You are on page 1of 36

Chapter 38

Oxygenation and Perfusion

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Factors Essential to Normal Functioning
of the Respiratory System
• Integrity of the airway system to transport air to and
from lungs
• Properly functioning alveolar system in lungs
– Oxygenates venous blood
– Removes carbon dioxide from blood
• Properly functioning cardiovascular and hematologic
systems
– Carry nutrients and wastes to and from body cells

Copyright © 2015 Wolters Kluwer • All Rights Reserved

Upper Airway

• Function: warm, filter, humidify inspired air
• Components
– Nose
– Pharynx
– Larynx
– Epiglottis

Copyright © 2015 Wolters Kluwer • All Rights Reserved

Lower Airway • Functions: conduction of air. production of pulmonary surfactant • Components – Trachea – Right and left mainstem bronchi – Segmental bronchi – Terminal bronchioles Copyright © 2015 Wolters Kluwer • All Rights Reserved . mucociliary clearance.

Copyright © 2015 Wolters Kluwer • All Rights Reserved .Anatomy of the Lungs • Main organs of respiration • Extend from the base of the diaphragm to the apex above the first rib • The right lung has three lobes. the left lung has two. pleura). surfactant. • The lungs are composed of elastic tissue (alveoli.

gas exchange • Perfusion.moving air in and out of lungs • Respiration.oxygenation of all body tissues Copyright © 2015 Wolters Kluwer • All Rights Reserved .Functions of the Respiratory System • Ventilation.

Pulmonary Ventilation • Inspiration: the active phase of ventilation – Involves movement of muscles and the thorax to bring air into the lungs • Expiration: the passive phase of ventilation – Movement of air out of the lungs Copyright © 2015 Wolters Kluwer • All Rights Reserved .

Copyright © 2015 Wolters Kluwer • All Rights Reserved . lengthening the thoracic cavity. enlarging the chest from front to back • Increased lung volume and decreased intrapulmonic pressure allow air to move from an area of greater pressure (outside lungs) to lesser pressure (inside lungs). • The sternum is pushed forward. • The relaxation of these structures results in expiration.Process of Ventilation • The diaphragm contracts and descends. • The external intercostal muscles contract. lifting the ribs upward and outward.

Gas Exchange (Respiration) • Refers to the intake of oxygen and release of carbon dioxide • Made possible by respiration and perfusion • Occurs via diffusion (movement of oxygen and carbon dioxide between the air and blood) Copyright © 2015 Wolters Kluwer • All Rights Reserved .

• Most oxygen (97%) is carried by red blood cells in the form of oxyhemoglobin.Perfusion • Oxygen is carried in the body via plasma and red blood cells.Transport of Respiratory Gases. Copyright © 2015 Wolters Kluwer • All Rights Reserved . • Internal respiration between the circulating blood and tissue cells must occur. • Hemoglobin also carries carbon dioxide in the form of carboxyhemoglobin.

Factors Influencing Diffusion of Gases in the Lungs • Change in surface area available • Thickening of alveolar-capillary membrane • Partial pressure • Solubility and molecular weight of inhaled air/gas • Any alteration in ventilation or gas exchange may affect tissue perfusion – Hypoxia: inadequate amount of oxygen available to the cells – Dyspnea: difficulty breathing – Hypoventilation: decreased rate or depth of air movement into the lungs Copyright © 2015 Wolters Kluwer • All Rights Reserved .

force blood out of the heart through the arteries (the left and right pulmonary arteries and the aorta). receive blood from the veins (the superior and inferior vena cava and the left and right pulmonary veins). atrium). muscular pump. divided into four hollow chambers • The upper chambers. the atria (singular. • The lower chambers.Cardiovascular System • Vital for exchange of gases • Composed of the heart and the blood vessels – The heart is a cone shaped. Copyright © 2015 Wolters Kluwer • All Rights Reserved . the ventricles.

The Conducting System of the Heart Copyright © 2015 Wolters Kluwer • All Rights Reserved .

