Oxygenation and perfusion

  1. Pulmonary ventilation
    • movement of air into and out of the lungs
    • inspiration expiration
  2. Respiration
    gas exchange between atmospheric air in alveoli and blood in the capillaries through the process of diffusion 

    • Upper Airway
    • Lower Airway
    • Cilia
    • Alveoli
    • Surfactant
  3. Perfusion
    the process of oxygenated capillary blood passes through body tissues.
  4. Upper Airway
    warm, filter and humidify inspired air

    nose, pharynx, larynx, epiglottis
  5. Lower Airway
    Conduction of air, mucociliary clearance, and production of pulmonary surfactant

    • Tracheobronchial tree
    • Trachea
    • Right and left main stem bronchi
    • Segmental bronchi
    • Terminal bronchioles
  6. Pulmonary ventilation 
    • Diaphragm contracts and descends
    • Lengthening thoracic cavity
    • External intercostal muscles contract
    • Lifting ribs upward and outward
    • Sternum pushed forward
    • Enlarging chest from front to back
  7. Lung compliance
    Ease of the lungs to be inflated 

    • the elasticity of lung tissue
    • surfactant 
    • alteration in elasticity - emphysema
  8. Airway resistance results from impediment or obstruction in the airway
    • Foreign substance
    • Drowning victim
    • Secretions
    • Tumors/Edema
  9. Transport of Respiratory Gases
    Oxygen is carried in the body via plasma and red blood cells.

    Most oxygen (97%) is carried by red blood cells in the form of oxyhemoglobin.

    Hemoglobin also carries carbon dioxide in the form of carboxyhemoglobin.

    Internal respiration between the circulating blood and tissue cells must occur.
  10. Factors affecting ventilation
    Musculature condition

    Lung elasticity/compliance - ability to stretch 

    Airway resistance/obstruction - emphysema
  11. Factors affecting gas exchange
    Surface area available

    Thickening of alveolar-capillary membrane

    Partial pressures of gases
  12. Auscultation of breath sounds
    Vesicular - low-pitched soft sound during expiration heard over most of the lungs

    Bronchial - high-pitched and longer, heard primarily over the trachea

    Bronchovesicular - medium pitch and sound during expiration, heard over the upper anterior chest and intercostal area
  13. Factors affecting perfusion
    Activity level 

    Cardiac output (stroke volume

    Carbon dioxide transport
  14. Alterations in Respiration Hypoxia
    A condition in which an inadequate amount of oxygen is available to cells. (shortage of O2).

    Occurs when there is a problem with ventilation, respiration and/or perfusion.
  15. Clinical Manifestation of hypoxia
    Dyspnea (the most common symptom) – shortness of breath

    Increased BP

    Increased respiratory rate

    Increased pulse rate

    Pallor (paleness), Cyanosis (bluish color), Anxiety, Restlessness, Confusion, Drowsiness, small or narrow pulse pressure
  16. Alterations in Respiration Functioning
    Level of health

    Developmental Considerations (Table 38-1) page 1405

    Medications – especially those affecting CNS

    ◦Opioids (depresses respiratory drive). Sedatives

    Lifestyle – activity level, culture, cigarette smoking

    Environment – pollutants, occupational exposure, household cleaning products

    Psychological Health – stress, anxiety
  17. Developmental Consideration

    ◦< 34 weeks may have less surfactant

    ◦Leading to the collapse of alveoli

    ◦Abdominal breathers (0-5yrs)

    ◦Short airways and prone to aspiration

    Toddlers, Preschoolers, School-aged Children, and Adolescents

    ◦Elongated and less angular Eustachian tubes, bronchi and bronchioles

    Antibody development

    Older Adults (Table 38-1)

    ◦Alveoli less elastic

    ◦Less efficient diaphragm movement
  18. Nursing Process: Assessment
    Why the patient needs nursing care.

    What kind of care is needed to maintain a sufficient intake of air?

    Identify current or potential health deviations.

    Identify actions performed by the patient for meeting respiratory needs.

