THIS WILL BE USEFUL FOR NURSING STUDENTS

1. OXYGENATION

8. PHYSIOLOGICAL
FACTORS
DEVELOPMENTAL
FACTORS
LIFESTYLE
FACTORS
CONDITIONS
AFFECTING
CHESTWALL
MOVEMENT
ENVIRONMENTAL
FACTORS

9.  ANEMIA
O2 carrying capacity is decreased because of
low Hb.
 CARBONMONOXIDE POISONING
It binds with Hb with makes O2 transport
less.

10.  Decreased Inspired O2 Concentration
Decrease in fraction of inspired O2
concentration (FiO2) occurs because of
Upper or lower airway obstruction.
Decreased environmental oxygen.
High altitudes.
Decreased inspiration in drug overdose.

11.  HYPOVOLEMIA
Shock and severe dehydration
Extracellular fluid loss
Reduced circulating blood volume
 INCREASED METABOLIC RATE
Pregnancy,Wound healing , exercise increase
the metabolic rate.

12.  PREGNANCY
Diaphragm moves upward
Decrease in inspiratory capacity
Dyspnea
 OBESITY
Heavy lower thorax & abdomen cause
reduced lung volume.

13.  MUSCULOSKELETAL DISORDERS
 Structural abnormalities in Rib cage,
Vertebral column such as lordosis, kyphosis,
scoliosis.
 Trauma to thoracic region, muscular &
neurological disorders impairs oxygenation.
 TRAUMA
Multiple rib fracture, Flail Chest, Chest wall or
upper abdominal incision, excessive dose of
opiods cause decreased chest wall movement.

14.  DISEASE CONDITIONS
Gullian Barre Syndrome, Myasthenia gravis,
polio, diseases of medulla oblongata, cervical
trauma, damage to Intercoastal Muscles.
Impaired ventilation

15.  Infants andToddler
 high risk for upper RTI but recovery is usually
good.
 Teething process can Increase bacterial
growth
 Schoolers and adolescents
Smoking increases the risk for
cardiopulmonary disease and cancer.

16.  Young and Middle age Adult
unhealthy diet , lack of exercise, stress, over the
counter and prescription drugs not used as intended,
illegal substances and smoking increase the risk of
CVD.
 Older adults
 The following may increase the RTI
 Calcification of heart valves, SA Node, Coastal
cartilage, trachea, bronchi
 Atherosclerosis
 Osteoporosis cause change in size of thorax
 Decreased functional cilia
 Decreased cough and sneezing mechanisms

17.  DIET
• Diet rich in fiber, grains, fruits, vegetables,
nuts, antioxidants, lean meat, fish, chicken,
citrus fruit juices, Sodium restriction, Diet
high in Potassium and low cholesterol
prevents CVD
• Diet rich in CHO increase the CO2 load
because of its metabolism

18.  EXERCISE
Exercise
Increase the body’s metabolic activity
Increase O2 demand
Rate and depth of respiration
Get more O2 & reduce Co2 through exhalation
pulse rate, BP, Cholesterol & Blood
cardiac output & efficiency of the myocardial
muscle

19.  SMOKING
Inhalation of nicotine
Vasoconstriction of peripheral and
coronary blood vessels.
Increase in BP
Decreased blood flow to peripheral blood vessels
Cardiopulmonary disorder and Lung cancer

20. SUBSTANCE ABUSE
Excessive use of alcohol & other drugs
Depress the respiratory center
Reduce the rate and depth of respiration
Reduction in the amount of inhaled oxygen.

21. Metabolic rate increases which increase
Oxygen demand
Body will respond by increasing the rate
and depth of respiration
STRESS OR SEVERE ANXIETY

22. Smoggy/
Urban areas
Occupational
pollutants
Asbestos
Airborne
fibers
Dust
Talcum
powder

23. RESPIRATORY
ALTERATIONS
CARDIAC
ALTERATIONS
ALTERATIONS

24.  It occurs due to Illness and conditions
affecting cardiac rhythm, strength of
contraction, blood flow through the
chambers, myocardial blood flow and
peripheral circulation.
 Older adults may have changes due to
calcification of the conduction system,
thicker and stiffer heart valves due to lipid
accumulation and fibrosis and decrease in the
number of pacemaker cells.

