UNIVERSITY OF LUZON

COLLEGE OF NURSING

MODULE 1

NS-II2 P
OXYGENATION PROBLEMS

COURSE DESCRIPTION

This course deals with concepts, principles, theories and techniques of nursing care management of at
risk and sick adult clients in any setting with alterations/problems in oxygenation. The learners are
expected to provide nursing care to at risk and sick adult clients utilizing the nursing process.

Theory 8 units
RLE Clinical 6 units 144 units
Skills Lab 1 unit 51 hrs
RLE 5 units 255 hrs
MODULE A
1. Oxygenation/Ventilation
a. Upper/Lower airway disorders
b. Nursing Care of Clients with
Ventilation disorders
c. Nursing Care of Clients with Gas
Exchange disorders
2. Oxygenation -Transport
a. Hematologic Disorder
b. Anemia
3. Oxygenation- Perfusion
a. Hypertension
b. Coronary Artery Disease (CAD) and
Acute Coronary Syndrome
d. Vascular Disease

Course Outcomes Performance Objectives:

Provide safe, appropriate nursing care to at risk 1. perform procedures accurately, safety,
and sick adult clients with problems in and effectively
oxygenation
Learning Objectives
1. Process of respiration
2. Principles of diffusion, perfusion and ventilation
3. Use of pulse oximeter
4. Interpretation of blood gas analysis
5. Acid base balance, acidosis and alkalosis
6. Hemodynamic monitoring
7. Principles of oxygen therapy
8. indication for Intubation
9. Tracheotomy care and principles of suctioning

Clinical Skills:
1. Assessment
2. Vital signs normal range
3. Normal Laboratory Values
4. Medication drug actions
5. Familiarity of equipments
6. Nursing Care Plan

Oxygenation is the delivery of oxygen to the tissues to maintain cellular activity (Reminga &
King 2016).It is part of the gas exchange process, wherein oxygenation occurs simultaneously
with the elimination of carbon dioxide from the bloodstream to the lungs (Dezube 2019; Kaynar
2020). These gases (oxygen and carbon dioxide) are transported through passive diffusion
across the membrane, meaning the gas exchange process requires no energy expenditure from
the individual (Wagner 2015).

A. OXYGENATION/ VENTILATION

SECTION 1. ASSESSING YOUR UNDERSTANDING

MULTIPLE CHOICES

1. Which of the following sites is NOT an area for attaching the pulse oximeters sensor?
a. Nose
b. Arms
c. Toes
d. Forehead
 The answer is B
2. It is an oxygen delivery system that supplies 40%-60% for short term O2 therapy or to
deliver O2 in an emergency situation?
a. Nasal cannula
b. Venturi mask
c. Simple face mask
d. Partial re-breather mask
  The answer is C

