Mid Oxygenation 2
Mid Oxygenation 2
Mid Oxygenation 2
College of Nursing
FUNDAMENTALS OF NURSING
MIDTERMS
OXYGENATION
Introduction
Oxygenation is a basic human need. Breathing is synonymous with life.
The respiratory system replenishes the body's oxygen supply and eliminates waste from thi blood in the form of
carbon dioxide. Nurses are responsible for promoting normal respiratory function regardless of practice area. School
nurses conduct classes about the hazards of smoking. Community nurses screen for and teach about prevention of
respiratory disorders like tuberculosis, SARS, (Severe Acute Respiratory Syndrome) and others.
Nurses also help to improve breathing in clients with altered respiratory function. Most important, nurses apply the
nursing process to promote normal respiratory function, and therefore, adequate oxygenation.
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Rambo Laguiwed Ebbes, RN
Instructor NCM 103 (Theory)
The paranasal sinuses are open areas within the skull, lined with mucous membrane. They help in
phonation. The different sinuses are as follows: frontal, maxillary, ethmoid and sphenoid.
The pharynx is a funnel-shaped tube that extends from the nose to res the larynx. It is a common opening
between the digestive and
respiratory system.
The three sections of the pharynx are as follows;
nasopharynx, oropharynx and laryngopharynx.
From the middle ear, the eustachean tubes open into the nasopharynx.
The larynx is the voice box.
The epiglottis covers the larynx. When eating, the epiglottis closes, when speaking it opens.
The trachea (windpipe) 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.
The cilia are microscopic hair-like projections which have rapid, coordinated, unidirectional upward
motion.
The cilia sweep out debris and excessive mucous from the lungs. no: • The goblet cells secrete 120 ml of
mucous per day. The mucous allerod secretions entrap debris in the respiratory tract.
The right mainstem bronchus is shorter, broader and more vertical than the left.
2. The Pleura
1) The pleurae are serous membranes that enclose the lungs.
2) The visceral pleura directly covers the lungs.
3) The parietal pleura lines the cavity of each hemithorax.
4) 4. The pleural space is a potential space between the two pleurae. Only few mi of serous fluid is found in
the pleural space, to serve as lubricant.
3. The Lungs
The right lung has three lobes, while the left lung has two lobes.
The two lungs are separated by a space called mediastinum.
There are approximately three hundred million alveoli in the lungs.
The right lung is broader but shorter due to the presence of the liver on the right side of the abdomen.
Residual volume is the amount of air that remains in the lungs after forceful expiration. It prevents collapse
of the lungs during expiration. (1200 ml.)
Tidal volume is the amount of air that moves in and out of the lungs with each normal breath (500 ml.)
Inspiratory reserve volume is the amount of extra air that can be exhaled, beyond the tidal volume.
Expiratory reserve volume is the amount of extra air that can be exhaled after a normal breath.
Total lung capacity is the total of all four volumes (residual, tidal, inspiratory reserve volume and
expiratory reserve volumes).
Functional residual capacity is the amount.of air that remains in the lungs after normal exhalation.
Pneumocytes. The type I pneumocytes line the alveoli, whereas the type Il pneumocytes produce surfactant.
5. Respiratory Control
a. Central Nervous System Control
medulla oblongata (central chemoreceptors)
b. Reflex Control
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Rambo Laguiwed Ebbes, RN
Instructor NCM 103 (Theory)
pons (apneustic center, pneumotaxic center)
cough reflex
Peripheral control
Carotoid and aortic bodies
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. Deep breathing and coughing exercises. To promote maximum lung expansion and to loosen mucous
secretions. Inhale deeply through the nose, then exhale passively through the mouth.
3. Positioning. The 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.
4. Patent airway. To promote gaseous exchange between the person and the environment.
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 mucus secretions. Fluid intake should
ideally be 6 go 8 glasses of fluid, preferably water, everyday.
6. Avoid environmental pollutants, alcohol and smoking. These factors inhibit mucociliary function.
7. Chest physiotherapy (CPT)
• Percussion, Vibration and Postural Drainage (PVD)
These procedures are dependent nursing functions.
Percussion (clapping) is forceful striking of the skin with cupped hands. It can mechanically dislodge
tenacious secretions from bronchial walls.
Vibration is a series of vigorous quivering produced by hands that are placed flat against the client's chest
wall. It is done to loosen mucous secretions.
Postural Drainage is expulsion of secretions from various lung segments by gravity. This involves placing
the client in different positions so that the area of lung congestion will be in vertical position with the
bronchus. This facilitates drainage by gravity.
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 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.
3
Rambo Laguiwed Ebbes, RN
Instructor NCM 103 (Theory)
a. Steam Inhalation
The purposes of steam inhalation are as follows:
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.
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.
Oxygen Systems
1. Low flow administration devices
• Nasal Cannula (24-45 % at 2-6 LPM)
May be used in clients with COPD at 2 - 3 L/min if venturi mask is not available.
• Simple Face Mask (40-60% at 5-8 LPM)
Partial Rebreathing Mask (60-90% at 6-10 LPM)
Non-Rebreathing Mask (95-100% at 6-15 LPM)
Croupette
Oxygen Tent
2. High flow administration devices
Venturi mask - low-concentration venture- type mask is preferred for clients with COPD because it
provides accurate amount of oxygen. They require 2-3 L/min or 28% oxygen.
Face mask
Incubator/Isolette – can be used for low and high flow concentration
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Rambo Laguiwed Ebbes, RN
Instructor NCM 103 (Theory)
Nursing Implications:
Since oxygen is colorless, odorless, tasteless and dry gas that supports combustion.
Since oxygen is dry gas, it can irritate mucous membrane of the airway’s.
Since oxygen supports combustion, it can cause fire
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Rambo Laguiwed Ebbes, RN
Instructor NCM 103 (Theory)
Other Clinical Signs of Chronic Hypoxia
1. fatigue, lethargy
2. pulmonary ventilation increases
3. RBC count increases
4. Hgb concentration increases
5. clubbing of fingers
b. Volume
Hyperventilation
Excessive amount of air in the lungs.
Hypoventilation
It results from deep rapid respirations
Decreased rate and depth of respiration
It causes retention of carbon dioxide.
c. Rhythm
Cheyne-stokes. Marked rhythmic waxing and waning of respirations 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. Difficult or labored breathing
Orthopnea. Inability to breath except in upright or sitting position.
Nursing Diagnosis
Client's with Oxygenation Problems
1. Ineffective airway clearance related to:
tracheobronchial infection, obstruction, secretions
decreased energy and fatigue
trauma
dehydration
2. Ineffective breathing pattern related to:
neuromuscular/musculoskeletal impairment
pain
anxiety
decreased energy and fatigue inflammatory process decreased lung expansion
tracheobronchial obstruction alteration of normal 02/CO2 ratio
3. Decreased cardiac output related to:
structural alterations
electrical alterations in rate, rhythm and conduction
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Rambo Laguiwed Ebbes, RN
Instructor NCM 103 (Theory)