[Music] welcome to craziness r and hub where learning becomes a tradition come join me as we explore the multifaceted worlds of nursing hi there student nurses my name is chris elmer dukanes clinical instructor teaching fundamentals of nursing practice today we will be talking about oxygenation what is oxygen it is a clear odorless gas that constitutes approximately 21 of the air we breathe and it is necessary for proper functioning of all living cells the absence of oxygen can lead to cellular tissue and organism death now let's discuss respiration respiration is the process of gas exchange between the individual and the environment and it involves four components first is ventilation or breathing it is the movement of air in and out of the lungs as we inhale or exhale next we also have your alveolar capillary gas exchange it involves the diffusion of oxygen and carbon dioxide between the alveoli and the pulmonary capillaries next is transport of oxygen and carbon dioxide between the tissues and the lungs and the fourth component is the movement of oxygen and carbon dioxide between the systemic capillaries and the tissues next let's have the structures of the respiratory system the structure of respiratory system facilitates gas exchange and protects the body from foreign matter such as particulates and pathogens the four processes of the respiratory system includes pulmonary ventilation alveolar gas exchange transport of oxygen and carbon dioxide and systemic diffusion the respiratory system is divided structurally into the upper respiratory system and the lower respiratory system the mouth nose pharynx and larynx compose the upper respiratory system and the lower respiratory system includes the trachea and lungs with a bronchi bronchus alveoli pulmonary capillary network and plural membranes air enters through the nose where it is warmed humidified and filtered hairs at the entrance of the nearest trap large particles in the air and smaller particles are filtered and trapped as air changes direction on contact with the nasal turbinates and septum irritants in the nasal passages initiate the sneeze reflex a large volume of air rapidly exits through the nose and during a sneeze helping to clear nasal passages next let's discuss about pulmonary ventilation pulmonary ventilation is the first process of the respiratory system and it is accomplished through the act of breathing first we have your inspiration or inhalation air flows into the lungs we also have your expiration or exhalation where air moves out of the lungs adequate ventilation depends on several factors we have clear airways and intact central nervous system or cns and respiratory center we also have an intact thoracic cavity capable of expanding and contracting and lastly adequate pulmonary compliance and recoil let's discuss intrapleural pressure expansion and recoil of the lungs occur passively in response to changes in pressures within the thoracic cavity and the lungs themselves the intra parallel pressure is the pressure in the productivity surrounding the lungs and it is always slightly negative in relation to atmospheric pressure this negative pressure is essential because it creates the suction that holds the visceral prula and the parietal plural together as the chest gauge expands and contracts now let's discuss the intrapulmonary pressure it is the pressure within the lungs and it always equalizes with atmospheric pressure inspiration occurs when the diaphragm and intercostal muscle contract increasing the size of the thoracic cavity the volume of the lungs increases decreasing intrapulmonary pressure and air then rushes into the lungs to equalize this pressure with atmospheric pressure now let's discuss tidal volume so it is a long volume representing the normal volume of air displaced between normal inhalation and exhalation when extra effort is not applied in a healthy young human adult tidal volume is approximately 500 ml per inspiration now let's proceed to long compliance lung compliance the expansibility and stretchability of lung tissues and it plays a significant role in the ease of ventilation at birth the fluid filled lungs are stiff and resistant to expansion much as a new balloon is difficult to inflate with each subsequent breathe the alveoli becomes more compliant and easier to inflate just as a balloon becomes easier to inflate after several tries lung compliance tends to decrease with aging making it more difficult to expand alveoli and increasing the risk for atelectasis when we say atelectasis it is the collapse of a portion of the lung in contrast to lung compliance is lung recoil the continual tendency of the lungs to collapse away from the chest wall just as lung compliance is necessary for normal inspiration lung recoil is necessary for normal expiration now we have surfactant surfactant is a lipoprotein produced by specialized alveolar cells acts like a detergent reducing the surface tension of alveolar fluid without surfactant lung expansion is exceedingly difficult and the lungs collapse premature infants whose lungs are not yet capable of producing adequate surfactant often develops respiratory distress syndrome now let's proceed to alveolar gas exchange it is the second phase of the respiratory process the diffusion of oxygen from the alveoli and into the pulmonary vessels diffusion is the movement of gases or other particles from an area of greater pressure or concentration to an area of lower pressure or concentration now let's proceed to transport of oxygen and carbon dioxide and this is the third part of the respiratory process and it involves the transport of respiratory gases oxygen needs to be transported from the lungs to the tissue and carbon dioxide however must be transported from the tissue back to the lungs we also have hemoglobin which is an oxygen carrying red pigment in the red blood cells and it is carried to the tissues as oxy hemoglobin it is the compound of oxygen and hemoglobin however there are various factors that influence the tendency of oxygen to bind with and release from hemoglobin so here are the factors affecting oxygen transport from the lungs to the tissue first is your cardiac output next is number of eretrocytes or red blood cells and blood hematocrit then we have exercise any pathologic condition that decreases cardiac output such as damage the heart muscle blood loss or pooling of blood in the peripheral blood vessels diminishes the amount of oxygen delivered to the tissue the heart compensates for inadequate output by increasing its pumping rate or heart rate however with severe damage or blood loss this compensatory mechanism may not restore adequate blood flow and oxygen to the tissues