COLLEGE OF NURSING

(MALE) LARKANA
UNIT NO : 09
OXYGENATION

Subject: Fundamental of Nursing-I

Assigned by: Tahir Ali Bhutto

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Presented by: Group No. 08
 GROUP MEMBERS

1. Masroor Ali
2. Javeed Kalhoro
3. Afzal Ali
4. Nanag Das
5. Mujahid Ali
6. Tiger Mahveer
7. Parveez Bhutto
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 OBJECTIVES:
 After the end of this presentation you will be able to:
1. Identify factors that can interfere with effective
oxygenation of body tissues.
2. Describe common manifestations of altered respiratory
and cardiovascular function.
3. Discuss lifespan-related changes and problems in
respiratory function and cardiovascular system.
4. Describe nursing measures to ensure a patient airway.

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5. Apply Nursing Process and teaching plan for a client
with altered respiratory function and cardiovascular
function.
6. Recognize the emergencies related to respiratory and
cardiovascular system.
7. Explain ways that caregivers can decrease the
exposure of clients to infection.
8. Differentiate between medical and surgical asepsis.

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 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.
 Cellular metabolism produces carbon dioxide, which
must be eliminated from the body to maintain normal
acid–base balance.
 . Delivery of oxygen and removal of carbon dioxide
require the integration of several systems including
the hematologic, cardiovascular, and respiratory
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systems
 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.
 Impaired function of the system can significantly affect
our ability to breathe, transport gases, and participate
in everyday activities.
 Respiration is the process of gas exchange between the
individual and the environment and involves four
components:
1. Ventilation or breathing, the movement of air in and
out of the lungs as we inhale and exhale
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 2. Alveolar-capillary gas exchange, which involves the
diffusion of oxygen and carbon dioxide between the
alveoli and the pulmonary capillaries
3. Transport of oxygen and carbon dioxide between the
tissues and the lungs
4. Movement of oxygen and carbon dioxide between
the systemic capillaries and the tissues.
Upper Lower respiratory tract :
respiratory tract: • Trachea
• Mouth • Lungs (with bronhi,
• Nose bronchioles, alveolar
• Pharynx pulmonary capillaries
• Larynx and pleural 7
membranes)
Q: 1; IDENTIFY FACTORS THAT CAN
INTERFERE WITH EFFECTIVE
OXYGENATION OF BODY TISSUES.
 There are six factors that can interfere with effective
oxygenation.
1) Environment
2) Life style
3) Health status
4) Medications (Narcotics/opioids)
5) Stress and coping
6) Gender

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1) Environment:

 Attitude, heat, cold and air pollution affect

oxygenation.
 Higher the attitude ----- lower PO2 -------
increased respiratory & cardiac rate.
 Heat -blood vessels dilation increase cardiac
output increase demand of O2
 Cold -blood vessels constriction decrease
cardiac output decrease demand of O2
 Air pollutionPeople who have history of lung
disease and altered respiratory function
experience difficulty in breathing.
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.
2) Life style:
 Physical exercise or activity increase the rate and
depth of breathing hence increasing heart rate
and the process is just opposite in people having
sedentary (sitting or inactive) lifestyle.
3) Health status:
Disease of cardiovascular system and
respiratory
system can adversely affect their functioning.
One cardiovascular condition that affects
oxygenation is anemia
4) Medications: (Narcotics/opioids)
 Narcotics such a morphine and meperidine 10
decrease the respiratory rate and depth by
5) Stress & Coping
 In stressful condition, sympathetic system is
activated that increase rate of respiration and
heart rate and vice versa.
6) Gender:
 Through middle adulthood (until menopause)
estrogen has a protective effect in women,
slowing the progress of atherosclerosis and
reducing the risk of CVS disease.
 This protection is absent in males.

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Q: 2; DESCRIBE COMMON MANIFESTATIONS OF
ALTERED RESPIRATORY AND CARDIOVASCULAR
FUNCTION.

1) Respiratory Alterations
1. Hypoxia
2. Altered breathing patterns
3. Obstructed airway

2) Cardiovascular Alterations
1. Decreased cardiac output
2. Impaired tissue perfusion
3. Blood alterations
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 1) RESPIRATORY ALTERATIONS
1) Hypoxia
 It is a condition of insufficient oxygen anywhere
in the body, from inspired gas to tissues.
 It can be related to any part of respiration
 Ventilation
 Diffusion of gases
 Transport of gases by blood.
 Hyperventilation: It is inadequate alveolar
ventilation that is caused by drugs, anesthesia or
due to disease of respiratory system that leads to
a condition hypecarbia/ hypercapnia 13

(decreased level of CO2).