Alterations in the Cardiovascular System • Dysrhythmia or arrhythmia • Myocardial ischemia • Angina • Myocardial infarction • Heart failure Copyright © 2015 Wolters Kluwer • All Rights Reserved .

Factors Affecting Cardiopulmonary Functioning and Oxygenation • Level of health • Developmental considerations • Medication considerations • Lifestyle considerations • Environmental considerations • Psychological health considerations Copyright © 2015 Wolters Kluwer • All Rights Reserved .

and aspiration is a potential problem.Development: Respiration in the Infant • Lungs are transformed from fluid-filled structures to airfilled organs. Copyright © 2015 Wolters Kluwer • All Rights Reserved . • Synthetic surfactant can be given to the infant to reopen alveoli. • Crackles heard at the end of deep respiration are normal. • Respiratory rate is rapid and respiratory activity is primarily abdominal. airways are short. • The infant’s chest is small.

the immune system protects from most infections.Development: Respiration in the Child • Some subcutaneous fat is deposited on the chest wall. • Eustachian tubes. • Good hand hygiene and tissue etiquette are encouraged. • The average number of routine colds and infections decreases until children enter daycare or school. bronchi. making landmarks less prominent. and bronchioles are elongated and less angular. • By the end of late childhood. Copyright © 2015 Wolters Kluwer • All Rights Reserved .

Copyright © 2015 Wolters Kluwer • All Rights Reserved . • Older adults have an increased risk for disease. especially pneumonia. diaphragm moves less efficiently. • Barrel chest deformity may result in increased anteroposterior diameter. • Kyphosis contributes to appearance of leaning forward.Development: Respiration in the Older Adult • Bony landmarks are more prominent due to loss of subcutaneous fat. • Tissues and airways become more rigid.

• Make use of aids to improve intake of air and effects on patient’s lifestyle and relationship with others. • Identify current or potential health deviations.Nursing Process: Guidelines for Obtaining a Nursing History • Determine why the patient needs nursing care. • Determine what kind of care is needed to maintain a sufficient intake of air. Copyright © 2015 Wolters Kluwer • All Rights Reserved . • Identify actions performed by the patient for meeting respiratory needs.

respiratory pattern • Palpation – Evaluate for masses. capillary refill • Percussion • Auscultation – Anterior. posterior. skin/mucous membrane color. pain. and lateral sounds Copyright © 2015 Wolters Kluwer • All Rights Reserved .Respiratory System • Inspection – Assess for symmetry.Physical Assessment. skin temp. chest size and shape.

soft sound during expiration heard over most of the lungs • Bronchial: high-pitched and longer. heard over the upper anterior chest and intercostal area Copyright © 2015 Wolters Kluwer • All Rights Reserved .Breath Sounds • Vesicular: low-pitched. heard primarily over the trachea • Bronchovesicular: medium pitch and sound during expiration.

medium. or coarse • Wheezes: continuous sounds heard on expiration and sometimes on inspiration as air passes through airways constricted by swelling. secretions. or tumors – Classified as sibilant or sonorous Copyright © 2015 Wolters Kluwer • All Rights Reserved .Abnormal (Adventitious) Lung Sounds • Crackles: intermittent sounds occurring when air moves through airways that contain fluid – Classified as fine.

Common Diagnostic Methods to Assess Cardiopulmonary Function • Labs – CBC. lipids • Electrocardiogram • Cardiac coronary catheterization • Cardiac exercise stress testing • Echocardiogram • Endoscopic studies • Holter monitor • Lung scan.Mantoux • Radiography. cardiac enzymes.V/Q scan (ventilation/perfusion) • Skin tests. ABG.chest X-ray Copyright © 2015 Wolters Kluwer • All Rights Reserved .

normal inhale and exhale • Vital Capacity (VC).Values Measured from Pulmonary Function Tests • Tidal Volume (TV).total exhale after full inhale • Forced Vital Capacity (FVC) • Forced Expiratory Volume (FEV) • Total Lung capacity (TLC) • Residual Volume (RV).remaining air in lungs • Peak Expiratory Flow Rate (PEFR) Copyright © 2015 Wolters Kluwer • All Rights Reserved .

flu • Promoting comfort • Promoting proper breathing • Managing chest tubes • Promoting and controlling coughing • Suctioning the airway • Meeting oxygenation needs with medications Copyright © 2015 Wolters Kluwer • All Rights Reserved .Nursing Intervention: Promoting Adequate Respiratory Functioning • Teaching about a pollution-free environment • Promoting optimal function • Vaccinations.pneumonia.

