FOR SEMINAR OF NURSING STUDENTS

1. OXYGEN
INSUFFICIENCY
BY LALAN KUMAR

2. INTRODUCTION
 Oxygen is the most essential physiological
need .The body depends on oxygen for
movement to movement survival .Some
tissue can survive for a time with out
oxygen and some depend totally on oxygen
for survival.

3. Cont.
Anaerobic metabolism: - Anaerobic
metabolism is the creation of energy through the
combustion of carbohydrates in the absence of
oxygen. When there isn't enough oxygen in the
bloodstream, glucose and glycogen cannot be fully
broken down to carbon dioxide and water. Lactic acid
is produced, which can build up in the muscles and
degrade muscle function.
Eg:- running or cycling

4. Cont.
Aerobic Metabolism:- Aerobic metabolism is the
way your body creates energy through the
combustion of carbohydrates, amino acids, and fats
in the presence of oxygen.
Eg:- walking

5. Cont.
So oxygen must be adequately delivered from the
environment to the lungs, blood stream & finally to
the tissue. At any point in life clients are at risk for
not meeting their oxygen needs,The need can be
acute, as with a cardiac arrest, or chronic as with the
disease emphysma.

6. Physiology of oxygenation
Oxygenation results from the co-operative function of
3 major systems.
1. Respiratory system
2. Hematological system
3. Cardio vascular system

7. CONT…
 Respiratory and cardiac systems function to supply
the body’s oxygen demands.
 Blood is oxygenated through the mechanism of
ventilation, perfusion and transport of respiratory
gases.

9. Process of oxygenation
There are 3 main steps:
1. Ventilation
2. Perfusion
3. Diffusion

10. 1. Ventilation :
Movement of gases into and out of the lungs.
Components : Inspiration and Expiration.
2. Perfusion :
Ability of cardiovascular system to pump oxygenated
blood to the tissues and return de-oxygenated
blood to the lungs.
2. Diffusion :
Exchange of gas molecules from the area of high
concentration to the area of low concentration.
Diffusion of respiratory gases occurs at alveolus-capillary
membrane.

11. RESPIRATORY GAS EXCHANGE
 Respiratory gases are exchanged in the alveoli and
the capillaries of the body tissues.
 Oxygen is transferred from the lungs to the blood
and carbon dioxide is transferred from the blood to
the alveoli.
 At the tissue level, oxygen is transferred from the
blood to tissues, and carbon dioxide is transferred
from tissues to the blood to return to alveoli and be
exhaled.

12. NORMAL OXYGENATION PROCESS

14. GAS EXCHANGE
EXTERNAL
RESPIRATION
 Gas exchange between air
in lungs and blood
 Movement driven by
diffusion gradient.
 Gasses exerts pressure,
the amount of pressure
each gas exerts is called
partial pressure (PO2 and
PCO2).
INTERNAL
RESPIRATION
 Gas exchange between
blood and tissue fluid
 Movement driven by
diffusion gradient.
 Gasses exerts pressure,
the amount of pressure
each gas exerts is called
partial pressure (PO2 and
PCO2).

15. Cardiovascular physiology

16. OXYGEN TRANSPORT
Once air enters lungs & cardiovascular system. Oxygen
transport depends on the ventatilion, Perfusion, Diffusion.
Oxygen is carried in blood in two forms
1) Dissolved oxygen in plasma
2) Dissolved oxyhemoglobin
Each 100ml to arterial blood carries 0.3ml of oxygen
dissolved in plasma and 20ml of oxygen in combination
with HB .So large amount of oxygen is carried in the
blood.

18. OXYGEN INSUFFICIENCY
Oxygen insufficiency is a condition in which the body as
a whole or a region is deprived of adequate oxygen
supply.
Oxygen insufficiency is a failure to provide adequate
oxygen to cells of the body and to remove excess carbon
dioxide from them.

19. FACTORS AFFECTING
OXYGENATION
 Physiological factors
 Developmental factors
 Environmental factors
 Lifestyle factors

20. 1. Physiological factors: cardiac
 Conduction disturbances
 Impaired valvular function
 Myocardial hypoxia
 Cardiomyopathic conditions
 Peripheral tissue hypoxia

21. 1. Physiological factors: respiratory
 Hyperventilation
 Hypoventilation
 Hypoxia
 COPD
 Pneumonia

22. Additional physiological factors
 Anemia
 Toxic inhalant
 Airway obstruction
 Fever
 Trauma

23. 2. DEVELOPMENTAL FACTORS
 Infants
 School-age children and
adolescents
 Older adults : older adults may
exhibit a barrel chest and require
increased effort to expand the
lungs.

