Oxygenation

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Oxygenation

• Unit Eight

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Respiratory system
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• Oxygen a clear, odorless gas that constitutes
  approximately 21 percent of the air we breathe
  for necessary all living cell.
• Respiration is the process of gas exchange
  between individual and the environment.

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The process of respiration involves several
components

• Pulmonary ventilation the movement of air
  between the atmosphere and alveoli of the lungs.
• Diffusion of oxygen and carbon dioxide between
  alveoli and capillaries.
• Transport of oxygen and carbon dioxide via blood
  to tissues.
• Diffusion of oxygen and carbon dioxide between
  capillaries and cell.

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Functions of pulmonary system

• Ventilation is the movement of air in and out of
  the lung.
• Respiration is the process of gas exchange.

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Manifestations of Altered Respiratory Function

• Cough
• Sputum Production
• Shortness of Breath
• Chest Pain
• Abnormal Breath Sounds
• Accessory Muscle Use
• Cyanosis
• Clubbing fingers.

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Anatomy and physiology of respiratory system

• 1) Upper respiratory tract
• a) Nose made of cartilage and bone and is
  designed to warm, moisten, and filter air as it
  comes into the system.
• b) Pharynx (throat) conducts food and air.

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Cont

• C) Larynx (voice box) connects the pharynx and
  the trachea made of cartilage contains vocal
  cords.
• D) Epiglottis flap of tissue that covers
  trachea ensures food travels down the esophagus.

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Cont

• 2) Lower Respiratory tract
• Trachea (windpipe) tubular passage way for air
  carries air to the lungs, C-shaped cartilage
  rings, divides at end.
• Bronchi pair of tubes that branch from
  trachea and enter lungs have cartilage, lining
  is ciliated secretes mucus.
• Bronchioles tiny tubes lacking cartilage and
  cilia possess smooth muscle

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• Alveoli cup shaped structures at the end of the
  bronchioles that resemble bunches of grapes are
  in direct contact with capillaries (gas
  exchange) covered with SURFACTANT that
  prevent alveoli from collapsing.
• Lungs paired, cone-shaped organs that are
  surrounded by a pleural membrane, made of elastic
  tissue, and divided into lobes

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Mechanics of Breathing

• Inhaling (active process) Air moves in. Why?
• Gases move from an area of high pressure to low
  pressure
• During inspiration diaphragm pulls down and
  lungs expand
• When lungs expand, it increase the volume, which
  decrease the pressure inside lungs

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• Lung pressure is lower than outside pressure, so
  air moves in.
• Exhaling (passive process) breathing out
• Diaphragm and muscles relax
• Volume in lungs and chest cavity decreases, so
  now pressure inside increases.
• Air moves out because pressure inside is HIGHER
  than OUTSIDE atmosphere.

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Respiration

• Exchange of O2 and CO2 between alveoli and blood
• Partial pressure of O2 higher in alveoli than
  blood so O2 diffuses into blood
• Partial pressure of CO2 higher in blood than
  alveoli, so CO2 moves into alveoli in opposite
  direction and gets exhaled out

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Internal respiration

• Internal respiration is exchange of O2 and CO2
  between blood and tissues
• Pressure of O2 higher in blood than tissues so O2
  gets release into tissues.
• Pressure of CO2 higher in tissue than in blood so
  CO2 diffused in opposite direction into blood.
• CO2 Is a waste product.
• O2 Is used in cellular respiration

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3 Muscle Groups of Inhalation

• Diaphragm
• contraction draws air into lungs
• 75 of normal air movement
• External intercostals muscles
• assist inhalation
• 25 of normal air movement
• Accessory muscles assist in elevating ribs
• sternocleidomastiod
• serratus anterior
• pectoralis minor
• scalene muscles

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Control of Breathing

• Breathing is regulated by the rhythmicity center
  in the medulla and pons in brain stem.
• Carotid body is sensitive to level of oxygen.
• medulla ? rate and depth of breathing

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Pons and medulla
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Factor effecting oxygenation

• Environment high altitude increase respiratory
  rate.
• Exercise physical exercise lead to increase
  respiratory rate.
• Life style smoking, occupation.
• Health status disease of cardiovascular disease.
• Narcotics morphine decrease respiratory rate.
• Stress and anxiety.

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• Respiratory alteration
• Hypoxia is condition of insufficient oxygen
  anywhere in the body from the inspired gas to the
  tissue. Cerebral function can tolerate hypoxia
  for only 3 to 5 min before permanent damage.

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• Sign of hypoxia
• Rapid pulse.
• Rapid shallow respiration.
• Increase restlessness.
• Flaring nares.
• Cyanosis.

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• Hypoventilation inadequate alveolar ventilation
  can lead to hypoxia may result from disease of
  respiratory muscle, drug, and anesthesia.
• Hypercabnia accumulation of carbon dioxide in
  the blood.
• Cyanosis bluish discoloration of the skin nails
  beds and mucosal membrane

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Altered breathing pattern

• Breathing pattern rate, volume, rhythm, effort
  of respiration.
• Normal respiration (Eupnea) quite, rhythmic and
  effortless.
• Tachypnea rapid rate is seen with fevers,
  metabolic acidosis, pain and Hypercabnia.
• Bradypnea slow respiration rate, seen with
  narcotics and increase intracranial pressure from
  brain injury.

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• Hyperventilation increase movement of air into
  and out of the lung.
• Dyspnea difficult of breathing.
• Orthopnea in ability to breathe except in an
  upright position

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• Obstructed air way
• Partially or completely in upper and lower
  respiratory tract.

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Assessment

• Nursing history
• Respiratory problem, cardiac problem, life style,
  cough and sputum.
• Physical assessment
• Inspection, palpation, percussion and
  auscultation.

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• Diagnostic studies
• Sputum specimen, throat culture, arterial blood
  gases.
• X- Ray examination.
• Bronchoscopy and laryngoscopy.
• Pulse oximetry non invasive device measuring
  oxygen saturation.

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• Sputum collected for the following reason
• Culture and sensitivity for identify a specific
  microorganism.
• Cytology to identify the origin, structure,
  function and pathology cell.
• Acid bacillus to identify the presence of
  tuberculosis.

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Nursing diagnosis

• Ineffective air way clearance related to
  accumulation of secretion.
• Ineffective breathing pattern related to dyspnea.
• Altered tissue perfusion related to decrease
  cardiac out put.
• Anxiety related to ineffective air way clearance.

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• Implementation
• Positioning the client to allow to maximum chest
  expansion.
• Encourage frequent changes in position.
• Encourage ambulating.
• Deep breathing exercise and coughing.
• Hydration to maintain moisturing of respiratory
  tract mucous membrane and easily to move
  respiratory secretion and decease incidence of
  infection.

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Oxygen Administration

• 1 Nasal Cannula.
• 2 Face Mask.
• 3 Oxygen Tent (for children).
• 4 Venturi Mask.
• 5 Non rebreather Mask.
• 6 Partial Rebreather Mask.
• 7 Endotracheal Tube (ETT).

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The End

• Good Luck