Seminar on

Oxygen
insufficiency
SL.NO CONTENT
I. INTRODUCTION
II. CONTENT
Oxygen Insufficiency
a) Defintion
b) Signs and symptoms of oxygen insufficiency
c) Etiology for oxugen insufficiency
d) Factors affecting oxygenation
e) Disease which occurs due to oxygen insufficiency
1. Hypoxemic respiratory failure or oxygen failure
2. Chronic respiratory insufficiency
3. Hypoxia
4. Hypoxemia
5. Anoxia
6. Renal failure
7. Cyanosis
8. Clubbing of fingers
9. Cerebral palsy
10.Ischemic heart disease
11.Syncope
f) Diagnostic evaluation
g) Management of the patient who is having oxygen insufficiency
h) Prognosis of the patient those who are affected with oxygen
insufficiency
i) Nursing diagnosis and intervention
III. CONCLUSION
IV. SUMMARY
V. BIBLIOGRAPHY
INTRODUCTION

Oxygen is essential to life. Al cells in the body requires it, some being
more sensituve to a lack of oxygen than others. The nomal amount of oxygen
in the external blood shoud be in the range of 80 – 100 mm hg. If it falls below
60 mm hg, irreversible physiologic effects may occur. Oxygen administration
helps to treat the oxygen insufficiency.

MEANING OF OXYGEN

A colourless, odourless gas constituting one fifth of the atmosphere.

21% of oxygen present in the atmospheric air.

DEFINITION OF OXYGENATION

Oxygenation is a process which occurs in the lungs to the haemoglobin

of blood, which is saturated with oxygen to form oxyhaemoglobin.

MEANING OF OXYGEN INSUFFICIENCY

Suffiecient amount of oxygen is not getting the organs to maintain their

functions.

ETIOLOGY

 Decreased haemoglobin & oxygen carrying capacity of blood.

 Diminshed concentration of inspired oxygen which may occur at high
attitude.
 Inability of the tissue to extract oxygen forms the blood in case of
cyanide poisoning.
 Decreased diffusion of oxygen from the alveoli to the blood as with in
pneumonia.
 Poor tissue perfusion with oxygenated blood as with shock.
  Impaired ventication as with multiple rib fracture or chest traumas.

SINGNS AND SYMPTOMS OF OXYGEN INSUFFICIENCY

 Anxious and tired

 Headache, dizziness, irritability and memory loss.
 Nausea, vomiting and cyanosis
 Oliguria and anuria
 Fatigue lethargic
 Shorness of breath,
 Clubbing of fingers
 Impairment in judgement

FACTORS AFFECTING OXYGENATION

1) ENVIRONMENTAL FACTORS:

Environmental can influence oxygenation. The incidence of

pulmonary disease is higher in urban areas than in rural areas. The
client’s work place may increase the risk for pulmonary disease.
Occupational pollutants include asbestos, talcum powder, dust and
airborne fibres.

Asbestosis in an occupational lung disease that develops after

exposure to asbestos. The lung is asbestosis is characterised by diffuse
interstitial fibrosis, creating a restrictive long disease.

Clients at risk for developing asbestos include those working with

textiles fire proofing or milling or in the production of paints, plastics or
some prefabricated construction.

Client exposed to asbestos who also have the habits of smoking

means increased risk of developing lung cancer.
AIR POLLUTION IS AN IMPORTANT FACTOR THAT EFFECT THE

OXYGENATION

SOURCES OF AIR POLLUTION

a) AUTOMOBILES

Motor vechiles are a major source of air pollution throughout the

urban areas.

b) INDUSTRIES
Industries emit large amount of pollutants into the atmosphere.
c) DOMESTIC SOURCES

Domestic combustion of coal, wook or oil is a major source of

smoke, dust, and sulphur dioxide and nitrogen oxide.

d) MISCELLANEOUS

Burning refuse, incinerators, pesticide spraying, nuclear energy

programme and also natural sources (bacteria)

HEALTH ASPECTS

The health effects of air pollution are both immediate and delayed. Immediate
effects are borne by the respiratory system, resulting state is acute bronchitis.
If the air – pollution is intense, it may result even in immediate death by
suffocation.