by the way when we say hematocrit it is the percentage of blood that is red blood cells okay and the other term of red blood cells is retrosite okay now let's proceed to systemic diffusion it is the fourth process of respiration and it is the diffusion of oxygen and carbon dioxide between the capillaries and the tissues and the cells down to a concentration gradient similar to diffusion at the alveolar capillary level as cells consume oxygen the partial pressure of oxygen in the tissues decreases causing the oxygen at the arterial ends of the capillary to diffuse into the cells when cells consume more oxygen during exercise or stress the pressure gradient increases and diffusion is enhanced allowing the cells to regulate their own flow of oxygen now let's proceed to the factors affecting respiratory function the factors that influence oxygenation affect the cardiovascular system as well as the respiratory system these factors include age developmental factors have important influences on respiratory function at birth profound changes occur in the respiratory systems the fluid filled lungs drain the partial carbon dioxide rises and the neonate takes a first breath the lungs gradually expand with each subsequent breath reaching full inflation by two weeks of age changes of aging that affect the respiratory system of older adults becomes especially important if the system is compromised by changes such as infection physical or emotional stress surgery anesthesia or other procedures we also have environment altitude heat cold and air pollution affect oxygenation the higher the altitude the lower the partial oxygen and individual breaths as a result the person at high altitudes has increased respiratory and cardiac rates and increased respiratory depth which usually becomes most apparent when the individual exercises next is lifestyle physical exercise or activity increases the rate and depth of respiration and hence the supply of oxygen in the body sedentary people by contrast lack the alveolar expansion and deep breathing patterns of people with regular activity and are less able to respond effectively to respiratory stressors next is health status in the healthy person the respiratory system can provide sufficient oxygen to meet the body's needs diseases of the respiratory system however can adversely affect the oxygenation of the blood next is medications a variety of medications can decrease the rate and death of respirations when administering these medications the nurse must carefully monitor respiratory status especially when the medication is begun or when the dose is increased older clients are at high risk of respiratory depression and hence usually require reduced dosages lastly we have stress when stress and stressors are encountered both psychological and physiological responses can affect oxygenation some people may hyperventilate in response to stress when this occurs arterial partial oxygen rises and partial carbon dioxide falls the person may experience lightheadedness and numbness and feeling of the fingers toes and around the mouth as a result now let's proceed to alterations in respiratory function respiratory function can be altered by conditions affecting the airway conditions affecting movement of air conditions affecting diffusion and conditions affecting transport first let's have conditions affecting airway upper airway obstruction is usually caused by foreign object tongue falls back or collection of secretions assessing for and maintaining a patent airway is a nursing responsibility one that often requires immediate action next is conditions affecting movement of air so we have here terms like your breathing patterns which refers to the rate volume rhythm and relative ease or effort of respiration we also have your yupniya it is in normal respiration quiet and rhythmic effortless we also have a condition called this is a rapid respiration also we have your bradypnea it is an abnormally slow respiratory rate and apnea which means the absence of breathing and we have your hypercarbia or hypercapnia it means there is an increased level of carbon dioxide we also have cosmos breathing it is characterized by a deep rapid breathing pattern the body starts to breathe faster and deeper we also have your cane stokes respirations it is a mark rhythmic waxing and waning of respirations from very deep to very shallow with short periods of apnea also we have your bias or cluster respiration it is a shallow breaths interrupted by apnea we also have your orthopnia it is an inability to breathe easily unless in sitting upright or standing and lastly we have dysmia it means it is a difficulty of breathing or feeling of being short of breath now let's proceed to conditions affecting diffusion impaired diffusion may affect levels of gases in the blood particularly oxygen which does not diffuse as readily as carbon dioxide we have a condition called hypoxemia it means reduced oxygen levels in the blood may be caused by conditions that impair diffusion at the alveolar capillary level such as pulmonary edema or atelectasis or the collapse of yolai or by low hemoglobin levels we also have your hypoxia it means insufficient oxygen anywhere in the body and it results potentially causing cellular injury or death we have your cyanosis this is a bluish discoloration of the skin nail beds mucous membranes due to reduce hemoglobin oxygen saturation and it may be present with hypoxemia or hypoxia next we have conditions affecting transport once oxygen moves into the lungs and diffuses into the capillaries the cardiovascular system transports the oxygen to all body tissues and transports carbon dioxide from the cells back to the lungs where it can be exhaled from the body conditions that decrease cardiac output such as your congestive heart failure which means it's a chronic progressive condition that affects the pumping power of your heart muscles and also hypovolemia it is also known as volume depletion or volume contraction it is a state of abnormally low extracellular fluid in the body now let's proceed to assessment nursing assessment of oxygenation status includes first nursing history a comprehensive nursing history relevant to oxygenation status should include data about current and past respiratory problems lifestyle presence of cough sputum or pain medications for breathing and presence of risk factors for impaired oxygenation status next is physical examination in assessing a client's oxygenation status the nurse uses all four physical examination techniques we have your inspection palpation percussion and auscultation lastly is diagnostic studies the primary care provider may order various diagnostic tests to assess