24. 3. LIFESTYLE FACTORS
 Exercise increase the rate and
depth of respiration
 Smoking
 Nutrition
 Substance abuse
 Stress
 Who are obese or underweight
 Smokers and second hand
smokers are also affect

25. ENVIRONMENTAL FACTORS
 Residence location
 Occupation
 Who are exposed to dust
 Chemicals in the home or
workplace
 Air pollution causes headache,
chocking and coughing

26. Signs & Symptoms of Inadequate
Oxygenation
Signs & Symptoms Onset
1.CNS
1. Unexplained apprehension
2. unexplained restlessness or irritability
3. Unexplained confusion or lethargy
4 Combativeness (aggressive)
5. Coma
Early
Early
Early
Late
Late
2. RESPIRATORY
1. Tachypnea
2. Dyspnea on exertion
3. Dyspnea at rest
4. Use of accessory muscles
5. Pause for breath between sentences,
words.
Early
Early
Late
Late
Late

27. Cont.
3.CARDIOVASCULAR
1. Tachycardia
2. Mild hypertension
3. Dysrhythmias
4. Hypotension
5. Cyanosis
6. Cool, clammy skin
Early
Early
Early/ late
Late
Late
Late
4.OTHER
1. Diaphoresis
2. Decreased urinary output
3. Unexplained fatigue
(early/late)
(early/late)
(early/late)

28. VARIENTS OF OXYGENATION

29. 1. HYPOXIA
 Deficiency of an adequate supply of oxygen to the
body tissues.
 A pathological condition in which the body as a whole
(generalized hypoxia) or a region of the body (regional
hypoxia) is deprived of adequate oxygen supply.
 It is classified into four types :
A. Hypoxic hypoxia
B. Anemic hypoxia
C. Stagnant(Ischemic) hypoxia
D. Histotoxic hypoxia

30. TYPES OF HYPOXIA
1. HYPOXIC HYPOXIA: an insufficient O2 supply reaches the
blood due to reduced PO2 in arterial blood (supply problem).
It is a generalized hypoxia.
CAUSES
 Less than normal amount of oxygen is inhaled
 Inadequate pulmonary ventilation (e.g. asthma,
emphysema, COPD)
 Impaired gas exchange in the lungs (e.g. chronic
bronchitis)

31. 2. ANEMIC HYPOXIA: due to decreased oxygen
carrying capacity of the blood (transport problem).
CO POISONING
HAEMORHAGE/
HEMOLYSIS
CHEMICALS/SULPHA DRUGS
ANEMIA

32. 3. STAGNANT(Ischemic hypoxia): occurs when blood
circulation through tissue is reduced (distribution
problem).
CAUSES
 cerebral ischemia
 circulatory failure
 hemorrhage
 shock
 ischemic heart disease

33. 4. HISTOTOXIC HYPOXIA: due to inability of the tissues
to make use of the oxygen supplied to them (utilization
problem).(dysoxia)
CAUSES
 carbon monoxide & cyanide poisoning
 chewing tobacco & alcohol
 certain narcotics
 oxygen toxicity

35. Pathophysiology of Hypoxia
Due to etiological factors
Cells can switch to anaerobic metabolism
Accumulation of acid by products e.g. lactate
Imbalance in chemical environment of cells.
Release of lysosomal enzymes
Tissues destruction

36. DIAGNOSTIC STUDIES
 Hematocrit :test reflects ratio of blood cells to plasma. Increased
hematocrit (polycythemia) is found in chornic hypoxia.
 Arterial Blood Gas analysis (ABG analysis): It gives a brief
estimate of the partial pressure of oxygen in the blood vessels and
the amount of hemoglobin that has been saturated with oxygen.
 Pulse oximetry: Hypoxia can also be estimated by a pulse
oximeter, which is placed at the tip of finger and is connected to the
monitor. The percentage of oxygen saturation is continuously
monitored on the screen.