2) PHYSIOLOGICAL FACTORS

1. DECREASED OXYGEN – CARRYING CAPACITY

Hhaemoglobin carries 99% of the oxygen tissues. Anaemia and

inhalation of toxic substances decreases the oxygen – carrying
 capacity of blood, by reducing the amount of availabe
haemoglobin to transport oxygen. Anaemia lower than normal
haemoglobin level is a result of decreased haemoglobin
production, increased red blood cell destruction and blood loss.
Clients will have complaints of fatigue, decreased activity
tolerance and increased breathlessness as well as pallor and an
increased heart rate.
2. DECREASED INSPIRED OXYGEN CONCENTRATION

When the concentration of inspired oxygen declines, the oxygen

carrying capacity of the clood is decreased. It may lead to
respiratory problems.
3. INCREASED METABOLIC RATE

Increased metabolic activity cause, increased oxygen demand.

When body systems are unable tomeet this increased demand the
level of oxygenation decliens.

DEVELOPMENT FACTORS

INFANTS AND TODDLERS

Infants and toddlers are at risk for upper respiratory tract infection as a
result of frequent exposure to other children and exposure to secondhand
smoke.

SCHOOL AGE CHILDRES AND ADOLESENTS

School age childrens and adolescents are exposed to respiratory

infection and respiratory risk factors such as second hand smoke and
cigarette smoking.
YOUNG AND MIDDLE – AGE ADULTS

Young and middle age adults are exposed to multiple caridopulmonary

risk factors such as unhealthy diet, lack of exercise, stress, illegal drugs,
smoking and unhealthy lifestyle.

OTHER ADULTS

Ventilation and transfer of respiratory gases dicline with age, because

the lungs are unable to expand fully, leading to lower oxygenation levels.

LIFESTYLE RISK FACTORS

NUTRITIONAL FACTORS

 Severe obesity decreases lung expansion.

 The increased body weight increases oxygen demands to meet
metabolic need.
 Malnourished (child) client may experience respiratory muscle wasting
resulting in a decreased muscle strength and respiratory excursion.
 Diet high in fat increase cholestrol and atherogenesis, artheroscienosis
in the coronary arteries.
 Client who are morbidly obese and malnourished are at risk for
anaemia.

MEDICATIONS

Many medications affect the function of the respiratory system. Patients

receiving drugs that affect the central nervous system need to be
monitored carefully for respiratory complications. For example, opioids are
chemical agents that depress the meducary respiratory center. As a result
the rate and depth of respiration decrease. The nurse must be alert fo the
possibility of respiratory depression or arrest when administering any
narcotic or sedative.
BEHAVIORAL FACTORS

Many physiology factors and conditions can affect the respiratory

system. Individuals responding to stress may sigh exessively or exhibit
hyperventilation (increased rate and depth of ventilation, above the body’s
normal metabolic requirement). Hyperventilation can lead to a lower level
of arterial carbon dioxide. Generalized anxiety has been shown to cause
enough bronchospasm to produce an episode of bronchial asthma. In
addition patient, with respiratory problem often develops some anxiety as
a result of the hypoxia caused by the respiratory problem.

LEVELS OF HEALTH

Acute and chronic illness can dramatically affect a person’s respiratory

function. For example, people with renal or cardiac disorders often have
compromised respiratory functioning because of fluid overload and
impaired tissue perfusion. People with chronic illness often have musle
wasting and poor muscle tone. These problems affect all the muscles,
including those of respiratory system. Alterations in muscle function
contribute to inadequate pulmonary ventilation and respiration.

