2. Objectives
At the completion of this unit learners will be able to:
1. Identify factors that can interfere with effective
oxygenation of body tissues.
2. Describe common manifestations of altered
respiratory and cardiovascular function
3. Discuss lifespan-related changes and problems in
respiratory function and cardiovascular system
4. Describe nursing measures to ensure a patient
airway
3. Cont..
6. Recognize the emergencies related to
respiratory and cardiovascular system
7. Explain ways that caregivers can decrease the
exposure of clients to infection
8. Differentiate between medical and surgical
asepsis.
5. Apply Nursing Process and teaching plan for a
client with altered respiratory function and
cardiovascular function
4. Oxygenation
Oxygen, a clear, odorless gas that constitutes
approximately 21%of the air we breathe, is necessary
for proper functioning of all living cells.
Oxygenation (the delivery of oxygen to the body’s
tissues and cells), is necessary to maintain life and
health.
5. PHYSIOLOGY OF OXYGENATION
The delivery of oxygen to the body’s cells is a process that
depends upon the interplay of the pulmonary, hematologic,
and cardiovascular systems.
Specifically, the processes involved include ventilation,
alveolar gas exchange, oxygen transport and delivery, and
cellular respiration.
The absence of oxygen can lead to cellular, tissue, and
organism death.
6. Respiration
Respiration is the process of gas exchange between
the individual and the environment and involves
following components:
Pulmonary ventilation –(breathing)
movement of air in and out of the lungs
Inspiration –(inhalation) act or breathing in
Expiration –(exhalation) act of breathing out
External respiration – exchange of O2 and CO2
between alveoli and blood
Internal respiration – exchange of O2 and CO2
between blood and tissue cells
Anatomy and Physiology of respiration
7. Cont.…
The Air way begins at nose and ends at terminal
bronchioles. Air way provides a pathway for transport of
oxygen and carbon dioxide.
Respiratory tract (Air Way) is divided into two:
• Upper Respiratory Tract (URT): consists of
nose, pharynx, larynx and epiglottis.
The main function is to warm, filter and humidify
inspired air.
• Lower Respiratory Tract (LRT): consists of
Trachea, Bronchi, bronchioles and lungs.
Its major function are conduction of air and surfactant
production.
10. Age
Oxygenation status can be influenced by age. Older adults are
also more susceptible to respiratory infection because of
decreased activity in the cilia, which normally are an effective
defense mechanism. Other changes includes the following.
• Chest wall and airways become more rigid and less elastic.
• Decreases in muscle strength
• The amount of exchanged air is decreased.
• The cough reflex and cilia action are decreased.
• Mucous membranes become drier and more fragile.
• Decreases in muscle strength and endurance occur.
• If osteoporosis is present, adequate lung expansion may be compromised.
• A decrease in efficiency of the immune system occurs.
• Gastroesophageal reflux disease is more common in older adults and
increases the risk of aspiration
11. Environmental Factors
Environmental factors can significantly affect a client’s oxygenation
status. Altitude, heat, cold, and air pollution affect oxygenation.
• The higher the altitude, the lower the PO2 an individual breathes.
As a result, the person at high altitudes has increased respiratory
and cardiac rates and increased respiratory depth, which usually
become most apparent when the individual exercises.
• Healthy people exposed to air pollution, such as smog or
secondhand tobacco smoke, may experience stinging of the eyes,
headache, dizziness, and coughing.
• People who have a history of existing lung disease and altered
respiratory function experience varying degrees of respiratory
difficulty in a polluted environment. Some are unable to perform
self-care in such an environment.
12. Lifestyle Factors
Physical exercise or activity increases the rate and depth of
respirations and hence the supply of oxygen in the body.
Sedentary people, by contrast, lack the alveolar expansion and
deep-breathing patterns of people with regular activity.
Clients who are exposed to dust, animal dander, asbestos, or
toxic chemicals in the home or workplace are at increased risk
for alterations in oxygenation.
• Silicosis is seen more often in sandstone blasters and potters
than in the rest of the population
• Asbestosis in asbestos workers
• Anthracosis in coal miners
• Organic dust disease in farmers and agricultural employees
who work with moldy hay
13. Health Status
• In the healthy person, the respiratory system can
provide sufficient oxygen to meet the body’s needs.
Diseases of the respiratory system, however, can
adversely affect the oxygenation of the blood.
