FOREWORD

Praise the presence of God Almighty over all the abundance of Grace, Inayah, Taufik
and His Hinayah so that we can complete the preparation of this paper in the simplest form and
contents. Hopefully this paper can be used as a reference,and guidance for readers in the
administration of education in the nursing profession.

We hope this paper will help increase the knowledge and experience for the readers so
that we can improve the form and content of this paper so that the future can be better.

We recognize that our paper is still many shortcomings because our experience is very
lacking. Therefore we expect the readers to provide constructive inputs for the perfection of this
paper.

Semarang, September 2017

Authors
 TABLE OF CONTENTS

FOREWORD................................................................................................................................. .2
TABLE OF CONTENTS ........................................................................................................... 3
CHAPTER I INTRODUCTION ............................................................................................ ..4-5
1.1 BACKGROUND
1.2 PROBLEM FORMULATION
1.3 WRITING OBJECTIVES
1.4 BENEFITS

CHAPTER II DISCUSSION ................................................................................................. .6-12

CHAPTER III CLOSING ......................................................................................................... 13
BIBLIOGRAPHY ................................................................. …………………………………...14
CHAPTER I
PRELIMINARY

1.1 Background

Oxygen (O2) is a component of gas that plays an important role in the body's metabolic
processes to maintain the viability of all body cells normally.

Lack of oxygen will cause a significant impact on the body, one of them death.
Therefore, efforts should always be made to ensure that these basic needs are met well. In
practice, the fulfillment of these basic needs goes into the field of nurse work. Therefore, every
nurse must be familiar with the manifestation of oxygen fulfillment level to his client and able to
overcome various problems related to the fulfillment of those needs. For that, nurses need to
understand in depth the concept of oxygenation in humans.

2.2 Problem Formulation

1. What is oxygenation requirement?

2. What are the body systems that play a role in the need for oxygenation?
3. How is oxygenation process?
4. What are the factors that affect oxygenation?
5. How many different types of breathing?
6. What is the measurement of lung function?
7. What are the oxygenation needs?
8. What are the risk factors for meeting oxygen needs?

2.3 Purpose of Writing

• To know the things related to the needs of oxygenization

• To know the type of breathing and lung function measurement
• To know the nursing process on the problem of oxygenization needs
• Knowing about the various risk factors for oxygen fulfillment.

2.4 Benefits

This paper is made by us to minimize errors in nursing practice actions caused by the lack of
understanding in the need for oxygenation in nursing so it has a major impact on the life of the
client.
CHAPTER II
DISCUSSION

2.1 Definition of oxygenation requirement.

The basic concept of oxygenation.

Oxygenation is the process of adding O2 into the system (chemistry or physics). Oxygen (O2) is
a colorless and odorless gas that is needed in cell metabolism processes. As a result, carbon
dioxide, energy, and water are formed. However, the addition of CO2 beyond the normal limits
of the body will have a significant impact on cell activity.
Fulfilling the need for oxygen is part of the physiological needs according to Maslow's hierarchy.
The need for oxygen is necessary for life processes. Oxygen is instrumental in the body's
metabolic processes. Oxygen needs in the body must be met because if the oxygen needs in the
body is reduced it will be damage to the brain tissue and if it lasts long will happen death.
Systems that play a role in the process of fulfilling needs is the respiratory system, persyarafan,
and cardiovascular.
The capacity of the air in the lungs is 4,500-5,000 ml (4.5-51). The air that is processed in the
lungs is only about 10% (approximately 500 ml), which is inhaled (inspired) and which is
breathed (expiratory) on ordinary breathing.

