Title page Objectives Outlines of the presentation Introduction about schizophrenia types and signs and symptoms Nursing diagnoses and behaviors commonly associated with psychotic disorders (Table 3-24) Nursing diagnoses for patients with schizophrenia, expected outcomes, and nursing interventions Summary slide References slide

1. JERASH UNIVERSITY
FACULTY OF NURSING
2025-2026 ACADEMIC YEAR
FIRST SEMESTER
Lecturer:
Assistant Professor. Dr. Jawad Abu-Shennar
EMERGENCY & DISASTER NURSING – CLINICAL PRACTICE

2. OXYGEN THERAPY FOR
NURSES-PART (1)
Lecture- nine

3. Learning Outcomes
1. Outline the structure and function of the respiratory system.
2. Describe the processes of breathing (ventilation) and gas exchange
(respiration) and the role of respiratory system in gas exchange.
4. Identify factors influencing respiratory function.
5. Describe nursing assessments for oxygenation status.
6. Describe nursing measures to promote respiratory function and oxygenation.
7. Explain the use of therapeutic measures to promote respiratory function.

4. Functions of the Respiratory System
• The function of the respiratory system is gas exchange.
• Oxygen is required for cell functioning.
• Movement of oxygen and CO2 involves integration of several body
systems.
• Oxygen from inspired air diffuses from alveoli in lungs into blood
in pulmonary capillaries.
• Carbon dioxide produced during cell metabolism builds up in
tissues and diffuses from blood into the alveoli to be exhaled.

5.  The nose has two openings called nostrils or nares, through which air enters.
 The nasal cavities are lined with a mucous membrane and have a rich
blood supply. As air enters the cavities it is warmed, filtered, and moistened.
 The pharynx, or thorax lies directly behind the nasal cavities.
 The epiglottis ( a leaf-like structure) protects the airway when food is swallowed;
it prevents food from entering the lungs
 The larynx, or voice box, lies between the pharynx and trachea.
 The trachea, or windpipe, is a tube extending from the larynx to the center of the
chest. It carries air between the pharynx and the bronchi.
Structure of the Respiratory System
• Upper respiratory tract

7. 7
The trachea divides into two bronchi near the
center of the chest
Each bronchus enters a lung and carries air from the
trachea to the lung
In the lungs the bronchi continue to divide into
smaller and smaller bronchi unto they finally divide
into the smallest branches, called bronchioles
They terminate into air sacs, called alveoli. This is
where O2 and CO2 are exchanged
Structure of the Respiratory System
• Lower respiratory tract

8. Pulmonary Ventilation
• Inspiration (inhalation)
■ Air flows into lungs.
• Expiration (exhalation)
■ Air flows out of lungs.

12. Pulmonary Ventilation
• Inspiration (inhalation)
■ Diaphragm and intercostals contract.
■ Thoracic cavity size increases.
■ Volume of lungs increases.
■ Intrapulmonary pressure decreases.
■ Air rushes into lungs to equalize pressure.
• Expiration (exhalation)
■ Diaphragm and intercostals relax.
■ Volume of the lungs decreases.
■ Intrapulmonary pressure rises.
■ Air is expelled.

13. Pulmonary Ventilation
• Ventilation depends on:
■ Clear airways (cilia)
■ Intact CNS and respiratory center
■ Ability of thorax to expand and contract
■ Lung compliance and lung recoil
 Compliance
• Expansibility or stretchability of lung tissue
 Recoil
• Continual tendency of lungs to collapse away from the chest wall
Factors affecting compliance & recoil:
• Intrapleural & intrapulmonary pressure, Tidal volume, Atelectasis,
Surfactant

14. Alveolar Gas Exchange
• Occurs after alveoli are ventilated.
• Pressure differences on each side of respiratory membranes affect diffusion.
■ Partial pressure
• Pressure exerted by each individual gas in a mixture according to its concentration in the
mixture
■ Torr- a unit of pressure based on an absolute scale
• Diffusion of oxygen from alveoli into pulmonary blood vessels on inspiration
• Diffusion of carbon dioxide from pulmonary blood vessels into alveoli for
expiration

15. Transport of Oxygen and Carbon Dioxide
• Oxygen
■ Transported from lungs to tissues
■ 97% of oxygen combines with hemoglobin in red
blood cells and is carried to tissues as
oxyhemoglobin.
■ Remaining oxygen is dissolved and transported in
plasma (as PaO2).
■ Rate of transport affected by:
• Cardiac output
• Erythrocytes (RBCs) and hematocrit
• Normal hematocrit 40-54% in men, 37-50% in women
• Exercise

16. Transport of Oxygen and Carbon Dioxide
• Carbon dioxide
■ Must be transported from tissues to lungs
■ Continually produced in process of cell metabolism
■ 65% is carried inside RBCs as bicarbonate.
■ 30% combines with hemoglobin as carbahemoglobin.
■ 5% transported in solution in plasma and as carbonic acid.