37. TREATMENT
Hypoxia can be a fatal condition
Establish airways
The blood pressure and heart rate should be monitored
Seizure if any should be suppressed
Sometime cold blanket are used as they slow down the
activity of the brain cells and decreses the need of
oxygen.

38. Nursing interventions
Interventions Additional Information
Raise the head of the bed Raising the head of the bed promotes
effective breathing and diaphragmatic
descent, maximizes inhalation, and
decreases the work of
breathing. Positioning enhances airway
patency in all patients. A Fowler’s or semi-
Fowler’s position promotes a patient’s
chest expansion with the least amount
of effort. Patients with COPD who are
short of breath may gain relief by sitting
with their back against a chair and rolling
their head and shoulders forward or
leaning over a bedside table while in bed

39. Deep breathing and coughing
techniques
Deep breathing and coughing
techniques help patients effectively
clear their airway while maintaining
their oxygen levels. If they have
difficulty coughing, teach the huffing
technique.
Oxygen therapy and equipment If patient is already on supplemental
oxygen, ensure equipment is turned on
and set at the required flow rate and is
connected to an oxygen supply source.
Ensure the connecting oxygen tubing is
not kinked, which could obstruct the flow of
oxygen

40. Assess need for bronchodilators Pharmacological management is essential
for patients with respiratory disease.
Medications such as bronchodilators
effectively relax smooth muscles and open
airways in certain disease processes such
as COPD. Glucocorticoids relieve
inflammation and also assist in opening air
passages. Mucolytics and adequate
hydration decrease the thickness of
pulmonary secretions so that they can be
expectorated more easily.
Oral suctioning Some patients may have a weakened cough
that inhibits their ability to clear secretions from
the mouth and throat.
Provide oral suction if patient is unable to clear
secretions, foreign debris, or mucous from the
mouth and pharynx

41. Anxiety and depression The most common co-morbidities of
COPD are anxiety and depression.
Anxiety is related to chronic shortness
of breath and an inability to breathe
effectively. Anxiety and depression are
chronically undertreated and may be
relieved with breathing retraining,
counselling, relaxation techniques, or
anti-anxiety medications if appropriate.

42. HYPOXEMIA
Hypoxemia is an inadequate partial pressure of
oxygen in arterial blood.
Hypoxemia has many causes, often respiratory
disorders, and can cause tissue hypoxia as the blood
is not supplying enough oxygen to the body.
Extreme hypoxia can be called anoxia, extreme
hypoxemia can be called anoxemia.

43. Hypoxemia is usually defined in terms of reduced
partial pressure of oxygen (mm Hg) in arterial blood
when the partial pressure of oxygen in blood is less
than 60 mm Hg, when hemoglobin oxygen saturation
is less than 90% .
Hypoxemia refers to low oxygen in the blood, and
the more general term hypoxia is an abnormally low
oxygen content in any tissue or organ, or the body as
a whole.Hypoxemia can cause hypoxia (hypoxemic
hypoxia), but hypoxia can also occur via other
mechanisms, such as anemia.

44. phyiological causes
There are 5 phyiological causes of HYPOXEMIA
HIGH ALTITUDE
DIFFUSION
HYPOVENTILATION
SHUNTING
 VENTILATION-PERFUSION MISMATCH

45. Symptoms and Signs of Hypoxemia
 Symptoms of hypoxemia may be acute or chronic which mainly include:
 Shortness of breath
 Rapid breathing
 Fast heart rate
 Cough
 Sweating
 Wheezing
 Sensation of choking
Severe symptoms seen with cerebral hypoxia may include:
 Confusion
 Inability to communicate
 Coma

46. DIAGNOSTIC EVALUATIONS
PULMONARY FUNCTION TEST (PFT)
 PFT is performed to assess respiratory function and to determine the
extend of dysfunction. Such tests include measurements of lung volumes,
ventilatory function and the mechanics of breathing, diffusion and gas
exchange.
ARTERIAL BLOOD GAS STUDIES
 Measurements of blood pH and of arterial O2 & CO2 tensions are
obtained when managing patients with
 respiratory problems and in adjusting oxygen therapy as needed. The
arterial oxygen tension indicates
 the degree of oxygenation of blood and the arterial CO2 tension indicates
the adequacy of alveolar
 ventilation. Alveolar blood gas studies aid in assessing the ability of lungs
to reabsorb or excrete
 bicarbonate ions to maintain to normal body Ph