2.2 Body systems that play a role in oxygenation requirements.

The human respiratory system has respiratory organs that support the respiratory process. The
respiratory organs have different structures and functions. Human respiratory organs consist of
nose, pharynx, larynx, trachea, bronchus, and alveous. How does the structure and function of
each respiratory organ play a role in the process of oxygenation? Consider the following
explanation.

a. Nose Breathing Organs

            The nose is the first air-breathing device to pass through. The tip of the nose is supported
by cartilage and the base of the nose is supported by the nasal bone. Both the nasal bones
connect the nasal cavity with the atmosphere to take air. The nasal cavity is composed of flat-
coated epithelial cells with coarse hair. The rough hairs serve to filter out the rough dust. The
nasal cavity is composed of epileptic ciliated epithelial cells that have goblet cells. Goblet cells
are mucus-producing cells that act to filter out the dust, attach the dirt to the hair of the nose, and
regulate the air temperature of the breath. As a sense of smell, on the roof or nasal cavity there is
an olfactory lobe containing the smell cells. Air travel enters the lungs starting as the air passes
through the nostrils. In the nostrils, air is filtered by the hairs in the nostrils. The air also becomes
warmer as it passes through the inner nasal cavity. In the inner nasal cavity, there are also nerve
endings that can capture the chemicals contained in the air so we know the various smells. The
ends of the olfactory nerve will then send the impulses to the brain.

b. Respiratory Organs Faring.

            Once through the nasal cavity, the air will pass through the pharynx. The pharynx is a
branch between the gastrointestinal tract (esophagus) and the respiratory tract (larynx and
trachea) of approximately 12.5-13 cm in length. The pharynx consists of three parts, the
nasopharynx, the oropharynx, and the laryngopharynx. Faring is a meeting between the
respiratory tract and the gastrointestinal tract. Therefore, when swallowing food, a valve
(epiglottis) will close the respiratory tract (glottis) so that food will enter the gastrointestinal
tract. In this branch, there is an epiglottic valve that prevents food from entering the trachea.

c. Larynx
            After passing through the pharynx, air will go to the larynx. The larynx is often referred
to as the voice box because it contains the vocal cords. The larynx is a conduit surrounded by
nine cartilages. One of the nine cartilage is a shaped thyroid cartilage resembling a shield. In
adult males, the thyroid cartilage is larger than that of a woman so as to form what is called the
Adam's apple.

d. Tracheal Respiratory Organs.

            From the pharynx, the air passes through the larynx, where the vocal cords are located.
From the larynx, air enters the trachea. Trachea is also called "wind pipe" or air duct. Trachea
has a length of approximately 11.5 cm with a diameter of 2.4 cm. The trachea is made up of four
layers, the mucosal layer, the submucosal layer, the cartilage layer, and the adventitia layer. The
mucosal layer is composed of ciliated quilted epithelial cells containing mucus-producing goblet
cells (mucus). Cilia and mucus function to filter out dust or dirt coming in. The submucosal layer
is composed of connective tissue. The cartilage layer consists of approximately 18 cartilage in
the form of letter C. The adventitia layer consists of connective tissue. The trachea wall is coated
by many ciliated false epic ciliated. This epitel secretes mucus in the tracheal wall. This mucus
serves to hold up the foreign object that is on the epithelial cell membrane.

e. Bronchus and Bronchiolus.

            After going through the trachea, the channel bifurcated. Both branches are called
bronkus. Each bronchus is connected to the right and left lung. The bronchus branches again, the
smaller branches are called bronchioles. The bronchial wall is also coated with epithelial cell
layer of cylindrical ciliated coating. Around the alveolus there are capillaries of blood vessels.
The blood vessel capillary wall is so close to the alveolus that it forms a very thin, respiratory
membrane. This thin membrane allows for diffusion between alveolar air and blood in blood
vessel capillaries. Bronchus, bronchial, and alveolus form a structure called the lung.
            The human lung consists of about 300 million alveoli, which is a cup-shaped sac
surrounded by capillary tissue. The red blood cells pass through the capillaries in a single file,
and the oxygen from each alveolus enters the red blood cells and binds to hemoglobin. In
addition, the carbon dioxide contained in the plasma and red blood cells leave the capillaries and
enter the alveoli when the breath is taken. Most carbon dioxide reaches the alveoli as bicarbonate
ions, and about 25 percent alone is loosely bound to hemoglobin.

