Lecture-9-OXYGEN THERAPY FOR NURSES-PART (1).pdf

Title page

Objectives

Outlines of the presentation

Introduction about schizophrenia types and signs and symptoms

Nursing diagnoses and behaviors commonly associated with psychotic disorders (Table 3-24)

Nursing diagnoses for patients with schizophrenia, expected outcomes, and nursing interventions

Summary slide

References slide

1. JERASH UNIVERSITY
FACULTY OF NURSING
2025-2026ACADEMIC YEAR
FIRSTSEMESTER
Lecturer:
Assistant Professor. Dr. Jawad Abu-Shennar
EMERGENCY & DISASTER NURSING –CLINICAL PRACTICE

2. OXYGEN THERAPY FOR
NURSES-PART (1)
Lecture-nine

3. Learning Outcomes
1.Outlinethestructureandfunctionoftherespiratorysystem.
2.Describetheprocessesofbreathing(ventilation)andgasexchange
(respiration)andtheroleofrespiratorysystemingasexchange.
4.Identifyfactorsinfluencingrespiratoryfunction.
5.Describenursingassessmentsforoxygenationstatus.
6.Describenursingmeasurestopromoterespiratoryfunctionandoxygenation.
7.Explaintheuseoftherapeuticmeasurestopromoterespiratoryfunction.

4. Functions of the Respiratory System
•Thefunctionoftherespiratorysystemisgasexchange.
•Oxygenisrequiredforcellfunctioning.
•MovementofoxygenandCO
2involvesintegrationofseveralbody
systems.
•Oxygenfrominspiredairdiffusesfromalveoliinlungsintoblood
inpulmonarycapillaries.
•Carbondioxideproducedduringcellmetabolismbuildsupin
tissuesanddiffusesfrombloodintothealveolitobeexhaled.

5. Thenosehastwoopeningscallednostrilsornares,throughwhichairenters.
Thenasalcavitiesarelinedwithamucousmembraneandhavearich
bloodsupply.Asairentersthecavitiesitiswarmed,filtered,andmoistened.
Thepharynx,orthoraxliesdirectlybehindthenasalcavities.
Theepiglottis(aleaf-likestructure)protectstheairwaywhenfoodisswallowed;
itpreventsfoodfromenteringthelungs
Thelarynx,orvoicebox,liesbetweenthepharynxandtrachea.
Thetrachea,orwindpipe,isatubeextendingfromthelarynxtothecenterofthe
chest.Itcarriesairbetweenthepharynxandthebronchi.
Structure of the Respiratory System
• Upper respiratory tract

7. 7
Thetracheadividesintotwobronchinearthe
centerofthechest
Eachbronchusentersalungandcarriesairfromthe
tracheatothelung
Inthelungsthebronchicontinuetodivideinto
smallerandsmallerbronchiuntotheyfinallydivide
intothesmallestbranches,calledbronchioles
Theyterminateintoairsacs,calledalveoli.Thisis
whereO2andCO2areexchanged
Structure of the Respiratory System
• Lower respiratory tract

8. Pulmonary Ventilation
•Inspiration(inhalation)
■Airflowsintolungs.
•Expiration(exhalation)
■Airflowsoutoflungs.

12. Pulmonary Ventilation
•Inspiration(inhalation)
■Diaphragmandintercostalscontract.
■Thoraciccavitysizeincreases.
■Volumeoflungsincreases.
■Intrapulmonarypressuredecreases.
■Airrushesintolungstoequalizepressure.
•Expiration(exhalation)
■Diaphragmandintercostalsrelax.
■Volumeofthelungsdecreases.
■Intrapulmonarypressurerises.
■Airisexpelled.