3. It refers to an oxygen delivery system that provides 70%-90% oxygen with flow rates of
6-15L/min
a. Face tent
b. Partial re-breather mask
c. Venturi mask
d. Simple face mask
 The answer is B
4. 2 liter/min of oxygen via nasal or simple face mask is given to client with underlying
chronic obstructive lung disease in order to
a. reduce the risk of oxygen toxicity
b. reduce the risk of carbon dioxide retention
c. increase pH level
d. increase diaphragmatic excursion
 The answer is B
5. Humidification is added to oxygen therapy via nasal cannula oxygen in order to
a. prevent drying of the nasal mucosa
b. Liquefy pulmonary secretion
c. increase the client’s cough
d. Improve oxygenation
 The answer is A
6. A pulse oximeter gives what type of information about the client
a. Amount of carbon dioxide in the blood
b. Amount of oxygen in the blood
c. Percentage of hemoglobin carrying oxygen
d. Respiratory rate
 The answer is C
7. Chest physiotherapy was prescribed by the doctor for your patient with respiratory
condition. As the nurse responsible for the patients care, you know that the best time
of doing the procedure is:
a. Upon arising in the morning 1 hour at least before breakfast
b. Upon arising in the morning 1 hour at least after breakfast
c. 1 hour before sleeping
d. 2 hours before sleeping
 The answer is B
8. A patient with a history of tonsillitis complains of difficulty breathing. Which patient
assessment data warrants emergency interventions by the nurse?
a. Bilateral erythema of especially large tonsils
b. Temperature 102.2° F, diaphoresis, and chills
c. Contraction of neck muscles during inspiration
d. β-hemolytic streptococcus in the throat culture
 The answer is C
9. Which nursing action would be of highest priority when suctioning a patient with a
tracheostomy?
a. Auscultating lung sounds after suctioning is complete
b. Providing a means of communication for the patient during the procedure
c. Assessing the patient's oxygenation saturation before, during, and after
suctioning
d. Administering pain and/or anti anxiety medication 30 minutes before
suctioning
 The answer is C
10. An emergency room nurse is assessing a male client who has sustained a blunt injury
to the chest wall. Which of these signs would indicate the presence of a pneumothorax
in this client?
a. a low respiratory rate
b. diminished breath sounds
c. a presence of a barrel chest
d. sucking sounds at the site of injury
 The answer is B
11. A nurse performs an admission assessment on a female client with a diagnosis of
tuberculosis. The nurse reviews the result of which diagnosis test that will confirm this
diagnosis?
a. Bronchoscopy
b. Sputum culture
c. Chest x-ray
d. Tuberculin skin test
 The answer is B
12. A nurse is caring for a male client with acute respiratory distress syndrome. Which of
the following would the nurse expect to note in the client?
a. pallor
b. low arterial PaO2
c. elevated PaO2
d. decreased respiratory rate
 The answer is B
13. The nurse, preparing instruction for a patient diagnosed with bacterial pneumonia,
would expect which of the following classes of medication to be prescribed?
Standard Text: Select all that apply.
a. antibiotics
b. steroids
c. bronchodilators
d. antiemetics
e. antihistamines
 The answer is A
14. Which of the following would the nurse assess in the patient with the nursing diagnosis
of Ineffective Airway Clearance?
Standard Text: Select all that apply.
a. Assess skin color at least every four hours
b. Assess breath sounds at least every four hours.
c. Assess oxygen saturation level at least every four hours.
d. Assess vital signs daily.
e. Assess respiratory rates every shift.
 The answer is B,C,D,E
15. A nurse instructs a female client to use the pursed-lip method of breathing and the
client asks the nurse about the purpose of this type of breathing. The nurse responds.
knowing that the primary purpose of pursed-lip breathing is to:
a. promote oxygen intake
b. strengthen diaphragm
c. strengthen intercostals muscle
d. promote carbon dioxide elimination
 The answer is A
16. If a pleural effusion develops, which of the following actions best describes how the
fluid can be removed from the pleural space and proper lung status restored?
a. Inserting a chest tube
b. Performing thoracentesis
c. performing Paracentesis
d. allowing the pleural effusion to drain by itself
 The answer is B

17. You are providing care to a patient with a chest tube. On assessment of the drainage
system, you note continuous bubbling in the water seal chamber and oscillation. Which
of the following is the CORRECT nursing intervention for this type of finding?
a. Reposition the patient because the tubing is kinked.
b. Continue to monitor the drainage system.
c. Increase the suction to the drainage system until the bubbling stops.
d. Check the drainage system for an air leak.

 The answer is D

18. A patient is receiving positive pressure mechanical ventilation and has a chest tube.
When assessing the water seal chamber what do you expect to find?
a. The water in the chamber will increase during inspiration and decrease
during expiration.
b. There will be continuous bubbling noted in the chamber.
c. The water in the chamber will decrease during inspiration and increase
during expiration.
d. The water in the chamber will not move.

 The answer is A
 19. You’re assessing a patient who is post-opt from a chest tube insertion. On
assessment, you note there is 50 cc of serosanguinous fluid in the drainage chamber,
fluctuation of water in the water seal chamber when the patient breathes in and out,
and bubbling in the suction control chamber. Which of the following is the most
appropriate nursing intervention?
a. Document your findings as normal.
b. B. Assess for an air leak due to bubbling noted in the suction chamber.
c. C. Notify the physician about the drainage.
d. D. Milk the tubing to ensure patency of the tubes.

 The answer is A

20.  While helping a patient with a chest tube reposition in the bed, the chest tube
becomes dislodged. What is your immediate nursing intervention?
a. Stay with the patient and monitor their vital signs while another nurse
notifies the physician.
b. Place a sterile dressing over the site and tape it on three sides and notify
the physician.
c. Attempt to re-insert the tube.
d. Keep the site open to air and notify the physician.