Myocardial infarction (heart attack) causes a lack of blood supply to

heart muscle. Damage to muscle interferes with effective contraction of the
muscle, leading to decreased perfusion of tissue and decreased gas
exchange.

Physical changes such as scoliosis (curvature of the spine) influence

breathing pattern and may cause air trapping.

EXERCISE

Exercise increase, the body metabolic activity and oxygen demand rate
and depth of the respiratory increase enabling the person to inhale more
oxygen and exhale excess carbon dioxide.
 People who exercise for one hour daily have a lower pulse rate, blood
pressure, decreased cholesterol level, increased blood flow and greater
oxygen extraction by working muscles.

SMOKING CESSATION

Inhaled nicotine cause vasoconstriction of peripheral and coronary

blood vessels increasing blood pressure and decreasing blood flow to
peripheral vessels. The risk of lung cancer is 10 times greater for a person
who smokes than for a non smoker. Explosure to second hand smoke
increase the risk of lung cancer and cardiovascular disease in th enon
smoker.

SUBSTANCE ABUSE

Excessive use of alcohol and other drugs can impair tissue oxygenation
in two ways. The person who chronically abuses substances often has a
poor nutritional intake.

Second: - excessive use of alchohol and certain other drugs can depress
the respiratory center, reducing the rate and depth of respiratory and th
amount of inhaled oxygen.

Substance abuse ny either smoking or inhalation such as crack cocaine

or inhaling fumes from paint or glue cans cause direct injury to lung tissue
that can load to permanent lung damage and impaired oxygenation.

STRESS REDUCTION

A continuous state of stress or severe anxiety increases the body’s

metabolic rate and the oxygen demand. The body responds to anxiety and
other stresses with in an increased rate and depth of respiration.
DISCASE WHICH OCCURS DUE TO OXYGEN INSUFFICIENCY

MUSCULOSKELETAL ABNORMALITIES

Musculoskeletal impairements in the thoracic region reduce

oxygenation. Such impairements may result from abnormal structural
configuration, trauma, muscular diseases and disease of central nervous
system.

Abnormal structural configuration imparting oxygenation include those

that affect the rib cage, such as pectus excavatum and those that affect the
vertebral column such as kyphosis, tordusis or scolliosis.

TRAUMA

The person with multiple rib fracture can develop a fail chest, a
condition in which fractures cause instability in part of the chest wall. The
instable chest wall allows the lung underlying the injured area to contract
on inspiration and bulge on expiration, resulting in hypoxia.

NEUROMUSCULAR DISEASES

Disease such as muscular clystrophy affects oxygenation of tissue by

decreasing the client’s ability to expand and contract the chest wall.
Ventilation is impaired an atelectasis, hypercapnia and hypoxemia can
occur.

CENTRAL NERVOUS SYSTEM ALTERATIONS

Disease or trauma involving the medulla oblongata and spinal cord may
result in impaired respiration. When the medulla oblongata is affected
neural regulation of respiration is damaged and abnormal breathing
patterns may develop. If the phrenic nerve is damaged, the diaphragm may
not descent, thus reducing inspiratory lung volume and causing hypoxia
medulla in lung volume and causing hypoxia medulla in the brain stem
immediately above the spinal cord is the brain stem immediately above the
spinal center.

MYOCARDIAL ISCHEMIA

When blood supply to the myocardium from the coronary arteries is

insufficient to meet the oxygen demand of the organ two common
manifestations of this ischemia are angina pectoris and myocardial
infarction.

Angina pectoris is usually a transient imbalance between myocardial

oxygen supply and demand. The pain can last for 1 to 15 minutes. Chest
pain may be left sided or substernal and my radiate to the left or both arms
and to the jaw, neck and back.

Myocardial infraction (MI) sudden decrease in coronary blood flow or

an increase in myocardial oxygen demand with out adequate coronary
perfusion. Infarction occurs because of ischemia and neurosis of
myocardial tissue.