47. PULSE OXIMETRY
It is a non-invasive method of continuously monitoring the o2
saturation of hemoglobin. A probe or sensor is attached to the
fingertip, forehead, earlobe or bridge of the nose. The sensor
detects changes in oxygen saturation levels by monitoring
high signals generated by the oxieter and reflected by blood
pulsing through the tissue at the probe. Normal SpO2 values
are 98% to 100%. Values less than 85% indicate that the
tissues are not receiving enough oxygen.
CULTURES
Throat cultures may be performed to identify organisms
responsible infection in the respiratory tract.
Nasal swabs may also be performed for the same purpose.

48. SPUTUM STUDIES
 Sputum is obtained to identify pathogenic organisms and to
determine whether malignant cells are present.
IMAGING STUDIES
 Chest X-ray
 Computed tomography
 Magnetic resonance imaging
 Fluoroscopic studies
 Pulmonary angiography

49. ENDOSCOPIC PROCEDURES
 Bronchoscopy
 Thoracoscopy
THORACENTESIS
BIOPSY

50. MANAGEMENT
1) O2 Therapy
2) Pharmacological agent
3) Physical technique
4) NURSING MANAGEMENT

51. 1.Oxygen Administration

52. LOW- FLOW DELIVERY SYSTEM
These contribute partially to the inspired gas the
patient breathes. This means the patient breathes
some room air along with oxygen. These systems
donot provide a constant or known concentration of
inspired oxygen. The amount of inspired oxygen
changes as the patient’s breathing pattern changes.

53. EXAMPLES OF LOW FLOW DELIVERY SYSTEMS
INCLUDE;
Nasal cannula

54. Simple mask

55. Non-rebreather mask

56. Oropharyngeal catheter

57. HIGH FLOW DELIVERY SYSTEM
These provide the total amount of inspired air. A
specific percentage of oxygen is delivered
independent of the patients breathing. High flow
systems are indicated for the patients who require a
constant and precise amount of oxygen

58. EXAMPLES OF HIGH FLOW OYGEN DELIVERY
SYSTEM:
Venture mask

59. Tracheostomy collars
Face tents

60. Aerosol masks

61. T-piece

63. METHOD USED IN CASE OF PAEDIATRICS
OXYGEN HOOD
It is the rigid plastic dome that encloses on an
infant’s head, it provides precise oxygen levels and
high humidity.

64. OTHER METHODS OF OXYGEN
ADMINISTRATION:
ENDOTRACHEAL TUBES
 it involves passing an endotracheal tube through the
mouth and nose into the trachea. et tube is used if
the patient requires an artificial airway for a brief
period.(e.g. 10 days or less) and full recovery is not
possible.

65. TRACHEOSTOMY TUBES:
Tracheostomy is a surgical procedure in which an
opening is made into thr trachea. The indwelling tube
inserted into the trachea is called tracheostomy tube.
It is preferred if the patient’s condition is critical and
recovery is not expected anytime soon.(e.g. more
than 21 days).

66. MECHANICAL VENTILATOR

67. INDICATIONS
Apnea with respiratory arrest including cases from
intoxication
Chronic obstructive pulmonary disease/COPD
Acute respiratory acidosis with partial pressure of
carban dioxide(Pco2)> 50 mm Hg and ph < 7.25,
which may be due to paralysis of the diaphragm due
to gullian barre syndrome. Gravis, spinal injury, or
the effect of anaesthetic and muscle relaxant drugs

68. Increase work of breathing as evidenced by
tachypnea, retractions, and other physical signs of
respiratory distress
Hypoxemia
Hypotension including sepsis, shock, congestive
heart failure
Coma

69. VENTILATOR MODES
MODES refer to how breaths are delivered to the
patient.
The most commonly used modes are:
ASSIST CONTROL VENTILLATION
INTERMITTENT MANDATORY VENTILATION
SYNCHRONIZED INTERMITTENT MANDATORY
VENTILATION
PRESSURE SUPPORT VENTILATION
AIRWAY PRESSURE RELEASE VENTILATION

70. ASSIST CONTROL MODE :-This provides full ventilator
support by delivering a preset tidal volume and
respiratory rate. If the patient initiates a breath between
the machine’s breaths, the ventilator delivers at the
preset volume. The cycle does not adapt to patient’s
spontaneous efforts, every breath is preset volume.
INTERMITTENT MANDATORY VENTILATION :-This
provides a combination of mechanically assisted
breaths and spontaneous breaths. Therefore, the patient
can increase the respiratory rate, but each spontaneous
breath is limited to the limited to the tidal volume the
patient generates. Mechanical breaths are delivered at
preset intervals and a preselected tidal volume ,
regardless of the patient’s efforts. IMV allows the patients
to use their own muscle atrophy.