 When diffusion of oxygen from alveoli does not
place properly then a condition appears called
Hypoxemia (decreased conc.: of O2 to Hb).
Cyanosis is a condition also associated with hypoxia
that is a blue discoloration of mucous membranes and
nail beds due to reduced Hb saturation with oxygen.
Signs of Hypoxia:
 Rapid pulse.
 Rapid shallow respiration and dyspnea
 Increased restlessness or light-headedness
 Flaring of the nares/nostrils
 Substernal or intercoastal retractions.
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2) Altered breathing patterns:
Rate:
 Trachypnea: Rapid respiration marked by
quick, shallow breaths.
 Bradypnea: Abnormally slow respiration.
 Apnea: Cessation(absence) of respiration
Volume:
 Hyperventilation: A increase in the amount of
air in the lungs characterized by prolong and
deep breaths; may be associated with anxiety.
 Hypoventilation : A reduction in the amount of
air in the lungs characterized by shallow
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respiration.
Rhythm:
 Cheyne-strokes breathing: It is an abnormal
pattern of breathing characterized by
progressively deeper & faster breathing followed
by a gradual decrease that results in a temporary
apnea. This pattern repeats itself. With each cycle
usually taking 30 seconds to 2 minutes.
Effort:
 Dyspnea: Difficult and labored breathing during
which the individual has a persistent, unsatisfied
need for air and feels distressed.
 Orthopnea: Ability to breath only in upright
sitting position. 16
3) Obstructed airway: A completely or partially
obstructed airway can occur anywhere along the
upper or lower respiratory passage-ways.
 An upper airway obstruction: that is in the nose,
pharynx, or larynx can arise because of foreign
objects such as food; because the tongue falls back
into the oropharynx when a person is
unconscious; or when secretions collect in the
passageways.
 A lower airway obstruction: is not always easy to
observe, stridor ( a harsh, high pitched sound,)
may be heard during inspiration. The client may
have altered arterial blood gas levels, restlessness,
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dyspnea and abnormal breath sounds.
 2 - CARDIOVASCULAR ALTERATIONS
1) Decreased cardiac output:
 The vessels that supply blood to the heart muscle
may become occluded by atherosclerosis or a blood
clot, shutting off the blood supply to a portion of
the myocardium. When this happens, the tissue
becomes necrotic and dies, a condition known as a
myocardial infarction (MI) or heart attack.
 If a large portion of the heart muscle is affected,
particularly in the left ventricle, cardiac output falls
because the affected muscle no longer contracts.
Heart Failure may develop if the heart is not able to
keep up with the body’s need for oxygen and 18
nutrients to the tissues.
2) Impaired tissue perfusion:
 Atherosclerosis is by far the most common cause of
impaired blood flow to organs and tissues. As vessels
narrow and become obstructed, distal tissues receive
less blood, oxygen and nutrients.
 Ischemia is a lack of blood supply due to obstructed
circulation. Any artery in the body may be affected
by atherosclerosis, although the effects are often
related to coronary arteries, vessels supplying blood
to the brain, and arteries in peripheral tissues.
 Angina pectoris & myocardial ischemia: obstruction
of the coronary arteries cause myocardial ischemia,
often resulting in angina pectoris 19
.
 Transient ischemia attack: if the cerebral vessels are
affected the result may be a transient ischemia attack
3) Blood Alterations:
 Because most oxygen is transported to tissues in
combination with hemoglobin, the problems of
inadequate red blood cells (RBCs), low
hemoglobin levels, or abnormal hemoglobin
structure can affect the tissue oxygenation.
Anemia has several different causes:
•RBCs are lost along with other components
because of acute or chronic bleeding.
•Hemoglobin and RBCs are not formed
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adequately.
Q:3;DISCUSS LIFESPAN-RELATED CHANGES AND
PROBLEMS IN RESPIRATORY FUNCTION AND
CARDIOVASCULAR SYSTEM.
1) Changes of Respiratory System with Aging
1. Physiological changes:
 Decrease respiratory muscle strength.
 Decrease in elastic recoil of lung tissues.
 Stiffening of chest wall and calcification
of coastal cartilages.
 Decreases in size of inter vertebral spaces.
 Loss of alveolar surface area and
pulmonary capillary blood volume.
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 2. Anatomical changes:
 Air spaces size increases due to senile
emphysema.
 Compliance; Chest wall compliance
decreased lung compliance
 Increased to normal- total respiratory
compliance decreased.
2) Changes of Cardiovascular System with Aging

