Oxygenation

OxygenationJanna Wickham RN MSNLake Sumter Community CollegeNursing FoundationJanuary 20131Learning ObjectivesSafe, Effective Care Environment

Describe physiological processes affecting the client's ventilation, perfusion, and exchange of respiratory gases Assess the clients oxygenation status

3Health Promotion and Maintenance

Develop nursing interventions that promote oxygenation Describe the impact of a client's level of health, age, lifestyle, and environment on tissue oxygenation

4Physiological Integrity

Interpret diagnostic testing related to oxygenation, breathing, circulation, and gas exchange

5 Systems Involved in OxygenationPulmonaryRespirationCirculatoryPerfusionMusculoskeletalVentilationNeurologicalVentilationRespiration refers to gas exchange oxygenation of the blood and elimination of carbon dioxide from the bloodVentilation the movement of air through the lungs to make enough oxygen available to the aveolarBrain stem uses feedback system and lung receptors to breathe.6 Pulmonary ReviewAirway- Uppernasal passagesmouthpharynxlarynxtracheabronchibronchioles

Nasal passages provide moisture and heat. Mouth breathing does not provide moisture and dries the mouthPharynx-openings to the esophagus and tracheaLarynx separates upper and lower airwaysTrachea extends from the larynx to the mainstem bronchioles7

8 Lungs-Lower- considered sterileRight- 3 lobesLeft- 2 lobesMediastinum- separates right from leftAlveoliAlveoli-capillary membraneGas ExchangeSurfactantPleuraPleural Space

Right mainstem bronchous is fatter and shorter leaving the trachea at a vertical angle. Left bronchous is narrower and longer leaving the trachea at a horizontal angle. Which one is more apt to have aspiration?Alveoli-capillary membrane- this is where the gas exchange occurs. Oxygen diffuses across the alveoli-capillary membrane into the blood of the pulmonary capillaries; carbon dioxide diffues out of the blood into the alveoli to be exhaled by the lungs.Gas exchange occurs at two levels: external- aveoli-capillary membrane and at the capillary-cellular membrane in body tissue internal What is the purpose of surfactant? To keep the alveoli from collapsing. A lipoprotein that lowers surface tension to prevent walls from adheringPleura- glidePleural space must be intact and needed to maintain negative pressure.Alveoli have two types of cells- one for gas exchange. The other to produce surfactant.9

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Gas ExchangePulmonary vein does it carry oxygenated or deoxygenated blood??11 Functions of Pulmonary SystemVentilationRespirationOxygenationHypoxemia (blood)PerfusionHypoxiaHypoxemia- low arterial blood oxygen. Poor oxygen diffusion across the alveolar-capillary membrane into the blood. External respiration. Due to lung or pulmonary circulation disorders. Hypoventilation what do you think happens?? Predisposes the development of hypoxemia and hypoxia.Hypoxia- inadequate oxygenation of tissue and organs. Can you have hypoxia with adequately oxygenated blood? Yes- because of poor perfusion. Causes are either hypoxemia or poor circulation. What would the patient look like if the brain was involved? Kidneys? Limb tissue?12 Pulmonary VentilationInhalationDiaphragm contractsExhalationDiaphragm HyperventilationHypoventilation

Lung expansion pulls down the diaphragm and the negative pressure pulls the outside air in through the trachea.Hyperventilation would cause additional oxygen requirements and blow off carbon dioxideHypoventilation would cause retaining carbon dioxide13 Lung ComplianceConditions that reduce lung complianceEdemaScar tissueLoss of surfactantLung elasticityLoss of elasticity results in lungs that inflate but air is trappedAirway resistanceSmall changes can cause increased airway resistance

14 RespirationExternal RespirationAlveolar-Capillary MembraneDiffusionConditions that slow or reduce gas exchangeInternal Respiration15

16 How is Breathing ControlledRespiratory CenterBrainstemFeedback systemChemoreceptors in the medulla, aorta, and carotid arteriesBlood pH, O2 levels, and CO2 levelsLung receptors provide feedback Blood CO2 levels provide the primary stimulus to breathe. High levels stimulate breathing. Hypoxemia stimulates breathing as well.

17 CardiovascularDeoxygenated blood flows into the right atrium Pulmonary circulationAlveolar-capillary membrane external gas exchange occursOxygenated blood flows from the lungs to the left side of the heart of out into the arterial circulation18Blood Flow Song HeartSinoatrial Node60-100Atrio-ventricular Node40-60Ventricular