NUR 504 FINAL STUDY
GUIDE OXYGENATION
CRAVEN CHAPTER 26
Oxygenation Craven Chapter 26
a. Identify individual, environmental, and pathological factors that influence oxygenation
a. Body Position
i. An upright position allows for the greatest ease of lung expansion
ii. When lying down the abdominal contents push against the
diaphragm making it more difficult to breath
1. This is more evident in people with compromised respiratory
function
b. Environment
i. Percentage of oxygen that humans breathe (fraction of inspired
oxygen concentration) is about 21% on “room air”
ii. Lower oxygen at higher elevations = less oxygen available to the lungs for
gas diffusion
iii. How does the patient tolerate the weather they are living in?
1. Some tolerate heat and humidity well, others have
difficulty breathing.
2. Chronic respiratory diseases often find breathing more difficult in
humid conditions because the air is thicker
iv. Air Pollution
1. Industrialized urban areas have elevated levels
2. Carbon monoxide emissions inhibit oxygen attachment
to hemoglobin on the RBC
3. Pollutants increase mucus production and contribute to bronchitis
and asthma
4. Second hand smoke
v. Pollens and Allergens
1. Body attempts to rid itself of substances perceived as harmful
by releasing chemical mediators that cause an inflammatory
response
, 2. Almost anything can be an allergen
3. Hay fever – result of allergies confined to the nose and
upper airways
4. Allergic responses in the lungs then breathing difficulties are far
more severe
5. Small airways become edematous, mucus production
increase, and inflammatory chemical mediators cause
bronchospasm
a. Hallmarks of allergic asthma
vi. Smoking
1. Most important lifestyle choice affecting respiration
, 2. Far more likely to experience emphysema, chronic bronchitis,
lung cancer, oral cancer, and cardiovascular disease
3. Producing more mucus and slowing the mucociliary escalator,
smoking inhibits mucus removal and can cause airway blockage
4. Smokers usually breath more rapidly than nonsmokers
vii. Drugs and Alcohol
1. Barbiturates, opioids, and some sedatives depress the CNS with
a resulting decrease in respiration
2. Large amounts of alcohol have the same effect, person is in
danger of vomiting and aspirating into the lungs
viii. Nutrition
1. Without proper diet the body cannot produce plasma
proteins and hemoglobin
2. Sufficient caloric and protein intake is needed for muscle strength
ix. Increased work of Breathing
1. In altered respiratory function, the amount of work required
for breathing becomes significant because the oxygen needs of
the respiratory muscle increases.
2. Patient who experiences increased work of breathing is at risk for
oxygen deprivation and exhaustion
3. Restricted lung movement and airway obstruction
4. Stiffer lungs tend to collapse, atelectasis
5. Any process that reduces the diameter of the conducting
airways causes increased airway resistance
6. They can become plugged by foreign material, mucus, or
abnormal growths.
a. Describe a focused assessment in relation to oxygenation, breathing, circulation, and
gas exchange
a. Normal Pattern
i. What is their normal?
ii. Is their normal really ‘normal’?
b. Risk identification
i. Breathing problem may be due to long term habits,
occupational exposure, or past illnesses
ii. Is the patient’s immunizations status current?
iii. Cigarette smoking is expressed in ‘pack years’.
1. 1 pack year is equal to smoking one pack of cigarettes a day for
1 year
2. 2 packs a day for 40 years would have an 80 pack year smoking
history
iv. Does the patient live in poverty and is malnourished?
v. Tuberculosis and respiratory infections are more common in people
who abuse alcohol
, vi. People with substance abuse are likely to have problems fighting
infection because of self-neglect and the lowered effectiveness of their
immune systems
vii. Work history – industrial or agricultural
viii. Family and personal history
ix. Investigate a sleep history – sleep apnea
c. Dysfunction Identification
i. Determine in the problem is continuous and intermittent
1. Continuous – some new exposure, carpeting or pet, contracted
an infection
2. Intermittent – can the patient identify the circumstances that
bring on difficulty
3. Assess cough, sputum production, shortness of breath,
and discomfort or pain
ii. Physical Assessment
1. Inspection
a. Observe the rate and pattern of respiration
b. Very slow breathing can cause hypoxemia and hypercapnia
c. Breathing too fast can cause excessive elimination of
carbon dioxide which causes dizziness and
respiratory alkalosis
d. Respirations should be smooth and regular
e. Observe for us of accessory muscles, flaring on
nostrils, and tripod position, dyspnea
f. Observe skin color, cyanosis, clubbing
g. Inspect chest for obvious chest deformities, wounds,
or masses, chest shape
2. Palpation
a. Assess swelling or tenderness
b. Determine and pattern of thoracic expansion and note
the position of the trachea
c. May detect the abnormal chest wall vibrations transmitted
through inflamed or fluid filled lung tissues, fremitus (99)
d. Increased tactile fremitus can be present in
consolidation in the lung, whereas decreased fremitus
may occur with pleural effusion, pulmonary edema,
emphysema, or bronchial obstruction
3. Percussion
a. Used to detect fluid filled or consolidated portions of
the lung
b. Pitch, intensity, duration, and quality of percussion notes
4. Auscultation
a. Bronchial, bronchovesicular, and vesicular
GUIDE OXYGENATION
CRAVEN CHAPTER 26
Oxygenation Craven Chapter 26
a. Identify individual, environmental, and pathological factors that influence oxygenation
a. Body Position
i. An upright position allows for the greatest ease of lung expansion
ii. When lying down the abdominal contents push against the
diaphragm making it more difficult to breath
1. This is more evident in people with compromised respiratory
function
b. Environment
i. Percentage of oxygen that humans breathe (fraction of inspired
oxygen concentration) is about 21% on “room air”
ii. Lower oxygen at higher elevations = less oxygen available to the lungs for
gas diffusion
iii. How does the patient tolerate the weather they are living in?