17. Respiratory Regulation
• Includes both neural and chemical controls to maintain correct concentrations
• Nervous system adjusts rate to maintain constant PO2 and PCO2.
• Respiratory center in medulla oblongata and pons of the brain:
■ Chemosensitive receptors in medulla oblongata respond to changes in blood and hydrogen ion
concentration.
■ Increased CO2 most strongly affects stimulation of respiration.
■ Neural receptors to O2 in carotid bodies stimulate respiratory center.
• In clients with emphysema, O2 concentration affects respiration more strongly (hypoxic drive)
because of constant buildup of CO2 in blood.

18. Factors Affecting Respiratory Function
• Age
■ Changes especially important if system compromised by infection, physical or emotional
stress, surgery, anesthesia, or other procedures.
■ Chest wall, airways more rigid and less elastic
■ Drier mucous membranes
■ Increased risk of aspiration from GERD (gastroesophageal reflux disease, or chronic acid
reflux)
• Environment- Altitude & Pollution
• Lifestyle- Physical activity, Occupation
• Health status- cardiac illnesses, trauma, musculoskeletal disorders, chronic
illnesses, etc.
• Medications- sedatives, antianxiety drugs
• Stress- Hyperventilation, Epinephrine

19. Assessing patients effectively
 WHEN YOU PERFORM a physical assessment, you’ll use four techniques:
inspection, palpation, percussion, and auscultation. Use them in sequence unless you’re
performing an abdominal assessment. Palpation and percussion can alter bowel sounds,
so you’d inspect, auscultate, percuss, then palpate an abdomen.
1. Inspection
 Inspect each body system using vision, smell, and hearing to assess normal conditions
and deviations. Assess
 for color, size, location, movement, texture, symmetry,
 odors, and sounds as you assess each body system.

20. Assessing patients effectively
2. Palpation
 Palpation requires you to touch the patient with different parts of your hands,
using varying degrees of pressure. Because your hands are your tools, keep your
fingernails short and your hands warm. Wear gloves when palpating mucous
membranes or areas in contact with body fluids. Palpate tender areas last.
3. Percussion
 Percussion involves tapping your fingers or hands quickly and sharply against
parts of the patient’s body to help you locate organ borders, identify organ shape
and position, and determine if an organ is solid or filled with fluid or gas.

21. Assessing patients effectively
4. Auscultation
 Auscultation involves listening for various lung, heart, and bowel sounds with a stethoscope.
Getting ready
 Provide a quiet environment.
 Make sure the area to be auscultated is exposed (a gown or bed linens can interfere with sounds.)
 Warm the stethoscope head in your hand.
 Close your eyes to help focus your attention.
How to auscultate
 Use the diaphragm to pick up high-pitched sounds, such as first (S1) and second (S2) heart sounds.
Hold the diaphragm firmly against the patient’s skin, using enough pressure to leave a slight ring on
the skin afterward.
 Use the bell to pick up low-pitched sounds, such as third (S3) and fourth (S4) heart sounds. Hold the
bell lightly against the patient’s skin, just hard enough to form a seal. Holding the bell too firmly
causes the skin to act as a diaphragm, obliterating low-pitched sounds.
 Listen to and try to identify the characteristics of one sound at a time.

26. What will we evaluate in auscultation?
Respiratory Rate
Breathing Depth
Respiratory Rhythm

29. 29
Photo by Andreas Hendrik
https://commons.wikimedia.org/wiki/File:Seifenblasen.jpg
Conditions Affecting Diffusion

30. 30
Respiratory Definitions
Eupnea - normal breathing
Bradypnea - decreased breathing rate
Tachypnea – breathing very fast. Pt not always aware of it.
Apnea – not breathing at all
Hyperpnea - faster and/or deeper breathing
Hyperventilation - rapid breathing with hypocarbia

31. 31
Hypoxemia and Hypoxia
Hypoxemia is a condition in which there is insufficient
oxygen in the blood.
Hypoxia is a condition in which there is insufficient oxygen
in the cells.
Patients who are immobile and those on bed rest are at risk.