HYPOVENTILATION

It occurs when alveolar ventilation is inadequate to meet the body’s

oxygen demand or to eliminate sufficent carbon dioxide.

HYPOXIA

Hypoxia is inadequate tissue oxygenation at the cellular level. This can

result from a deficiency in oxygen delivery or oxygen utilization at he
cellular level.

CYANOSIS

Blue discoloration of the skin and mucous membrane caused by the

presence of desaturated hemoglobin in capillaries is a late sign of hypoxia.
 CEREBRAL PALSY

Cerebral palsy is a non-progressive neurological disorder that is present

from birth and ususally invloves motor function. Common cause imclude,
hypoxia or ischemia during labour and birth but a substantial number of
cases are caused by factors occuring during intrauterine life.

SYNCOPE

Temporary loss of consciousness, feeling faint. It may indicate

decreased cardiac output, fluid deficit or defects in cerebral perfusion.
Synlope frequently occurs as a result of postural hypotension. When the
patient is ambuiates. It is more common in older adult or in the patient
who has been immobile for long period of time. Normally when the patient
quickly moves to a standing position.

DIAGNOSIS EVALUATION OF THE PATIENT THAT WHO IS

HAVING OXYGEN INSUFFICIENCY

A. HISTORY COLLECTION

Nursing history should focus on the clients ability to meet

oxygen needs. Nursing history for cardiac function includes pain,
dyspnea, fatigue, peripheral circulation, cardia risk factors, presence
of past or current conditions.

Nursing history for respiratory function includes the presence

of a cough, shortness of breath,wheezing, pain environmental
exposure, frequently of respiratory tract infections, past respiratory
problem, current medications use and smoking history or second
hand smoke exposure.
PHYSICAL EXAMINATION

INSPECTION

At first nurse has to performe a head to toe observation of the client for
skin and mucous membrane, general appearance level of consciousness,
breathing pattern and chest wall movement any abnormalities should be
investigated during palpation, percussion and ausculation.

Inspection includes observation of the nails for clubbing. Clubbed nails,

obliteration of the normal angle between the use of the nail and the skin, are
seen in clients with prolonged oxygen deficiency endocarditis and congenital
heart defects.

Inspect the chest contour and shape. Normally the adult chest contour is
slightly convex with no sternal depression, the anteroposterior diameter
should be less that the transverse diameter. Note the anteroposterior
diameter of the chest wall conditions such as empty sema, advancing age and
copd cause the chest to assume a rounded shape.

PALPATION

Palpation of the chest provides assessment data in several areas. It

documents the type and amount of thoracic excursion, elicit andy areas of
tenderness and can identify tactile fremitose the capacity to feel sound on the
chest wall by placing your plam to the patients chest wall, avoiding boney
areas. Ask the patients to repeat some nulti – syllable word (eg: “ninenty –
nine”) and feel for the vibration. Normally the vibrations are equal bilaterally
in different areas on the chest wall. The greatest intensity is noted at the
anterior and posterior base of the neck and along the tranchea and large
bronchi. Increased fremitus occurs inpatient with pneumonia because solid
tissue conducts sound well conversely; patients with copd have decreased
fremitus because air does not conduct sound as well. Note the presence or
absence of masses, edema or tenderness on palpation.
 PERCUSSION

Percussion allows the nurse to detect the presence of abnormal fluid or

air in the lungs. It also used to determine diaphragmatic excursion.

AUSCULTATION

Auscultation enables the nurse to identify normal and abnormal heart

and lung sounds. Auscultation of the lung sound involves listening for
movement of air throughout all lung fields. Anterior, posterior and laternal.
Adventitious breath sounds occur with collapse of a lung segment, fluid in a
lung segment ar narrowing or obstruction of an airway.

COMMON DIAGNOSIS TESTS

a. PULMONARY FUNCTION TEST

It helps to determine the ability of the lungs to efficiently exchane and carbon
dioxide.

