FUNDAMENTALS

OF NURSING

Oxygenation
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Essential to Normal Functioning
of the Respiratory System
Integrity of the airway system to transport air
to and from lungs
Properly functioning alveolar system in lungs
Oxygenate venous blood
Remove carbon dioxide from blood
Properly functioning cardiovascular and
hematological system
Carry nutrients and wastes to and from body cell
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The Respiratory System

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 Upper Airway
Function — warm, filter, humidify inspired air
Components
Nose
Pharynx
Larynx
Epiglottis

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 Lower Airway
Functions — conduction of air, mucociliary
clearance, production of pulmonary surfactant
Components
Trachea
Right and left mainstem bronchi
Segmental bronchi
Terminal bronchioles

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 Anatomy of the Lungs
Main organs of respiration
Extend from the base of diaphragm to the
apex above first rib
The right lung has three lobes; left lung has
two
The lungs are composed of elastic tissue
(alveoli, surfactant, pleura)
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 Pulmonary Ventilation
Inspiration — the active phase of ventilation
Involves movement of muscles and thorax to
bring air into lungs
Expiration — the passive phase of ventilation
Movement of air out of the lungs

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Pulmonary Ventilation

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 Process of Ventilation
The diaphragm contracts and descends, lengthening the
thoracic cavity.
The external intercoastal muscles contract, lifting the ribs
upward and outward.
The sternum is pushed forward, enlarging the chest from
front to back.
Increased lung volume and decreased intrapulmonic
pressure allows air to move from an area of greater pressure
(outside lungs ) to lesser pressure (inside lungs).
The relaxation of these structures results in expiration.

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 Gas Exchange
Refers to the intake of oxygen and release of
carbon dioxide
Made possible by respiration and perfusion
Occurs via diffusion (movement of oxygen
and carbon dioxide between the air and
blood)

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Gas Exchange in the Alveolus

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 Four Factors Influencing Diffusion
of Gases in the Lungs
Change in surface area available
Thickening of alveolar-capillary membrane
Partial pressure
Solubility and molecular weight of the gas

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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
form of carboxyhemoglobin.
Internal respiration between the circulating
blood and tissue cells must occur.
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Respiratory Activity in the Infant
Lungs are transformed from fluid-filled structures to
air-filled organs.
The infant’s chest is small, airways are short, and
aspiration is a potential problem.
Respiratory rate is rapid and respiratory activity is
primarily abdominal.
Synthetic surfactant can be given to the infant to
reopen alveoli.
Crackles heard at the end of deep respiration are
normal.
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Respiratory Activity in the Child
Some subcutaneous fat is deposited on the chest wall
making landmarks less prominent.
Eustachian tubes, bronchi, and bronchioles are
elongated and less angular.
The average number of routine colds and infections
decreases until children enter day care or school.
Good hand hygiene and tissue etiquette are
encouraged.
By end of late childhood, immune system protects
from most infections.
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Respiratory Functioning in the Older Adult

Bony landmarks are more prominent due to loss of

subcutaneous fat.
Kyphosis contributes to appearance of leaning
forward.
Barrel chest deformity may result in increased
anteroposterior diameter.
Tissues and airways become more rigid; diaphragm
moves less efficiently.
Older adults have an increased risk for disease,
especially pneumonia.
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 Factors Affecting Respiratory
Functioning
Levels of health
Developmental considerations
Medications
Lifestyle
Environment
Psychological health

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Guidelines for Obtaining a Nursing
History
Determine why the patient needs nursing care.
Determine 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.

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Sounds Heard Upon Percussion
of Chest
Resonance — loud, Wall sound,
hollow low-pitched
heard over normal lungs
Hyperresonance — loud, low booming sound heard
over emphysematous lungs
Flat sound — detected over bone or heavy muscle
Dull sound — with medium pitch and intensity heard
over the liver
Tympany — high-pitched, loud, drum-like sound
produced over the stomach

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 Breath Sounds
Vesicular — low pitched soft sound during
expiration heard over most of lungs
Bronchial — high pitch and longer, heard
primarily over trachea
Bronchovesicular — medium pitch and sound
during expiration, heard over upper anterior
chest and intercostal area

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 Abnormal (Adventitious) Lung
Sounds
Crackles — intermittent sounds occurring when air
move through airways that contain fluid
Classified as fine, medium, or coarse
Wheezes — continuous sounds heard on expiration
and sometimes on inspiration as air passes through
airways constricted by swelling, secretions, or
tumors
Classified as sibilant or sonorous

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 Common Diagnostic Methods
Pulmonary function studies
Peak expiratory flow rate
Pulse oximetry
Thoracentesis

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 Lung Volumes
Tidal volume (TV) — amount of air inspired and
expired in normal respiration (normal = 500mL)
Inspiratory reserve volume (IRV) — amount of air
inspired beyond tidal volume (normal = 3100mL)
Expiratory reserve volume (ERV) — amount of air
that can be exhaled beyond tidal volume (normal =
1200mL)
Residual volume (RV) — amount of air remaining in
lungs after a maximal expiration (normal = 1200mL)

