For all medical students

1. Chapter 09
Oxygenation ,Respiration Function &
Cardiovascular System
Farhana Aziz
CON(Male)SGHL
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2. Objectives
At the end of lecture student will able to learn ;
1) Define normal mechanisms of oxygen ,respiratory and cardiovascular system .
2) Identify factors that can interfere with effective oxygenation of body tissues .
3) Describe common manifestation of altered respiration and cardiovascular
function .
4) Discuss lifespan –related changes and problems in respiratory function and
cardiovascular system .
5) Describes nursing measures to ensure a patient airway .
6) Apply nursing process and teaching plan for a client with altered respiratory
function and cardiovascular function .
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3. Conti…..
7. Recognize the emergencies related to respiratory and cardiovascular
system .
8. Explain ways that caregivers can decreases the exposure of clients to
infection .
9. Differentiate between medical and surgical asepsis.
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4. • Oxygen
it is a colourless, odourless reactive gas, the chemical element of atomic number 8
and the life-supporting component of the air.
• Oxygenation
The delivery of oxygen to the body’s tissues and cells is called oxygenation.
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5. Composition of Gases in Air
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6. Terms
related to
Oxygenatio
n
FiO2: Fraction of inspired oxygen
(%).
PaO2: The partial pressure of
oxygen in arterial blood. It is
used to assess the adequacy of
oxygenation.
normal range of 80–100 mmHg
SaO2: Arterial oxygen saturation
measured from blood specimen.
normal range of 95–100 mmHg
SpO2: Arterial oxygen saturation
measured via pulse oximetry.
normal SpO2 should be
between 96% to 99%
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7. • Respiration
Respiration is a process of gas exchange, it's necessary to supply cells
with O2 for metabolism and to remove CO2.
• Mechanisms of respiration
The mechanisms of respiration require an integration of factors
involving
(1) nervous system,
(2) chemoreceptors in cardiovascular system, as well as
(3) respiratory system.
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. 7

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10. Mechanisms of Cardiovascular system
• The heart is a pump, usually beating about 60 to 100 times per minute.
With each heartbeat, the heart sends blood throughout our bodies,
carrying oxygen to every cell. After delivering the oxygen, the blood
returns to the heart and carrying deoxygenated blood from body cells .
This cycle repeats over and over again
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12. Factors Affecting on Oxygenation
• .1. Age
• 2. Environmental factor.
• 3. Lifestyle Factors
• 4. Disease Processes
• 5. Medications
• 6. Stress
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13. Factors affecting Oxygenation
• 1. Age: Oxygenation status can be influenced by age due lower
oxygen carrying capacity in lungs.
• 2. Environmental factor: Heat, cold and air pollution affect
oxygenation.
• 3. Lifestyle Factors: lifestyle factors can affect a client’s oxygenation
status: Physical exercise or activity increases the rate and depth of
respirations
• Occupations predispose individual to lung disease.
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14. Factors affecting Oxygenation
• 4. Disease Processes: Oxygenation alterations can often be traced to disease
states related to alterations in ventilation, alveolar gas exchange, oxygen
uptake, or circulation. Many disease states may affect oxygenation,
including COPD, atelectasis, atherosclerosis, heart failure, and anemia.
• 5. Medications: a variety of medications can decreases rate and depth of
respirations. The most common medications are; sedative-hypnotics and
antianxiety drugs e.g., diazepam; and narcotics such as morphine.
• 6. Stress: the sympathetic nervous system is stimulated and epinephrine is
released during stress and causes the bronchioles to dilate..
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15. Common Manifestation of Altered Respiration
and Cardiovascular function
Altered respiratory
System
• Hypoxia
• Altered breathing pattern
• Obstructed airway
Altered cardiovascular
function
• Decrease cardiac output
• Impaired tissue perfusion
• Blood alteration
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16. Hypoxia
• Hypoxia is a condition in which the body or a region of
the body is deprived of adequate oxygen supply at the
tissue level.
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17. Hypoxia Causes
A lack of
atmospheric
oxygen
Obstruction of the
airway
Chest or lung
trauma
Conditions
affecting the
respiratory system
An inability to use
oxygen
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20. Altered Breathing Pattern
• Apnea
• Absence of breathing.