25. • Disturbances in the normal
cardiac rhythm
Dysrhythmia
• Cardiac response greater
than 100 beats per minute
Sinus
tachycardia
• Cardiac response less than
60 beats per minute
Sinus
bradycardia

26. • The electrical impulse in
the atria is chaotic and
arise from multiple sites.
Atrial fibrillation
• Abnormal impulses arising
above the ventricles.
Supraventricular
dysrhythmia
• Sudden rapid onset of
tachycardia originating
above the AV node.
Paroxysmal
supraventricular
tachycardia

27. • Abnormal irregular heart
rhythm caused by rapid
twitching of the ventricles
Ventricular
fibrillation
• Represents the ectopic site
of impulse generation
within the ventricles.
Ventricular
dysrhythmia
• Tachycardia that originates
in one of the ventricles of
the heart.
Ventricular
tachycardia

28.  It is an inadequate tissue oxygenation at the
cellular level.
 This results from a deficiency in oxygen delivery or
oxygen utilization at the cellular level.
 Hypoxia if untreated produce cardiac dysrhythmias
that possibly result in death.

29. Low Hb level and lowered
O2 carrying capacity of
the blood
Diminished concentration of
inspired oxygen (e.g) high
altitudes
Inability of the tissues to
extract O2 from the blood
(e.g) cyanide poisoning
Decreased diffusion of O2
from the alveoli to the
blood (e.g) pneumonia
Poor tissue perfusion
with oxygenated blood
(e.g) shock
Impaired ventilation
(e.g) multiple rib
fracture or chest trauma

30. Apprehension
Restlessness
Inability to concentrate
Alteration in level of consciousness
Dizziness
Behavioral changes
Fatigue
Agitation
Increased pulse rate and depth of respiration

31.  Bluish discoloration of the skin and
the mucus membrane caused by the
presence of desaturated
hemoglobin in capillaries.
 The presence or absence of cyanosis
is not a reliable measure of oxygen
status.
CYANOSIS

32. Central cyanosis
Observed in the tongue, soft palate
and conjunctiva where blood flow is
high, indicates hypoxemia
Peripheral cyanosis
Observed in the extremities, nail beds
and earlobes as a result of
vasoconstriction and stagnant blood
flow

33. It occurs when alveolar ventilation is inadequate to
meet the body’s O2 demand or to eliminate
sufficient Co2.
The signs and symptoms includes mental status
changes, dysrhythmias and potential cardiac
arrest, convulsions, unconsciousness and death.
Treatment requires improving tissue oxygenation,
restoring ventilatory function, treating the
underlying cause and achieving acid base balance.

34. It is a state of ventilation in excess of that
required to eliminate the Co2 produced by
cellular metabolism.
The causes may be anxiety, infections, drugs,
acid-base imbalance, fever, metabolic
acidosis, salicylate poisoning and
amphetamines.

35.  HYPERCAPNIA
It is otherwise known as hypercabia and CO2
retention.Abnormally elevatedCarbondioxide in
the blood stream.
 ORTHOPNOEA
The client can breathe only in an upright position.
 TACHYPNOEA
Increased respiratory rate over 24 breaths per
minute
 BRADYPNOEA
Decreased respiratory rate over 10 breaths per
minute

36.  ANOXIA
It is the lack of Oxygen in the tissues
 ANOXEMIA
It is the lack of Oxygen in the blood stream
 DYSPNOEA
Difficulty in breathing or Labored breathing
 APNEA
Cessation of breath for more than 20 second
 POLYPNEA
Rapid painful breathing.
 ASPHYXIA
It is a state of suffocation.This condition is
produced by prolonged interference with a
sufficient supply of oxygen.

