Basic Interventions to Maintain:
OXYGENATION
What do you think of when you hear the
word intervention?
= Interventions are the backbone of
nursing.
= The term describes any action nurses
may take to improve the health and comfort
of their patients.
= Nurses may work in specialized settings
(i.e. ICU, surgical unit, pediatrics), which
may require knowledge of specific
interventions unnecessary in other areas.
= And every nurse may not be familiar with
every intervention, the concept remains
universal across the field.
BASIC INTERVENTIONS TO MAINTAIN
Oxygenation and Circulation
A. Oxygenation
1. structure and processes of the respiratory
system
2. factors affecting respiratory function
3. alterations in respiratory function
4. nursing management
5. sample of nursing care plan
Oxygenation
Oxygen, a clear, odorless gas that
constitutes approximately 21% of the air we
breathe, is necessary for proper functioning
of all living cells.
= The absence of oxygen can lead to
cellular, tissue, and organism death.
=The respiratory system provides the
essential first process in this integrated
system, that is, movement and transfer of
gases between the atmosphere and the
blood.
CARDIOVASCULAR SYSTEM AND
TRANSPORT OF GASES:
= For oxygen and carbon dioxide to move
though out the body an adequately
functioning cardiovascular system is vital.
- The cardiovascular system is
composed of:
- heart and blood vessels
- atria- receive blood from veins
- ventricles- receive blood from atria and
force blood to the body and lungs
- one way valves that direct flow are
locate at entrance and exit of each
ventricle (mitral, tricuspid, pulmonary
and aortic)
 Oxygen is carried via plasma and red
blood cells
 although 02 is dissolved in the plasma,
the majority (97%) is carried by red
blood cells
 oxyhemoglobin
 Internal respiration must occur
 Internal respiration is the exchange of
02 and CO2 between circulating blood
and tissue cells
 any abnormality in blood's constituents
can change internal respiration, i.e.
 hemorrhage or loss or blood can
decrease CO
 decrease in CO causes decrease in
circulating blood that is able to deliver
02
 Anemia, decrease in red blood cells
results in insufficient hemoglobin
available to transport 02
Anatomy and Physiology of Respiration
Three Functions:
1. Ventilation – Breathing process
which may occur naturally
(pulmonary ventilation) or with a
help an external device, such as a
ventilator (mechanical ventilation)
2. Respiration – Act of breathing
3. Perfusion – Higher to lower
concentration
Normal function depends on:
1. integrity of airway to transport air to and
from lungs
2. ability of alveoli to participate in gas
exchange
3. properly functioning cardiovascular and
hematologic system to wastes and nutrients
to and from tissues
4. function is to warm, filter, and humidify air
STRUCTURES OF RESPIRATORY
SYSTEM:
- Begins at nose and ends at terminal
bronchioles
- Divided into upper and lower airways
- Upper Airway:
o Nose (nasal cavity)
o Pharynx
o Larynx
o Epiglottis
o Tracheobronchial tree
- Lower Airway:
o includes trachea, R and L
mainstream bronchi, segmental
bronchi, and terminal
bronchioles.
o functions are conduction of air,
mucocilliary clearance, and
production of surfactant.
o Airways are lined with mucous
to trap cells, particles, and
infectious debris.
o Cilia propels trapped material
toward the upper airway to be
removed by coughing or
swallowing.
o adequate fluid intake in needed
for mucous to maintain watery
consistency to move particles.
o Lungs are the main organs of
respiration.
 o Each lung is divided into lobes,
right has 3 Lobes, left has 2,
At the end of the terminal bronchioles are
clusters of alveoli.