71. SYNCHRONIZED INTERMITTENT MANDATORY
VENTILATION :-Delivers a preset tidal volume and
number of breaths per minute. Between ventilator
delivered breaths, the patient can breathe
spontaneously with no assistance from the ventilator
on those extra breaths. As the patient’s ability to
breathe spontaneously increases, the preset number
of ventilator breaths is decreased and the patient
does more of the wok of breathing.

72. PRESSURE SUPPORT VENTILATION :- It assists by
applying a pressure plateau to the airway throughout the
patient triggered inspiration to decrease resistance
within the tracheal tube and ventilator tubing. Pressure
support is reduced gradually as the patient’s strength
increases.
AIRWAY PRESSURE RELEASE VENTILATION(APRV)
:-It produces tidal ventilation by release of airway
pressure from an elevated baseline airway pressure to
stimulate expiration.it is a time triggered , pressure-
limited, time cycled mode of mechanical ventilation that
allows unrestricted , spontaneous breathing throughout
the ventilator cycle. It also allows alveolar gas to be
expelled through the lung’

73. NURSING CARE OF PATIENT ON
VENTILLATORS
Review communications
Check ventilator settings and mode
Suction appropriately

74. Assess pain and sedation needs:- Even though
your patient can’t verbally express her needs, you’ll
need to assess her pain level using a reliable scale.

75. Prevent infection:- Ventilator-associated pneumonia
(VAP) is a major complication of mechanical ventilation.
Much research has focused on how best to prevent VAP
Prevent hemodynamic instability:- Monitor the
patient’s blood pressure every 2 to 4 hours, especially
after ventilator settings are changed or adjusted.
Mechanical ventilation causes thoracic-cavity pressure to
rise on inspiration, which puts pressure on blood vessels
and may reduce blood flow to the heart; as a result,
blood pressure may drop.

76. Manage the airway:-The cuff on the endotracheal or
tracheostomy tube provides airway occlusion. Proper
cuff inflation ensures the patient receives the proper
ventilator parameters, such as TV and oxygenation.
Meet the patient’s nutritional needs:-For optimal
outcomes, ventilator patients must be well nourished
and should begin taking nutrition early. But like any
patient who can’t swallow normally, they need an
alternative nutrition route.

77. Wean the patient from the ventilator appropriately:-
As your patient’s indications for mechanical ventilation
resolve and she’s able to take more breaths on her own,
the healthcare team will consider removing her from the
ventilator. Weaning methods may vary by facility and
provider preference
Educate the patient and family:- To ease distress in the
patient and family, teach them why mechanical
ventilation is needed and emphasize the positive
outcomes it can provide. Communicate desired
outcomes and progression toward outcomes so the
patient and family can actively participate in the plan of
care.

78. HAZARDS OF OXYGEN INHALATION
A) Infection
The use of contaminated equipment can spread infection in the
patient. The causative organisms may be present in such
places as catheters, tracheostomy or endotracheal
tubes,humidifying water and masks.
B) Combustion (fire)
Oxygen itself does not burn, but it supports combustion.
Hence, fire is potential hazard when oxygen is administered.
C) Drying of mucus membranes of the respiratory tract
If oxygen is administered without sufficient humidity, it causes
drying and irritation of the mucus membranes.