 The answer is B

ENUMERATION

1. Identify the three areas of the body that are assessed during a physical
examination of the respiratory system
a. Supraclavicular region-lung apices
b. Chest wall- percuss over 3-4 locations bilaterally
c. Axilla
2. What are the three main function of the nose and sinuses
a. Passageway for air to pass to and from the lungs.
b. What are the three purposes of surfactant in the respiratory process
c. Filters impurities and humidifies and warm the air as it is inhaled.
3. What are the three purposes of surfactant in the respiratory process
a. It lines the alveoli to lower surface tension, thereby preventing atelectasis during
breathing.
b. Stimulates lung host defense system
c. Prevent movements of fluid into the alveolus and keeps lungs dry.
4. What are four indication for intubation
a. Inability to maintain airway patency.
b. Inability to protect airway against aspiration
c. Failure to ventilate
d. Failure to oxygenate
5. Indicate 5 nursing interventions to prevent hypoxia in a client with a tracheostomy
tube
 a. Monitor for cyanosis
b. Administer prescribed oxygen and monitor oxygen saturation
c. Auscultate lung sound
d. Use sterile technique when suctioning and performing tracheostomy care.
e. Administer adequate warmed humidity.

MATCHING TYPE
Match the following adventitious and normal breath sounds

A. BREATH SOUNDS DESCRIPTION

a. Popping sounds as air moves through
1. _E_ Bronchial moisture in small airways
2. _H_ Bronchophony b. Normal sounds heard over lung periphery
3. _F_ Bronchovesicular c. Grating, scratching sounds with respiration
4. _G_ Egophony d. Musical, squeaky sounds related to
5. _C_ Pleural Friction narrowing of airway
6. _K_ Crackles e. Normal sounds heard over bronchi;
7. _I_ Rhonchi abnormal when heard elsewhere in the lung
8. _B_ Vesicular f. Normal sounds heard over trachea
9. _D_ Wheezes g. Vocalized “A” is heard as “E” with
10. _J_ Whispered pectoroloquy stethoscope
11. _A_ Rales h. Abnormal loud transmission of “99” during
auscultation
i. Snoring, rattling sounds, coarse, in large
airways
j. Loud sounds when client softly says “1, 2, 3”
k. Rattling sounds that change with coughing or
suctioning

B. Match each of the following DESCRIPTION

processes of respiration with its
description
1. ___B ___Diffusion a. Movement of air in and out of the lungs
2. ___C ___Perfussion b. Exchange of oxygen and carbon dioxide
3. ___A ___Ventilation in the capillary alveolar network
c. Pumping of oxygenated blood through
the body

CASE STUDY
(1). CLIENT WITH COPD

A 72 years old patient is being evaluated in his home by the home health nurse. He was
admitted to the hospital for an exacerbation of his COPD and discharged 2 days ago. He states,
that “I feel a little more out of breath today than I usually do, but I am breathing better than I was
when I went to the hospital” He is thin with a barrel-shaped chest. He is slow moving and slightly
stooped. He demonstrates that, rapid, shallow respirations at 30/min. He currently denies chest
pain, but he reports feeling exhausted.

