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Delivery of oxygen to the body
Depends upon the interplay of pulmonary, hematologic and cardiovascular system
Processes involved are ventilation, alveolar gas exchange, oxgen trans!ort and cell"lar res!iration#
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 (C!" in body and fluid
&echanics o' $entilation
#. Air Press"re $ariances
$ir flo%s from region of higher pressure to a region of lo%er pressure. During inspiration, movement of
diaphragm and other muscles of respiration enlarge the thoracic cavity and thereby lo%er the pressure inside the
thorax to a level belo% that of the atmospheric pressure.
During the normal expiration, the diaphragm relaxes and the lungs recoil. &he alveolar pressure then exceeds
atmospheric pressure, and air flo%s from the lungs into the atmosphere.
!. Air (a Resistance
$ny process that changes the bronchial diameter or %idths affects air%ay resistance and alters the rate of airflo%
for a given pressure gradient during respiration.
'. Co)!liance
(t measures the (characteristics of lungs" elasticit, ex!an*a+ilit, and *istensi+ilit of the lungs and thoracic
structures. (t is determined by examining the volume)pressure relationship in the lungs and the thorax. (n normal
compliance, the lungs and the thorax easily stretch and distend %hen pressure is applied. *igh or increased
compliance occurs %hen the lungs have lost their elasticity and the thorax is distended. +hen lungs and thorax are
stiff, there is lo% or decreased compliance.
((. A%$EO%AR GAS EXCHANGE (oxygen upta,e or external respiration"
nce fresh air reaches the lung-s alveoli, oxygen moves from area of higher concentration (alveoli" to lo%er
concentration (pulmonary capillary blood". &he same %ay that C! diffuses from the blood to the alveolar space.
nce the diffusion of oxygen across the alveolar)capillary membrane occurs, the C! molecules are dissolved in the
blood plasma. Plasma is not able to carry enough dissolved oxygen to meet the metabolic needs of the body. xygen
carrying capacity of the blood is greatly enhanced by the presence of hemoglobin in the erythrocytes. nce oxygen is
bound to hemoglobin, the oxygen is delivered to the cell of the body by circulation
He)oglo+in . R/C-s ma0or component %hich contains heme, a complex molecule of iron and porphyrin %hich gives
blood its color and globin, a simple protein
He)oglo+in Test . Measures the grams of hemoglobin in a #11ml of %hole blood.
2ormal 3alues4 Males #5.1 . #6.5 g7d8 Females #!.1 . #9.1 g7d8
#'.: . #6.: g7d8 ##.: . #:.: g7d8
&eas"re)ent o' Oxgen in ,loo* Sa)!les
#. Partial Press"re o' Oxgen -PaO./
. measures oxygen dissolved in plasma. 2ormal 3alue4 ;1 . #11 mm*g
!. Oxgen Sat"ration -SaO./
. measures the percentage of hemoglobin saturated %ith oxygen. 2ormal 3alue4 <: . #11 =
<9 . <;=
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Aas exchange at the cellular level ta,es place via diffusion in response to pressure gradient. xygen diffuses from
the blood to the tissues %hile carbon dioxide moves from the tissues to the blood. /lood is reoxygenated.
#. Age
lder adults often exhibit barrel chest and reCuire increased effort to expand the lung. &hey are also
susceptible to respiratory infection due because of decreased activity %hich is an effective defense mechanism.
!. Environ)ental an* li'estle 'actors
Clients %ho are exposed to dust, animal dander, asbestos or toxic chemicals are at an increased ris, for
alterations in oxygenation. >mo,ers as %ell as those exposed to it should be Cuestioned as to the type,
freCuency of smo,ing.
'. 1isease !rocesses
(dentify the chief reason for see,ing health care
2urse determines %hen the health problems started, ho% long it lasted, if it %as relieved any time, and ho%
relief %as obtained.
Collects information about precipitating factors, duration, severity and associated factors or symptoms
$ssess ris, factors and genetic factors that contribute to the condition
$ssess the impact of sign and symptoms on the patient-s ability to perform activities of daily living
1s!nea . difficulty or labored breathing, shortness of breath to any constantly recurring irritant
Co"gh . results from the irritation of mucous membrane any%here in the respiratory tract. (t may arise from infectious
process and from airborne irritants such as smo,e, dust and gas
S!"t") Pro*"ction . reaction of lungs to any constantly recurring irritants
Chest Pain . sharp, stabbing and intermittent or may be dull, aching and persistent
(hee2ing . high pitched musical sound heard mainly on expiration. (bronchoconstriction or air%ay narro%ing"
Cl"++ing Fingers . found in clients %ith chronic hypoxic condition, chronic lung infection and malignancies of the
lungs. (t is described as sponginess of the nail bed and loss of nail bed angle
He)o!tsis . expectoration of blood from respiratory tract. $ symptom of both pulmonary and cardiac disorder
Canosis . bluish discoloration of the s,in. (t is a late sign of hypoxia (can lead to shoc, or death". Cyanosis appears of
there is : g7d8 of unoxygenated hemoglobin
#. Nose an* Sin"ses
inspect the external nose for lesions, asymmetry or inflammation
examine the internal structure for s%elling, color, exudates or bleeding
inspect for septum deviation, perforation or bleeding
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palpate the frontal and maxillary sinuses for tenderness. Dsing the thumb the nurse applies gentle
pressure in an up%ard fashion at the supraorbital ridges (frontal sinuses" and in the chee, area ad0acent to the nose
(maxillary". &enderness suggests inflammation
!. Pharnx an* &o"th
(nstruct the client to open mouth and ta,e deep breath
(nspect structures for color, symmetry and evidence of exudates, ulceration or enlargement
'. Trachea
Place thumb and index finger of one hand on either side of the trachea 0ust above the sternal notch. (t is
normally in the midline as it enters the thoracic inlet behind the sternum.