37.  NURSING HISTORY
 The history should focus on the client’s ability to meet
Oxygen needs.
 The cardiac history should include pain, dyspnea,
fatigue, peripheral circulation, cardiac risk factors and
the presence of past or concurrent cardiac conditions.
 The respiratory history includes the presence of a
cough, shortness of breath, wheezing, pain,
environmental exposures, frequency of RTI, current
medication use and smoking.

38. • Cardiac pain occurs on the left side
of the chest and radiates to the left
arm.
• Pericardial pain results form
inflammation of the pericardial sac.
• Pleuritic chest pain is often
knifelike and radiates to the
scapula.
PAIN
• Client reports loss of endurance.
• Early sign of worsening of the chronic
underlying condition
FATIGUE
• Determine the direct and secondary
exposure to tobacco.
• It increases the risk of cardiopulmonary
diseases
Smoking

39. • It is a clinical sign of hypoxia
• It is associated with pulmonary,
cardiovascular, neuromuscular
conditions and anemia.
• It is associated with use of accessory
muscles of respiration, nasal flaring,
exaggerated respiratory effort, marked
increases in the rate and depth and
depth of respiration.
DYSPNEA
• High pitched musical sound
caused by high velocity
movement of air through a
narrowed airway.
• It is associated with asthma,
acute bronchitis and pneumonia
WHEEZING

40. • Investigate about the client’s
home and workplace and
smoking habits
Environmental /
Geographical
exposures
• Obtain information about RTI,
bronchitis, pneumonia, sinusitis,
rhinitis,Tuberculosis and HIV.
• Enquire about the use of OTC, folk,
herbal or alternative medicines
Respiratory
infections &
Medications
• Enquire about the airborne allergens. (e.g.
pet dander or pollen)
• The allergic response is often watery eyes,
sneezing, runny nose, cough or wheezing.
Allergies

41. • It is a sudden, audible expulsion of
air from the lungs.
• It is a protective reflex to clear the
trachea, bronchi and lungs of
irritants and secretions.
• Determine whether the cough is
productive or non-productive.
• Productive cough results in sputum
protection. Sputum contains the
mucus, cellular debris, microbes and
sometimes pus or blood.
• Observe for hemoptysis(blood-
tinged sputum)
COUGH

42.  INSPECTION
Perform head to toe observation of the client
for skin and mucus membrane color, general
appearance, LOC, adequacy of systemic
circulation, breathing patterns and chest wall
movement.

43. •Pale conjunctiva
indicates anemia
•Cyanotic
conjunctiva
indicates
hypoxemia

44. •Cyanotic mucus
membrane
indicates hypoxia
•Nasal flaring
indicates air
hunger, dyspnea

45. • Clubbing of nails
indicates O2
deficiency and
chronic hypoxemia
• Chest wall
retraction
indicates dyspnoea

46. • Round barrel chest
indicates the
emphysema,
advanced age and
COPD.
• Peripheral cyanosis
indicates the
vasoconstriction &
diminished blood flow

47. • Central cyanosis
indicates decreased
cardiac output or
hypoxia.
• Pursed-lip breathing
is associated with
chronic lung
disease.

48. PALPATION
 Identify the type and
amount of thoracic
excursion
 Elicit any area of
tenderness
 Identify tactile fremitus,
thrills, heaves and the
point of maximal impulse
 Identify the presence and
quality of peripheral
impulse, skin temperature,
color ,capillary refill and
peripheral edema
 Percussion detects the
presence of abnormal fluid
or air in the lungs.
 It also determines the
diaphragmatic excursion.

49.  Percussion detects the
presence of abnormal
fluid or gas in the
lungs.
 It also determines the
diaphragmatic
excursion.

