Oxygenation Fundamentals PDF

Oxygenation yn Prepared by Mr. Khaled Metwaly Lecturer – Nursing program  Objectives At the end of this lecture , the student will know :  Anatomy of respiratory system  Function of respiratory system  Common terms related to oxygenation  Definitio...

Oxygenation yn Prepared by Mr. Khaled Metwaly Lecturer – Nursing program  Objectives At the end of this lecture , the student will know :  Anatomy of respiratory system  Function of respiratory system  Common terms related to oxygenation  Definition and benefits of oxygenation  Factors affecting oxygenation  Oxygen deficiency related-terms and manifestation  Impact of oxygen deficiency on the body  Definition , types , causes and prevention of oxygen toxicity  Diagnostic tests to assess oxygenation  Oxygenation and Ventilation Devices  NANDA-I Nursing Diagnoses Related to Decreased Oxygenation and Dyspnea  Outlines  Anatomy of respiratory system.  Function of respiratory system.  Common terms related to oxygenation.  Definition and benefits of oxygenation.  Factors affecting oxygenation.  Oxygen deficiency related-terms and manifestation.  Impact of oxygen deficiency on the body.  Definition , types , causes and prevention of oxygen toxicity.  Diagnostic tests to assess oxygenation.  Oxygenation and Ventilation Devices.  NANDA-I Nursing Diagnoses Related to Decreased Oxygenation and Dyspnea.  Anatomy of respiratory system The upper respiratory tract is made up of the: Nose Nasal cavity Mouth Sinuses Throat (pharynx) Voice box (Larynx) The lower respiratory tract is made up of the: Windpipe (trachea) Lungs Large airways (bronchi) Small airways (bronchioles) Air sacs (alveoli)  Respiratory system function Respiratory System The main function of our respiratory system is to provide the body with a constant supply of oxygen and to remove carbon dioxide. To achieve these functions, muscles and structures of the thorax create the mechanical movement of air into and out of the lungs called ventilation. Gas exchange occurs at the alveolar level where blood is oxygenated and carbon dioxide is removed, which is called respiration.  Common terms related to oxygenation Respiration is the process of moving air in and out of the lungs, through inspiration and expiration. During inspiration, oxygen enters the lungs and crosses into the bloodstream, where it’s delivered to tissues, a process known as oxygenation. Then, during expiration, carbon dioxide is expelled from the lungs. Ventilation, or breathing, is the movement of air through the conducting passages between the atmosphere and the lungs. Inspiration (inhalation) is the process of taking air into the lungs. It is the active phase of ventilation because it is the result of muscle contraction. During inspiration, the diaphragm contracts and the thoracic cavity increases in volume. This decreases the interalveolar pressure so that air flows into the lungs. Inspiration draws air into the lungs. Expiration (exhalation) is the process of letting air out of the lungs during the breathing cycle. During expiration, the relaxation of the diaphragm and elastic recoil of tissue decreases the thoracic volume and increases the interalveolar pressure. Expiration pushes air out of the lungs.  Oxygenation Oxygenation refers to the process of supplying oxygen to the body's tissues and cells to support their metabolic functions. It involves the delivery of oxygen from the environment to the lungs, its diffusion into the bloodstream, transportation via the circulatory system, and finally, its uptake and utilization by cells for energy production. Key Components of Oxygenation: 1.Ventilation: The movement of air into and out of the lungs. 2.Diffusion: The transfer of oxygen from the alveoli (air sacs in the lungs) into the blood capillaries. 3.Perfusion: The circulation of oxygen-rich blood to tissues and organs. 4.Cellular Uptake: The utilization of oxygen by cells for metabolic processes.. Benefits of Oxygenation: 1.Energy Production: Cellular Respiration: Oxygen is crucial for cellular respiration, the process where cells convert glucose (sugar) into energy. This energy is used for various bodily functions, including muscle contraction, cell growth, and repair. 