3# CHEST CONFIG0RATION . normal ratio of the antero posterior diameter to lateral diameter is
,arrel Chest . increase in the antero posterior diameter of the thorax, ribs are more %idely spaced and the
intercostals space tend to bulge
F"nnel Chest . (pectus excavatum" depression of the lo%er portion of the sternum
Pigeon Chest . results from displacement of sternum. &here is an increase in the anterior diameter.
5!hoscolosis . elevation of the scapula and a corresponding > shaped spine
E"!nea . normal breathing #!)#; bpm
,ra*!nea . slo%er than normal E#1 bpm normal depth and regular rhythm
Tach!nea . rapid, shallo% F!5 bpm
A!nea . cessation of breathing
5"ss)a"l6s . increased rate and depth of breathing
Chene7Sto8es . regular cycle %here the rate and depth of breathing increase and then decrease until apnea
(usually !1 seconds" Gtachypnea . stop . tachypnea . stop . tachypnea . flat line
,iot6s Res!iration . period of normal breathing (')5 breaths" follo%ed by varying period of apnea (usually #1
seconds to # minute" Gshallo% . deep . irregular
9# ,REATH SO0N1>
Crac8les . formerly ,no%n as rales, are discrete non continuous sounds that result from delayed reopening of
deflated air%ays. >oft high itched sound heard during inspiration
Coarse Crac8les . discontinuous popping sound heard in early inspirationH harsh moist sound originating in the
large bronchi
Fine Crac8les . discontinuous popping sound heard in late inspirationH sound li,e hair rubbing together
Sonoro"s (hee2es -ronchi/ . deep lo%)pitched rumbling sound heard primarily during expirationH caused by air
moving through narro%ed tracheo bronchial passages
Si+ilant (hee2es . continuous, musical, high pitched, %histle li,e sounds hears during inspiration and expiration
caused by air passing through narro%ed or partially obstructed air%ays may clear %ithout
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Friction R"+s . harsh crac,ling sound, li,e t%o pieces of leather being rubbed together. *eard during inspiration
alone or during both inspiration and expiration
#. P"l)onar F"nction Tests
Performed to assess respiratory function and to determine the extent of dysfunction
Aenerally performed by a technician using spirometer that has a volume collecting device attached to a
recorder. (t measures lung volume, ventilatory function and the mechanics of breathing, diffusion and gas
exchange. PF& results are interpreted on the basis of the degree of deviation from normal.
!. Arterial ,loo* Gas
$/A levels are obtained thru an arterial puncture at the radial, brachial or femoral artery. (t measures
arterial oxygen tension (Pa!" %7c indicates the degree of oxygenation of the blood and arterial carbon dioxide
pressure (PaC!" indicates adeCuacy of alveolar ventilation. (t also measures the body-s ability to maintain
normal p*.
Nor)al $al"es4
p* 6.': . 6.5: indicates acid)base balance
*C' !! . !9 mBC78 indicates metabolic component of acid base balance
PaC! ': . 5: mm*g indicates adeCuacy of alveolar ventilation
Pa! ;1 . #11 mm*g represents oxygen dissolved in plasma
>a! <: . #11= saturation of hemoglobin %ith oxygen
'. P"lse Oxi)etr
2on invasive method of continuously monitoring the oxygen saturation of hemoglobin (>a!"
$ probe or sensor is attached to the fingertip, forehead, earlobe or bridge of the nose. &he sensor detects
changes in oxygen saturation levels by monitoring light signals generated by the oximeter
2ormal value4 <: . #11=
3alues less than ;:= indicates that tissues are not receiving enough oxygen
5. Ca!nogra!h
Bnd)tidal C! monitoring
Measures amount of C! expired %ith each breath
:. $entilation7Per'"sion St"*ies
9. Chest X7Ra
2ormal pulmonary tissues are radioluscent
May reveal densities indicating pathologic process
&a,en after full inspiration because the lungs are best visualiIed %hen aerated
6. P"l)onar Angiogra!h
Most commonly used to identify thromboembolic disease of the lungs
(t involves rapid in0ection of a radiopaCue agent into the vascula are of the lungs for radiographic study of the
pulmonary vessels
;. C"lt"res
throat cultures may be performed to identify organisms responsible for pharyngitis
<. S!"t") St"*ies
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Dsed to identify pathogenic organisms and to determine %hether malignant cells are present
Bxpectoration is the usual method for collecting sputum specimen
>pecimen is obtained early in the morning after they have accumulated overnight
&he patient is instructed to clear the nose and throat rise the mouth to decrease contamination of the
sputum. $fter ta,ing fe% deep breaths, the patient coughs rather than spits.
&he specimen is delivered to the laboratory %ithin t%o hours.
#1. Co)!"te* To)ogra!h -CT Scan/
$n imaging method in %hich the lungs are scanned in successive layers by narro%)beam x)ray
(t can distinguish fine tissue density
May be used to define pulmonary nodules and small tumors ad0acent to pleural surfaces that are not visible
to routine chest x)ray
##. &agnetic Resonance I)aging
>imilar to C& >can except that magnetic fields and radio freCuency signals are used instead of narro% beam
@ields are more detailed diagnostic image than C& >can
#!. Fl"orosco!ic St"*ies
Dsed to assist in invasive procedure such as chest needle biopsy or transbronchial biopsy
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