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Q: 4; DESCRIBE NURSING MEASURES TO
ENSURE A PATIENT AIRWAY
1) Airway is called patent whenever there is an open
pathway between a patient’s lungs and the outside
world.
2) Airway obstruction is a blockage in the airway. It
may partially or totally prevent air from getting into
your lungs.
3) Nursing Measures:
1. Assist patient in performing deep breathing and
coughing exercises.
2. Optimal positioning(sitting position)
3. Use of abdominal muscles for more forceful 24
cough
4. Use of incentive spirometry
5. Importance of frequent position changes.
6. If cough is ineffective use suctioning as needed to
remove sputum and mucus plugs.
7. Encourage adequate intake of fluids to prevent
dehydration.
8. Administer medications ( e.g; antibiotics, mucolytic
agents, bronchodilators, expectorants) as ordered.
9. Consult respiratory therapist for chest
physiotherapy
10. Instruct patient how to use prescribed inhalers.
11. Provide steam inhalation to clear the secretions.
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Q: 5; APPLY NURSING PROCESS AND TEACHING
PLANS FOR A CLIENT WITH ALTERED
RESPIRATORY FUNCTION AND
CARDIOVASCULAR FUNCTION.

1) Assessment:
 Nursing history
 Physical examination
 Pulse oximetry
 Cardiac monitoring

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2) Diagnosis :

a) Diagnosis studies: b) Diagnosis :

Sputum test Ineffective airway
Throat test Clearance
Blood test Ineffective breathing
ECG Patterns.
Pulmonary function Impaired gases
test Exchange
X-ray Impaired tissue
Laryngoscope. perfusion

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3) Planning:

 Maintain a patient airway

 Improve comfort and ease of breathing
 Maintain or improve pulmonary ventilation
and oxygenation
 Maintain or improve tissue perfusion
 Maintain or restore an adequate cardiac
output
 Improve ability to participate in physical
activities.
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4) Implementation:
 Promoting oxygenation
 Deep breathing and coughing(Huff
coughing)
 Hydration + humidifiers ( Nebulizers)
 Medications
 Incentive spirometry
 Percussion, vibration and
postural drainage.
 Oxygen therapy.

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5) Evaluation:
 What is the client’s perception of the
problem?
 Is the client complaining of shortness of
breath or difficulty breathing.
 Is the client taking medications or
performing treatment such as
 Percussion, vibrations, postural
drainages as prescribed?
 Do other factors need to be considered
such as the client’s
 Psychological stress level.
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Difficult terms:

1) Huffing:
 Huffing is also known as huff coughing.
 It is a technique that helps move mucus from the
lungs.

2) Incentive spirometer:
 It is a handheld device that helps your lungs
recover after a surgery or lung illness.
 Your lungs can become weak after prolonged
disuse. 31
3) Chest percussion:
 It is a manual technique which involves
clapping on the chest and / or back to loosen the
thick, sticky mucus from the sides of the lungs.
 This will enable the secretions to move into the
larger airway when you take deep breaths so
that you are able to cough and clear the
secretions effectively.

4) Vibration:
 it is a technique that gently shakes the mucus so
it can move into the larger airways.
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5) Postural Drainage:
 The patient’s body is positioned so that the
trachea is inclined downward and below the
affected chest area.
6) Oxygen therapy:
 It is a treatment that delivers oxygen gas for
you to breathe.
 You can receive oxygen therapy from tubes
resting in your nose, a face mask, or a tube
placed in your trachea, or windpipe.
 This treatment increases the amount of
oxygen your lungs receive and deliver to
your blood. 33
RELATED TO RESPIRATORY AND
CARDIOVASCULAR SYSTEM.
Cardiovascular Respiratory emergencies:
emergencies:

1. Arrhythmias 1. Asthma
2. Cardio-pulmonary 2. Chronic obstructive
arrest pulmonary disease
3. Hypertensive (COPD)
emergency 3. Chronic Bronchitis
4. Acute myocardial 4. Emphysema
infarction 5. Lung cancer 34