Nursing Intervention: Promoting Comfort • Positioning • Maintaining adequate fluid intake • Providing humidified air • Maintaining good nutrition • Pacing physical activities Copyright © 2015 Wolters Kluwer • All Rights Reserved .

Nursing Intervention: Promoting Proper Breathing • Deep breathing • Using incentive spirometry • Pursed-lip breathing • Diaphragmatic breathing • Controlling cough • Performing chest physiotherapy • Airway suctioning • Supplemental oxygen • CPAP and BiPAP Copyright © 2015 Wolters Kluwer • All Rights Reserved .

Types of Cough Medications • Cough suppressants • Expectorants • Lozenges Copyright © 2015 Wolters Kluwer • All Rights Reserved .

Administering Inhaled Medications • Bronchodilators: open narrowed airways • Nebulizers: disperse fine particles of liquid medication into the deeper passages of the respiratory tract • Meter-dose inhalers: deliver a controlled dose of medication with each compression of the canister • Dry powder inhalers: breath-activated delivery of medications Copyright © 2015 Wolters Kluwer • All Rights Reserved .

Oxygen Delivery Systems • Nasal cannula • Nasopharyngeal catheter • Transtracheal catheter • Simple mask • Partial rebreather mask.up to 5LPM Copyright © 2015 Wolters Kluwer • All Rights Reserved .highest O2 concentration • Venturi mask.collection bag to rebreathe • Nonrebreather mask.delivers exact O2 concentrations • Tent • Concentrator.

• Avoid wearing and using synthetic fabrics (builds up static electricity). • Check to see that electrical equipment in the room is in good working order.Precautions for Oxygen Administration • Avoid open flames in the patient’s room. • Place “no smoking” signs in conspicuous places. Copyright © 2015 Wolters Kluwer • All Rights Reserved . • Avoid using oils in the area (oils ignite spontaneously in oxygen).

• Monitor the patient’s respiratory status and vital signs. • Check the dressing. • Maintain the patency and integrity of the drainage system. • Measure drainage • Have emergency clamp and occlusive dressing at bedside • Never tip collection box Copyright © 2015 Wolters Kluwer • All Rights Reserved .Managing Chest Tubes • Assist with insertion and removal of the chest tube.

surgically inserted. cuffed or cuffless Copyright © 2015 Wolters Kluwer • All Rights Reserved .Type of Artificial Airways • Oropharyngeal and nasopharyngeal airway.nasal or oral usually cuffed. temporary • Tracheostomy tube.to maintain a patent airway • Endotracheal tube.

Two Types of Tracheostomy Sets: Cuffless and Cuffed Copyright © 2015 Wolters Kluwer • All Rights Reserved .

If the victim has no pulse. • Defibrillation: Apply the AED as soon as it is available.Administering Cardiopulmonary Resuscitation (CAB) • Chest Compressions: Check the pulse. • Airway: Tilt the head and lift the chin. give two breaths lasting 1 second each. Copyright © 2015 Wolters Kluwer • All Rights Reserved . • Breathing: If the victim does not start to breathe spontaneously after the airway is opened. initiate chest compressions to provide artificial circulation. check for breathing. The respiratory tract must be opened so that air can enter.

Planning: Expected Outcomes • Demonstrate improved gas exchange in lungs by absence of cyanosis or chest pain and a pulse oximetry reading >95%. • Relate the causative factors and demonstrate adaptive method of coping. Copyright © 2015 Wolters Kluwer • All Rights Reserved . • Preserve pulmonary function by maintaining an optimal level of activity. • Demonstrate self-care behaviors that provide relief from symptoms and prevent further problems.