Oxygenation and Respiration Processes

• Oxygen is essential for sustaining life
• The cardiac and respiratory systems work together to meet the body's oxygen needs
• The cardiovascular system transports oxygen to cells and tissues
• Respiratory gases are exchanged between the environment and the blood
• Neural and chemical regulators control respiratory rate and depth based on tissue oxygen demands

Respiration

• Respiration involves exchanging oxygen and carbon dioxide during cellular metabolism

Respiratory Physiology

• Gas exchange occurs in the lungs due to pressure changes
• Intrapleural pressure is negative compared to atmospheric pressure
• Intrapleural pressure becoming more negative creates a pressure gradient for air flow into the lungs
• The diaphragm and external intercostal muscles contract, which increases the size of the thorax

Steps in Oxygenation

• Ventilation is the process of moving gases into and out of the lungs.
• Diffusion involves exchanging respiratory gases across the alveoli capillary membrane
• Perfusion is when the cardiovascular system pumps blood to and from the lungs and body

Respiratory Terminology

• Involves concepts like airway resistance, compliance, work of breathing, inspiration, expiration, atelectasis, and surfactant
• Decreased lung compliance leads to increased airway resistance
• Increased airway resistance causes increased use of accessory muscles
• Increased use of accessory muscles leads to increased breathing work
• Increased breathing work results in increased energy expenditure

Respiratory Physiology

• Normal lung values are determined by age, gender, and height
• Involves tidal volume, residual volume, and forced vital capacity
• Spirometry is used to measure lung volumes

Respiratory Gas Exchange

• Diffusion of respiratory gases occurs at the alveolar capillary membrane
• The thickness of the membrane affects diffusion rate
• Increased membrane thickness slows diffusion, reduces gas exchange, and decreases oxygen delivery to tissues
• Pulmonary edema, pulmonary infiltrates, or pulmonary effusion thickens the membrane
• Chronic diseases, acute diseases, and surgical processes can alter the alveolar capillary membrane surface area

Oxygen Transport

• The oxygen-transport system consists of the lungs and cardiovascular system
• Delivery depends on ventilation, perfusion, rate of diffusion, and oxygen-carrying capacity
• Carbon dioxide is transported back to the lungs for exhalation.

Regulation of Respiration

• The central nervous system controls respiratory rate, depth, and rhythm
• The cerebral cortex regulates voluntary control of respiration
• It maintains the rate and depth of respiratory based on changes CO2 and hydrogen ion concentration
• Chemoreceptors sense changes in chemical content and adjust neural regulators

Cardiovascular Physiology

• The right ventricle pumps deoxygenated blood through the lungs
• The left ventricle pumps oxygenated blood through the systemic circulation
• Consists of two atria and two ventricles

Blood Flow Regulation

• Cardiac output is the amount of blood ejected from the left ventricle each minute
• Stroke volume is the amount of blood ejected from the ventricle with each contraction
• Afterload is the resistance to left ventricle ejection
• Preload is the amount of blood in the left ventricle at the end of diastole

Conduction System

• Includes the sinoatrial (SA) node, atrioventricular (AV) node, bundle of His, and Purkinje fibers
• Generates and transmits electrical impulses
• Sinoatrial (SA) node acts as the pacemaker
• Atrioventricular (AV) node acts as the mediator

Electrocardiogram

• Reflects the electrical conduction system of the heart

Factors Affecting Oxygenation

• Decreased oxygen-carrying capacity can be attributed to anemia or Carbon Monoxide
• Hypovolemia can be attributed to shock or severe dehydration
• Decreased inspired oxygen concentration includes airway obstruction and decreased environmental oxygen
• Increase in metabolic rate is due to pregnancy, exercise, wound healing or a fever
• Conditions such as pregnancy, obesity, or neuromuscular diseases affect chest wall movement
• Chronic lung disease and changes in the anteroposterior diameter of the chest wall occur because of overuse of accessory muscles & air trapping

Alterations in Respiratory Functioning

• Hyperventilation occurs when ventilation exceeds the requirement to eliminate carbon dioxide produced by the cells
• Can be caused by anxiety, infection, drugs, acid-base imbalance, fever, and aspirin poisoning
• Hypoventilation occurs when alveolar ventilation is inadequate to meet the body's oxygen demand
• Can be caused by atelectasis and collapsed alveoli
• Hypoxia is inadequate tissue oxygenation at the cellular level
• Can be caused by anemia, carbon monoxide poisoning, pneumonia, and spinal cord injury
• Cyanosis is a blue discoloration of the skin and mucous membranes
• Can be caused by desaturated hemoglobin in capillaries and is a late sign of hypoxia

Alterations in Cardiac Functioning

• Disturbances in conduction (dysrhythmias) are caused by electrical impulses that do not originate from the Sinoatrial (SA) node
• Altered cardiac output occurs when insufficient volume is ejected into systemic and pulmonary circulation
• Impaired valvular function includes stenosis and regurgitation
• Myocardial Ischemia occurs when blood to the myocardium does not meet myocardial oxygen needs
  • Includes conditions such as angina and Myocardial Infarction

Developmental Factors

• Infants and Toddlers - Risk for upper respiratory infections and nasal congestion
• School-aged children and adolescents - Risk for respiratory infections & secondhand smoke
• Young & middle-aged adults - Smokng, unhealthy diet and stress
• Older adults - Calcification of valves, SA node & costal cartilage. Osteoporosis

Risk Factors

• Includes smoking, substance abuse, and stress

Environmental Factors

• Includes air pollution from air particles

Aspiration

• Should ensure proper posture when eating
• Evaluate by determining if patients can swallow
• Feed through feeding tubes

Nursing History

• It is also important to know what the patients symptoms are (I.e. Wheezing)
• Also imporatnt to determine health risks (allergies, and medications)

Implementations

• Flu shots prevent pnemonia and influenza
• It is vital to eliminate hazardous environmets that can hinder on breathing

Implementations: Acute Care

• Care includes, dyspnea, humidification, airway maintenence, and chest physio treament

Suctioning

• Used when patients are unable to clear respiratory secretions from the airways by coughing

Artificial airways

• Include Endotracheal Tubes

Maintenence and Promotion of Lung Expansion

• It is important to promote ambulation and positioning and incentive spirometry

Breathing treatment

• It is important to treat hypoxia, it can be due to a combustible from a flame
• Supply of oxygen is due to tanks or wall-piped systems

Oxygen Devices

• Comes in the form of
• Nasal Cannula
• Venturi Mask
• Non rebreather mask
• Ambu bam and face mask
• Aerosol mask

CPR

• Pumping 30 breaths at a time

Restorative Care

• Nutrition is important as well as breathing treatment