e. Alveolus.
            Bronchiolus leads to alveoli (single: alveolus), a small ball-shaped structure covered by
blood vessels. The flat epithelium lining the alveoli makes it easier for blood in the blood
capillaries to bind the oxygen from the air in the alveolar cavity.
            When a person inhales, the ribs and diaphragm muscles contract, thereby increasing the
volume of the chest cavity. This increase causes a decrease in air pressure in the chest cavity, and
air rushes into the alveoli, forcing them to expand and replenish. The passive lungs acquire air
from the environment by this process. During respiration, the ribs and diaphragm muscles relax,
the chest cavity is reduced, and increases internal air pressure. The compressed air forces the
alveoli to close, and air flows out.
            Nerve activity that controls breathing arises from impulses transported by nerve fibers
passing into the chest cavity and ending in the ribs and diaphragm muscles. This drive is
regulated by the amount of carbon dioxide in the blood: high concentrations of carbon dioxide
lead to an increase in the number of nerve impulses and higher respiratory rate.

 2.3 Process of oxygenation.

          
  Breathing / breathing is a process of air exchange between individuals and the
environment where inhaled O2 (inspiration) and CO2 are expendable (expiration).
The process of breathing consists of 3 parts, namely:
1. Ventilation is the entry and exit of atmospheric air from the alveolus to the lungs or vice
versa.
 The process of escaping lung air depends on the pressure difference between atmospheric air
and alveoli. On inspiration, chest, expands, diaphragm down and lung volume increases. While
expiration is a passive movement.
Factors that affect ventilation:
a. Atmospheric air pressure
b. A clean airway
c. Adequate lung development

2. Diffusion is the exchange of gases (oxygen and carbon dioxide) between the alveoli and the
lung capillaries.
          
    The process of outflow of air from the blood pressure / concentration is greater to the blood
with pressure / lower concentration. Because the walls of the alveoli are very thin and are
surrounded by tightly enclosed capillary blood vessels, they are sometimes called respiratory
membranes.
     The pressure difference on the gases present on each side of the respiratory membrane greatly
affects the diffusion process. Normally the oxygen-pressure gradient between the alveoli and the
blood entering the pulmonary capillaries is about 40 mmHg.
Factors that affect diffusion:
a. The surface area of the lung
b. Thickness of the respiratory membrane
c. The amount of blood
d. The circumstances / amount of blood capillaries
e. Affinity
f. Time of air in the alveoli
3. Transport is the transport of oxygen through the blood to the body tissue cells and vice versa
carbon dioxide from body tissues to capillaries.
Oxygen needs to be transported from the lungs to the tissues and carbon dioxide must
be transported from the tissue back to the lungs. Normally 97% of oxygen binds to hemoglobin
in red blood cells and is brought into tissue as oxyhemoglobin. The remaining 3% is transported
into plasma fluids and cells.
In the other literature it is said that the oxygenation process is divided into 4 parts:
1. Ventilation: The process of entering the air through the nose.
2. Diffusion: The exchange process of O2 and CO2 produces O2 that occurs in the capillary
alveoli membrane.
3. Transportation: The process of spreading O2 throughout the body.
4. Perfusion: The process of exchange of O2 and CO2 produces CO2 that occurs in the
capillaries.
2.4 Factors affecting oxygenation.
The body's need for oxygen is not fixed, at any time the body needs a lot of oxygen, for a reason.
Oxygen needs in the body is influenced by several factors, including the environment, exercise,
emotions, lifestyle and health status.
1. Environment
In hot environments the body responds to the occurrence of peripheral blood vessel vasodilation,
resulting in much blood flowing to the skin. This results in much heat being released through the
skin. Such a response causes increased cardiac output and increased oxygen demand. Conversely
in cold environments, blood vessels constrict and decrease blood pressure to decrease the heart's
work and oxygen demand.
The environmental influence on oxygen is also determined by the height of the place. At high
places the barometer pressure will drop, so the oxygen tension also goes down. The implication
is that if a person is in a high place, for example at an altitude of 3000 meters above sea level, the
oxygen tension of the alveoli is reduced. This indicates the oxygen content in the lungs is small.
Thus, in high places the oxygen content is reduced. The higher a place, the less oxygen content,
so someone who is in a high place will experience lack of oxygen.
In addition, the levels of oxygen in the air are also affected by air pollution. Air is inhaled in air
polluted environments, low oxygen concentrations. This causes the oxygen demand in the body
is not met optimally. The body's response to the air pollution environment include sore eyes,
headache, dizziness, cough and feel choked.
2. Exercise
Physical exercise or increased activity can increase heart rate and respiration rate so that the need
for oxygen is higher.
3. Emotions
Fear, anxiety, and anger will speed up the heart rate so that the need for oxygen increases.
4. Lifestyle
Smoking habits will affect one's oxygenation status because smoking can aggravate coronary
artery disease and arterial blood vessels. Nicotine contained in cigarettes can cause vascular
constriction of peripheral blood vessels and coronary blood vessels. As a result, the blood supply
to the tissues decreases.
5. Health Status
In healthy people, the cardiovascular system and respiratory system function properly so as to
meet the body's oxygen demand adequately. Conversely, people who have heart disease or
respiratory diseases can experience difficulties in fulfilling the body's oxygen needs.
The body's need for oxygen is not fixed, at any time the body needs a lot of oxygen, for a reason.
Oxygen needs in the body is influenced by several factors, including the environment, exercise,
emotions, lifestyle and health status.