79. d) Oxygen toxicity Its symptoms initially start as a tracheal
irritation and cough. Others include dryness and irritation of
the mucus membrane, substernal pain, nausea and vomiting
and formulation of a membrane similar to the hyaline
membrane on the alveolar valves, which causes dyspnea.
e) Atelectasis Collapse of the alveoli develops as a result of
increased oxygen concentrations in the inspired air.Oxygen
induced apnea Since the CO2 is completely washed off from
the blood by a high concentration of oxygen, the respiratory
centre is not stimulated sufficiently. Normally a part of CO2
remaining in the blood, stimulates the respiratory centre

80. f) Retrolental fibroplasias
The hazards of the oxygen therapy may affect the eyes.
Retrolental fibroplasias is noted in premature infants who
have a high concentration of oxygen inhalation. The
infants exposed to high oxygen concentrations which
cause an oxygen tension of 200mmHg or more in the
blood will develop fibrotic changes behind the lens which
impairs light penetration to the retina. The eyes of the
adult may also be damaged by the oxygen
administration. Ulceration, odema, visual impairment etc.
may result from the toxic effects of oxygen on the cornea
and the lens of the adult.
g) Asphyxia Patients receiving oxygen inhalation by
means of masks and closed tents must be protected
from the danger of asphyxia resulting from unexpected
and unobserved depletion of oxygen cylinders.

81. 2:-Pharmacological agent-Bronchodilators, Steroids
A bronchodilator is a substance
that dilates the bronchi and bronchioles, decreasing
resistance in the respiratory airway and increasing
airflow to the lungs. Bronchodilators may be endogenous
(originating naturally within the body), or they may
be medications administered for the treatment of
breathing difficulties. They are most useful in obstructive
lung diseases, of which asthma and chronic obstructive
pulmonary disease are the most common conditions.
How they work
Bronchodilator drugs relax the muscles in the lungs,
which allows the airways to widen and makes breathing
easier. Some bronchodilators also help to clear mucus
and reduce inflammation in the lungs.

82.  Types of bronchodilator
 Bronchodilators are often inhaled, but are also available as
tablets, syrup and an injection. There are two types:
 Short-acting bronchodilators – these provide short-term
relief from breathlessness.
Eg- Metaproterenol, Levalbuterol
 long-acting bronchodilators – these have no immediate
effect, but can help control the symptoms of conditions such
as asthma if used regularly, and have more long-lasting
effects
 Eg- Perforomist
 3:-Physical Technique-Breathing Exercise,
positioning(High Flower Position )

83. 4.NURSING MANAGEMENT
ASSESSMENT
Nursing health history: it includes exploration of present
problems, any past respiratory diseases. Cough , pain,
characteristics of cough and sputum, lifestyle and
medication used for breathing.
INSPECTION
The nurse performs a head to toe observation of the
client for skin and mucus membrane color, general
appearance, level of consciousness, breathing pattern
and chest wall movements

84. PALPATION
It will reveal vocal fremitus and displacement of trachea.
Perfusion deficit is noted by change in pulse rate or
character , and clammy skin ulcer in the lower
extremities.
PERCUSSION
May reveal hyper resonance , dull percussion tone or
change in the density of the lungs and the surrounding
tissues.

85. AUSCULATATION
NORMAL BREATH SOUNDS
VESICULAR
Soft low pitched breezy sounds heard over most
of the peripheral lung field
BRONCHO VESICULAR
Harsh sounds heard over the main stem bronchi
BRONCHIAL
loud, course, blowing sound heard over the
trachea

86. ABNORMAL/ ADVENTITIOUS BREATH
SOUNDS
RALES(CRACKLES)
Crackling or gurgling sounds heard on inspiration
WHEEZES
Squeaky sounds heard during inspiration and
expiration
PLEURAL FRICTION RUB/ STRIDOR
Grating sound or vibration heard during inspiration
and expiration

87. NURSING DIAGNOSIS GOALS INTERVENTIONS
1.INEFFECTIVE
BREATHING PATTERN
RELATED TO
Restricted pulmonary
disease or CNS disorder or
thoracic surgery.
Any major abdominal or
thoracic surgery or whose
mobility is restricted.
Neuromascular disease
that can weaken the
respiratory muscles e.g.
Gullien Barre Syndrome
and Myasthenia Gravis.
Abnormal curvature like
alteration of
spine(scoliosis, kyphosis,
chest wall injuries and
pleural defects)
To promote lung
expansion.
To improve breathing
pattern
1. Fowler positioning
2. Teaching controlled
breathing exercises:
a) Deep breathing and
abdominal breathing
exercises
b) Incentive spirometry
3) Health education

