses are as follows:
• Frontal ● Ethmoid ● Maxillary ● Sphenoid
Pharynx – a funnel-shaped tube that extends from the nose to the larynx. It is a common opening
between the digestive and respiratory system. The three sections of the pharynx are as
follows:
• Nasopharynx ● Oropharynx ● Lryngopharynx

Larynx – is the voice box.

Epiglottis – covers the larynx. Seals the airway when swallowing food and fluids. When eating, the
epiglottis closes, when speaking it opens.
Trachea (wind pipe) – is 12 cm. (4.5 in.) long. The point at which it divides is called Carina. The
trachea and bronchi are lined with Cilia and Goblet cells.
Cilia – are microscopic hair-like projections which have rapid, coordinated, unidirectional upward
motion. They sweep out debris and excessive mucous from the lungs.
Goblet Cells – secrete 120 ml. of mucous per day. The mucous secretions entrap debris in the
respiratory tract.
The right main stem Bronchus is shorter, broader and more vertical than the left.

VISION MISSION
A leading univerity in the Philippines recognized for its To develop competitive graduates and empowered community members by providing relevant,
proactive contribution to Sustainable Development through innovative and transformative knowledge, research, extension and production programs and services
equitable inclusive programs and services by 2030. through progressive enhancement of its human resource capabilities and institutional mechanism.
 Factors that May Jeopardize the Patency of the Airway:
1. Increased volume of mucous
2. Thick mucous
3. Fatigue or weakness.
4. Decreased level of consciousness.
5. Ineffective cough. Impaired airway.
6.

II. THE PLEURA – are serous membranes that enclose the lungs.
Visceral Pleura – directly covers the lungs.
Parietal Pleura – lines the cavity of each hemithorax.
Pleural Space – a potential space between the two pleurae. Only few ml of serous fluid is found in the
pleural space, to serve as lubricant.

III. THE LUNGS

Right Lung – broader but shorter due to the presence of the liver on the right side of the abdomen.
Right Lung has three lobes, while the left lung has two lobes.
Mediastinum – space that separates the two lungs.
There are approximately three hundred million alveoli in the lungs.
Residual Volume – amount of air that remains in the lungs after forceful expiration. It prevents collapse
of the lungs during expiration. (1,200 ml.)
Tidal Volume – amount of air that moves in and out of lungs with each normal breath. (500 ml.).
Inspiratory Reserve Volume – amount of extra air that can be inhaled, beyond the tidal volume.
Expiratory Reserve Volume – amount of extra air that can be exhaled after a normal breath.
Total Lung Capacity – the total of all four volumes (residual, tidal, inspiratory reserve volume, and
expiratory reserve volumes.)
Functional Residual Capacity – amount of air that remains in the lungs after normal exhalation.

IV. THE THORAX AND THE DIAPHRAGM

Thorax – provides protection for the lungs, heart and great vessels.
− Made up of 12 pairs of ribs, bounded anteriorly by the sternum and posteriorly by the thoracic
vertebrae.
Diaphragm – the main respiratory muscle for inspiration. It is supplied by the phrenic nerve. The
following are accessory muscles for inspiration used during increased work of breathing:
• Sternocleidomastoid ● Trapezius ● Scalene
• Pectoralis muscle ● Parasternal

V. RESPIRATORY CONTROL
a. Central Nervous System Control
• medulla oblongata ( central chemoreceptors)
• pons (apneustic center, pneumotaxic center)
b. Reflex Control
• cough reflex
c. Peripheral Control
• carotid and aortic bodies

