OXYGEN

INSUFFICIENCY
GENERAL OBJECTIVE:
At the end of the class the group will be able to get the knowledge about the oxygen
insufficiency, develop a positive attitude towards it and practice this knowledge in
teaching and clinical areas.
SPECIFIC OBJECTIVES
At the end of the class the student will be able to :
 Define oxygen insufficiency.
 Enlist the etiology of oxygen insufficiency.
 Enumerate factors affecting oxygenation
 Know the types of oxygen insufficiency.
 Discuss the pathophysiology of oxygen insufficiency.
 Enlist sign and symptoms of oxygen insufficiency.
SPECIFIC OBJECTIVES
 Explain different diagnostic evaluation of oxygen insufficiency.
 Describe the management of oxygen insufficiency.
 Identify the nurses role in the management of oxygen insufficiency.
 Explain about oxygen therapy.
 Discuss about nurses responsibility while administering oxygen.
 MEANING OF OXYGEN
1.A colorless, odorless gas constituting one fifth of the atmosphere.
2.21% of oxygen present in the atmospheric air.
3.Oxygen is essential to life. All cells in the body require it, some being more
sensitive than others.
4.A person whose oxygen needs are met adequately is not aware of the
process of respiration.
5.The normal range of oxygen in the external blood should be 80-100 mm of
Hg.
6.For treating Oxygen insufficiency effectively, early diagnosis and correct
cause should be ruled out.
7.The only management for Oxygen insufficiency is Oxygen administration.
DEFINITION

DEFINITION OF OXYGENATION :

Oxygenation is a process which occurs in the lungs

to the hemoglobin of blood, which is saturated with
oxygen to form oxyhemoglobin.
OXYGENATION
1.Oxygenation means the delivery of oxygen to the body’s tissues and cell, it is necessary to

maintain life and health

2.Oxygenation results from the co- operative function of 3 major system

1.Pulmonary

2.Hematological

3.Cardiovascular system
PULMONARY VENTILATION

A movement of air into and out of lungs.

It’s main purpose is to supply fresh air.
Composed of…..
1.Inspiration: air flows into the lungs.
2.Expiration: air moves out of lungs..
 RESPIRATION

It is the process of movement of air from the atmosphere to the lungs and vice versa.


Inspiration is an active process brought about by the contraction of inspiratory

muscles, where as Expiration is a passive process due to elastic recoil of lungs.

1.
External respiration:-


It is between atmosphere and lungs.


It takes place in the lungs. The O2 is absorbed from air and into the blood and Co2 is

excreted from the blood into the air.

2.Internal respiration: or tissue respiration: O2 is transferred from blood to the

tissue which gives up Co2

RESPIRATION
PROCESS OF OXYGENATION

1. Ventilation = the exchange of air between the environment and the lungs

2. Diffusion = the exchange of oxygen from the alveoli into the blood and CO2 in
the opposite direction

3. Transportation= movement of oxygen, CO2, other nutrients, metabolic wastes

etc in the blood.

4. Perfusion = the process of delivering blood to a capillary bed in its biological

tissue
 MEASUREMENT OF OXYGENATION

 Oxygen saturation (SO2)

 Arterial oxygen saturation (SaO2)
 Venous oxygen saturation (SvO2)
 Tissue oxygen saturation (StO2) :
 Average oxygen saturation of the hemoglobin in all red blood cells (RBC) is referred

to as the tissue oxygen saturation

 Saturation of peripheral oxygen (SpO2)

PULSE OXYMETER
DEFINITION
1.Oxygen insufficiency means “ deficient in oxygen”.

2.Oxygen insufficiency is a condition in which the body as a whole or a region is

deprived of adequate oxygen supply.

3.Oxygen insufficiency is a failure to provide adequate oxygen to cells of the body

and to remove excess carbon dioxide from them.
 MEANING OF
OXYGEN DEFICIENCY
 It is the condition in which the lungs cannot take in sufficient oxygen or expel
sufficient carbon dioxide to meet the needs of the cells of the body. Also called
pulmonary insufficiency.

