Seminar
on
OXYGEN
INSUFFICIENY
Introduction:
Oxygen insufficiency means “deficient in oxygen”.
The normal range of oxygen in the external blood should
be 80-100mm of Hg.
For treating oxygen insufficiency effectively early
diagnosis and correct cause should be ruled out.
The only management for oxygen insufficiency is oxygen
administration.
Definition:
Oxygen insufficiency is a
condition in which the body
as a whole or a region is
deprived of adequate
oxygen supply .
Causes:
Decreased hemoglobin
High altitude
Inability of the tissue to extract oxygen from the blood
Decreased diffusion of oxygen from the alveoli to the
blood
Poor tissue perfusion with oxygenated blood
Impaired ventilation
Factors affecting oxygenation:
Developmental factors
Physiological factors
Behavioral factors
Lifestyle factors
Environmental factors
Medication
Developmental factors
Physiological factors
Behavioral factors
Lifestyle factors
Environmental factors
Medication
HYPOXIA:
Inadequate supply of oxygen to the cells.
TYPES OF HYPOXIA:
HYPOXICHYPOXIA ANAEMICHYPOXIA
TYPES OF
HYPOXIA
CIRCULATORY HYPOXIA HISTOTOXIC HYPOXIA
HYPOXEMIC HYPOXIA:
Hypoxemic hypoxia is a decreased oxygen level in the
blood resulting in the decreased oxygen diffusion into the
tissue
It may be caused by hypoventilation , high attitude ,
ventilation- perfusion mismatch (as in pulmonary
embolism) , shunts in which the alveoli are collapsed and
cannot provide oxygen to the blood.(commonly caused by
atelectasis ) , and pulmonary diffusion defects. It is
corrected by increasing alveolar ventilation or providing
supplement oxygen.
CIRCULATORY HYPOXIA:
Circulatory hypoxia is hypoxia resulting from capillary
circulation.
It may be caused by decreased cardiac output, local
vascular obstruction , low- flow states such as shock, or
cardiac arrest.
Although tissue partial pressure of oxygen (PO2) remains
normal.
Circulatory hypoxia is corrected by identifying and
treating the underlying cause.
ANAEMIC HYPOXIA:
Anemic hypoxia is a result of decreased effective
hemoglobin concentration, which caused a decreased in
the oxygen carrying capacity of the blood.
It is rarely accompanied by hypoxemia.
Carbon monoxide poisoning , because it reduce the
oxygen – carrying capacity of hemoglobin produced
similar effects but is not strictly anemic hypoxia because
hemoglobin levels may be normal.
HISTOTOXIC HYPOXIA:
Histotoxic hypoxia occurs when a toxic substance, such as
cyanide, interferes with the ability of tissues to use
availability oxygen.
OXYGEN INSUFFICIENCY:
Shortness of breath Vomiting
Clubbing of finger Headache
Impairment if judgment Dizziness
Visual impairment Irritability
Oliguria\ anuria Memory loss
Nausea Anxiety
Tired
INDICATION:
Anemia
Lung disease [COPD, emphysema, bronchitis , pneumonia
, pulmonary edema]
Strong pain medicines and other drugs that hold back
breathing.
DIAGNOSTIC EVALUVATION:
NURSING MANAGEMENT:
Breathing exercise
Nebulization
Chest physiotherapy
Postural drainage, Chest percussion
,Vibration.
Suctioning
Breathing exercise
Breathing slowly and rhythmically to exhale completely
and empty the lungs completely.
Inhale through the nose to filter, humidify and warm the
air before it enters the lungs.
If you feels out of breath, breathe more slowly by
prolonging the exhalation time.
Keep the air moist with a humidifier.
Nebulization
The nebulizer is a handheld apparatus that disperses a
moisturizing agent or medication such as bronchodilator
or mucolytic agent, into microscopic particles and delivers
it to the lungs as the patient inhales.
Chest physiotherapy
POSTURAL DRANAGE:
Postural drainage allows the force of gravity to assist in
the removal of bronchial secretions.
The secretions rain from the affected bronchioles into the
bronchi and trachea and are removed by coughing or
suctioning.
Postural drainage is used to prevent or relive bro0nchial
obstruction caused by accumulation of secretions.
CHEST PERCUSSION AND VIBRATION:
Percussion is carried out by cupping the hands and lightly
stacking the chest wall in a rhythmic fashion over the lung
segment to be drained.
The wrist are alternatively flexed an extended so that the
hest is cupped or clapped in a painless manner.
Vibration is the technique of applying manual
compression and tremor to the chest wall during the
exhalation phase of respiration.
Oxygen therapy:
NASAL CANNNULA FACE MASK
NON BREATHER
MASK
VENTURE MASK
TRANSTRCHEAL
FACE TENT OXYGENATION
Nasal cannula:
It is the most common in expensive method used to
administer oxygen to client.
It delivers a relatively low concentration of oxygen9
24% to 45%) at flow rate of 2-6 l/min.
But this is not use these days.
Now a day’s nasal prongs are used.
Face mask:
The simple face mask delivers oxygen concentration
from 40% to 60% at flowrate of 5 to 8 l/min
respectively.