1. Some tolerate heat and humidity well, others have
difficulty breathing.
2. Chronic respiratory diseases often find breathing more difficult in
humid conditions because the air is thicker
iv. Air Pollution
1. Industrialized urban areas have elevated levels
2. Carbon monoxide emissions inhibit oxygen attachment
to hemoglobin on the RBC
3. Pollutants increase mucus production and contribute to bronchitis
and asthma
4. Second hand smoke
v. Pollens and Allergens
1. Body attempts to rid itself of substances perceived as harmful
by releasing chemical mediators that cause an inflammatory
response
, 2. Almost anything can be an allergen
3. Hay fever – result of allergies confined to the nose and
upper airways
4. Allergic responses in the lungs then breathing difficulties are far
more severe
5. Small airways become edematous, mucus production
increase, and inflammatory chemical mediators cause
bronchospasm
a. Hallmarks of allergic asthma
vi. Smoking
1. Most important lifestyle choice affecting respiration
, 2. Far more likely to experience emphysema, chronic bronchitis,
lung cancer, oral cancer, and cardiovascular disease
3. Producing more mucus and slowing the mucociliary escalator,
smoking inhibits mucus removal and can cause airway blockage
4. Smokers usually breath more rapidly than nonsmokers
vii. Drugs and Alcohol
1. Barbiturates, opioids, and some sedatives depress the CNS with
a resulting decrease in respiration
2. Large amounts of alcohol have the same effect, person is in
danger of vomiting and aspirating into the lungs
viii. Nutrition
1. Without proper diet the body cannot produce plasma
proteins and hemoglobin
2. Sufficient caloric and protein intake is needed for muscle strength
ix. Increased work of Breathing
1. In altered respiratory function, the amount of work required
for breathing becomes significant because the oxygen needs of
the respiratory muscle increases.
2. Patient who experiences increased work of breathing is at risk for
oxygen deprivation and exhaustion
3. Restricted lung movement and airway obstruction
4. Stiffer lungs tend to collapse, atelectasis
5. Any process that reduces the diameter of the conducting
airways causes increased airway resistance
6. They can become plugged by foreign material, mucus, or
abnormal growths.
a. Describe a focused assessment in relation to oxygenation, breathing, circulation, and
gas exchange
a. Normal Pattern
i. What is their normal?
ii. Is their normal really ‘normal’?
b. Risk identification
i. Breathing problem may be due to long term habits,
occupational exposure, or past illnesses
ii. Is the patient’s immunizations status current?
iii. Cigarette smoking is expressed in ‘pack years’.
1. 1 pack year is equal to smoking one pack of cigarettes a day for
1 year
2. 2 packs a day for 40 years would have an 80 pack year smoking
history
iv. Does the patient live in poverty and is malnourished?
v. Tuberculosis and respiratory infections are more common in people
who abuse alcohol
, vi. People with substance abuse are likely to have problems fighting
infection because of self-neglect and the lowered effectiveness of their
immune systems
vii. Work history – industrial or agricultural
viii. Family and personal history
ix. Investigate a sleep history – sleep apnea
c. Dysfunction Identification
i. Determine in the problem is continuous and intermittent
1. Continuous – some new exposure, carpeting or pet, contracted
an infection
2. Intermittent – can the patient identify the circumstances that
bring on difficulty
3. Assess cough, sputum production, shortness of breath,
and discomfort or pain
ii. Physical Assessment
1. Inspection
a. Observe the rate and pattern of respiration
b. Very slow breathing can cause hypoxemia and hypercapnia
c. Breathing too fast can cause excessive elimination of
carbon dioxide which causes dizziness and
respiratory alkalosis
d. Respirations should be smooth and regular
e. Observe for us of accessory muscles, flaring on
nostrils, and tripod position, dyspnea
f. Observe skin color, cyanosis, clubbing
g. Inspect chest for obvious chest deformities, wounds,
or masses, chest shape
2. Palpation
a. Assess swelling or tenderness
b. Determine and pattern of thoracic expansion and note
the position of the trachea
c. May detect the abnormal chest wall vibrations transmitted
through inflamed or fluid filled lung tissues, fremitus (99)
d. Increased tactile fremitus can be present in
consolidation in the lung, whereas decreased fremitus
may occur with pleural effusion, pulmonary edema,
emphysema, or bronchial obstruction
3. Percussion
a. Used to detect fluid filled or consolidated portions of
the lung
b. Pitch, intensity, duration, and quality of percussion notes
4. Auscultation
a. Bronchial, bronchovesicular, and vesicular