• Eupnea
• Normal breathing
• Only able to breathe comfortable in upright position (such as sitting in chair), unable
to breath laying down.
• Dyspnea
• Difficulty in breathing
• Paroxysmal nocturnal dyspnea - attacks of severe shortness of breath that wakes a
person from sleep, such that they have to sit up to catch their breath - common in
patient's with congestive heart failure.
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21. Conti…….
• Hyperpnea
• Increased volume with or
without and increased
frequency (RR), normal blood
gases present.
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22. Conti…….
• Hyperventilation
• "Over" ventilation - ventilation in
excess of the body's need for
CO2 elimination. Results in a
decreased PaCO2, and a
respiratory alkalosis.
Hyperventilation. Increased rate (A) or depth (B), or
combination of both. 22

23. Conti…….
• Hypoventilation
• Under" ventilation - ventilation that is less than needed for
CO2 elimination, and inadequate to maintain normal PaCO2.
Results in respiratory acidosis.
Decreased rate (A) or depth (B), or some combination of
both.
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24. Conti…….
• Tachypnea
• Increased frequency without blood
gas abnormality
Kussmaul's Respiration
Kussmaul's respiration. Increased
rate and depth of breathing over a
prolonged period of time. In
response to metabolic acidosis.
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25. Conti…….
• Cheyne-Stokes respirations (CSR)
• Gradual increase in volume and frequency, followed by a gradual
decrease in volume and frequency, with apnea periods of 10 - 30
seconds between cycle..
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26. 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 ,larynx can arise foreign objects such as food ,
tongue falls back into the orophynx when a person is unconscious and when
secretions collect the passageways.
• 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 dyspnea and adventitious breath sound (abnormal breath sound )
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27. An upper airway obstruction
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29. Altered Cardiovascular Function
• Decrease cardiac output
• Impaired tissue perfusion
• Blood alteration
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30. Cardiac output
• Cardiac output is the amount of blood pumped by the
heart per minute. It is the product of the heart rate,
which is the number of beats per minute, and the stroke
volume, which is the amount pumped per beat. CO =
HR X SV. The cardiac output is usually expressed in
liters /minute.
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31. Decreased Cardiac output
• Decreased cardiac output is an often-serious medical
condition that occurs when the heart does not pump enough
blood to meet the needs of the body. It can be caused by
multiple factors, some of which include heart disease,
congenital heart defects, and low blood pressure.
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32. Tissue Perfusion
• Blood is a connective tissue comprised of a liquid extracellular matrix
termed as blood plasma which dissolves and suspends multiple cells
and cell fragments. It carries oxygen from the lungs and nutrients from
the gastrointestinal tract. The oxygen and nutrients subsequently
diffuse from the blood into the interstitial fluid and then into the body
cells
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33. Ineffective Tissue Perfusion
• Exchange of gases between the blood and the cells is
disrupted, meaning the cells (and ultimately the tissues and
organs) stop getting adequate oxygen supply. The body can’t
function without oxygen, so obviously this is a problem.
When tissues don’t receive enough oxygen through the
capillaries, this is called ineffective tissue perfusion.
• Many conditions can disrupt the exchange of oxygen and
carbon dioxide, but diabetes, obesity, anemia, high blood
pressure, and coronary artery disease are some of the more
common risk factors that can cause ineffective tissue
perfusion.
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34. Blood Alteration
• Altering any one of the determinants of resistance (vessel length, vessel radius, or
blood viscosity) produces a change in flow.
• Vessel radius
• Vessel radius is the primary determinant of vascular resistance. that make up the
walls of the small arteries and arterioles contract and relax as a way of controlling
flow.
. Vessel length
• Blood flow through a vessel is inversely related to vessel length, again reflecting
blood's tendency to interact with the vascular endothelium.
• Blood viscosity
• Blood is a complex fluid, whose viscosity varies with flow. A fluid's viscosity is
measured relative to water. Adding electrolytes and organic molecules (including
proteins) to water raises viscosity from 1.0 cp to ~1.4 cp.