 Respiratory failure is a syndrome in which the respiratory system fails in one

or both of its gas exchange functions: oxygenation and carbon dioxide
elimination.
CAUSES OF OXYGEN INSUFFICIENCY
1.Carbon monoxide inhalation : When CO is inhaled, it bonds with hemoglobin,
displacing oxygen and forming carboxyhemoglobin (COHb) resulting in
a lack of oxygen to the body cells. ... The brain and heart require large
amounts of oxygen and quickly suffer from any oxygen shortage.
2.Contact with certain chemicals
3.Self-induced hypocapnia
4.A seizure which stops breathing activity
5.Sleep apnea
6.Drug overdose
7.Central alveolar hypoventilation syndrome, or primary alveolar hypoventilation
CAUSES OF OXYGEN INSUFFICIENCY

1.Acute respiratory distress syndrome.

2.Exposure to extreme low pressure or vacuum
3.Hanging
4.Respiratory diseases
5.Drowning
6.Anemia
7.Cyanide poisoning
8.Respiratory Failure
 ETIOLOGY
Decreased hemoglobin

Anemia and inhalation of toxic substances

decreases the oxygen carrying capacity of High altitude
blood
ETIOLOGY
 ETIOLOGY
Poor tissue perfusion with Impaired ventilation
oxygenated blood
 OXYGEN INSUFFICIENCY OCCURS DUE TO SOME DISEASE

1.MUSCULOSKELETAL ABNORMALITIES:

Musculoskeletal impairments in the thoracic region reduce oxygenation.

Abnormal structural configuration

Muscular diseases

Disease of central nervous system.

TRAUMA: The person with multiple rib fracture can develop a flail
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.
 ETIOLOGY
NEUROMUSCULAR DISEASES:

Disease such as muscular dystrophy affects oxygenation of tissue

by decreasing the client’s ability to expand and contract the chest wall.
Ventilation is impaired and 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.
ETIOLOGY
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..

Myocardial infarction (MI) sudden decrease in coronary blood flow or an

increase in myocardial oxygen demand without adequate coronary perfusion.
Infarction occurs because of ischemia and necrosis of myocardial tissue.
FACTORS AFFECTING
OXYGENATION
 

DEVELOPMENTAL FACTORS:
 Change in aging effect respiratory system of elders,

 PHYSIOLOGICAL FACTORS:

 Various diseases affect oxygenation including respiratory disease like COPD, pneumonia.
Cardiovascular disease like congenital cardiac anomalies
 FACTORS AFFECTING
OXYGENATION
BEHAVIOURAL FACTORS :
 Whenever stress is there both psychological & physiological changes can affect
the respiratory system.

 Person may experience light headedness, numbness, tingling of the fingers,

toes, and around the mouth.

LIFESTYLE FACTORS

Physical activity or exercise increase the rate and depth of respiration

Smoking affects the oxygenation status.
Substance abuse.
 FACTORS AFFECTING
OXYGENATION
ENVIRONMENTAL FACTORS

 Altitude heat, cold and air pollution affect oxygenation.

 The higher the altitude lowers is the PO2 a patient breaths.

 Air pollution causes head ache, chocking and coughing even in healthy people.
 FACTORS AFFECTING
OXYGENATION
MEDICATION

 Certain medication including sedative , hypnotics (eg.diazepam) and

narcotics including morphine can cause respiratory distresses
CLINICAL MANIFESTATIONS
•Confusion. Anxiety
•Cough. Dizziness,
•Tachycardia Irritability and memory loss
•Tachypnea Oliguria / anuria
•Shortness of breath Visual impairment
•Bradycardia Clubbing of finger
•Sweating Impairment in judgement
Tired
Changes in the color of your skin,
Headache ranging from blue to cherry red.
DIAGNOSTIC TESTS
History Collection Bronchoscopy
Physical Examination Thoracentesis
Pulmonary Function Test Spirometry
Arterial Blood Gas Analysis Pulse Oximetry
Sputum Studies Pulmonary Angiography
Chest X- Ray and CT- Scan
DIAGNOSTIC TESTS

1.HISTORY COLLECTION: Nursing history should

focus on the client’s ability to meet oxygen needs.
History for cardiac function includes pain, dyspnea,
fatigue, peripheral circulation, cardiac risk factors,
presence of past or current conditions.