2.Waste Removal: Carbon Dioxide Removal: Oxygenation is part of the process that removes carbon dioxide, a waste product of cellular respiration, from the body. 3.Immune System Function: White Blood Cell Activity: Oxygen supports the activity of white blood cells, which are essential for fighting infections.  Cont.. Benefits of Oxygenation 4.Wound Healing: Tissue Repair: Adequate oxygen supply is necessary for the repair of damaged tissues, including wounds. 5.Brain Function: Cognitive Processes: The brain requires a constant supply of oxygen to function properly. Oxygen deficiency can impair cognitive function, including memory, concentration, and decision-making. 6.Overall Health: Maintaining Vital Organ Function: Oxygenation is essential for the proper functioning of vital organs, including the heart, lungs, brain, and kidneys.  Factors Affecting Oxygenation Several factors can influence the oxygenation process, affecting the body's ability to efficiently deliver oxygen to cells. These factors can be broadly categorized into: 1.Respiratory Factors: Ventilation: Refers to the movement of air in and out of the lungs. Factors affecting ventilation include: Respiratory rate and depth: Rapid or shallow breathing can impair oxygenation. Airway patency: Obstructed airways (e.g., due to foreign bodies, mucus, or swelling) hinder airflow. Lung compliance and elasticity: Conditions like pneumonia or pulmonary fibrosis can reduce lung expansion and airflow. Respiratory muscle strength: Weakened muscles can affect breathing effort. Diffusion: This is the process of oxygen moving from the alveoli (air sacs) into the bloodstream. Factors affecting diffusion include: Alveolar-capillary membrane thickness: Thickened membranes (e.g., due to pulmonary edema or fibrosis) slow down diffusion. Alveolar surface area: Reduced surface area (e.g., due to emphysema) decreases the area available for gas exchange.  Factors Affecting Oxygenation 2.Cardiovascular Factors: Cardiac output: This is the amount of blood pumped by the heart per minute. It's influenced by heart rate and stroke volume. Hemoglobin concentration and function: Hemoglobin in red blood cells carries oxygen. Low hemoglobin levels (anemia) or abnormal hemoglobin structure can impair oxygen transport. Blood flow: Adequate blood flow to tissues is essential for oxygen delivery. Conditions like heart failure or peripheral vascular disease can reduce blood flow. 3.Other Factors: Neurological control: The brain regulates breathing and heart rate. Neurological conditions affecting these centers can disrupt oxygenation. Metabolic demand: Increased metabolic activity (e.g., during exercise) requires more oxygen Environmental. factors: High altitude, air pollution, and exposure to certain chemicals can affect oxygen availability and delivery.  Conditions that Affect Oxygenation Several conditions can impair oxygenation, including:  Respiratory diseases: Asthma, chronic obstructive pulmonary disease (COPD), pneumonia, pulmonary fibrosis  Cardiovascular diseases: Heart failure, coronary artery disease, arrhythmias  Blood disorders: Anemia, carbon monoxide poisoning  Neurological conditions: Stroke, brain injury, spinal cord injury  Musculoskeletal disorders: Conditions affecting chest wall movement (e.g., scoliosis, kyphosis)  Environmental factors: Exposure to high altitude, air pollution, or toxic fumes Diagnostic tests to assess a patient's oxygenation status: 1.Pulse Oximetry: This non-invasive test measures the percentage of hemoglobin in the blood that is saturated with oxygen. A small sensor is placed on the finger or earlobe, and the reading is displayed on a monitor. Normal oxygen saturation levels are typically between 95% and 100%. 2.Arterial Blood Gas (ABG) Test: This test measures the levels of oxygen and carbon dioxide in the blood. 3.Chest X-ray:.  