32. Hypoventilation:
It occurs when alveolar ventilation is inadequate to meet the
oxygen demand of the body or eliminate sufficient carbon dioxide.
Breathing at an abnormally slow rate, resulting in an increased
amount of carbon dioxide in the blood.
 Hypoventilation- decreased rate & depth of respiration

34. Hyperventilation:
 It is a state of ventilation in which the lungs remove
carbondioxide faster than it is produced by celluler metaboism.
 Increased movement of air in and out of lungs. Such as
Kussmaul's breathing (deep & rapid) happens as a result of
metabolic acidosis

36. DyspneaDyspnea
36
Dyspnea – from Latin ‘dyspnoea’
Dyspnea (also Shortness of breath (SOB), air hunger)
subjective symptom of breathlessness.
normal in heavy exertion
pathological if it occurs in unexpected situations.

37. 37
What is NOT Dyspnea?
Not the O2 saturation of Hemoglobin
Not the total amount of O2 attached to Hemoglobin
Not the amount of O2 in solution in the blood (the PaO2)
Not the respiratory rate, (not all tachypnea is dyspnea)
But: a subjective sensation of air hunger.

38. Breath Sounds
 What are breath sounds?
 Breath sounds come from the lungs when you breathe in and out. These sounds can be heard
using a stethoscope or simply when breathing.
 Breath sounds can be normal or abnormal. Abnormal breath sounds can indicate a lung problem,
such as:
 obstruction
 inflammation
 infection
 fluid in the lungs
 asthma
 Listening to breath sounds is an important part of diagnosing many different medical conditions.

39. Breath Sounds
Types of breath sounds
A normal breath sound is similar to the sound of air. However,
abnormal breath sounds may include:
Rhonchi (a low-pitched breath sound)
Crackles (a high-pitched breath sound)
Wheezing (a high-pitched whistling sound caused by narrowing of
the bronchial tubes)
Stridor (a harsh, vibratory sound caused by narrowing of the upper
airway)

40. Abnormal Lung Sounds

42. 42
Factors that Affect a Person’s O2 Needs
Red Blood Cells (RBC’s)
Aging
Fever
Pain
Patient’s airway and intact Nervous System
An early sign of risk for hypoxia is restlessness

43. 43 Other high-risk conditions
Cardiac disease-CHF (congestive heart failure)
Pulmonary disease
Postoperative patients (for up to a week after surgery)
Sleep apnea
Decreased level of consciousness
Neuromuscular diseases
Morbid obesity

44. 44
Signs and Symptoms of Decreased
Oxygenation
 Noisy breathing
 Gasping breath
 Changes in mental status
 Tachycardia
 Dusky, pale, blue, or gray skin color
 Unusual color of lips, mucous
membranes, nail beds, lining or roof of
mouth
 Cool, clammy skin
 Slow, rapid, or irregular breathing
 Shortness of breath or difficulty breathing
Photo by James Heilman, MD

46. Postural drainage:
Postural drainage uses gravity to help move mucus from the
lungs up to the throat.
The person lies or sits in various positions so the part of the
lung to be drained is as high as possible.

49. Common Positions of Patient for Postural Dranaige :

52. Lateral position

54. Trendelenburg’s:

55. Oxygen Therapy
Oxygen is necessary for life
colorless, odorless, tasteless gas
O2 in our atmosphere is at 21 %
The red blood cells give blood its red color, carry O2 to cells,
and take away the carbon dioxide (CO2)
Some diseases and conditions prevent enough oxygen from
feeding the body’s tissues
Oxygen is a prescription item and a physician’s order is
necessary to administer it

56. Oxygen Administration Devices
Nasal Cannula
Simple Mask
Nonrebreathing Mask
Air Entrainment Mask (Venturi Mask)

57. Oxygen cylinder/tank: oxygen is as a gas

62. Flow Meter
http://img.medicalexpo.com/images_me/photo-g/oxygen-flowmeter-pressure-regulator-81490-6353139.jpg
• Oxygen flow is regulated by a flow meter.
• It shows how many liters of oxygen are being delivered to the
patient each minute.
• Flow meters come in different sizes and shapes.
The flow of oxygen is
increased by turning the
knob on the flow meter
clockwise and decreased by
turning it counterclockwise

63. Pressure
Gauge
• The pressure gauge is connected to the flow meter on an oxygen cylinder.
• The gauge shows how much oxygen is left in the cylinder
• Oxygen is measured in pounds.
Do not let the cylinder
run out!!
Many facilities consider cylinders empty when
the pressure reaches 500 pounds.
Pressure Gauge:

64. 64 Oxygen Flow
Check the flow each time you are in the room to be sure it is set at
the proper rate!!