2.PHYSICAL EXAMINATION:
DIAGNOSTIC TESTS
3.PULMONARY FUNCTION TEST:
 DIAGNOSTIC
TESTS
ABG ANALYSIS : 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.

CHEST X – RAY: Usually posterior-anterior and lateral films are

taken to adequately visualize all of the lung fields. Radiography
of the thorax is used to observe the lung field for fluid
(pneumonia), masse (lung cancer), other abnormal process.
DIAGNOSTIC TESTS
MANAGEMENT
POSITIONING
BREATHING EXERCISES
NEBULIZATION
CHEST PHYSIOTHERAPY
SUCTIONING
OXYGEN THERAPY
METHODS OF O2
ADMINISTRATION
Nasal canula
Face mask
Non breather mask
Venture mask
Face tent
Transtracheal oxygenation
METHODS OF O2
ADMINISTRATION
NASAL CANNULA:

It is the most common inexpensive method used to

administer oxygen to client.it delivers a relatively low
concentration of oxygen (24% to 45%)at flow rate of 2-6
l/mt.

NASAL MASK :

The simple face mask delivers oxygen concentrations

from 40% to 60%at flow rate of 5 to 8L/min respectively.
METHODS OF O2
ADMINISTRATION
The face mask is sub divided into two types namely

1. REBREATHER MASK

2. NON REBREATHER MASK

Rebreather mask :In rebreather mask the oxygen the oxygen reservoir bag
that is attached allows the client to rebreathe the exhaled air in conjunction
with oxygen. Thus it increases FiO2(fractional oxygen of inspired air) by
recycling expired oxygen.

Non rebreather mask :It delivers the highest oxygen concentration

possible 95% to 100% by means other than intubations or mechanical, at
liter flow of 10 to 15 L/min.
METHODS OF O2 ADMINISTRATION
VENTURI MASK :

It delivers oxygen concentration varying from 24% to 40% or 50%at flow

rate of 4 to 5 lit /min. The venturi mask has wide tubing and color coded jet
adaptors that correspond to a precise oxygen concentration and flow rate

TRANSTRACHEAL DELIVERY:

This is used for oxygen dependent clients. 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. Advantage-with
the method client requires less oxygen (0.5 to 2 L/ min) as 5ml of saline twice
or thrice a day.
NURSES RESPONSIBILITY IN
O2 THERAPY
1. Check the identification data of the patient.
2. Confirm diagnosis and the need of oxygenation.
3. Assess the patient for any sign of clinical anoxia.
4. Monitor for result of ABG.
5. Oxygen should be monitored for toxicity.
6. Check that oxygen is properly humidified.
7. Precaution to be taken to prevent infection.
8. Discontinue oxygen therapy gradually.
9. Place a calling bell near patient for emergency.
10. Since oxygen supports combustion, fire precautions to be taken during oxygen therapy.
11. Do proper documentation including rate of flow of oxygen.
HAZARDS OF O2 INHALATION
1.Infection
2.Combustion
3.Drying of mucous membrane of respiratory tract
4.Oxygen toxicity
5.Atelectasis
6.Oxygen induced apnea
7.Ulceration, edema and visual impairment
8.Asphyxia
 MECHANICAL VENTILATOR
“Mechanical ventilation is the use of a ventilator to move room air or oxygen
enriched air into and out of the lungs mechanically to maintain proper levels of
oxygen and carbon dioxide in the blood.”
 MECHANICAL VENTILATOR
Mechanical ventilation alone does not treat or reverse the underlying pathology
leading to the need for ventilator support. Rather, it is applied as one of the support
systems until the reversal of the pathological condition, so that the patient may then
become weaned from mechanical ventilation.
GOALS
1.Improve gas exchange
2.Relieve respiratory distress
3.Improve pulmonary mechanics
4.Permit lung and airway healing
5.Avoid complication
 TARGET
1. Reverse hypoxemia/Relieve acute respiratory acidosis
2. Reverse respiratory muscle fatigue
3. Prevent and reverse atelectasis
4. Improve lung compliance/Maintain lung and airway function
5. Prevent disuse respiratory muscle dystrophy
PURPOSES
A. To maintain gas exchange in case of acute and chronic respiratory failure.