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PLANNING
Measures That Promote Adequate Respiratory Function
1. Adequate oxygen supply from the environment. Man requires 21 % of oxygen from the
environment in order to survive. The higher the altitude, the lower is the oxygen concentration.
2. Breathing Techniques.
Deep breathing and coughing exercises
− To promote maximum lung expansion and to loosen mucus secretion.
− Inhale deeply through the nose, hold the breath briefly then, exhale passively through the mouth.
Incentive Spirometry
− A technique for deep breathing using a calibrated device, encourages patients to reach goals –
directed volume of inspired air.
− Done to enhance deep inspiration.
Pursed – Lip Breathing
− A form of controlled ventilation in which the expiration phase of breathing is consciously
prolonged, it is also another technique for improving gas exchange.
Diaphragmatic Breathing
− Breathing that promotes the use of the diaphragm rather than the upper chest muscles.
3. Positioning.
Semi Fowler’s or High Fowler’s position
− Promotes maximum lung expansion.
− By gravity, the diaphragm moves down, and abdominal organs do not compress the diaphragm.
Orthopneic position
− a seated position wherein the patient leans forward over the pillow, bed tray, or at the back of
the chair.
4. Patent airway. To promote gaseous exchange between the person and the environment.
Causes of Airway Obstruction
• Tongue (among unconscious clients, the tongue tends to fall back).
• Mucus secretions
• Edema of airways ( rhinitis, laryngitis, bronchitis)
• Spasm of airways (laryngospasm, bronchospasm)
• Foreign bodies (aspirated foods, fluids)
Airway obstruction is characterized by noisy breathing.
5. Adequate Hydration. To maintain moisture of the mucous membrane lining and respiratory tract.
This is necessary to prevent irritation and infection. Fluids also liquefy mucous secretion. Fluid
intake should ideally be 6 – 8 glasses of fluid, preferably water every day.
6. Avoid Environmental Pollutants, Alcohol & Smoking. These inhibit muco-ciliary function.
7. Chest Physiotherapy (CPT)
These procedures (PVD) are dependent nursing functions:
Percussion (clapping)
− Forceful striking of the skin with cupped hands.
− It can mechanically dislodge tenacious secretions from bronchial walls.
Vibration
− Series of vigorous quivering produced by hands that are placed flat against client’s chest wall.
− It is done to loosen mucous secretion.
Postural Drainage
− Expulsion of secretions from various lung segments by gravity.
− This involves placing client in different positions so that area of lung congestion will be in
vertical position with bronchus.
− This facilitates drainage by gravity.

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 - Each position during postural drainage will be assumed by the client for 10-15 minutes.
- The entire treatment should last only for 30 minutes.
- Gradual change of position should be observed to prevent exhaustion and postural
hypotension.
- Before postural drainage, bronchodilator medication or nebulization therapy is given to
loosen mucous secretions, as ordered.
- The best time to do postural drainage treatment is before meals, in the morning upon
awakening and at bedtime.
- Do not perform postural drainage immediately after meals because it may cause vomiting,
thereby aspiration.
- Provide good oral hygiene after the procedure. To remove unpalatable taste of the mucus
secretions from the mouth.
8. Bronchial Hygiene Measures
a. Steam Inhalation
Purposes:
1. To liquefy mucous secretions.
2. To warm and humidify inspired air.
3. To relieve edema of airways.
4. To soothe irritated airways.
5. To administer medications.

STEPS RATIONALE
1. Check the doctor’s order. • Dependent nursing function.
2. Inform the client and explain the purpose • To allay anxiety.
of the procedure.
3. Place the client in semi-fowler’s position. • For maximum inhalation of steam.
4. Cover the client’s eyes with wash cloth. • To prevent irritation.
5. Check the electrical device before use. • To prevent injury.
6. Place the steam inhalator in a flat, stable • To prevent scalding from the hot water.
surface.
7. Place the spout 12-18 inches away from the • To prevent moisture burns.
client’s nose or adjust the distance as
necessary.
8. Instruct the patient to perform deep • To facilitate expectoration of mucous
breathing and coughing exercises secretions.
9. Provide good oral hygiene after the • To remove unpalatable taste of sputum from
procedure. the mouth.
10. Do after care, wash hands. • To prevent transfer of microorganisms
11. Make relevant documentations. • To report client’s response to steam inhalation
and respiratory condition should further
treatment be necessary.
CAUTION: Avoid burns. Cover the chest with towel to prevent burns due to dripping of condensate
from the steam. Assess for redness on the side of the face which indicates first degree burns.
b. Aerosol Inhalation
• Done among pediatric clients to administer bronchodilators or mucolytic – expectorants.
c. Medimist Inhalation
• Done among adult clients to administer bronchodilators or mucolytic – expectorants.
9. Suctioning

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− A technique for removing the liquid secretions with a catheter using a negative (vacuum)
pressure.
− The amount of negative pressure varies depending on the patient and the type of suction
equipment.
− The airway is suctioned from the nose to the mouth.

Purpose of Suctioning:
1. To remove secretions obstructing the airway.
2. To facilitate respiration.
3. To obtain a specimen for diagnostic purpose.
4. To remove accumulated secretions that can cause infection.
5. To stimulate coughing and deep breathing.

Types of Suctioning Technique:

1. Nasopharyngeal Suctioning. Removal secretions from the throat through a nasally inserted
catheter.
2. Oropharyngeal Suctioning. Removal secretions from the throat through an orally inserted
catheter.
3. Oral Suctioning. Removal of secretions from the mouth. It is performed with a suctioning
device called Yankeur-tip or tonsil-tip catheter.
4. Tracheostomy Suctioning. Similar to nasotracheal suctioning except that the catheter is inserted
through the tracheostomy tube rather than the nose. The catheter is inserted approximately 4-5
inches (10-12.5 cm) or until resistance is felt.