- They are the site of gas exchange
- walls are made of single layer of simple
squamous epithelium
- allow for gas exchange with capillaries
covering alveoli
- adult has: 300 million alveoli
- surfactant reduces surface tension
between moist membranes of alveoli,
preventing collapse 1. Pulmonary Ventilation:
o Movement of air into and out of
*SURFACTANT – fluid in alveoli lungs
o 2 phases, inhalation and
* About 300 million alveoli are present in the
two lungs, 95% of which are added after exhalation
birth  Inspiration- active
phase, Involves
Lungs and thoracic cavity lined with serous movement of muscles
membrane called pleura  Expiration- passive
phase, movement of air
- Visceral pleura covers lungs, parietal
out of lungs
pleura lines thoracic cavity.
o Immediately before inspiration,
= two membranes are continuous with
air pressure in lungs is equal to
each other, and form fluid filled sac
that of surrounding atmospheric
- pleural space lies between the two
pressure.
layers, where excess fluid/mucus go
o The pressure in the lungs
- pleural fluid acts as adhesive and
lubricant decreases as the volume
= aids with ease of filling and emptying increases.
of lungs Other factors that contribute to air flöw into
- Pressure within pleural space (intra- and out of lungs:
pleural space) is always sub
atmospheric and keeps the lungs in an o musculature
expanded position. o compliance of lung tissue
o airway resistance
Physiology of Respiratory System:
Lung Compliance is ease with which lungs
Cells require oxygen and removal of carbon
can be inflated and affects lung volumes
dioxide with is a byproduct of oxidation.
Pulmonary ventilation is the movement of - ability of lungs to fill is aided by
air into and out of the lungs. elasticity and surfactant
- emphysema results in decreased
Respiration is the exchange of air.
elasticity and compliance
Perfusion is delivery to tissues.
- airway Resistance = is any obstruction
or impediment of air as it moves
through the airway
- bronchial constriction in asthma is a
form of airway resistance due to
decreased diameter of airways
2. Respiration:
Gas exchange occurs at terminal
alveolar capillary system
- via diffusion - high concentration to
lower concentration
- the greater pressure of 02 in the alveoli
forces the 02 to diffuse into the
unoxygenated venous blood; C02 from
blood to alveoli
Ventilation – Is the movement of air
between the environment and the lungs via
inhalation and exhalation
Diffusion of gases in the lung is influenced
by four factors:
1. change in surface area available
2. thickening of alveolar capillary
membrane
3. partial pressure
4. solubility and molecular weight of gas
1. Surface Area:
o any detrimental change in area
available for gas exchange
hinders diffusion
o removal of lug or disease that
damages tissue decreases
surface area
o atelectasis decreases surface
area
 o conditions that can lead to
atelectasis: obstruction d/t
foreign body, mucous plugging,
alrway constriction, external
compression (tumors or large
blood vessels), and Immobility
o any disease that results in
thickening or alveolar
membrane affects diffusion
2. Partial Pressure
o pressure resulting from any gas
in a mixture depending on its
concentration
o higher altitudes have lower
partial pressure of oxygen
3. Solubility and Molecular Weight
o CO2 has greater solubility and
diffuses more quickly allowing it
to be exhated during each
expiratory phase
ALVEOLI
PO2 = 100 mmHg
PCO2 = 40mmHg
What is responsible for this drop in partial
pressure?
- Water Vapor
- Carbon Dioxide
4. Perfusion:
Perfusion – oxygenated capillary
blood passes through the tissues of
the body
= the amount of blood flowing
through the lungs is a factor in the
amount of oxygen and other gases
exchanged
= can depend on pts position and
activity level
= increased activity results in
increased needed for cellular oxygen
in body's tissue which leads to an
increase in cardiac output and
increase of blood to lungs
= perfusion also depends on
adequate cardiovascular functioning
Hypoxia- condition in which
inadequate amount of oxygen is
available to cells
- most common symptoms of hypoxia
are:
o dyspnea
o elevated blood pressure with
small pulse pressure
o Increased respiratory and pulse
rates
o pallor
o cyanosis
o hypoxia is often caused by
hypoventilation
o can be chronic
o manifested as altered thought
processes, headaches, chest
pain, enlarged heart, clubbing,
anorexia, constipation,
decreased urinary output,
decreased libido, weakness,
muscle pain
- Regulation of Respiration:
o Respiratory center is located in
the medulla oblongata
o it is stimulated by an increase in
CO2 and hydrogen ions and, to
a lesser degree, by decreased
02 in arterial blood
o chemoreceptors in aortic arch
and carotid bodies are sensitive
to arterial blood gas levels and
blood pressure and can activate
the medulla
o proprioceptors in muscles and
joints respond to body
movement and can increase
ventilation
o Stimulation of medulla increased
rate and depth of ventilation to
blow off CO2 and hydrogen and
increase 02
o if a condition causes a chronic
change in 02 and CO2 levels,
the chemoreceptors may
 become desensitized and not
regulate ventilation adequately
FACTORS AFFECTING RESPIRATORY
FUNCTION
1. Level of Health:
o Acute and chronic Illness can
affect respiratory function
o pts with renal and cardiac have
compromised respiratory
function because of fluid
overlaid and impaired tissue
perfusion
o patient with chronic illness often
have muscle wasting and poor
tone
o Anemia can lead to impaired
gas exchange
o MI causes lack of blood to heart.