MEASUREMENT NORMAL CLINICAL SIGNIFICANCE

RANGE
Tidal volume (Vt) 5-10 ml/kg Decreased in restrictive lung
Volume of air inhaled or exhaled disease and older client.
per breath.
Residual volume (Rv) Increase in clients with copd
Voulme of air left in lungs after a 1000 – 1200 ml and older clients due to
maximal exhalation. decreased respiratory muscle
mass, strength, elastic recoil
and chestwall compliance.

Functional residual capacity Increased in clients, with

Volume of air left in lungs after a 2000 – 2400 ml copd and older clients due to
normal exhalation. decreased respiratory muscle
mass, strength, elastic recoil
and chestwall compliance.
MEASUREMENT NORMAL CLINICAL SIGNIFICANCE
RANGE

Vital capacity(Vc) Decreased in pulmonary

Volume of air exhaled after a 4500 – 4800 ml edema a telectusis and
maximal inhalation changes associated with a
giving.
5000 – 6000 ml
Total lung capacity(TLC) Decreased in restrictive lung
Total volume of air in lungs disease increase in
following a maximal inhalation obstructive lung disease.

PEAK EXPIRATORY FLOW RATE (PEFR)

The point of highest folow during moximal expiration. Normal is based

on age and body weight. It is routinely used for patients with moderate or
severe asthma to measure the severity of the disease and degree of disease
control.

ARTERIAL BLOOD GAS

Measures the hydrogen concentration partial pressure of carbon

dioxide, partial pressure of oxygen, oxygen concentration.

SPIROMETRY

Spirometry measure, the volume of air in liters exhaled or inhaled by a

patient over time.
PULSE OXIMETRY

It is a noninvasive technique that measures the arterial oxyhaemoglobin

satruation of arterial blood. It is useful for monitioring patients receving
oxygen therapy, litrating oxygen therapy, monitoring those at risk for hypoxia
and post operative patients. A range of 95% to 100% is considered normal
spo2; values less than 85% indicate that oxygentation to the tissue is
inadequate.

CHEST X – RAY

Usually posteranterior and lateral films ar etaken to adequately

visualtize all of the lung fields. Radiography of the thorux is used to observe
the lung field for fluid (pneumonia), masse (lung cancer), other abnormal
process.

BRONCHOSCOPY

Visual examination of the tracheobronchial tree through a narrow,

flexible fiberoptic bronchoscope. Performed to obtain fluid, sputum or biopsy
samples, remove mucous plugs or foreign bodies.

THORACENTESIS

Thoracentesis is a surgical procedure of puncturing the chest and

aspirating pleural fluid, for diagnostic or therapeatic purposes or to remove a
specimen for biopsy. The procedure is performed using aseptic technique and
local anesthesic. The client usually sits upright with the anterior thorax
supported by pillows or an over – bed table.

SPUTUM SPECIMENS

Obtained to identify a specific micro – organs. Organism growing in the

sputum identify drug resistance and sensitivities
THROUT CULTURE

It determines the presence of pathogenic organisms. Positive results are

used to determine the correct antibiotic. For treatment based on the organism
cultured.

MANAGEMENT

1. POSITION

Semi fowler’s or fowler’s allows maximum expansion. Pysgenic

patients often assume orthopaedic position sit in need and lean over
bed tables, usually with a pillow for support.

2. BREATHING EXERCISES

DEEP BREATING EXERCISES

When hypoventilation occur a decreased amount of air enters and

leaves the lungs. However deep – breathing exercises can be used to
overcome hypoventilation.