B. To maintain ventilator support after CPR.

C. To reduce pulmonary vascular resistance.

D. To excrete increased CO2 production.

E. To give general anesthesia with muscle relaxants.

INDICATIONS
1.Acute respiratory failure
2.Apnea or impending inability to breath
3.Severe Hypoxia/Hypoxemia
4.Respiratory muscle fatigue
5.Cardiac Insufficiency
6.Neurological problems
7.Therapeutic and prophylactic
INDICATIONS
1.Respiratory failure: An inability of the heart and lungs to provide adequate tissue
oxygenation or removal of carbon dioxide.
A. Hypoxemic respiratory failure

B. Hypercapnic respiratory failure

2.Neuromuscular diseases : Myasthenia Gravis, Guillain-Barre Syndrome, and

Poliomyelitis (failure of the normal respiratory neuromuscular system)

3.Musculoskeletal abnormalities :Such as chest wall trauma .

INDICATIONS

1.Infectious diseases of the lung such as pneumonia, tuberculosis.

2.Obstructive lung disease in the form of asthma, chronic bronchitis or emphysema.

3.Conditions such as pulmonary edema, atelectasis, pulmonary fibrosis.

4.Patients who has received general anesthesia as well as post cardiac arrest patients
requires ventilatory support until they have recovered from the effects of the
anesthesia or out from a Danger.
 PARAMETERS MEASURED BY
VENTILATORS

Fraction of inspired oxygen (FiO2):

“The concentration of O2 in the inspired gas, usually between 21% and 100% O2.

The lowest possible fraction of inspired oxygen (FiO2) necessary to meet

oxygenation goals should be used. “
Tidal volume (TV): “The amount of air delivered to the patient per breath. It is
expressed in milliliters.”

A starting point for the VT setting is 8 to 10ml/kg of ideal weight.

Respiratory rate/frequency (f): “The number of breaths per minute. This can be
from the ventilator, the patient, or both. “

The RR is set as near to physiological rates (14 to 20 breaths/min) as possible.

Minute ventilation (V E): “The product of V and respiratory frequency (VT * f). It
is usually expressed in liters/minute.”

Exhaled Tidal Volume:(E TV): “It is the amount of gas that comes out of the
patients lungs on exhalation.”

This is the most accurate measure of the volume received by the patient 

If the ETV deviates from the set TV by 50ml or more, troubleshoot the system to
identify the source of gas loss.
Inspiratory to Expiratory ratio (I:E):

“The I:E ratio is usually set to mimic the pattern of spontaneous ventilation.”

During spontaneous breathing, the normal I:E ratio is 1:2, indicating that for normal
patients the exhalation time is about twice as long as inhalation time.

If exhalation time is too short “breath stacking” occurs resulting in an increase in end-
expiratory pressure also called auto-PEEP.

Depending on the disease process, such as in ARDS, the I:E ratio can be changed to
improve ventilation
Inverse Inspiratory to Expiratory ratio:

“I:E ratios such as 1:1,2:1 and 3:1 are called inverse I:E ratios”

Inverse I:E ratio allows unstable alveoli time to fill and also prevents collapse by
shortened expiratory phase.