88. 2.IMPAIRED GAS
EXCHANGE
RELATED TO
Ventilation-perfusion
mismatching
Widespread shunting as
with atelectasis and
pneumonia
To improve oxygen to the
client
1) Fowler positioning
2) Administer oxygen to
the client according to
the doctor’s order
3.Activity intolerance related
to inadequate oxygenations
To improve the activity Avoid smoking, teach the
client for deep
diaphragmatic breathing
exercise
■Maintain O2 supplement
O2 therapy as needed
■Gradual increase daily
activities

89. ASSOCIATED NURSING DIAGNOSIS
Activity intolerance related to dyspnea and hypoxia
Altered nutrition related to dyspnea and cough
Deficient knowledge related to disease process,
diagnostic procedures and treatment modalities

90. FLUID AND ELECTROLYTE
IMBALANCE

91. Fluid and electrolyte balance is a dynamic process
that is crucial for life.
 It plays an important role in homeostis
 Imbalance may result from many factors, and it is
associated with the illness.

92. COMPOSITION OF BODY FULIDS

93.  Electrolyte Composition of Body Fluids
Each fluid compartment of the body has a distinctive pattern of
electrolytes
Extracellular Fluids
ECFs are similar except for the high protein content of plasma
Sodium (Na+) is the major cation
Chloride (Cl-)is the major anion
Intracellular Fluids
Have low sodium and chloride
Potassium (K+) is the chief cation
Phosphate (PO4-) is the chief anion

94. REGULATION OF BODY FLUIDS
COMPARTMENT
OSMOSIS :- Fluid shifts through the membrane from the
region of low solute concentration to the region of high
solute concentration until the solution are of equal
concentration.
DIFFUSION :-A substance to move from an area of lower
concentration to one of the lower concentration.
FILTRATION:- Movement of solute and solvent across a
membrane caused by hydrostatic (water pushing)
pressure Occurs at the capillary level If normal pressure
gradient changes (as occurs with right-sided heart
failure) edema results from “third spacing

95. ROUTES OF GAIN AND LOSS

96. Intake = Output = Fluid Balance
Sensible losses
Urination
Defecation
Wound drainage
Insensible losses
Evaporation from skin
Respiratory loss from lungs

97. Primary Regulatory Hormones
1. Antidiuretic hormone (ADH) (also
called vasopressin)
Is a hormone made by the hypothalamus, and stored and
released in the posterior pituitary gland
Primary function of ADH is to decrease the amount of
water lost at the kidneys (conserve water), which
reduces the concentration of electrolytes
ADH also causes the constriction of peripheral blood
vessels, which helps to increase blood pressure

98. ADH is released in response to such stimuli as a rise
in the concentration of electrolytes in the blood or a
fall in blood volume or pressure. These stimuli occur
when a person sweats excessively or is dehydrated.
1. Sweating or dehydration increases the blood osmotic
pressure.
2. The increase in osmotic pressure is detected by
osmoreceptors within the hypothalamus that
constantly monitor the osmolarity ("saltiness") of the
blood
3. Osmoreceptors stimulate groups of neurons within
the hypothalamus to release ADH from the posterior
pituitary gland.

99. 4. ADH travels through the bloodstream to its target organs:
 a. ADH tavels to the collecting tubules in the kidneys and
makes the membrane more permeable to water (that is
it increases water reabsorption) which leads to a decrease
in urine output.
 b. ADH also travels to the sweat glands where it stimulates
them to decrease perspiration to conserve water.
 c. ADH travels to the arterioles, where it causes the smooth
muscle in the wall of the arterioles to constrict. This narrows
the diameter of the arterioles which increases blood pressure.

100. 2. Aldosterone –

101. TYPES OF SOLUTION MICROSCOPIC VIEWS INDICATION WITH EXAMPLE
Isotonic  To increase the extracellular
fluid volume.
 To treat hypovolemia for
electrolyte replacement.
Eg-
NS(0.9%),RL,5%DEXTROSE IN
WATER
Hypertonic To correct the severe hyponatremia
To treat hypoglycemia
Eg-DNS 5% ,10 % DEXTROSE IN
WATER, 3% NS
Hypotonic To expand the intracellular fluid
compartment.
Eg-0.45% sodium chloride (0.45%
NS), commonly called half normal
saline.