50. • Identify the normal and
abnormal heart and lung
sounds.
• Auscultate f0or normal S1
& S2 sounds and
abnormal S3 and S4
sounds.
• Identify the location,
radiation, intensity, pitch
and quality of murmur
and assess for bruits.
• Auscultate for movement
of air through all lung
fields, and abnormal
adventitious lung sounds

51. • Determines the ability of the lungs
to efficiently exchange O2 & Co2
Pulmonary
function test
• Visual examination of the
tracheobronchial treeBronchoscopy
• Identify the abnormal masses by
size and locationLung Scan

52. • Specimen of plural fluid is obtained for
cytological examination.Thoracentesis
• Identify the specific microorganism in the
sputum.
Sputum
specimen
• Creatine kinase(CK),Troponin I andTroponinT
diagnose the acute myocardial infarcts.
Cardiac
enzymes

53. • Diagnose the alterations in the
conduction system.ECG
• Non invasive measure to detect the
abnormalities in the heart structure and
heart wall motion.
Echocardiography
• It determines the level of the RBC,
WBC, Platelets and Hemoglobin.CBC

54. Oxygen therapy is cheap, widely available,
and used in a variety of settings to relieve or
prevent the tissue hypoxia.
O2 is not a substitute for other treatment,
however it is used only when indicated.
O2 is not a medication. It has dangerous side
effects such as atelectasis or O2 toxicity.
The dosage or concentration of O2 is
continuosly monitored.

55.  O2 is a highly combustible gas.
 Place an “Oxygen in Use” sign on the unit.
 Keep O2 delivery systems 10 feet from any open
flames.
 No smoking should be allowed on the premises.
 Secure O2 cylinders so that they do not fall.
 Store O2 cylinders upright, chained or in
appropriate holders.
 Determine whether all the electrical equipment
is functioning correctly or properly grounded.
 Check the oxygen level of portable tanks.

56. OXYGENTANKS

57. PERMANENTWALL-PIPED SYSTEM

58. It is the process of adding water to gas.
Normal air that we inhale is 45% humidified
and further humidified by nasopharyngeal
mucosa.This allows the optimum functioning
of respiratory mucosal lining.
Air or oxygen with high relative humidity
keeps the airway moist and helps loosen and
mobilize the pulmonary secretions.
Bubbling oxygen through water adds
humidity to the oxygen.

59. To prevent damage to vital organs resulting
from inadequateO2 supply.
To manage the condition of hypoxia.
To maintain the O2 tension in blood plasma.
To increase the Oxyhemoglobin and reduce the
carboxyhemoglobin in RBC.
To maintain the ability of cells to carry out the
normal metabolic function.
To provide and maintain a normal supply of O2
for blood and tissues.
To reduce the complications caused by hypoxia.

60. Cardiac or Respiratory arrest.
Chest pain, stroke, seizure, altered mental status
Oxygen saturation less than 94%
Carbon monoxide or cyanide poisoning
Hypoxia
Decreased cardiac output
 hypercapnia
Metabolic acidosis
Acute and chronic hypoxemia
Shock & circulatory failure
Dysponea
Cyanosis
Hemorrhage and air hunger
Anemia
Patients under anesthesia or surgery
asphyxia

61. Invasive
devices
Non
Invasive
devices
High
flow
system
Low flow
system

62. DEVICE
OPTIMUM FLOW
RATE(l/min)
FiO2
%
Nasal cannula 1-6 25-50
Face mask 6-12 36-65
O2 tent 8-10 21-55
Mask with reservoir bag 6-12 60-80
Venturi Mask 2-12 Upto 40
Oxygen hood 6 90-95

64.  A nasal cannula is a simple , comfortable
device used for O2 delivery.
 The two cannulas, about 1.5 cm long,
protrude from the center of a disposable tube
are inserted into the nares.
 O2 is delivered via the cannulas with a flow
rate of up to 6L/min.
 Flow rate >4L/min often cause drying effect
on the mucosa and relatively little increase in
deliveredO2 concentration.