Oropharyngeal and Nasopharyngeal Suctioning

ACTION RATIONALE
Assessment:
1. Assess indications for suctioning: − To determine the need for suctioning.
1. audible secretions during respiration
2. adventitious breath sounds (auscultated)
3. respiratory effort
4. oxygen saturation level
2. Determine how much the patient under − To provide opportunity for health teaching.
stands about suctioning the airway.
3. Inspect the nose to determine which nostril − To facilitate easy insertion of catheter.
to be used.
Planning:
1. Pressure of suction equipment − To prevent trauma to mucous membrane of
• Wall Unit: airways.
Adult: 100-120 mm Hg
Child: 95-110 mm Hg
Infant: 50-95 mm Hg
• Portable Unit:
Adult: 10-15 mm Hg
Child: 5-10 mm Hg
Infant: 2-5 mm Hg
2. Appropriate size of sterile suction − To promote comfort and prevent catheter
Adult: Fr. 12-18 trauma to mucous membrane of airways.
Child: Fr. 8-10
Infant: Fr. 5-8
3. Obtain a flask of sterile normal saline and − To provide items that are not prepackaged.
suction machine, if wall outlet is not
available.
4. Attach suction canister to wall outlet or − To provide source for negative pressure.
plug portable suction machine into an
electric outlet.

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5. Connect suction tubing to canister. − To provide the means for connecting the
canister to the suction catheter.
6. Turn on the suction machine, occlude the − To ensure safe pressure during suctioning.
suction tubing, and adjust the pressure
gauge to the desired amount.
7. Open the canister of saline. − To reduce the risk of contamination later.
Implementation:
1. Pull privacy curtain. − To demonstrate respect for patient’s dignity.
2. Position:
Conscious: Semi-Fowler’s position − To aid ventilation.
Unconscious: Lateral position
3. Pre-oxygenate the patient for 1-2 minutes − To reduce the risk of causing hypoxemia.
until SpO2 is maintained at 95%-100%.
4. Hand washing − To reduce transmission of microorganisms.
5. Open suction kit without contaminating the − Principles of asepsis.
contents.
6. Don sterile gloves. − To prevent introduction of microorganisms into
the respiratory tract.
7. Pour sterile normal saline into the basin − For wetting and rinsing the suction catheter.
with your non-dominant hand.
8. Pick up suction catheter with your sterile − To complete the circuit for applying suction
(dominant) hand and connect it to the
suction tubing.
9. Place the catheter tip in the saline and − To reduce friction and facilitate insertion.
occlude the vent.
• Nasopharyngeal suction tip
- Water – soluble lubricant
• Oropharyngeal suction tip
- Sterile water or NSS
10. Insert the catheter without applying suction − To reduce potential for sneezing & gagging.
along the floor of the nose or side of the
mouth.
11. Apply suction during withdrawal of the − To prevent trauma to the mucous membrane
suction catheter(never during insertion)
12. Advance catheter to depth: − To place the distal tip into the pharynx.
− 5-6 inches (12.5 -15 cm) in the nose
− 3-4 inches (7.5-10 cm) in the mouth
13. Encourage patient to cough if it does not − To break up mucus and raise secretions.
occur spontaneously.
14. Occlude air vent for no longer than 10 − To maximize effectiveness of suctioning.
seconds and rotate catheter as it is
withdrawn.
15. Complete suction process for 5-10 seconds − Over-suctioning causes hypoxia and vagal
(maximum of 15 seconds) stimulation.
16. Rinse secretions from the catheter by − To flush mucus from the inner lumen.
inserting the tip in the basin of saline and
applying suction.
17. Hyperventilate client with 100% oxygen − To prevent hypoxia
before and after suctioning
18. Allow 20-30 second interval between each − To bring up mucous secretions into the upper
suction airways, and prevent hypoxia
19. Provide oral and nasal hygiene −
20. Remove gloves to enclose suction catheter − To enclose soiled catheter, reducing
in an inverted glove. transmission of microorganisms.
21. Dispose contaminated equipment / articles − To prevent contamination of environment
safely.

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 • Use one sterile suction catheter for each
episode of suctioning.
22. Assess effectiveness of suctioning. − To determine if resuctioning is necessary.
• Auscultate chest for clear breath
sounds.
23. Document relevant data. − To report client’s response to suctioning and
client’s condition should further treatment be
necessary.