2.5 Respiratory type.

Based on the organs involved in inspirational and expiratory events, people often refer to chest
and abdominal breathing. Actual respiratory and abdominal breathing occurs simultaneously. For
more details please note the following description.

1. Chest breathing
Chest breathing is the breathing that involves the muscles between the ribs. The mechanism can
be distinguished as follows.
1. The inspiration phase. This phase is in the form of muscle contraction of the ribs so that the
chest cavity enlarges, consequently the pressure in the chest cavity becomes smaller than outside
pressure so that oxygen-rich outer air comes in.
2. Expiration phase. This phase is the phase of relaxation or the return of muscles between the
ribs to the original position followed by the decline of the ribs so that the chest cavity becomes
small. As a result, the pressure inside the chest becomes bigger than the outside pressure, so the
air in the chest cavity is rich in carbon dioxide out.
• Chest breathing inspiratory mechanisms are as follows:
The intercostal muscle of the ribs (the external intercostal muscle) contracts -> raised rib (flat
position) -> The lungs expand -> the air pressure in the lungs becomes smaller than the outside
air pressure -> the outside air enters the lungs.
• The respiratory expiratory mechanism of the chest is as follows:
Muscle ribs relaxation -> ribs decrease -> lungs shrink -> the air pressure in the lungs is greater
than the outside air pressure -> air out of the lungs.

2. Abdominal breathing
Abdominal breathing is the breathing that involves the diaphragm muscles. The mechanism can
be distinguished as follows.
1. The inspiration phase. This phase of the diaphragm muscle berkontraksinya so that the chest
cavity enlarged, consequently the pressure in the chest cavity becomes smaller than outside
pressure so that oxygen-rich outside air entering.
2. Expiration phase. This phase is the phase of relaxation or return of the diaphragic muscle to its
original position followed by the decrease of the rib cage so that the chest becomes small. As a
result, the pressure inside the chest becomes bigger than the outside pressure, so the air in the
chest cavity is rich in carbon dioxide out.
• The respiratory stomach inspiration mechanism is as follows:
chest cavity (diaphragma) contracts -> position from curved to horizontal -> expanded lungs ->
air pressure in lungs smaller than outside air pressure -> intake air
• The abdominal respiratory expiratory mechanism is as follows:
muscle diafraghma relaxation -> position of the horizontal back arched -> deflate lung -> air
pressure in the lungs is bigger than the outside air pressure -> air out of the lungs.