Sigh : A deep breath , A breath that has a greater volume than the tidal volume.

It provides hyperinflation and prevents atelectasis.

Sigh volume : Usual volume is 1.5 –2 times tidal volume.

Positive end-expiratory pressure (PEEP):

“The amount of positive pressure that is maintained at end-expiration.” Typical settings for
PEEP are 5 to 20 cm H2O

PEEP increases oxygenation by preventing collapse of small airways

It increases the functional residual capacity of the lungs

A typical initial applied PEEP is 5 cmH2O. However, up to 20 cmH2O may be used in

patients undergoing low tidal volume ventilation for acute respiratory distress syndrome
(ARDS)
1..”
Auto PEEP:

“Auto PEEP is the spontaneous development of PEEP caused by gas trapping in the
lung resulting from insufficient expiratory time and incomplete exhalation.”

Causes of auto PEEP formation include rapid RR, airflow obstruction

Auto PEEP = Total PEEP - Set PEEP

Sensitivity ( Trigger Sensitivity) :

“The sensitivity function controls the amount of patient effort needed to initiate an inspiration.”

Increasing the sensitivity (requiring less negative force) decreases the amount of work the
patient must do to initiate a ventilator breath.

Decreasing the sensitivity increases the amount of negative pressure that the patient needs to
initiate inspiration and increases the work of breathing.

The most common setting for pressure sensitivity are -1 to -2 cm H2O

The more negative the number the harder it to breath.

MECHANICAL VENTILATION
1.Invasive ventilation or conventional mechanical ventilation
(MV)
2.Non invasive ventilation (NIV)

Non Invasive Ventilation: “Ventilatory support that is given

without establishing endo- tracheal intubation or tracheostomy
is called Non invasive mechanical ventilation.”
MECHANICAL VENTILATION
Invasive Ventilation: “Ventilatory support that is given through endotracheal
intubation or tracheostomy is called as Invasive mechanical ventilation.”
TYPES OF MECHANICAL
VENTILATION
A. Positive pressure ventilation
B. Negative pressure ventilation
 NEGATIVE PRESSURE:
Producing Neg. pressure intermittently in the pleural space/ around the thoracic cage.

 e.g.: Iron Lung Positive pressure:

Elongated tank, which encases the patient up to the neck.

The neck is sealed with a rubber gasket, the patient's face are exposed to the room air.

These exert negative pressure on the external chest decreasing the intra-thoracic pressure during
inspiration, allows air to flow into the lungs, filling its volume.

The cessation of the negative pressure causes the chest wall to fall and exhalation to occur.

The iron lung are still occasionally used today.  These are simple to use and do not require
intubations of the airway;
NEGATIVE PRESSURE
 POSITIVE PRESSURE
VENTILATION
1.Positive pressure ventilation inflate the lungs by exerting positive pressure on the airway
forcing the alveoli to expand during inspiration.

2.Expiration occurs passively.

3.Positive-pressure ventilators require an artificial airway (Endotracheal or tracheostomy

tube) in invasive ventilation and in NIV includes BiPAP Mask , O2 mask , Nasal
mask/cannula , O2 high concentrated reservoir mask etc.

4.Inspiration can be triggered either by the patient or the machine.

5.Positive invasive pressure ventilation deliver gas to the patient under positive-pressure,
during the inspiratory phase.
POSITIVE PRESSURE
VENTILATION
NURSING DIAGNOSIS
1) Impaired gas exchange related to broncho- construction and inflammation of
airways.

 2) Ineffective airway clearance related to increased mucous production due to upper
respiratory infection and asthma.

3) Activity intolerance related to dyspnea and hypoxia manifested by fatigue.

4) Anxiety related to difficulty in breathing as manifested by asking more doubts.