Oxygen deficiency related- terms Hypoxia is defined as a reduced level of tissue oxygenation. Hypoxia has many causes, ranging from respiratory and cardiac conditions to anemia. Hypoxemia is a specific type of hypoxia that is defined as decreased partial pressure of oxygen in the blood (PaO2) indicated in an arterial blood gas (ABG) result. Hypercapnia, also referred to as hypercarbia, is an elevated level of carbon dioxide in the blood. This level is measured by the PaCO2 level in an ABG test and is indicated when the PaCO2 level is greater than 45. Hypercapnia is caused by hypoventilation or when the alveoli are ventilated but not perfused. Sings and Symptoms of Oxygenation Deficiency: Shortness of breath Rapid breathing (tachypnea) Rapid heart rate (tachycardia) Bluish discoloration of the skin (cyanosis)  Impact of Oxygen Deficiency (Hypoxia) on the Body 1. Cellular Level: Energy Production: Oxygen is crucial for cellular respiration, the process by which cells convert nutrients into energy. Without adequate oxygen, cells cannot produce sufficient energy to function properly. This leads to: Fatigue: Decreased energy production results in feelings of tiredness and weakness. Impaired organ function: Vital organs like the heart, brain, and kidneys rely heavily on oxygen for proper function. Hypoxia can impair their ability to work effectively.  Cont.. Impact of Oxygen Deficiency (Hypoxia) on the Body 2- Organ System Level: Brain: The brain is particularly sensitive to oxygen deprivation. Hypoxia can cause: Confusion: Difficulty thinking clearly, impaired judgment. Dizziness: Loss of balance and coordination. Headache: Often a prominent symptom of hypoxia. Loss of consciousness: In severe cases, hypoxia can lead to fainting or even coma. Long-term cognitive impairment: Prolonged or severe hypoxia can cause permanent brain damage. Heart: Arrhythmias: Irregular heartbeats can occur as the heart struggles to compensate for the lack of oxygen. Heart failure: In severe cases, hypoxia can worsen existing heart conditions or even lead to heart failure. Lungs: Increased respiratory rate: The body attempts to compensate for the lack of oxygen by increasing breathing rate (tachypnea). Pulmonary hypertension: Increased pressure in the pulmonary arteries, which can strain the heart.  Cont..Impact of Oxygen Deficiency (Hypoxia) on the Body Systemic Effects: Cyanosis: Bluish discoloration of the skin, lips, or nail beds due to deoxygenated blood. Metabolic acidosis: A buildup of acidic byproducts in the blood due to impaired cellular metabolism. Organ failure: Prolonged or severe hypoxia can lead to the failure of multiple organs, which can be life-threatening.  Oxygen Toxicity Oxygen Toxicity Oxygen toxicity, also known as oxygen poisoning, occurs when you breathe in too much oxygen. While oxygen is essential for life, high concentrations can be harmful. Causes High Oxygen Concentrations: Medical Settings: High-flow oxygen therapy: Used to treat certain medical conditions. Hyperbaric oxygen therapy: Involves breathing pure oxygen in a pressurized chamber. Diving: Breathing compressed air at high depths. Premature Infants: Their lungs are more susceptible to oxygen toxicity.  Types of Oxygen toxicity Pulmonary Oxygen Toxicity: Primarily affects the lungs. Symptoms: Cough Chest pain Difficulty breathing Central Nervous System (CNS) Oxygen Toxicity: Affects the brain and nervous system. Symptoms: Seizures Visual disturbances Muscle twitching Nausea Dizziness Confusion Risk Factors for oxygen toxicity High oxygen concentrations: Breathing oxygen at levels significantly higher than normal atmospheric air. Duration of exposure: Prolonged exposure to high oxygen levels increases the risk. Prematurity: Premature infants are more susceptible. Prevention of oxygen toxicity Use the lowest effective oxygen concentration: If you are receiving supplemental oxygen, use the lowest concentration necessary to maintain adequate blood oxygen levels. Monitor oxygen levels: Healthcare providers carefully monitor oxygen levels in patients receiving supplemental oxygen. Limit exposure: Minimize the duration of exposure to high oxygen concentrations whenever possible.  Oxygenation and Ventilation Devices Oxygenation and ventilation devices are medical tools used to support breathing and deliver oxygen to the body when a person is unable to do so adequately on their own. Here are some common types: 1. Oxygen Delivery Devices:  Nasal Cannula: Delivers low-flow oxygen through two prongs placed in the nostrils.  