respiratory status function and oxygenation included are sputum specimens throat cultures visualization procedures venus and arterial blood specimens and pulmonary function tests now let's have the possible nursing diagnosis first is ineffective airway clearance we also have an effective breathing pattern impaired gas exchange and activity intolerance anxiety fatigue fear powerlessness insomnia and social isolation for the goals of care the overall outcomes or goals for a client with oxygenation problems are to maintain patent airway improve comfort and ease of breathing maintain or improve proper ventilation and oxygenation improve the ability to participate in physical activities and lastly prevent risk associated with oxygen problems such as skin and tissue breakdown syncope acid-base imbalances and feelings of hopelessness and social isolation now let's have the implementation phase so it is geared to promote oxygenation deep breathing and coughing exercises and also we have to hydrate our patient and to administer medications related to respiratory problems also incentive spirometry also we perform percussion vibration and postural drainage mucous clearance devices oxygen therapy now let's discuss about humidifiers what are humidifiers these are devices that add water vapor to inspired air and it provides moist and air directly to the client and it prevents mucous membranes from drying and becoming irritated and of course to lose to loosen secretions for easier expectations so that means it liquefies the secretions for easy expectoration we also have your incentive spirometers so it is referred to as sustained maximal inspiration devices or your smi's and it measures the flow of air inhaled through the mouthpiece so this is your incentive spirometer the indications of your incentive spirometer it is used after surgery especially thoracic and abdominal surgery and the goal is to promote expansion of alveoli and prevent or treat atelectasis for the nursing management on the use of incentive spirometer are first we have to place the patient in the proper position position like sitting or semi fowler's position we also have to educate the patient on the technique using the incentive spirometer and we should set realistic goals for our patient and lastly we have to record the results of the therapy next is percussion vibration and postural drainage so for the percussion it is also known as clapping it is a forceful striking of the skin with cupped hands vibration vibration is a series of quiverings produced by hands that are placed flat against the client's chest wall and lastly we have the postural drainage the drainage by gravity of secretions from various lung segments so the main purpose why we perform percussion vibration postural drainage is to remove the secretions from our patient's airway so here is an image of your percussion the vibration and your postural drainage next is mucus clearance devices it is used for clients with excessive secretions such as cystic fibrosis copd and bronchiectasis the device produces vibrations that loosen mucus from the airway and asses its movement up the airways to be expectorated next is your oxygen therapy it is the administration of oxygen at a concentration greater than that found in the environmental atmosphere and it provides adequate transport of oxygen in the blood while decreasing the work of breathing and reducing stress on the myocardium and oxygen concentration at room air is 21 percent for the indications of your oxygen therapy first we have your hypoxemia so it is a decrease in the arterial oxygen tension in the blood so basically it means that there is a decreased oxygen in the blood so if you note this to your patient so you administer oxygen therapy of course we need a written order from the doctor if it's not an emergency case also we have hypoxia it is a decrease in oxygen supply to the tissue or cells so basically it means that there is a decreased oxygen to the tissues or cells now let's have the methods of oxygen administration so these are oxygen administration devices so it is categorized low flow systems and high flow systems so when we say low flow systems it contributes partially to the inspired gas the patient breeds and for your high flow systems it provides the total inspired air for our patient low flow system devices are we have your cannula we have your oropharyngeal catheter your simple face mask your partial breathing mask and your non breathing mask so here are the suggested flow rate as well as the oxygen concentration based on a particular device that you will be using for your patient so this is an example of your cannula we also have your simple face mask partial re-breather mask non-rebreather mask and we also have your venturi mask your venturi mask is classified under your high flow systems now let's have your high flow systems so we have here your transtracheal catheter venturi mask aerosol mask trichostomy color teepees and face tense we also have here the suggested flow rate as well as the oxygen concentration offered by these particular devices here we have your transtracheal catheter we also have your aerosol mask we also have here your tracheostomy color teepees now let's have your small volume nebulizer therapy also known as your mini nebulizer so it is a handheld apparatus that disperses a moisturizing agent or medication and it is usually air driven by means of compressor through connecting tubes and the visible mist must be inhaled by the patient for the indications of your mini nebulizers we have difficulty in clearing secretions reduced vital capacity successful trials of simpler and less costly methods and diaphragmatic breathing technique prior to administration now we have here your endotracheal intubation it involves passing an endotracheal tube through the mouth or nose into the trachea and it provides a patent airway when the patient is having respiratory distress and it is a method of choice in emergency care now let's have your tracheotomy tracheotomy it is a surgical procedure in which an opening is made into the trachea we also have your tracheostomy it is the stoma that is the product of tracheotomy and it may be temporary or permanent for the nursing management of your endotracheal intubation and tracheostomy care we have here continuous monitoring and assessment opening kept patent by proper suctioning of secretions that means we have to suction our patient to maintain a pattern airway and also we have to position them in semi fowler's position and of course we have to provide paper and pencil for means of communication so i believe that would be all for our discussion on oxygenation so thank you so much for listening