10. Intermittent Positive Pressure Breathing (IPPB)

• Done to administer oxygen at pressures higher than the atmospheric pressure.
11. Administration of Supplemental Oxygen
• Indication : hypoxemia
• Signs of Hypoxemia
− Cyanosis (late signs) − Rapid, shallow respiration and dyspnea
− Increased pulse rate − Substernal or intercostals retractions
− Light-headedness − Restlessness (initial sign)
− Flaring of nares

Oxygen Systems
1. Low flow administration devices
• Nasal Cannula – hollow tube with half inch prongs place into the patient’s nostrils. ( 24-45
% at 2-6LPM)
− May be used in clients with COPD at 2-3 L/min if venturi mask is not available.
• Mask
− Simple Face Mask ( 40-60 % at 5-8 LPM)
− Partial Rebreathing Mask – oxygen delivery device through which a patient inhaled a
mixture of atmospheric air oxygen from its source, or oxygen contained within a
reservoir bag.(60-90 % at 6-10 LPM)
− Non- Rebreathing Mask – oxygen delivery device through which all the exhaled air
leaves the mask rather than partially entering the reservoir bag. ( 95-100 % at 6-15 LPM)
• Croupette
• Oxygen Tent
2. High flow administration devices
• Venturi mask. Oxygen delivery device that mixes a precise amount of oxygen and
atmospheric air. Low – concentration venture –type mask is preferred for clients with COPD
because it provides accurate amount of oxygen. They require 2-3 LPM, or 28% oxygen.
• Face mask
• Oxygen hood. Can be used for low and high flow concentration.
• Incubator/Isolette. Can be used for low and high flow concentration.
NOTE: Oxygen is colorless, odorless, tasteless and dry gas that supports combustion.
Nursing Implications:
− Since oxygen is colorless, odorless, tasteless gas, leakage cannot be detected.
− Since oxygen is a dry gas, it can irritate mucous membrane of the airways.
− Since oxygen supports combustion, it can cause fire.
3. Equipment Used in Oxygen Administration:
a. Flow Meter – gauge used to regulate the amount of Oxygen delivered to the patient; it is
attached to the Oxygen source.
- The flow of Oxygen is measured in liters per minute (L / min.).
b. Oxygen Analyzer – device that measures the percentage of delivered oxygen.
- Used to determine whether patient is receiving the amount prescribed by the physician.

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 -Used often when caring for newborn in isolettes, children in croup tents, and patients
who are mechanically ventilated.
c. Humidifier – device that produces small water droplets.
- May be used during oxygen administration because oxygen has the tendency to dry
mucous membranes.
4. Oxygen Source:
a. Wall Outlet – Outlet is connected to large reservoir that is filled with oxygen in routine basis.
b. Portable Tanks – not piped into individual rooms.
- Also used when transporting patients.
- Made of steel cylinders that hold various volumes under extreme pressure.
- A large tank contains 2,000 lbs. of oxygen pressure per square inch.
c. Liquid Oxygen Unit – device that converts cooled liquid oxygen to a gas by passing it
through heated coils.
- It holds approximately 4-8 hours-worth of oxygen.
d. Oxygen Concentrator – a machine that collects and concentrates oxygen from room air and
stores it for patient use.
5. Oxygen Hazards:
a. Fire Potential – oxygen itself does not burn, but it does support combustion, thus it
contributes to the burning process.
- It is necessary to control all possible sources of open flames or ungrounded electricity.
b. Oxygen Toxicity – lung damage that develops when oxygen concentration of more than 50%
are administered for longer than 48 to 72 hours, it is a potential hazard.
Signs and Symptoms of Oxygen Toxicity:
− Non-productive cough – Nasal stuffiness
− Substernal chest pain – Fatigue
− Nausea and vomiting – Headache
− Hypoventilation – Sore throat

Nursing Planning, Interventions and Evaluation in Oxygen Therapy Administration:

ACTION
Assessment:
1. Perform physical assessment techniques
that focus on oxygenation. Assess signs
and symptoms of hypoxemia.
2. Check doctor’s order for type of oxygen
delivery device, liter flow or prescribed
percentage, and whether oxygen is to be
administered continuously or as needed.
3. Determine how much patient understands
about oxygen therapy.
Planning:
1. Obtain equipment, which includes a flow
meter, delivery device, and humidifier.
2. Explain procedure to patient.
3. Eliminate safety hazards that may support
a fire or explosion.
Implementation:
1. Wash your hands.
2. Position patient, preferably semi-Fowler’s
RATIONALE
− To provide baseline for future comparisons.
− To ensure compliance with plan for medical
treatment, because except in emergencies,
oxygen therapy is medically prescribed.
− To indicate the need for and type of teaching
that must be done.
− To promote organization and efficient time
management.
− To decrease anxiety and promote cooperation.
− To demonstrate concern for safety because
open flames, electrical sparks, smoking, and
petroleum products are contraindicated when
oxygen is in use.
− To reduce transmission of microorganisms.
− To enhance lung expansion and promote
ventilation.