103. FLUIDS VOLUME DISTURBANCE (Fluid
Imbalances)
Hypovolemia
Hypervolemia

104. Hypovolemia
Isotonic fluid loss from the extracellular space
Can progress to hypovolemic shock
Caused by:
Excessive fluid loss (hemorrhage)
Decreased fluid intake
Third space fluid shifting

105. CLINICAL FEATURE
 Mental status deterioration
 Thirst
 Tachycardia
 Delayed capillary refill
 Orthostatic hypotension
 Urine output < 30 ml/hr
 Cool, pale extremities


106. MANAGEMENT
Fluid replacement
Albumin replacement
Blood transfusions for hemorrhage
Dopamine to maintain BP
MAST trousers for severe shock
Assess for fluid overload with treatment

107. Hypervolemia
Excess fluid in the extracellular compartment as a result of
fluid or sodium retention, excessive intake, or renal failure
Occurs when compensatory mechanisms fail to restore
fluid balance
Leads to CHF and pulmonary edema

108. CLINICAL FEATURES:-
Tachypnea
Dyspnea
Crackles
Rapid, bounding pulse
Hypertension Increased CVP,
pulmonary artery pressure and pulmonary artery wedge
pressure (Swan-Ganz)
JVD
Acute weight gain
Edema

109. MANAGEMENT
One of the most common treatments for
hypervolemia is diuretics. Diuretics are drugs that
increase the amount of urine the body produces

116. ACID BASE
The body normally maintains a steady balance
between acid produced during metabolism and
bases that neutralize and promote the excreation of
the acid , many health problems lead to acid base
imbalance in addition to fluid and electrolyte
imbalance
 Patient with diabetes mellitus, chronic obstructive
pulmonary disease and kidney disease frequently
develop acid-base imbalance

117. HYDROGEN ION CONCENTRATION
Acidity or alkalinity of a solution is determined by its concentration
of hydrogen ions (h+) The unit used to describe acid base is PH.
The PH scale ranges from 1-4. A neutral solution measures
7.Normal blood plasma is slightly alkaline and has a normal ph
range of 7.35-7.45
ACIDOSIS It is the condition characterized by an excess of H ions
or loss of base ions/bicarbonate in ECF in which the PH falls
bellow 7.35
ALKALOSIS It occurs when there is a lack of H ions or a gain of
based and the PH exceeds 7.45

118.  ACID BASE REGULATION
 The body’s metabolic processes constantly produce acids. These
acids must be neutralized and excreted to maintain acid base
balance . Normally the body has three mechanisms by which it
regulates acid-base balance to maintain the arterial ph 7.35 and 7.45
BUFFER SYSTEM
 THE RESPIRATORY SYSTEM
 THE RENAL SYSTEM
 The regulatory mechanisms react at different speeds. BUFFER
reacts immediately
 THE RESPIRATORY SYSTEM responds in minutes and reaches
maximum effectiveness in hours
 THE RENAL RESPONSE takes 2-3 days to responds maximally.

119. ALTERATION IN ACID BASE BALANCE
The acid-base imbalance is produced when the ratio
of 1:20 between acid and base content is altered .A
primary disease or process may alter one side of the
ratio.The compensatory process attempts to maintain
the other side of the ratio .When compensatory
mechanism fails, an acid –base imbalance occurs
Acid-base imbalances are classified as
RESPIRATORY IMBALANCE:- It affects carbonic acid
concentration
 METABOLIC IMBALANCE:- It affects the base
bicarbonate

121. ANY QUERIES??

122. SUMMARIZATION

123. REFERENCES:-
 Brunner and Suddarth’s., Medical Surgical Nursing., Twelfth Edition,2011.,
Published by Wolters Kluwer India.636-640.
 Nightingale nursing times volume X Issue 7, 2003, Page no:14-17 7. The Nursing
journal of India, Vol XVIX, Jan 1992,Page no:21-25
 Joyce M.Black, Jane Hokanson Hawks, "Medical surgical Nursing, Clinical
management for positive outcomes”,7th edition, Volume I, 2005, saunders
publication, Missouri, Page No:205-244
 https://www.slideshare.net/J-E-N-I/0xygen-insuffficiency
 https://www.ncbi.nlm.nih.gov/pubmed/1007238
 http://www.healthline.com
 http://www.webmd.com/guide/hypoxia-hypoxemia#1