2.6 Measurement of lung function.

Pulmonary function tests (PFTs) - as the name implies - tests designed to measure and
assess lung function. PFTs were initially research tools, which were available only in educational
hospital centers. Now these tools are widely available and often used because of their benefits in
the diagnosis and treatment of asthma. Keep in mind when you read the results of tests on PFT
tests that the lung function abnormalities seen in active asthma are reversible.
The term PFTs is used to describe collectively some specific tests different from lung
function. Spirometry is the most useful PFTs when used in the diagnosis and treatment of
asthma. Spirometry, in turn, includes two important subtests. The first is called an expired peak
current called PEF. The second one is FEV1, the expiratory volume of coercion in 1 second. The
PEF and FEV1 measurements are the parts or subtests of the spirometry PFTs. The availability
of inexpensive, highly portable, and peak flow monitors every day to monitor asthma activity.
Measurements FEV1, on the other hand, require the use of a spirometer, which is more
expensive, requires special care, and is not currently recommended for home use. PEF
monitoring alone provides asthma sufferers with knowledge of the condition and allows
assessment of asthma control. Both PEF and FEV1 play a very important role in the National
Program for Asthma Education and Prevention (NAEPP), ranging from asthma diagnosis,
classification, and treatment guides.
To perform spirometry and PEF, the first patient is asked to take a deep breath. Then,
the largest single greatest exhale strongly and quickly into the mouth is connected to the
spirometer or peak flow meter. This maneuver is repeated several times during tests to ensure
accurate and reproducible values. Spirometers measure lung volume during respiratory
secretions, as well as airflow through the mouth during exhalation time. Spirometry
measurements are recorded by the spirometer, printed and drawn for future reviews and
references. Each patient's measurement result is compared to the predicted value. The predicted
value of pulmonary function tests is based on three variables: age, height, and sex. The
prediction value is different for a 21-year-old man, 182.88 cm tall than a female, 64 years old
with a height of 152.40 cm. This means that the value of PEF (and FEV1) considered to be
within normal limits for the elderly, short, asthmatic woman above, would be abnormally low if
applied to high men, adolescents, asthmatics, even though they are both asthmatics.
Because asthma is characterized as a lung discharge disease, with abnormally
prolonged abnormal lengths of asthma symptoms. Anyone with active asthma who tries to blow
out all the candles on a birthday cake with a strong airflow knows there will be a direct lung
disruption! Depending on the degree of asthma and other factors, such as how much airway
constriction, or bronchospasm, if any, full exhalation during spirometry examination may last for
14 seconds while normal, 5 to 6 seconds. The FEV, and PEF values reflect the efficiency and
levying status of the lung, and thus provide information about how an asthma's lung function is
affected by its condition.
FEV1 measures the amount (volume) of air exhaled in the first second of the forced
exhalation during spirometry examination as you exhale as strongly and as quickly as you can
after you take a deep breath. When asthma symptoms are so out of control, it takes longer than
expected for the lungs to become completely empty. Because the total prolongation of asthma
and asthma is inadequately controlled, the amount (volume) of air exhaled during the first second
of the exhale is lower than expected. Decreased FEV1 occurs in uncontrolled asthma or asthma
symptoms. With treatment, lung emptying is more efficient, and FEV values return to normal
limits. When asthma symptoms are suspected, spirometry is performed before and after the
inhalation of short-acting bronchodilator drugs to achieve normal FEV1 states, this phenomenon
is called reversibility. The most up-to-date guidelines of the third EPR (Expert Panel Report)
from the National Institute of Heart, Lung and Blood define an increase of 12% or more of the
FEV1 references in spirometry after the use of bronchodilators was a significant response.
When asthma is in active condition or in a state of exacerbation of asthma will prolong
the exhalation, the air flow through the narrowed airways becomes reduced. Spirometry
examination in people with active asthma also shows reduced air flow rate. Peak current is the
single highest value of current measurements that occur when the lungs start to empty.
Peak currents reflect the flow of air through a more extended channel, called the airway
conduction in asthma. Peak currents usually track the activity of asthma. Peak home monitoring
allows for comparison of PEF predictions of a person, with the actual personal best measurement
results obtained when asthma is well controlled. Monitoring PEF at home can then help identify
even for mild exacerbations and guide adjustment of up or down treatment, depending on how
PEF values fluctuate from the best personal measurements. The results of self-administered PEF
measurements over time are components of an asthma action plan.
Peak flow meter is an easy-to-use device, designed to help you assess your asthma
control level. Persons suffering from moderate or severe persistent asthma, people with a history
of severe exacerbations, and people who have difficulty understanding when their asthma
worsens, most likely to benefit from monitoring this peak flow alone. Long-term monitoring,
daily peak flow measurements can detect early changes in asthma controls that require
adjustment in treatment and help measure response to treatment changes. Asthma monitoring
alone should not interfere. In contrast, daily peak monitoring at home has been shown to improve
asthma control, reduce exacerbations, and reduce absenteeism in schools and workplaces. Using
peak monitoring can also increase your confidence as it helps you learn how to optimize asthma
control and achieve better asthma control. Most children can accurately measure their peak
currents under the guidance of adults ranging in age from about 6 years of age. Peak monitoring
is also possible to make an objective decision to modify your asthma regimen based on the
information contained in the written asthma action plan your doctor has provided.
If your doctor prescribes for peak flow monitoring at home, you will be asked to
determine the personal best value based on the measurements obtained when you are in good
condition and symptom free. The asthma action plan provides clues about what asthma
medications are taken as peak current values, including in one of three zones labeled green,
yellow, or red. The green zone includes peak flow measurements in the range of 80 - 100% of
your best personal. Yellow is related to peak current measurements in the range 60 - 80% of the
best personal value. The red zone includes all peak current values below 60% of the best. Peak
flow measurements in the red zone indicate that your asthma is very uncontrolled, and you need
to contact your doctor, proceed to the emergency room, or both.
2.7 Problem of oxygen demand.
The problem of oxygen demand refers to the frequency, volume, rhythm, and respiratory effort.
Normal breathing patterns are characterized by quiet, rhythmic breathing, with no effort.
Changes in respiratory patterns that often occur as follows:
a. Hypoxia
Hypoxia is an inadequate condition of the fulfillment of oxygen demand in the body due to
oxygen deficiency or increased use of oxygen in the cell, so that it can appear as a sign of bluish
skin (cyanosis).