65. 65
A humidifier is a water bottle that moistens the oxygen for comfort
and prevents drying of mucous membranes in the nose, mouth, and
lungs
Oxygen passes through the water in the humidifier, picking up
moisture, before it reaches the patient
Sterile distilled water is always used in the humidifier
Humidifiers

68. Image from CareFusion
Nasal Cannula

69. Nazal Canula:
 Simple Nasal Cannula a small tube with two prongs that fit into the patient’s
nostrils
 Two sizes—pediatric and adult
 The prongs are slightly curved; make sure that the curves point inward when
you insert then into the nostrils
 Two types of straps—single strap positioned at the back of the patient’s head;
or thin plastic tubes that are placed over the ears and adjusted under the chin
 The disadvantage of this system is that it can be easily dislodged and causes
drying of the nasal mucosa.

70. Points to Consider in Oxygen Administration
with Nasal Cannula:
 The cannula should be placed properly in the patient's nose so that the oxygen
concentration does not decrease.
 The patient is encouraged to breathe through the nose.
 Prolonged oxygen delivery with nasal cannula irritates the respiratory tract mucosa, and
a humidifier should be added to flow meters to prevent this situation.
 The patient should be observed behind the ear for irritation, this area should be cleaned
and supported with a softening lotion.
 The nasal cannula method of oxygen administration should not be preferred in patients
who breathe through the mouth and have a blocked nose.
 Cannula tips can irritate the nostrils, so the nostrils should be checked and cleaned
frequently.
 A sterile nasal cannula should be used for each patient and should be changed when
visibly soiled.

71. Nasal Cannulae in Oxygen therapy:

73. Complications:
Can irritate the skin on the cheeks and behind the ears
Higher concentrations dry nasal and oral mucous membranes
Rarely complications are perforation of nasal septum(long-term use)

74. Face mask:

76. Spirometer:

77. Incentive spirometer:
Encourages voluntary deep breathing by providing
visual feedback to patients about inspiratory
volume.

78. Venturi mask: for giving higher flow rate

79. Diagram from Ignatavicius and Workman,2000.
Venturi
Mask

80. http://brainly.co.id/tugas/133042
Nonrebreathing Mask
Should be
inflated at all
times; should
not collapse
more than
halfway during
inspiration
Non-rebreathing masks are used to
deliver high concentrations of oxygen
in emergency situations. These masks
may be used for traumatic injuries,
after smoke inhalation, and in cases of
carbon monoxide poisoning.

81. Caring for a Patient Receiving Oxygen
Therapy
http://commons.wikimedia.org/wiki/File:MR._ROBERT_B._JONES,_78_YEARS_OLD,_IS_TOTALLY_DEPENDENT_ON_H
IS_HOME_OXYGEN_MACHINE_FOR_SURVIVAL._THE_POLLUTED_AIR_IS..._-_NARA_-_545409.jpg

82. Complications of O2 Therapy
• Suppressed respiratory drive and low O2 tension
• Fire
• Oxygen toxicity: O2 concentrations of greater than 50% for extended
periods of time (longer than 48 hours) can cause an overproduction of free
radicals, which can severely damage cells
■ Symptoms of Oxygen toxicity include substernal discomfort, paresthesias,
dyspnea, restlessness, fatigue, malaise, progressive respiratory
difficulty, refractory hypoxemia, alveolar atelectasis, and alveolar
infiltrates on x-ray.

84. Complications of O2 Therapy
• CO2 retention
■ When hypoxemia is corrected, hypoventilation occurs
leading to CO2 retention (CO2 narcosis)
• PaCO2 may increase severely to cause respiratory
acidosis, drowsiness and coma
• PaCO2 increase secondary to combination of:
• Abolition (ending) of hypoxic drive to breathe
• Increase in dead space
• Atelectasis:
■ High O2 displaces nitrogen that keeps the alveoli open. O2
is absorbed quickly into circulation

85. Caring for a Patient Receiving Oxygen Therapy
Elevate the head of the bed when the patient is receiving oxygen
A patient wearing an oxygen mask cannot eat while wearing the
mask; the physician may order a cannula for meals
Being unable to breathe can be frightening; the patient may need
reassurance and emotional support. Check the patient frequently
and spend as much time as possible in the room

86. 86
Nursing Care
 Carefully check the skin under the device for signs of redness or irritation
 Report any skin problems to the RN
 Because oxygen is drying, the patients receiving oxygen may need extra liquids to
drink
 They also need frequent care of the mouth and nose
 Some patients may feel warm and perspire heavily; extra bathing and linen changes
may be necessary