ABDOMINAL AND PURSED LIP BREATHING

a) Assume comforatble semisitting position in a bed or chair or a lying

position I bed with one pillow.
b) Flex your knees to relax the muscle of abdomen.
c) Place one or both hands on your abdomen just below the ribs.
d) Breathe in deeply through the nose keeping the mouth closed.
e) Concentrate on feeling or skin and tighter the abdomen muscle
breathing out to enhace effective exhalation.
f) If indicated, cough two or more time during exhalation.
g) Use this exercise whenever feeling short of breath and increase
gradually to 5 – 10 minutes a day.
 3. NEBULISATION

Nebulisation is a process of adding moisture or medication to

inspired air by mixing particle of varying sizes with air.

PURPOSE

a. To relieve respiratory insufficiency due to broncho spasm.

b. To correct the underlying respiratory disorder responsible broncho
spasm.
c. To liquefy and remove retained thick secretion form the lower
respiratory tract.
d. To reduce inflamatory and allergic response in the upper respiratory
tract.
e. To correct humidity deficit.

TYPES

1. JET NEBULISER

The jet nebulisier utilises a high velocity gas flow, to generate

particel from the presecribed solution either oxygen or
compressed air power the nebulizer.
2. ULTRA SONIC NEBULIZER

It utilise fluid contained a chamber which is rapidly vibrated

causing the fluid to break into particle.

CHEST PHYSIOTHERAPY

Chest physiotherapy is a group of therapies used in combination t

mobilize pulmonary secretion. These therapies include postural drainage,
chest percussion and vibration. Chest physiotherapy should be followed by
productive coughing and suctioning of the eclient who has a decreased ability
to cough.
 Positional drainage is use of positioning technique that draw secretions
form specific segments of the lungs and bronchi in to thr trachea. Coughing or
suctioning normally removes secretion from the trachea.

Chest percussion involves striking the chest wall over the area being
drained the hand is positioned so that finge and thumb touch and the hands
are cupped. Chest percussion is performed by striking the chest wall
alternatively with cupped hands.

SUCTIONING

The suctioning technique includes oropharyngeal and nusopharyngeal

suctioning. Orotracheal and naso tracheal suctioning and sanctioning
secreation should perform after suctioning of the oropharynx trachea, by
using a rounded – tipped catheter.

OXYGEN THERAPY

OXYGENATION BY APPLYING NASAL CANNULA

A nasal cannula is a simple, comfortable device for delivering oxygen to

a client. The two tips of the cannula about 1.5 cm long proturole form a centre
of a disposable tube an dare inserted into the nostrils. Oxygen is delivered via
the cannula with a flow rate of 5 – 6 liter / minute.

OXYGENATION BY APPLYING AN OXYGEN MASK

An oxygen mask is shaped to fit snugly over the client’s mouth and nose
and is secured in place a strap. Th e two primary type of mask are the high
and low concentration ozxygen mask. Oxygen concentration of 21% to 56%
may be delivered.
NASAL CATHETER

A nasal or oropharyngeal catheter is another efficient means for

adminstering oxygen, but it is infrequently used because it is uncomfortable
for the patient and may cause trauma to respiratory mucous membrane.

OXYGEN TENT

Oxygen tent is a light, portable structure made of clear plastic and

attached to a motor driven unit. The motor helps to circulate and cool the air
in the tent.

OXYGEN THERAPY IN THE HOME

Liquid oxygen and oxygen concentration rather than cylinders are used
more commenly in the home setting. Liquid oxygen is kept inside a small
thermal storage tank kept in the home. An oxygen concentration removes
nitrogen form the room air and concentrates the oxygen left in the air oxygen
concentration is portable, cost effective and easy to use but cannot deliver
oxygen flow at greater than 4 lit / min.

NURSING DIAGNOSIS AND INTERVENTIONS

 Impaired gas exchange related to broncho construction and

inflammation of airways.
 Ineffective airway clearance related to increased mucous production
due to upper respiratory infection and asthma.
 Anxiety related to difficulty in breathing as manifested by asking more
doubts.
 Inffective breathing pattern related to neuromuscular impairement of
respirations (pain, anxiety, decreased level of consciousness,
respiratory muscle, fatigue and bronchospasm.) as evidenced by altered
respiratory rte.
  Fluid volume deficit related to sodium and water retension as
manifested by crackles.
 Imbalanceed nutrition less than body requirement related to poor
appetite, shortness of breath, decreased energy level and increased
caloric requirement as evidenced by weight loss, weakness, muscle
waiting.