b. Changes in Respiratory Patterns

1. Tachypnoea, is breathing with frequency more than 24 times per minute. This process occurs
because the lungs in the state of atelektaksis or emboli occur.
2. Bradipnea, is a slowly abnormal breathing pattern, ± 10 times per minute. This pattern can be
found in situations of increased intracranial pressure accompanied by narcotics or sedatives.
3. Hyperventilation, is the way the body compensates for a higher body metabolism with faster
and deeper breathing, resulting in an increase in the amount of oxygen in the lungs. This process
is marked by an increase in pulse rate, shortness of breath, the presence of chest pain, decreased
CO2 concentration and others.
4. Kussmaul, is a rapid and shallow breathing pattern that can be found in people in a state of
metabolic acidosis.
5. Hypoventilation, is the body's attempt to extract enough carbon dioxide at the time of alveolar
ventilation, and insufficient amount of air entering the alveoli in the use of oxygen.
6. Dyspnea, is breathless and severe during respiration. This can be caused by changes in blood
gas levels / tissues, heavy work / drills, and psychic influences.
7. Orthopnea, is a difficulty breathing except in a sitting or standing position and this pattern is
often found in someone who has congestive lungs.
8. Cheyne stokes, is the breathing cycle of the amplitude of the first nik then decreases and stops,
then the breathing begins again from the new cycle. Periods of apnea recur regularly.
9. Paradoxical breathing, is a breathing in which the lung wall moves in the opposite direction
from the normal state. Often found in the state of atelectasis.
10. Biot, is a breathing with a rhythm similar to that ofcheyne stokes, but its amplitudes are
irregular.
11. Stridor, is a respiratory noise that occurs due to narrowing of the respiratory tract. It is
generally found in cases of tracheal spasms or laryngeal obstruction
c. Airway obstruction
Airway obstruction is a condition with respiratory threats, related to the inability to cough
effectively. This is caused by a thick or excessive secretion from infectious diseases,
immobilization; static skill; and cough is not effective because of neurological diseases such as
cerebro vascular accident (CVA), due to sedative treatment effects, etc. Clinical signs
1) Cough is ineffective or not present
2) Not able to dissolve the secret in the airway
3) The sound of breath indicates a blockage
4) The number, rhythm, and depth of breathing is not normal