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 Lung Capacities
Vital capacity (VC) — amount of air that can be
exhaled after a maximal inhalation (normal = 4800mL)
Inspiratory capacity (IC) — largest amount of air that
can be inhaled after normal quiet exhalation (normal
= 3600mL)
Functional residual volume (FRV) — equal to the
expiratory reserve volume plus the residual volume
(normal = 2400mL)
Total lung capacity (TLC) — the sum of the TV, IRV,
ERV, and RV (normal = 6000mL)
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 Planning: Expected Outcomes
Demonstrate improved gas exchange in lungs by
absence of cyanosis or chest pain and a pulse
oximetry reading >95%
Relate the causative factors and demonstrate
adaptive method of coping
Preserve pulmonary function by maintaining an
optimal level of activity
Demonstrate self-care behaviors that provide relief
from symptoms and prevent further problems

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Nursing Interventions Promoting
Adequate Respiratory
Teaching aboutFunctioning
a pollution-free environment
Promoting optimal function
Promoting proper breathing
Managing chest tubes
Promoting and controlling coughing
Promoting comfort
Meeting respiratory needs with medications
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 Promoting Proper Breathing
Deep breathing
Using incentive spirometry
Pursed-lip breathing
Abdominal or diaphragmatic breathing

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 Managing Chest Tubes
Assist with insertion and removal of chest
tube
Monitor the patient’s respiratory status and
vital signs
Check the dressing
Maintain the patency and integrity of the
drainage system
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 Types of Cough Medications
Cough suppressants
Expectorants
Lozenges

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 Promoting Comfort
Positioning
Maintaining adequate fluid intake
Providing humidified air
Performing chest physiotherapy
Maintaining good nutrition

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 Promoting Comfort
Positioning
Maintaining adequate fluid intake
Providing humidified air
Performing chest physiotherapy
Maintaining good nutrition

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Administering Inhaled Medications
Bronchodilators — open narrowed airways
Mucolytic agents — liquefy or loosen thick
secretions
Corticosteroids — reduce inflammation in
airways

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 Types of Inhalers
Nebulizers — disperse fine particles of
medication into deeper passages of
respiratory tract where absorption occurs
Metered dose inhalers — delivers controlled
dose of medication with each compression of
the canister
Dry powder inhaler — activated by the
patient’s inspiration

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Nebulizers

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MDI: Albuterol
with a spacer

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DPI

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 Oxygen Therapy
Purpose: To treat hypoxia
Administration: Nasal Cannula
Partial rebreathing mask Low flow oxygen
Reservoir must remain inflated
Nasal irritation
Delivers 40-60% O2
Not recommended for COPD > 5 liters should be
Non-rebreathing mask humidified
Reservoir must remain inflated Trach Mask
Valve prevents rebreathing CO2 Small, for tracheostomies
Delivers 60-90% O2 Watch for condensation in
Simple mask mask, liquid could lead to
Poor patient tolerance aspiration.
Delivers 35-50% O2 at 6-12 liters
Humidification
Venturi Mask
Delivers 24-50% O2 Dry O2 irritates tissues
Keep ports open Not necessarily needed at
low flow rates (1-4
liters/minute)

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Oxygen Delivery System

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Oxygen Regulator

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Nasal Prong or Cannula

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Non-Rebreather Mask

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Simple Mask

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Venturi Mask

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 Oxygen Delivery Systems
Nasal cannula
Nasal catheter
Transtracheal catheter
Simple mask
Partial rebreather mask
Nonrebreather mask
Venturi mask
Tent
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 Precautions for Oxygen
Administration
Avoid open flames in patient’s room
Place no smoking signs in conspicuous places
Check to see electrical equipment in room is in
good working order
Avoid wearing and using synthetic fabrics (builds up
static electricity)
Avoid using oils in the area (ignite spontaneously in
oxygen)

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Effects of Smoking while on Home O2 Therapy

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 Type of Artificial Airways
Oropharangeal and nasopharyngeal airway
Endotracheal tube
Tracheostomy tube
Laryngeal mask airway
Combitube airway

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Laryngeal Mask Airway

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 Oropharyngeal and
Nasopharyngeal Airway

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Combitube Airway

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Endotracheal Tube

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Tracheostomy Tube

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 • SUCTIONING
Principles:
1. Performed to clear the airways
2. Irritates mucosa and removes oxygen from the
respiratory tract
3. Should be painless and relieve respiratory
distress
4. It is normal for suctioning to cause coughing,
sneezing, and gagging
5. Protect against exposure to body fluids

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Manifestations of the need for suctioning: (4D)
1. Dyspnea; pallor, and cyanosis

2. Drooling, vomitus in mouth; bubbling or

rattling breath sound

3. Decreased oxygen saturation (check the ABG)

4. Decreased breath sound

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 Tracheostomy/E
ROUTE Oropharyngeal Nasopharyngeal ndotracheal

Position - Semi – Semi – fowler’s Semi – fowler’s

fowler’s with with neck position unless
neck at the side hyperextend (+) contraindicated
(+) gag reflex gag reflex
- if unconscious:
side – lying
position facing
the nurse
Pressure 110 – 150 mmHg 110 – 150 90 –110 mmHg
mmHg
*depends upon
the age and
type of
apparatus

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Length of the 3 – 5 inches or 3 – 5 inches or 2 – 3 inches
tube to be distance from the distance from the
inserted client’s earlobe client’s earlobe
and tip of the nose and tip of the nose

Lubricant water water - soluble Saline solution

Duration of 5 – 15 minutes 5 – 15 minutes 5 – 10 minutes

Suctioning
Resting period 20 – 30 seconds 20 – 30 seconds 2 – 3 minutes
b/n suctioning

Oxygenation
delivery before Face mask Face mask Ambubag
and after
suctioning

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