THE PROCESS OF OXYGENATION

−
Delivery of oxygen to the body
−
Depends upon the interplay of pulmonary, hematologic and
cardiovascular system
−
Processes involved are ventilation, alveolar gas exchange,
oxygen transport and cellular respiration.
I.
VENTILATION
−
First step in the process of oxygenation
−
Movement of air into and out of the lungs for the purpose of
delivering fresh air in the alveoli
−
Regulated by the respiratory centers in the pons and
medulla oblongata.
−
Rate and depth depends on the concentrating hydrogen ion
and carbon dioxide (CO2) in body and fluid
Mechanics of Ventilation
1.Air Pressure Variances

Air flows from region of higher pressure to a region of lower

pressure. During inspiration, movement of
diaphragm and other muscles of respiration enlarge the
thoracic cavity and thereby lower the pressure inside the
thorax to a level below that of the atmospheric pressure.
During the normal expiration, the diaphragm relaxes and the
lungs recoil. The alveolar pressure then exceeds
atmospheric pressure, and air flows from the lungs into the
atmosphere.

2.Air Way Resistance

Any process that changes the bronchial diameter or widths
affects airway resistance and alters the rate of airflow
for a given pressure gradient during respiration.
3.Compliance
It measures the (characteristics of lungs) elasticity,
expandability, anddistensibil ity of the lungs and thoracic
structures. It is determined by examining the volume-
pressure relationship in the lungs and the thorax. In normal
compliance, the lungs and the thorax easily stretch and
distend when pressure is applied. High or increased
compliance occurs when the lungs have lost their elasticity
and the thorax is distended. When lungs and thorax are
stiff, there is low or decreased compliance.

II.
ALVEOLAR GAS EXCHANGE(oxygen uptake or external
respiration)
Once fresh air reaches the lung’s alveoli, oxygen moves from
area of higher concentration (alveoli) to lower
concentration (pulmonary capillary blood). The same way
that CO2 diffuses from the blood to the alveolar space.
III.
OXYGEN TRANSPORT

Once the diffusion of oxygen across the alveolar-capillary

membrane occurs, the CO2 molecules are dissolved in the
blood plasma. Plasma is not able to carry enough dissolved
oxygen to meet the metabolic needs of the body. Oxygen
carrying capacity of the blood is greatly enhanced by the
presence of hemoglobin in the erythrocytes. Once oxygen is
bound to hemoglobin, the oxygen is delivered to the cell of
the body by circulation

Hemoglobin – RBC’s major component which contains heme,

a complex molecule of iron and porphyrin which gives
blood its color and globin, a simple protein
Hemoglobin Test – Measures the grams of hemoglobin in a
100ml of whole blood.
Normal Values: Males 14.0 – 17.4 g/dL
Females 12.0 – 16.0 g/dL
13.5 – 17.5 g/dL
11.5 – 15.5 g/dL
Measurement of Oxygen in Blood Samples
 1.Partial Pressure of Oxygen (PaO2)
– measures oxygen dissolved in plasma. Normal Value: 80 –
100 mmHg
2.Oxygen Saturation (SaO2)
– measures the percentage of hemoglobin saturated with
oxygen. Normal Value: 95 – 100 %
96 – 98%

CELLULAR RESPIRATION
Gas exchange at the cellular level takes place via diffusion in
response to pressure gradient. Oxygen diffuses from
the blood to the tissues while carbon dioxide moves from the
tissues to the blood. Blood is reoxygenated.

FACTORS AFFECTING OXYGENATION

1.AgeOlder adults often exhibit barrel chest and require
increased effort to expand the lung. They are also
susceptible to respiratory infection due because of
decreased activity which is an effective defense mechanism.

2.Environmental and lifestyle factors

Clients who are exposed to dust, animal dander, asbestos or
toxic chemicals are at an increased risk for
alterations in oxygenation. Smokers as well as those
exposed to it should be questioned as to the type,
frequency of smoking.