NURSIN G INTERVENTIONS

 Impaired gas exchange related to broncho construction and

inflammation of airways
 Monitor pure oximetry every 4 hrs.
 Monitor and evaluate vital sign ever 4 hrs.
 Maintain patient in position of comfort.
 Evaluate effectiveness of albuterol nebulizer treatments.
 Auscultate lung every 4 hrs.
 Ineffective airway clearance related to increased mucous production
due to upper respiratory infection and asthma
 Encourage and instruct in coughing and pursed lib breathing
techniques.
 Monitor effectiveness of bronchodilators in increasing
expectoration of secretions.
 Note characteristics of sputum.
 Evaluate respiratory rate and effort.
 Encourage increased fluid intake.
 Auscultate breath sounds every 4 hrs.
 Anxiety related to difficulty breathing as manifested by asking more
doubts.
 Assess the level of anxiety.
 Provide calm reassuring presence.
 Utilize therapeutic touch.
 Keep patient and family informed of actions taken to improve
breathing.
 Use brief, simple explanation.
  Maintain quiet, calm environment.
 Encourage pursed lip breathing to manage dyspnea.

JOURNAL ABSTRACT

1. A study conducted by Norman .R. Kreisman, Thomas .J. Sick and Myron
Rosenthal in1983 of “Important Of Vascular Responses In
Determining Contical Oxygenation During Recurrent Paroxysmal
Events Of Varying Duration And Frequency Of Repetition”. Through
this study they state that continuous measurements were made of local
changes in cortical blood volume, redox levels of cytochrome article PO2
and sustamatic arterial blood pressure during recurrent seizure induced
by pentylenetetrazol or brcuculline. In contrast to expectations,
systemic and cerebral valscular responses and associated increases in
cerebral oxygenation were better maintaining during long duration ictal
episodes than during shor – duration ictal bursts, interictal spikes or
evoked potential short – duration paroxysmal events were often
accompanied by decreases in cerebral oxygenation whereas long
duration events where skills accompanied by increases in oxygenation.
Ictal bursts occuring with short interburst intervals caused a more rapid
failure of vascular responsiveness than those occuring at longer
intervals. These relations of intensity and frequency of repetition of
seizures to change in vascular responses indicate progressive
disassociation of the normally tight couple between neuronal activity
energy demand and cerebral blood flow during status epilepticus.
2. A study conducted by bertin germany I 2007 “oxygen insufficiency as
determining factors in stroke” published in th ejournal of molecular
medecine. Publishers are Springer – verlag, volume - 85 issue- 12; Page
no: 1331 – 1338.
Through this study the brain demands oxygen and glucose to
fulfill its role as the master regulator of body functions as diverse as
bladder control and creative thinking. Chemical and electrical
transmission in the nervous system is rapidly distrupted in stroke as a
result of hypoxia and hypoglycemia. Despite being highly evolved in its
 architecture, the human brain appears to utilize phylogenetically
conserved homeostatic strategies to conbat hypoxia and ischemia
specifically, several converging lines of inquiry have demonstrated that
the transcriptionfactor hypoxia – inducible factor mediates the
activation of a large cassette of genes involved in aduptation to hypoxia
in surviving neurons after stroke.
3. Lawerence.M.Agius conducted a study in (2006) on “Dynamic of the
pneumbral zone in neuronal ischemia and prosoruival “ published in the
international Journal of molecular medecine and advane science.
Volume -2 , page no: 84 – 89.