d. Gas exchange
Gas exchange is a condition in individuals who experience a decrease in gas, either oxygen or
carbon dioxide, between the alveoli of the lungs and the vascular system. This can be caused by
a thick secret or immobilization due to the nervous system; depression of the central nervous
system; or inflammatory disease in the lungs. The occurrence of this interruption in gas exchange
suggests that decreasing the diffusion capacity can lead to transport of O2 from disrupted tissue
lung, anemia with all its forms, CO2 poisoning, and disruption of blood flow. The decrease in
diffusion capacity is due, among others, to the decreasing of the diffusion surface area, the
thickening of the capillary alveolar membrane, and the poor perfusion ratioventilation. Clinical
signs:
1. Dispeas on breathing effort
2. Breath with lips in a long expiratory phase
3. Aggression
4. Tired, allergies
5. Increased lung vascular resistance
6. Decreased oxygen saturation and increased PaCO2
7. Cyanosis

2.8 RISK FACTORS OF OCCUPATION OF OXYGEN REQUIREMENTS

1. Oxygen Poisoning
The pathophysiology of oxygen toxicity is not well understood, but is associated with
the destruction and decrease of surfactant, the formation of the lung hymen membrane layer, and
the occurrence of pulmonary edema that is not of the heart (Brunner & Suddarth, 2001). This can
damage the structure of lung tissue such as atelectasis and surfactant damage. As a result the
process of diffusion in the lungs will be disrupted. This oxygen poisoning can occur when
oxygen is given with a fraction of more than 50% continuously for 1-2 days. When O2 80-100%
is given to humans for 8 hours or more, the respiratory tract will be irritated, causing substernal
distress, nasal congestion, sore throat and cough.
Exposure for 24-48 hours results in lung tissue damage. Pulmonary tissue damage
occurs due to the formation of metabolic oxygen that stimulates PMN and H2O2 cells releasing
proteolotic enzymes and lysosomal enzymes that can damage the alveoli (Razi, 2008).
Pure oxygen will cause damage or irritation of the respiratory tract mucosa. The respiratory tract
mucosa contains body-defense factors, including the above PMN, and it also contains
immunoglobulins (IgA), interferon, and specific antibiotics (Pierce, 1995).
Damage to the mucosal lining of the respiratory tract will exacerbate the state of a
disease and cause pulmonary collapse that ends with respiratory failure and death. Marked by:
First Signs:
-Retro sternal depression
-Extreme numb (incredible numbness)
-Nausea, vomiting (nausea, vomiting)
-Dyspnea, cough
-Anxieties (anxious)
-Appetite decrease (decreased appetite)
Second Signs:
-Worst Dyspnea
-Cyanosis
-Respiratory gets worst progressively
Prevention of oxygen toxicity is achieved by using oxygen only when prescribed. If
high concentrations are required, duration is kept minimal and reduced as soon as possible
(Brunner & Suddarth, 2001). The use of high concentration of oxygen for a long time does not
mean it should not be done.
100% oxygen concentration can be given if it is still needed. After hypoxia is resolved
gradually oxygen consolidation should be lowered as low as possible during SaO2 over 96%
(ICU Training Materials RSUP Dr. Soetomo, 2005).
The use of PEEP (Positive End Expiratory Pressure) or CPAP (Continous Positive
Airway Pressure) is often done in relation to oxygen therapy to prevent microatelectasis, and
thus allows the use of oxygen with a lower percentage.
2.CO2 Narcosis
In patients with COPD (Chronic Obstructive Pulmonary Disease) such as asthma,
chronic bronchitis, emphysema, respiratory stimuli are decreased blood oxygen, not increased