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 3. Attach flow meter to oxygen source.
4. Fill humidifier bottle with distilled water
to appropriate level if administering 4 or
more Liter per minute.
5. Connect humidifier bottle to flow meter.
6. Attach distal end of tubing from oxygen
device to flow meter or humidifier bottle.
7. Open source of oxygen before insertion of
oxygen device.
8. Place a “No Smoking” sign at bed side.
9. Avoid use of oil, greases, alcohol and
ether near the client receiving oxygen.
10. Check electrical appliances before use.
− Avoid materials that generate static
electricity such as woolen blankets and
synthetic fabrics. Use cotton blankets.
11. Regulate oxygen flow accurately.
12. Turn on oxygen by adjusting flow meter to − To fill delivery device with O2 - rich air.
prescribed volume.
13. Note that bubbles appear in humidifier
bottle.
14. Attach delivery device to patient.
15. Drain any tubing that collects condensation. − To maintain a clear pathway for oxygen and
16. Remove oxygen delivery device and
provide skin, oral, and nasal hygiene at
least 4-8 hours.
17. Assess effectiveness of oxygen therapy.
− Check VS, especially RR; not quality
of respiration; evaluate arterial blood
gas results (ABG analysis).
− To provide means for regulating prescribed
amount of oxygen.
− To provide moisture because oxygen dries
mucous membrane.
− The potential increases with the percentage
being administered.
− To add moisture to oxygen.
− To provide a pathway for oxygen delivery from
its source to the patient.
− To check for malfunctioning of the device.
− Oxygen greatly accelerates combustion and
could cause fire from a small spark.
− These may further support combustion.
− Small spark may cause fire if there is leakage
of oxygen.
− Excessive oxygen administration can cause
oxygen narcosis (respiratory alkalosis).
− Indication that oxygen is being released.
− To provide oxygen therapy.
prevent accidental aspiration when turning
patient.
− To maintain intact skin & mucous membranes;
to reduce growth of microorganisms.
− To see how well the patient is responding to
oxygen therapy.

ALTERATIONS IN RESPIRATORY FUNCTIONS

1. Hypoxia
• Insufficient oxygen of tissues.
Clinical signs of Hypoxia
Early Signs Late Signs
1. Tachycardia 1. Bradycardia
2. Increased rate and depth of respiration 2. Dyspnea
3. Slight increase in systolic BP 3. Decreased systolic BP
4. Cough
5. Hemoptysis

Other Clinical Signs of Acute Hypoxia

− Nausea and vomiting – Headache
− Oliguria, anuria – Apathy
− Memory loss – Dizziness
− Irritability

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 Other Clinical Signs of Chronic Hypoxia
− Pulmonary ventilation increases – Clubbing of fingers
− Hgb concentration increases – Fatigue, lethargy
− RBC count increases

2. Altered Breathing Patterns

a. Rate
• Tachypnea - Rapid respiratory rate
• Bradypnea - Slow respiratory rate
• Apnea - Cessation of breathing
b. Volume
• Hyperventilation
- Excessive amount of air in the lungs.
- It results from deep rapid respirations.
• Hypoventilation
- Decreased rate and depth of respiration.
- It causes retention of carbon dioxide.
c. Rhythm
• Cheyne-stokes. Marked rhythmic waxing and waning of respiration from very deep to very
shallow breathing and temporary apnea.
• Kussmaul’s (Hyperventilation). Increased rate and depth of respiration, seen in metabolic
acidosis and renal failure.
• Apneustic. Prolonged gasping inspiration followed by a very short, usually inefficient
expiration.
• Biot’s. Shallow breaths interrupted by apnea.
d. Ease of Effort
• Dyspnea. Difficulty or labored breathing.
• Orthopnea. Inability to breathe except in upright or sitting position.

Submitted by: NRCM 0103 RLE – BSN I-B Instructors

JOCELYN F. VILLANUEVA, EdD, RN ROSITA D. VIANZON, RN, MAN

MA. ELENA O. AGUILAR, RN, MAN RUBY V. DAVID, RN MAN

GERARDO SALVADOR G. BALANA, RN, MAN

NRCM0103 - RLE 10