Through this study; the prosence of a core of ischemia necross in

cerebral tissue would determine evolving mechanisms in the penumbral
zone determining pathology and clinical sterilization of progessive
neuronal would constitue one expresson of many in a vascular occlusive
series of phenomenon associated with progression or non progression
of such neuronal injury. Active tissue participation may develop in
directly and indirectly induced cell injury and cell death as either
necrosis or apoptosis. Indeed, a central role for tissue vascularity might
perhaps determine either cell apoptosis or necrosis in ischemia events
of progression or non progression.

4. Rishu Piao, Hedehino conducted a study in (2005) on “Oxygen

insufficiency compensated during acute ischemia? A pet study in an
ischemia model of non – human primates.” Published in the Journal of
cerebral blood flow and metabolism.

Through this study they reveal that in acute ischemia regions

there is little response in vasculature and that change is diffusion.
Efficiency of oxygen doesnot act as a compensatory response rather
passively depends on the metabolic demand although oxygen extraction
fraction is increased. The findings idicate that brain tolerance for
oxygen insufficiency is not so large that oxygen metabolism during
ischemia con – related final tissue outcome.
5. A study conducted by Samuel .N. Heyman on “Regional alterations in
renal haemoglobin and oxygenation a role in contract medium –
induced nephropathy” published in oxford Journal volume – 20; page
no: 6 – 11.

Through this study they state that most clinical risk factors for
contrast nephropathy are characterized by predisposition to medullary
oxygen insufficiency by co – existing vasoconstrictive stimuli, by
enhanced transport workload or by structurally altered
microcirculation. Under such predisposing conditions, regional hypoxia
stress may intensify and supress the capacity for the generation of
adaptive responses, evolving into adoptotic or necrotic tubullar cell
death, associated with renal dysfunction. Amelionation of medullary
hypoxic stress should be taken into account when designing strategies
to prevent or atenvate contrast media induced nephropathy.

BIBLIOGRAPHY
A. BOOK BIBLIOGRAPHY

1. Chintamani (2011) “Lewis’s medical surgical nursing” published by

Elsevier a division of need Elsevier india private limited page no
1751.
2. Suzanne .C. Smeltzer, Brenda Bare (2004) “Brunner & Suddarth’s text
book of medical surgical nursing” published by lippincott williams
and wilkins 10th edition. Page no 577, 600,601.
3. Potter and Perry (2005) “Fundamental sof nursing” publised by most
by an imprint of Elsevier, 6th edition. Page no 1068 – 1071.
“Fundamentals of nursing the art and science of nursing care” 6th
edition volume 2, published by wolters kluwer india private limited
New Delhi.
4. Dugas (2006) “Introduction to patient care a comprehensive
approach to nursing” 4th edition, volume published by elsevier New
Delhi. Page no 371 - 395.
B. JOURNAL REFERENCE

1. Norman .R. Kreisman Thomas .J.Sick and Myron Rosenthal

(1983) “Journal of cerebral blood flow & metabolism”, “ Importance
of vascular responses in determining cortical oxygenation during
recurrent paroxysmal events of varying duration and frequency of
repetition” volume – 31. Page no: 330 – 338.
2. Berin Germany (2007) “Journal of molecular medecine” publishers
springer – verlage “Oxygen insufficiency as determining factor in
stroke” volume 85. Issue -12, page no: 1331 – 1338.
3. Lawernce .M>Agius (2006)”International Journal fo molecular
medecine and advance science” interactive dynamics of the
pneumbral zone in neuronal ischemia and propuruival” volume – 2.
Page no 84 – 89.
4. Rishu Piao, Hedihiro Lida (2005) Journal fo cerebral blood flow and
metabolism “ Is oxygen insufficiency compensated during acute
ischemia? A pet study in an ischemia model of non – human
primates.
5. Samuel .N.Heyman, “regional alterationsin renal haemoglobin and
oxygenation a role in contrast medium – induced nephropathy”.
Oxford journal volume – 20, page no i6 – i11.