The partial rebreather mask delivers oxygen
concentrations of 60%% to 90% at flow of 6 to
10l/min respectively.
In rebreather mask the oxygen reservoir bag that is
attached allows the client to rebreath about first third
of the exhaled air in conjunction with oxygen. This it
increases FiO2 by recycling expired oxygen.
Non breather mask:
It delivers the highest oxygen concentration possible
95% to 100% by means other than intubation or
mechanical ventilation at liter flow of 10 to 15% l/min.
Venture mask:
It delivers oxygen concentration varying from 24% to
40% at flow rate of 4 to 5 l/min.
The venture mask has wide bore tubing and colour
coded jet adapters that correspond to a precise oxygen
concentration and flow rate.
Nurse should take care while selecting the mask as it
should fit to the face of patient snuggly.
Trans tracheal oxygenation:
This is used for oxygen dependent client.
Oxygen is delivered through a small narrow plastic
cannula surgically inserted through the skin directly
into trachea.
A collar around the neck holds the catheter in place.
PEDIATRICS:
IN CASE OF INFANTS:
Oxygen hood:
It is a rigid plastic dome that encloses on infant head.
It provided precise oxygen levels and high humidity.
Special consideration:
The gas should not be allowed to blow directly into the infants
face and hood should not rub against the infants face, neck,
chin or shoulder.
IN CASE OF CHILDREN:
It is made up of rectangular clear plastic canopy with outlets
that connect to an oxygen source. Flow rate is adjusted at 10 to
15 l/min after flooding the tent for 5 min .At rate of 15l/m.
HAZARDS OF OXYGENATION
INHALATION:
INFECTION. OXYGEN INDUCED
COMBUSTION APNOEA
DRYING MUCUS REROLENTAL
MEMBRANE OF THE FIBROPLASIAS
RESPIRATORY TRAT DAMAGE
OXYGEN TOXICITY
ATELECTASIS ASPHYXIA
MECHANICAL
VENTILATION:
It is a positive or negative pressure breathing
device that can maintain ventilation and
oxygen delivery for a prolonged period.
INDICATION
Continuous decrease in PaO2
Increase in arterial CO2 levels.
Persistent acidosis.
TYPES:
Negative pressure ventilation:
This exerts negative pressure on the external chest; which
in turn decrease intra- thoracic pressure during inspiration
and allows the air o flow to lungs, filling its volumes.
These are mainly used in case of client with
neuromuscular conditions.
Advantages:
Easy to use and do not require intubation.
Disadvantages:
Unsuitable for patients who requires frequent ventilator changes.
Positive pressure ventilation:
These inflate the lungs by exerting pressure on the
airways, forcing the alveoli to expand during inspiration.
Expiration occurs passively which further includes time
cycled ventilators, pressure cycled ventilators and volume
cycled ventilators.
Modes of mechanical ventilation:
Continuous mandatory volume (CMV):
Means continuous mandatory volume, without allowances
for spontaneous breathing.
Assist control ventilation(ACV):
Where assisted breaths are facsimiles of controlled
breaths.
Intermittent mandatory ventilation(IMV):
Which mixes controlled breaths and spontaneous breaths.
Pressure support ventilation(PSV):
Where the patient has control over all aspect of his/her
breathe expect the pressure limits.
High frequency ventilation:
Where mean airway pressure is maintained constant and
hundreds of tiny breaths are delivered/ minutes.
Continuous positive airway pressure(CPAP):
Spontaneous ventilation with continuous positive airway
pressure(CPAP). The ventilator adjunct is used only with
spontaneous ventilations.
The patient breathes spontaneously through the ventilator
at an elevated baseline pressure throughout the breathing
cycle.
Synchronized intermittent mandatory
ventilation(SIMV):
Gas flow in the synchronized intermittent mandatory
ventilation (SIMV) mode. A present minimum number of
breaths are synchronously delivered to the patient but the
patient may also take spontaneous breaths of varying
volume.
Note how inspiratory and expiratory pressure between
spontaneous and ventilator breaths.
Positive end expiratory pressure:
Airway pressure with varying levels of positive and
expiratory pressure
Note that at end expiration the airway is not allowed to
return to zero.
NURSING CARE OF PATIENT
ON VENTILATOR:
The nurse has a vital role in assessing the patient status
and functioning of the ventilator.
The nurse evaluates the patients physiologic status and
how he or she is coping with mechanical ventilation.
In physical assessment includes systematic assessment of
all body system, with an in depth focus on the respiratory
system.
Respiratory assessment includes vital signs respiratory
rate and pattern breath sounds, evaluation of spontaneous
ventilator effort and potential evidence of hypoxia.
Increased adventitious breath sound may indicates a need
for suctioning.
The nurse also evaluates the sittings and functioning of the
mechanical ventilator as described previously.
Assessment also addresses the patient neurologic status
and effectiveness of coping with the need for assisted
ventilation and the changes that accompany it.
The nurse should assess the patient comfort level and
ability o communicate as well.
Finally, weaning from mechanical ventilation requires
adequate nutrition. Therefore, it is important to assess the
function of the gastro-intestinal system and nutritional
status.