1. list at least 8 questions the nurse could ask to evaluate this current condition
 Does patient position affect breathing?
 Do you routinely use oxygen?
 Do you have dyspnea with routine activity? Or chronic coughing?
 Do you smoke
 Are you taking medication routinely?
 Do you have wheezing while exhaling
 Which time does difficulty in breathing occur
 Do you feel shortness of breath?
 Do you feel any improvement in your condition?
2. describe how the nurse uses the following assessment tools to determine the
severity of the dyspnea
 Visual analog Dyspnea scale
Using a dyspnea scale the subject is instructed to give a qualification of his
dyspnea placing a horizontal or vertical line, usually 100mm in length. Exercise is
conducted and patient can give a rating of dyspnea at different levels
 Peak expiratory flowmeter
The nurse can check your peak flow using these basic steps
• Move the marker to the bottom of the numbered scale.
• Stand up straight.
• Take a deep breath. Fill your lungs all the way.
• Ask to hold breath while you place the mouthpiece in mouth, between your
teeth. Close your lips around it.
• Blow out as hard and fast as you can in a single blow. first burst of air is the
most important. So blowing for a longer time will not affect your result.
• Write down the number you get.
• Move the marker back to the bottom and repeat all these steps 2 more times.
The highest of the 3 numbers is your peak flow number. it is written down in log
chart.
• And by this values dyspnea can be measured
 Pulse Oximeter
Using a pulse oximetry A blood oxygen level lower than 89% means there may
not be enough oxygen in blood to meet body's needs. This could be used to
asses any v/ q mismatch
3. identify 4 or 5 common nursing diagnoses for patients with COPD
1. Ineffective Airway Clearance
2. Impaired Gas Exchange
3. Ineffective Breathing Pattern
4. Imbalanced Nutrition: Less Than Body Requirements
5. Risk for Infection
 6. Deficient Knowledge
7. Activity Intolerance
4. Identify at least 8 teaching points to help this patient conserve energy
• Simplify tasks and set realistic goals. Don't think you have to do things the same way
you've always done them.
•Plan activities (chores, exercise, and recreation) ahead of time. Space out your
activities throughout the day. Do not schedule too many things to do in one day. Do the
things that take more energy when you are feeling your best.
•If needed, rest before and after activities.
•If you become tired during an activity, stop and rest. You might need to finish it on
another day or when you feel less tired.
•Do not plan activities right after a meal. Rest 20 to 30 minutes after each meal.
•Ask for help. Divide tasks among family and friends.
•Get a good night's sleep and elevate your head when sleeping. Be careful not to nap
too much during the day or you might not be able to sleep at night.
•Do all of your grooming (shaving, drying your hair, etc.) while sitting.
•If needed, use devices and tools that assist you such as a walker, shower chair, hand-
held shower head, bedside commode, or long-handled tools for dressing (such as a
dressing stick, shoe horn, or sock donner).
•Wear clothes that have zippers and buttons in the front so you don't have to reach
behind.
5. The patient tells the nurse that he has heard about pulmonary rehabilitation. He is
not sure why his doctor did not suggest this for him, but he is wonders if it is a
possibility
 What is pulmonary rehabilitation: is a program for people with chronic lung
diseases like COPD, emphysema and chronic bronchitis? It will allow them to be
as active as possible. Pulmonary rehab is aimed to improve quality of life by:
Decreasing respiratory symptoms and complications.
 Describe a typical simple rehabilitation plan: Rehabilitation means developing
your skills and capabilities and creating a living environment that supports
independent coping. For rehabilitation, a rehabilitation plan will be drawn up for
you that gives an assessment of your operational capacity and your need for help
and lays down rehabilitation activities. Gives you a thorough summary of your
rehabilitation possibilities helps the medical assessment committee or the
medical expert correctly determine the degree of severity of your disability and
assess the need for additional expenses.

(2). THE CLIENT WITH PNEUMONIA

A 75 year old married woman reports to the out-patient clinic with her husband. She has had a
severe cough, says that she has had left sided chest pain, and holds her left side while
coughing. She appears anxious. Her body is flushed. Vital signs are temperature 102.6 ‘ F,
pulse 118,apical; respirations 32, shallow, and blood pressure 120/80. A diagnosis of
pneumonia is suspected. A sputum specimen, chest x-ray, arterial blood gases, and CBC are
ordered.

1. What should the nurse teach this client and her husband about the sputum collection
and x-ray? To be sure that test is accurate, you must cough up sputum from deep inside your
lungs. Sputum is usually thick and sticky. Saliva comes from your mouth and is watery and thin.
Do not collect saliva.

2. What will the nurse probably hear when she auscultates the client’s lungs? Explain
your answer? Check for crackling or rubbing noises that called rales made by movement of
fluid in the tiny air sacs of the lungs. A diagnosis of Pneumonia is confirmed by the chest x-ray
and sputum cultures. Because the client’s blood gases are within normal limits, she will be
managed on an outpatient basis.

3. Identify the relevant nursing diagnoses for this client based on the above data.

The physician order Cefaclor 500mg PO every 8 hrs and wants the client to return to the clinic in
1 week. If her condition does not improve within 48 hrs or she becomes short of breath, she
should call or return to the clinic.

4. Develop teaching-learning and discharge care plans for the client and her
husband? Take deep breathes and cough several times each us loosen up mucus and
get it out of your lungs.
Wash your hands with soap and water or use an alcohol based hand rub after blowing
your nose or using the bathroom and before eating.
Cough or sneeze into tissue or into your elbow or sleeve.

BaElaian, Ahmed A