5. Cardiac tamponade. 6. Pneumonia

 1- CARDIOVASCULAR EMERGENCIES:
1; Arrhythmia (Irregular heart beat)
 An arrhythmia is a problem with the rate or
rhythm of the heartbeat.
 During an arrhythmia, the heart can beat too fast,
too slowly, or with an irregular rhythm.
 When a heart beats too fast, the condition is
called tachycardia. This resting heart beat I s
greater than 100 beat a minute.
 When a heart beats too slowly, the condition is
called bradycardia. This resting heart beat is less
than 60 beat a minute.
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 Signs includes anxiety, sweating, fatigue, slow or
fast heartbeat, chest pain.
2) Cardiac arrest:
 It is a sudden loss of blood flow resulting from
the failure of the heart to pump effectively.
 The condition usually results from with a
problem of hearts electrical system, which
disrupt heart pump action and stops the blood to
body.
A person loses consciousness and has no pulse.
3) Hypertensive emergency:
 It is a condition in which elevated blood pressure
results in target organ damage.
It is a medical emergency.
It can lead to heart attack stroke or36
other life health problems.
4) Heart attack > Acute myocardial infarction
It is the medical name for a heart attack.
 A heart attack occurs when blood flow to the
heart muscle is abruptly cut off, causing tissue
damage.
 This is usually the result of a blockage in one or
more of the coronary arteries.
The person will be conscious and breathing.
5) Cardiac tamponade:
 It is a serious medical condition in which blood
or fluids fill the space between the sac
(Pericardium) that encases the heart and heart
muscle. 37

 This places extreme pressure on heart.

 2- RESPIRATORY EMERGENCIES:
1) Asthma:
 It is defined as a common chronic respiratory
condition that causes difficulty breathing due to
inflammation of the airways.
 Asthma symptoms include dry cough, wheezing,
chest tightness and shortness of breath.
It is a most common in children, but adults can
have asthma too.
Genetic, enviromental and other factors have
been linked to developing asthma.
2) Chronic Obstructive Pulmonary Disease (COPD):
 It refers to agroup of diseases that cause airflow38
blockage and breathing.
  People usually experiences symptoms including
shortness of breath, and normally cough up
sputum( mucus from the lungs) especially in the
morning.
3) Chronic Bronchitis:
 It is long-term inflammation of the bronchi.
It is common among smokers.
People with chronic bronchi tend to get lung
infections more easily.
 Usually people cough up sputum (mucus from
the lungs) especially in the morning.
4) Emphysema:
 It is a serious respiratory disease, which is 39
another form of COPD.
  Those who suffer from emphysema have trouble
exhaling air from their lungs.
5) Lung cancer:
 With the ability to develop in any part of the
lungs, this cancer is difficult to detect.
 Most often, the cancer develops in the main part
of the lungs near the air sacs.
6) Pneumonia:
 It is a common lung disease caused by an infection
in the air sacs in the lungs.
 The infection can be bacterial, viral, or fungal.
7) Pleural effusion:It is a collection of fluid between the
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lung and the chest wall in what’s called the pleural
space.
Q: 7; EXPLAIN WAYS THAT CAREGIVERS CAN
DECREASE THE EXPOSURE OF CLIENTS TO
INFECTION.

Maintain adequate bed spacing

Handle properly waste contaminated with blood or
body fluid.
Use aseptic techniques in invasive procedures.
Adopt universal precautions before attending patient.
Proper hand washing before and after attending
patient.
Use PPE (personnel protective equipments gloves,
mask, gown, apron)
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Use sterilization techniques
Incinerate hospital waste.
Avoid reuse of syringes.
Don’t recap syringes but use cutter in ward.
Proper cleansing of hospital floor with finis or
phenyl.
Maintain distance from patients having droplet
infections and use mask.

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Q: 8; DIFFERENTIATE BETWEEN MEDICAL AND
SURGICAL ASEPSIS.
Asepsis: it is freedom from infection or prevention of
contact with microbes.
1) Medical Asepsis:
 Aseptic techniques are the universally practice
to reduce the spread of infection or disease from
patient to patient.
 Examples :-
Hand washing
Changing bed sheets
Cleaning hospital floor
Wearing face mask 43

 
2) Surgical Asepsis:
 Sterile techniques refer to those practices that
keep an area or object free of all
microorganisms ; it includes practices that
destroy all microorganisms and spores.
 Examples :-
 Sterilization of OT instruments.
 Autoclaving of hospital linen.

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REFERENCES:

 Erb, G.K.,B.(2000).FUNDAMENTAL OF NURSING:

Concepts, Process and Practice (10th edition) Addition:
Wesley.
 https://you.be/EA18sqOgMU4

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