    Make use of aids to improve intake of air and effects on patient’s lifestyle and relationship with others.
  19. Assessment
    Patient history

    Interview patient or family member

    Assessment guide 38-1

    Current and potential health problems

    Actions performed by the patient to meet respiratory needs

    Aids used by patient to improve ventilation

    Effect on the patient’s lifestyle and relationships

    Physical assessment

    Inspection, palpation, percussion and auscultation

    Laboratory and diagnostic tests

    Pulmonary function tests

    Common diagnostic tests
  20. Adventitious (abnormal) Breath Sounds
    Crackles—soft, high pitched intermittent popping sounds produced by fluid in airways or alveoli

    Wheezes—continuous musical/whistling sounds heard as air passes through airways constricted by swelling, narrowing, secretions, or tumors
  21. Heart Sounds

    Closure of mitral and tricuspid valve

    Contraction of the ventricles

    Beginning of systole



    Closure of aortic and pulmonic valve

    Relaxation of the venticles

    Beginning of diastole

  22. Pulmonary Function Studies

    Peak Inspiratory Flow Rate (PEFR)

    Pulse Oximetry
  23. Common Diagnostic Studies
    Arterial blood gas & pH Analysis


    Lung scan


    Cardiac biomarkers


    Skin test

    Endoscopic studies

    Complete blood counts

  24. Nursing Diagnosis
    Alteration in oxygenation as the problem

    Inefective airway clearance r/t recent development of pneumonia AEB…

    Impaired gas exchange r/t asbestos in the workplace AEB…

    Ineffective breathing pattern r/t pain AEB…

    Alteration in respiratory functioning as Etiology

    Activity intolerance r/t imbalance in oxygen supply and demand AEB …

    Anxiety r/t felling of suffocation AEB …

    Disturbed sleep pattern r/t orthopnea and bronchodilators AEB…
  25. Planning/Expected Outcome
    The patient will:

    Demonstrate improved gas exchange in lungs by absence of cyanosis and pulse oximetry reading of 95% or greater

    Verbalize understanding of causes and demonstrate adaptive methods of coping

    Preserve cardiopulmonary function by maintaining an optimal level of activity

    Demonstrate behaviors to improve or maintain clear airway

    Identify potential complications and initiate preventive or corrective actions
  26. Interventions
    Promoting Optimal Function

    Healthy lifestyle


    Pollution-free environments

    Reducing anxiety

    Maintaining good nuturition
  27. Interventions
    Promote optimal functioning of cardiopulmonary systems

    Promote comfortPromote and control coughing

    Chest physiotherapy - Percussion, Vibrating, Postural

    Suctioning airway

    Supplemental oxygen
  28. Interventions
    Promoting Comfort

    Proper positioning- high Fowler’s position

    Adequate fluid intake - 2-3 quarts daily to thin secretions


    Breathing techniques - Deep, Pursed lip, Diaphagmatic

    Pace physical activity
  29. Interventions Promoting and Controlling Coughing


    Cough Medications



  30. Interventions Medications






    Mast Cell Stabalizer

    Cromolyn sodium




    Metered dose inhaler (MDI)

    Dry powder inhaler (DPI)
  31. Interventions Oxygen Delivery
    Oxygen is a medication!

    In emergencies do not delay oxygen administration!

    Nasal cannula

    Nasal catheter

    Simple mask

    Partial rebreather mask

    Nonrebreather mask

    Venturi mask

  32. Intervention Oxygen Therapy in the Home

    No smoking or use open flames within 10 feet of the O2 source

    O2 is a combustible gas, sparks ignite

    Do not use electrical equipment near O2 administration set

    Ground oxygen concentrators

    Secure tank in the holder

    Allow adequate airflow around the concentrator

    Notify local fire department of oxygen use in the home


    Follow prescription

    Have HCP number

    Ensure enough O2 on hand prior to leaving the home

    O2 vendors contact

    Signs and symptoms indicating an emergency
  33. Evaluation
    Ongoing process

    Compare patient’s health status with previously defined outcomes

    Where the outcomes met, partially met or unmet?

    Adjust plan of care if outcomes are not met/partially met
Card Set
Oxygenation and perfusion
Oxygenation and perfusion