65. LITRE FiO2
1L/min 24-25%
2L/min 27-29%
3L/min 30-33%
4L/min 33-37%
5L/min 36-41%
6L/min 39-45%
APPROXIMATE FiO2 DELIVERED

66. To relieve dyspnea.
To administer low
concentration of O2
to patients.
To allow
uninterrupted supply
of O2 during
activities like eating,
drinking.
 PURPOSE  ARTICLES
Oxygen source
Nasal cannula with
connecting tubes
Humidifier with
distilled water
Flowmeter
Gauze pads
“No smoking” sign

67. Check physician order.
Assess the vital signs, LOC, lab values etc.,
Assess for risk factors in patient and
environment.
Instruct the procedure to the patient.
Post “No smoking” sign on the patient dooe
side.
Wash hands

68.  Set up Oxygen equipment and humidifier
Fill humidifier upto the level marked on it
with sterile water.
Attach flowmeter to source , set flowmeter
in ‘off’ position
Attach humidifier to base of flowmeter
Attach tubing and nasal cannula to
humidifier
Regulate flowmeter to prescribed level
Ensure proper functioning by checking for
bubbles in humidifier or feeling oxygen at the
outlet.

69. Place tips of cannula to patient’s nares and adjust
straps around ear for snug fit.
The elastic band may be fixed behind head or
under chin.
Pad tubing with gauze pads over ear and inspect
skin behind ear periodically for irritation or
breakdown.
Inspect patient and equipment for flow rate,
clinical condition, level of water in humidifier.
Encourage the patient to breath through his/her
nose with mouth closed.
Remove and clean the cannula with soap and
water, dry and replace every 8 hours.

70. Safe and simple.
Easily tolerated.
Delivers low concentration of O2 while
allowing the client to eat, speak and drink
Inexpensive.
Disposable.
Does not impede eating or talking.

71. Unable to use with nasal obstruction.
Drying to mucous membrane.
Can dislodge easily.
Causes skin irritation or breakdown.
Client’s breathing pattern will affect exact
FiO2.

72.  An oxygen mask is a device used to
administer oxygen, humidity or heated
humidity.
 It fits snugly over the mouth and nose and is
secured in place with a strap.
 There are two primary types of O2 mask
Mask delivering low concentrations of O2.
Mask delivering high concentrations of O2.

74.  Used for short term O2 delivery.
 It fits loosely and delivers oxygen
concentrations from 30% to 60%.
 The mask is contraindicated for clients with
Co2 retention because retention can be
worsened.

75.  It delivers the O2
concentrations of
24% to 60% with
oxygen flow rates
of 4 to 12L/min
depending on the
flow control
meter selected.

77.  A partial re-breather mask used as a reservoir
to capture some exhaled gas for re-breathing.
 Vents on the sides of the mask allow room air
to mix with oxygen.
 It can oxygen concentration of 50 percent or
greater.

78.  Provides high concentration of Oxygen.
 Delivers 10 to 15 L/min.
 Fill the reservoir bag before placing on the
patient.
 Frequently inspect the reservoir bag to make
sure it is inflated.
 If it is deflated, the client is breathing large
amounts of exhaled carbondioxide.
 The reservoir bag minimizes rebreathing
exhaled air.

81.  Follow the same procedure except few steps.
 Attach tubing and face mask to humidifier.
 Regulate flowmeter to prescribed level.
 Guide mask to patient’s face and apply it from
nose downward. Fit the metal piece of mask to
conform to shape of nose.
 Secure elastic band around patient’s head.
 Apply padding behind ears as well as scalp
where elastic band passes.
 Remove the mask and dry the skin every 2-3
hours if O2 is administered continuously. Do not
put powder around the mask.

82.  ADVANTAGES
 Assist in
providing
humidified
oxygen.
 Does not dry the
mucus
membrane
quickly.
 DISADVANTAGES
 Exact FiO2 level is
difficult to
estimate.
 Interferes with
talking and eating
 Hot and confining,
increased levels of
humidification
irritate the skin,

83. OXYGEN HOOD OXYGENTENT

84.  It is a method of
administering oxygen
to a child through an
oxygen hood.
 This is made up of
transparent material
which has a lid that
surround the child’s
head or upper body
which is also called
croupette.
Oxygen hood Oxygen tent
 An oxygen tent consists
of a canopy over the
client’s bed that may
cover the body fully or
partially and is
connected to a supply
of oxygen.