3.Disease processes
ASSESSMENT OF CLIENT WITH RESPIRATORY DISORDERS
HEALTH HISTORY
−
Identify the chief reason for seeking health care
−
Nurse determines when the health problems started, how
long it lasted, if it was relieved any time, and how relief
was obtained.
−
Collects information about precipitating factors, duration,
severity and associated factors or symptoms
−
Assess risk factors and genetic factors that contribute to the
condition
−
Assess the impact of sign and symptoms on the patient’s
ability to perform activities of daily living
SIGNS AND SYMPTOMS
Dyspnea – difficulty or labored breathing, shortness of
breath to any constantly recurring irritant
Cough – results from the irritation of mucous membrane
anywhere in the respiratory tract. It may arise from
infectious
process and from airborne irritants such as smoke, dust and
gas

Sputum Production – reaction of lungs to any constantly

recurring irritants

Chest Pain – sharp, stabbing and intermittent or may be dull,

aching and persistent

Wheezing – high pitched musical sound heard mainly on

expiration. (bronchoconstriction or airway narrowing)

Clubbing Fingers – found in clients with chronic hypoxic

condition, chronic lung infection and malignancies of the

lungs. It is described as sponginess of the nail bed and loss

of nail bed angle
Hemoptysis – expectoration of blood from respiratory tract. A
symptom of both pulmonary and cardiac disorder
Cyanosis – bluish discoloration of the skin. It is a late sign of
hypoxia (can lead to shock or death). Cyanosis appears of
there is 5 g/dL of unoxygenated hemoglobin
PHYSICAL ASSESSMENT OF UPPER RESPIRATORY STUCTURES
1.Nose and Sinuses
−
inspect the external nose for lesions, asymmetry or
inflammation
−
examine the internal structure for swelling, color, exudates
or bleeding
−
inspect for septum deviation, perforation or bleeding

palpate the frontal and maxillary sinuses for tenderness.

Using the thumb the nurse applies gentle pressure in an
upward fashion at the supraorbital ridges (frontal sinuses)
and in the cheek area adjacent to the nose (maxillary).
Tenderness suggests inflammation

2.Pharynx and Mouth

−
Instruct the client to open mouth and take deep breath
−
Inspect structures for color, symmetry and evidence of
exudates, ulceration or enlargement
3.Trachea
−
Place thumb and index finger of one hand on either side of
the trachea just above the sternal notch. It is
normally in the midline as it enters the thoracic inlet behind
the sternum.
PHYSICAL ASSESSMENT OF UPPER RESPIRATORY STUCTURES
1.CHEST CONFIGURATION – normal ratio of the antero
posterior diameter to lateral diameter is 1:2
Barrel Chest – increase in the antero posterior diameter of
the thorax, ribs are more widely spaced and the
intercostals space tend to bulge

Funnel Chest – (pectus excavatum) depression of the lower

portion of the sternum

Pigeon Chest – results from displacement of sternum. There

is an increase in the anterior diameter.

Kyphoscolosis – elevation of the scapula and a corresponding

S shaped spine

2. BREATHING PATTERNS AND RESPIRATORY RATE

Eupnea – normal breathing
12-18 bpm
Bradypnea – slower than normal <10 bpm
normal depth and regular rhythm
Tachypnea – rapid, shallow
>24 bpm

Apnea – cessation of breathing

Kussmaul’s – increased rate and depth of breathing

Cheyne-Stokes – regular cycle where the rate and depth of

breathing increase and then decrease until apnea

(usually 20 seconds) *tachypnea – stop – tachypnea – stop –

tachypnea – flat line
Biot’s Respiration – period of normal breathing (3-4 breaths)
followed by varying period of apnea (usually 10
seconds to 1 minute) *shallow – deep – irregular
3.BREATH SOUNDS
Crackles – formerly known as rales, are discrete non
continuous sounds that result from delayed reopening of
deflated airways. Soft high itched sound heard during
inspiration
Coarse Crackles – discontinuous popping sound heard in
early inspiration; harsh moist sound originating in the
large bronchi
Fine Crackles – discontinuous popping sound heard in late
inspiration; sound like hair rubbing together
Sonorous Wheezes (ronchi) – deep low-pitched rumbling
sound heard primarily during expiration; caused by air
moving through narrowed tracheo bronchial passages
Sibilant Wheezes – continuous, musical, high pitched, whistle
like sounds hears during inspiration and expiration
caused by air passing through narrowed or partially
obstructed airways may clear without
coughing.