CO2 levels. Thus giving a high concentration of oxygen will remove the breathing impulse that
has been formed largely by the patient's chronic low oxygen pressure. Due to the decrease in
alveolar ventilation, it can lead to a progressive increase in carbon dioxide (PaCO2) pressure,
eventually leading to death from CO2 narcosis and acidosis.
3. Microatelectasis
Caused by decreased nitrogen gas and surfactant in the alveoli due to high-dose oxygen
therapy in more than 24 hours. Pure oxygen can damage type II alveolar cells so that they can
not produce surfactants (Corwin, 2000: 405-406), which is indicated by:
Cough
Chest pain
Hard to breath
Fever
Cyanosis and increased heart rate
4. Retrolental fibroplasia in premature infants
In premature infants, retinal capillaries are very sensitive to high oxygen delivery. High
percentage oxygen will stimulate immature capillary retina for spasm and proliferation, thus
damaging the retina and causing blindness. Therefore PaO2 must be maintained between 60 - 80
mmHg.
5.Barotrauma
Caused by high air pressure, such as:
Empyema mediastinum
Pneumothorax
May occur in patients with:
1. Patient with ventilator
Because PEEP is too high and the volume is large
Fighting / fighting machine
2. Patients with bag and mask
High pressure / volume
Not sincronize
Patients are given oxygen directly (wall outle / O2 cylinder) without going through flow meter.
6. Depressed breath
In patients with certain pulmonary disorders, such as COPD, high concentrations of oxygen
delivery are not helpful, but may suppress ventilation due to loss of "Hypoxic drive"
7. Explosive and Fire
Because oxygen has a combustible nature, there is always a fire danger when using oxygen. Do
not use electricity tools during O2 therapy.
No smoking is available near the patient receiving oxygenated therapy.
Make sure hands are free of oil when opening O2 tube. Place the O2 tube away from the source
of the fire and direct sunlight.
8.Infection
Oxygen therapy equipment is also potential as a source of bacterial cross infection and hence
must be frequently replaced, depending on the infection control policy and the type of oxygen
delivery equipment. Water humidifiers can also be a growth medium for germs, therefore must
be cleaned and replaced daily.
 CHAPTER III
CLOSING
3.1 Conclusions.
The need for oxygenation is one of the basic needs in humans that is physiological
needs. The fulfillment of oxygenation needs is aimed at maintaining the continuity of body cell
metabolism, maintaining its life, and conducting activities for various organs or cells.
Oxygenation is giving oxygen gas (O2) flow more than 21% at atmospheric pressure 1 so that
the oxygen concentration increases in the body.
There are so many factors that can affect a person's oxygenizing needs. Can be from
body system, environment, lifestyle, etc. And there are several ways that can help cure
abnormalities in blocking the need for oxygenation. As well as the risk factors of oxygen
fulfillment such as oxygen poisoning, CO2 Narcosis, Microatelectasis, Fibroplasia Retrolental in
premature infants, Barotrauma, respiratory Depression, Explosive and fire, and infection.

3.2 Suggestions.
From the above explanation, we give advice in health sciences especially nursing science is very
important to understand and adept to meet the oxygenation needs of clients in care of nursing
properly in order to avoid the mistakes in the actions either in the hospital or in the community
related to health services.

Bibliography

http://afrizalonar.blogspot.co.id/2013/07/peran pendahuluan-kebutuhan-oksigen.html
http://nurseviliansayah.blogspot.co.id/2015/01/kebutuhan oksigeasi.html