85.  Select the appropriate size of the tent that will
achieve the desired concentration of oxygen and
maintain patient comfort.
 Tuck the edges of the tent under the mattress
securely.This is especially important if the child is
restless and can dislodge the tent by pulling the
covers loose.
 Pad the metal frame that supports the canopy.
 Flush the tent with oxygen after it has been
opened for a period of time, to increase the
concentration of the gas, then reset the flowmeter
to original level.
 Analyze and record the tent atmosphere every 1-2
hours.

86. Advantages
Provides an
environment for the
patient with controlled
oxygen concentration,
temperature
regulation and
humidity control.
It allows freedom of
movement in bed.
Disadvantages
It creates a feeling of
isolation
It requires high level of
oxygen(10-12L/min)
Loss of desired concentration
occurs each time the tent is
opened for feeding.,etc
There is an increased chance
of hazards due to fire.
It requires much time and
effort to clean and maintain a
tent.

87. NASAL CATHETHER
TRACHEOSTOMY
TUBE
ENDOTRACHEAL
TUBE

88.  8 – 14Fr catheters(red
rubber or portex) are
used.
 It will deliver upto
6L/min and gives upto
50%

89.  Catheter should be
lubricated with local
anesthetic jelly before
introduction.
 The distance should
be measured from the
tip of the nose to the
earlobe.
 The catheter is passed
backward into pharynx
till the tip of the
catheter is opposite to
the uvula.

90.  Never force the catheter
against an obstruction.
 Connect the fine
catheter with the
pressure tubing.
 Turn on the fine
adjustment to the
required rate of flow.The
maximum liters flow
being 6-7 litres per
minute.
Disadvantages
 Catheter should be
changed every 8-10
hours.
 Pediatric and
uncooperative patients
doe not tolerate it.
 Patient with
anticoagulant therapy
and bleeding disorders
may have complications
 It can be blocked by
secretions

91.  Creating a surgical
opening into the
anterior wall of trachea
and inserting a tube to
maintain patent airway
is known as
tracheostomy.
 It is connected to
oxygen delivery
system or ventilators

92.  Passing a slender hollow
tube into the trachea
through nose or mouth
to facilitate artificial
ventilation and
resuscitation.
 It is usually done for
giving artificial
ventilation or oxygen
delivery or to remove
the tracheobronchial
secretions.

94.  High flow rate is sufficient to meet the
patient’s requirement through endotracheal
tube or controlled ventilation mask.
 The low flow system cannot meet the total
inspiratory requirement of the patient for
example, nasal catheter, nasal cannula and
facemask.

95. COMBUSTION
Oxygen supports burning which may cause fire accident.
RETROLENTAL FIBROPLASIA
The formation of a fibrovascular membrane posterior to
the lens may occur in premature babies who have been
exposed to high pressure of O2.
ATELECTASIS
Collapse of alveoli develops as a result of increased O2
concentration in the inspired air.This is due to
elimination of nitrogen.

96.  OXYGEN INDUCED APNOEA
The Co2 is washed off completely from the blood by a
high concentration of O2. the respiratory center is not
stimulated sufficiently.
 INFECTION
By using the contaminated equipments the microbes
can be present in such places like tracheostomy or
endotracheal tubes, catheters , humidifying water
and masks etc.
 Asphyxia
 Bronchopulmonary dysplasia
 Respiratory depression
 Seizure disorders
 Epilepsy

97.  OXYGENTOXICITY
It may occur when
concentrations over
60% are inhaled for
prolonged periods at
atmospheric pressure,
perhaps due to
inactivation of
surfactant and damage
to pulmonary
epithelium.
 It is characterized by
 Substernal distress
 Reduction in vital
capacity
 Paraesthesia
 Joint pain
 Anorexia
 Nausea
 Contracted visual field
 Vomiting
 Bronchitis
 Atelectasis
 Mental changes
 Confusion