Simple Face Mask: Covers the nose and mouth, delivering oxygen at slightly higher flow rates than nasal cannulas.  Oxygen Delivery Devices:  Non-Rebreather Mask: A type of face mask with a reservoir bag that helps deliver higher concentrations of oxygen.  Venturi Mask: Delivers precise oxygen concentrations by mixing oxygen with room air.  High-Flow Nasal Cannula: Delivers heated and humidified oxygen at high flow rates, improving comfort and potentially reducing the risk of complications. Flow meter Nebulizer mask Nasal Cannula Simple Face Mask  Venturi Mask Different sizes Green Blue Red Yellow FiO2 = 60% FiO2 = 24% FiO2 = 40% FiO2 = 35% Flow rate: 12 - 15L/min Flow rate: 2 - 3L/min Flow rate: 10 - 15L/min Flow rate: 8 - 12L/min  Ventilation Devices: Non-Invasive Ventilation (NIV): Continuous Positive Airway Pressure (CPAP): Delivers a steady stream of air pressure to keep the airways open. Bi-Level Positive Airway Pressure (BiPAP): Delivers different levels of air pressure during inhalation and exhalation, making it easier to breathe. Invasive Ventilation: Mechanical Ventilator: A machine that provides mechanical breaths to patients who are unable to breathe on their own. This may require an endotracheal tube inserted into the trachea. Factors to Consider in Device Selection:  Patient's condition: Severity of respiratory distress, underlying medical conditions, and overall stability.  Oxygenation needs: The level of oxygen required to maintain adequate blood oxygen levels.  Comfort and patient tolerance: The device should be comfortable and well- tolerated by the patient.  Clinical goals: The specific goals of therapy, such as improving gas exchange, reducing respiratory work, or providing rest for the respiratory muscles.  Oxygenation and Ventilation Devices Device Flow Rates and Oxygen Percentage Flow rate: 1-6 L/min Nasal Cannula FiO2: 24% to 44% Flow rate: up to 60 L/min High-Flow Nasal Cannula FiO2: Up to 100% Flow rate: 6-10 L/min Simple Mask FiO2: 28% to 50% Flow rate: 10 to 15 L/min FiO2: 60-80% Non-Rebreather Mask Safety Note: The reservoir bag should always be partially inflated. CPAP, BiPAP, Venturi Mask, Mechanical Use the settings provided by the respiratory Ventilator therapist and/or provider order. Flow rate: 15 L/min FiO2: 100% Bag Valve Mask Squeeze the bag once every 5 to 6 seconds for an adult or once every 3 seconds for an  NANDA-I Nursing Diagnoses Related to Decreased Oxygenation and Dyspnea NANDA-I Nursing Selected Defining Definition Diagnoses Characteristics Abnormal ABG results Abnormal breathing pattern Excess or deficit in oxygenation Confusion and/or carbon dioxide elimination Abnormal skin color Impaired Gas Exchange Irritability at the alveolar-capillary membrane. Restlessness Tachycardia Sleepiness Abnormal breathing pattern Bradypnea (Decreased respiratory rate) Dyspnea Increased anterior-posterior chest Inspiration and/or expiration that diameter Ineffective Breathing Pattern does not provide adequate Nasal flaring ventilation. Orthopnea Pursed-lip breathing Tachypnea Use of accessory muscles to  NANDA-I Nursing Selected Defining Definition Diagnoses Characteristics Adventitious breath sounds Alteration in respiratory rate Inability to clear secretions or Dyspnea Ineffective Airway Clearance obstructions from the respiratory Excessive sputum tract to maintain a clear airway. Ineffective cough Orthopnea Restlessness Adventitious breath sounds Abnormal skin color Tachycardia Inadequate blood pumped by the Restlessness Decreased Cardiac Output heart to meet the metabolic Fatigue demands of the body. Edema Weight gain Decreased peripheral pulses Exertional dyspnea Activity Intolerance: Insufficient Fatigue physiological or psychological energy Abnormal heart rate response to Activity Intolerance to endure or complete required or activity desired daily activities. Generalized weakness  References This work is a derivative of Anatomy & Physiology by OpenStax and is licensed under CC BY 4.0. 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