14. Medications
A variety of medications can decrease the rate and
depth of respirations. The most common medications
having this effect are the benzodiazepine sedative-
hypnotics and antianxiety drugs (e.g., diazepam
[Valium], lorazepam [Ativan], midazolam [Versed]),
barbiturates (e.g., phenobarbital), and narcotics such as
morphine and meperidine hydrochloride (Demerol).
15. Cont..
• When administering these, the nurse must
carefully monitor respiratory status, especially
when the medication is begun or when the
dose is increased. Older clients are at high risk
of respiratory depression and, hence, usually
require reduced dosages.
16. Stress
When stress and stressors are encountered, both
psychological and physiological responses can affect
oxygenation. Some people may hyperventilate in response to
stress. When this occurs, arterial PO2 rises and PCO2 falls. The
person may experience light-headedness and numbness and
tingling of the fingers, toes, and around the mouth as a result.
Physiologically, the sympathetic nervous system is stimulated
and epinephrine is released during stress. Epinephrine causes
the bronchioles to dilate, increasing blood flow and oxygen
delivery to active muscles. Although these responses are
adaptive in the short term, when stress continues they can be
destructive, increasing the risk of cardiovascular disease.
17. Maintaining Healthy Oxygenation
Encourage clients to:
1. Leave windows open for ventilation instead of using
an air conditioner or humidifier.
2. Wear a mask when working with hazardous
materials, such as asbestos.
3. Limit physical exertion if it causes shortness of
breath.
4. Refrain from smoking.
5. Change filters on furnaces, heaters, and range
hoods as recommended by manufacturer.
18. Common Manifestations Of Altered Respiratory
And Cardiovascular Function
• Apnea: Temporary cessation of breathing.
• Dyspnea: Difficulty in breathing. Eg. SOB
• Eupnea: Normal breathing. 12 to 20 b/m
• Hyperpnea: Increased rate and depth of breathing.
• Hyperventilation: Increased pulmonary ventilation
leading to low blood level of CO2
• Hypoventilation: Decreased pulmonary ventilation
leading to increased blood level of CO2
19. Cont.…
• Orthopnea: Dyspnea that occurs when a person is
lying down.
• Tachypnea: Accelerated respiration
• Bradypnea: Abnormal slowness of breathing.
• Hypoxia: Low oxygen level in tissues
• Hypercarbia: (c): Accumulation of CO2 in the blood
• Hypoxemia: Reduced oxygen in the blood,
23. Life Span Considerations
Problems
Premature infant:
• Lack of surfactant ( A substance in alveoli which
keeps the lungs wet and prevents collapse).
Infants & Toddlers:
• Risk of upper respiratory tract infections due to
exposure to other children and second hand smoke.
• Risk of airway obstruction also.
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24. Life Span Considerations
Problems
School age children & Adolescents:
• Respiratory infections and respiratory risk factors
such as second hand smoke & cigarette smoking. Can
lead to cardiopulmonary disease if continues.
Young & Middle age adults:
• Multiple cardiopulmonary risk factors due to
unhealthy diet, lack of exercise, stress, drugs &
smoking.
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25. Life Span Considerations
Problems
Older Adults:
• Body systems undergo changes throughout the aging
process, eg, atherosclerosis which leads to increased
BP.
Respiratory system changes-----thoracic cage changes---
-- eg, barrel chest-------decreased ventilation.
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28. Cardiac Emergencies
• Cardiac Arrest (the abrupt loss of heart function, breathing
and consciousness.)
• Myocardial infarction (MI) (permanent damage to the heart
muscle.)
• Congestive Heart Failure:(Heart failure is a condition in which
the heart can't pump enough blood to meet the body's needs.
Heart failure does not mean that your heart has stopped or is
about to stop working. It means that your heart is not able to
pump blood the way it should.)
• Disturbances of Cardiac Rhythm (Arrhythmias)
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30. Nursing Process
Assessment: (History Taking)
• Current respiratory problems
• History of respiratory diseases
• Current or past cardiovascular problems
• Life style
• Presence of Cough
• Signs of hypoxia
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31. Nursing Process
Assessment:
• Sputum / (Characteristics of sputum)
• Description of sputum
• Presence of chest pain
• Presence of risk factors
• Medication history
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38. Implementation
3. Interventions to Improve Oxygen Uptake and
Delivery
– Administer oxygen.
• simple mask
• Nasal canula
• Venturi mask
• Rebreathing and Non-rebreathing mask
– Administer blood components.
39. Implementation
4. Interventions to Increase Cardiac Output and
Tissue Perfusion
– Manage fluid balance.
– Encourage activity restrictions and assistance
with activities of daily living.
– Position client properly.
– Administer medications.