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Blood viscosity

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42. Nursing Measures to ensure a Patient Airway
Assessment of airway
• Colour
The colour of the patient’s skin and mucus membranes is a useful indicator of
haemoglobin saturation
• Pursed lips
A sign of respiratory compromise. The patient appears to pucker or purse his/her
lips, as if he/she is going to whistle
• Flared nostrils
Flaring of nostrils is another sign of respiratory distress
• Ability to speak
Increased effort to speak and/or inability to speak, as well as only being able to
speak in monosyllables
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43. Conti…..
• Use of accessory
A patient who is in respiratory distress uses additional muscles to muscles
breathe. These include sterno-mastoid, scalene and abdominal muscles
• Rate, rhythm and depth
Nurses should assess whether the patients’ respiratory rate is above of
breathing or below normal level.
• Shape and expansion
it is important to consider of chest both the shape and expansion of the
chest.
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44. Nursing Measures to ensure a
Patient Airway
• If cough is ineffective use suctioning as needed to remove sputum
and mucus plugs.
• Encourage adequate intake of fluids to prevent dehyderation.
• Administer medication as per order.
• Consult respiratory therapist for chest physiotherapy .
• Instruct patient how to use prescribed inhalator .
• Provide steam inhalation to clear the secretions.
• Oxygen administration .
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45. Emergencies related to Respiratory System
• According European Respiratory Society
• . Hypoxic and hypercapnic respiratory failure
• Exacerbation of obstructive lung diseases: therapy
• Ventilation in obstructive lung disease
• . Acute respiratory distress syndrome
• Inhalation injury
• Extrapulmonary causes of respiratory failure including acute neuromuscular
disorders
• Management of massive haemoptysis
• Pneumothorax and bronchopleural fistula
• Pulmonary embolism
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46. Devices used to Potent Airway
Low flow delivery method oxygen mask
• Simple face mask (It can deliver around 40 percent to 60 percent oxygen at 6 to 10 L/min)
• Non re-breather face mask (A non-rebreather mask can deliver between 60 percent to 80 percent oxygen at a
flow rate of about 10 to 15 liters/minute (L/min)
• Nasal prongs (low flow) (24% to 40% O2 1 to 6 litres per minute (L/min)
• Tracheostomy mask
• Tracheostomy HME connector
• Isolette - neonates (usually for use in the Neonatal Intensive Care Unit only)
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50. High flow delivery method
• Ventilators
• CPAP/BiPAP drivers
• High Flow Prong Therapy
(There is separate nasal prong for adult and neonate)
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52. Nebulizer
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55. Emergencies related to Cardiovascular System
• Acute Coronary Syndrome.
• Heart Failure.
• Hypertension and Hypertensive Crisis.
• Pericarditis, Pericardial Effusion, and Cardiac Tamponade.
• Myocarditis and Cardiomyopathy.
• Aortic Aneurysms and Dissections.
• Congenital Heart Disease.
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56. Explain ways that caregivers can decreases the exposure of clients
to infection .
Infection control includes various measures that prevent and contain the
spread of infectious disease. These measures include:
Hand Washing
Infection control standard, contact, droplet and airborne precautions
Procedures for decontamination of persons and disinfection of
equipment and the environment
Quarantine of contacts (if necessary)
Prophylaxis of exposed individuals
Control of the vectors of infection
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57. 5 Standard Precautions for Infection
Control
• Standard Precautions
• Hand hygiene.
• Use of personal protective equipment (e.g., gloves, masks,
eyewear).
• Respiratory hygiene / cough etiquette.
• Sharps safety (engineering and work practice controls).
• Safe injection practices (i.e., aseptic technique for parenteral
medications).
• Sterile instruments and devices.
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59. Surgical vs Medical Asepsis
Medical asepsis is the reduction of the number of disease-causing
agents and their spread.
Surgical asepsis is the complete elimination of the disease-
causing agents and their spores from the surface of an object.
Techniques
The techniques used in the process are called clean techniques. In surgical asepsis, sterile techniques are used.
Occasions
This procedure is carried out in the administration of enemas,
medications, tube feedings, etc.
Sterile techniques are followed in changing dressings of a wound,
catheterization, and surgeries.
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