Damaged tissue results in less
effective contractions and
decreased perfusion and gas
exchange
o scoliosis- air trapping
o Obesity- lack of exercise,
decreased inflation at base of
lungs chronic bronchits
2. Developmental Considerations:
2.1. Neonates and Infants:
- Lungs transition from fluid filled to air
filled
- airways are short and aspiration is a
potential problem
- RR is rapid
- surfactant is formed in utero at 34 to 36
weeks
- synthetic surfactant can be given
- respiratory activity is primarily
abdominal
2.2. Toddlers, Preschoolers,
School Aged and Adolescent:
o preschool child's Eustachian
tubes, bronchi, and bronchioles
are elongated and less angular
o number of colds increases as
child enters preschool or
daycare and is exposed to
pathogens
o encourage good hand hygiene
o many children have cold or ear
infections and upper respiratory
infections
o by end of late childhood,
immune system is more
developed
2.3. Older Adults:
o airways become less elastic
o respiratory muscles are less
effective
o airways collapse more easily
o increased risk for PNA and other
infections
3. Medications:
o Px receiving drugs that affect
the CNS need to be monitored
for respiratory depression or
arrest
o opioids depress the medullary
respiratory center
4. Lifestyle:
o sedentary activity patterns do
not encourage expansion of
alveoli
o people who exercise respond
better to respiratory stressors
o cigarette smoking is the most
important risk factor for COPD
5. Environment:
o high correlation between air
pollution and lung disease
o occupational exposure to
asbestos, silica, coal dust, can
lead to chronic pulmonary
disease
6. Psychological Health:
o those responding to stress may
experience hyperventilation
 o can lead to lowered C02
o can develop anxiety as
response to hypoxia
Alterations to Oxygenation
Mild impairments
o Fatigue
o Irritability
o Discomfort
Severe alterations
o Hypoxia
Alterations in Respiratory Functioning
1. Hyperventilation
o Ventilation in excess of that
required to eliminate carbon
dioxide produced by cellular
metabolism
2. Hypoventilation
o Alveolar ventilation inadequate
to meet the body's oxygen
demand or to eliminate sufficient
carbon dioxide
3. Hypoxia
o Inadequate tissue oxygenation
at the cellular level
4. Cyanosis
o Blue discoloration of the skin
and mucous membranes
5. Hypoxemia
o Decreased level of oxygen in
the blood
o Cyanosis late sign of hypoxemia
o Commonly seen in COPD
o o Congestive heart failure
o Healthy respiratory system B
 Management of
environmental air quality
 Vaccination
Alterations to oxygenation
- Changes in breathing patterns
- Patency of airway
- Interference with gas exchange
o Causes
 Airway of infant very
small
 Adults can aspirate large
bites of food
 Decreased cough reflex
in older adults
 Loss of airway patency
from sputum
Respiratory Rate
Eupnea (Normal respiration) is quiet,
rhythmic, and effortless.
o Tachypnea > 20 breaths/min
o Bradypnea < 10 breaths/min
o Apnea: absence of breathing
o Dyspnea: labored breathing or
shortness of breath that is
painful
o Orthopnea: difficulty breathing
when supine
Respiratory patterns
Kussmaul breathing
- type of hyperventilation that
accompanies metabolic acidosis, by
which the body attempts to compensate
for increased metabolic acids by
blowing off acid in the form of CO2.
Cheyne-Stokes respirations
- marked rhythmic waxing and waning of
respirations from very deep to very
shallow with short periods of apnea
commonly caused by:
o Increased intracranial pressure
o Drug overdoses