41. Implementation
• Interventions to Address Associated Nursing
Diagnoses
– Explore lifestyle and activity adaptations.
– Encourage dietary and nutritional modifications.
– Promote comfort measures.
42. Asepsis
• Asepsis is the absence of microorganisms.
• Medical asepsis uses practices to reduce the
number, growth, and spread of microorganisms.
Medical asepsis is also referred to as “clean
technique.
• Surgical asepsis, or sterile technique, consists of
those practices that eliminate all microorganisms and
spores from an object or area.
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44. Ways That Can Decrease The Exposure Of
Clients To Infection
45. Oxygen Therapy
is the administration of oxygen at a concentration greater than
that found in the environmental atmosphere.
Goal:
Is to provide adequate transport of oxygen in the blood while
decreasing the work of breathing and reducing stress on the
myocardium
To prevent Hypoxia
Oxygen administration:
Oxygen therapy is prescribed by the physician who specifies the
concentration, method of delivery and liter flow per minute. The
concentration is of more importance than the liter flow per
minute
47. Cont..
Humidifiers – prevent mucous
membranes from drying and becoming
irritated and loosens secretions for easier
expectoration. Oxygen passing through
water picks up water vapor before it
reaches the client
The oxygen passes through sterile
distilled water or tap water and then
along a line to the device through which
the moistened oxygen is inhaled ( e.g. a
Cannula, Nasal Catheter, or Oxygen
Mask).
49. Nasal Cannula/Nasal Prongs)
• Flow rate up to 6L/min
• Unable to determine exact concentration
• Comfortable – allows patient to eat, drink talk
• Can still be used if patient’ mouth breathing
• Delivers O2 into the patient’s nostrils by way of two small
plastic prongs
• Delivers low concentration of O2 (24% to 45%) at flow rates of
2-6 L/min
• Most common inexpensive device
50. Face Masks
Face masks that cover the client’s nose and
mouth may be used for oxygen inhalation.
Exhalation ports on the sides of the masks
allowed exhaled carbon dioxide to escape.
Simple Face Masks delivers oxygen
concentrations from 40% to 60% at liters flows of
5 – 8 L/minute, respectively
Partial Rebreather Masks
delivers oxygen concentrations of 60% to 90% at
liter flows of 6 to 10 L/ minute, respectively. The
oxygen reservoir bag that is attached allows the
client to rebreathe about the first third of the
exhaled air in conjunction with oxygen
51. Non Rebreather Masks
It delivers the highest oxygen concentration
possible – 95% to 100% - by means other than
intubation or mechanical ventilation at liter
flows of 10 – 15 L/ minute,respectively.
Venturi Masks
The venturi masks delivers oxygen
concentrations varying from 24% to 40% or
50% at liter flows of 4 to 10 L/ minute.
is often used with air-entrainment nebulizers to
provide humidification and oxygen therapy.
Face Masks
52. Face Tents (Face Shield)
Can replace oxygen masks when
masks are poorly tolerated by clients.
Face tents provide varying
concentration of oxygen, for example
30% to 50% concentration of oxygen
at 4 to 8 L/minute.
53. Artificial Airways
Oropharyngeal Airways
• An OPA is a device usually made of plastic
• It is inserted into patients mouth and into back of throat
• Helps to maintain an open airway for breathing/ resuscitation
• Use OPA’s only on unconscious patients who DON’T have a gag
reflex
Oropharyngeal airways stimulate the gag reflex and are only
used for clients with altered level of consciousness;
Example:
o Because of general anesthesia
o Overdose
o Head injury
54. Suctioning
• NEVER suction for longer than 15 seconds at a time
• NEVER suction as you are inserting the catheter,
place the suction tip in the patients mouth before
starting suction
55. Nurses Responsibilities
• The nurse should explain the reason and the
objective for the therapy
• The nurse should know the proper care of and
administration of oxygen
• Instruct the patient and family the methods for
administering oxygen
• Demonstrate safe and appropriate use of oxygen and
oxygen device
• Identify to patient and family the signs and
symptoms indicating the need for oxygen
56. References
Berman, A., Snyder, S. J., Kozier, B., Erb, G., Levett-
Jones, T., Dwyer, T., ... & Park, T. (2010). Kozier and
Erb's fundamentals of nursing (Vol. 1). Pearson
Australia.
Delaine, S., & Lander, P. (2008). Fundamentals of
nursing standard and practice.
Waugh, A., & Grant, A. (2001). Ross and Wilson
anatomy and physiology in health and illness.
Churchill Livingstone.
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