13. Pulmonary Ventilation
•Ventilationdependson:
■Clearairways(cilia)
■IntactCNSandrespiratorycenter
■Abilityofthoraxtoexpandandcontract
■Lungcomplianceandlungrecoil
Compliance
•Expansibilityorstretchabilityoflungtissue
Recoil
•Continualtendencyoflungstocollapseawayfromthechestwall
Factorsaffectingcompliance&recoil:
•Intrapleural&intrapulmonarypressure,Tidalvolume,Atelectasis,
Surfactant

14. Alveolar Gas Exchange
•Occursafteralveoliareventilated.
•Pressuredifferencesoneachsideofrespiratorymembranesaffectdiffusion.
■Partialpressure
•Pressureexertedbyeachindividualgasinamixtureaccordingtoitsconcentrationinthe
mixture
■Torr-aunitofpressurebasedonanabsolutescale
•Diffusionofoxygenfromalveoliintopulmonarybloodvesselsoninspiration
•Diffusionofcarbondioxidefrompulmonarybloodvesselsintoalveolifor
expiration

15. Transport of Oxygen and Carbon Dioxide
• Oxygen
■Transportedfromlungstotissues
■97% of oxygen combines with hemoglobin in red
blood cells and is carried to tissues as
oxyhemoglobin.
■Remaining oxygen is dissolved and transported in
plasma (as PaO
2).
■Rateoftransportaffectedby:
•Cardiacoutput
•Erythrocytes(RBCs)andhematocrit
• Normal hematocrit 40-54% in men, 37-50% in women
•Exercise

16. Transport of Oxygen and Carbon Dioxide
•Carbondioxide
■Mustbetransportedfromtissuestolungs
■Continuallyproducedinprocessofcellmetabolism
■65%iscarriedinsideRBCsasbicarbonate.
■30%combineswithhemoglobinascarbahemoglobin.
■5%transportedinsolutioninplasmaandascarbonicacid.

17. Respiratory Regulation
•Includesbothneuralandchemicalcontrolstomaintaincorrectconcentrations
•NervoussystemadjustsratetomaintainconstantPO
2andPCO
2.
•Respiratorycenterinmedullaoblongataandponsofthebrain:
■Chemosensitivereceptorsinmedullaoblongatarespondtochangesinbloodandhydrogenion
concentration.
■IncreasedCO
2moststronglyaffectsstimulationofrespiration.
■NeuralreceptorstoO
2incarotidbodiesstimulaterespiratorycenter.
•Inclientswithemphysema,O
2concentrationaffectsrespirationmorestrongly(hypoxicdrive)
becauseofconstantbuildupofCO
2inblood.

18. Factors Affecting Respiratory Function
•Age
■Changesespeciallyimportantifsystemcompromisedbyinfection,physicaloremotional
stress,surgery,anesthesia,orotherprocedures.
■Chestwall,airwaysmorerigidandlesselastic
■Driermucousmembranes
■IncreasedriskofaspirationfromGERD(gastroesophagealrefluxdisease,orchronicacid
reflux)
•Environment-Altitude&Pollution
•Lifestyle-Physicalactivity,Occupation
•Healthstatus-cardiacillnesses,trauma,musculoskeletaldisorders,chronic
illnesses,etc.
•Medications-sedatives,antianxietydrugs
•Stress-Hyperventilation,Epinephrine

19. Assessingpatientseffectively
WHENYOUPERFORMaphysicalassessment,you’llusefourtechniques:
inspection,palpation,percussion,andauscultation.Usetheminsequenceunlessyou’re
performinganabdominalassessment.Palpationandpercussioncanalterbowelsounds,
soyou’dinspect,auscultate,percuss,thenpalpateanabdomen.
1.Inspection
Inspecteachbodysystemusingvision,smell,andhearingtoassessnormalconditions
anddeviations.Assess
forcolor,size,location,movement,texture,symmetry,
odors,andsoundsasyouassesseachbodysystem.

20. Assessingpatientseffectively
2.Palpation
Palpationrequiresyoutotouchthepatientwithdifferentpartsofyourhands,
usingvaryingdegreesofpressure.Becauseyourhandsareyourtools,keepyour
fingernailsshortandyourhandswarm.Weargloveswhenpalpatingmucous
membranesorareasincontactwithbodyfluids.Palpatetenderareaslast.
3.Percussion
Percussioninvolvestappingyourfingersorhandsquicklyandsharplyagainst
partsofthepatient’sbodytohelpyoulocateorganborders,identifyorganshape
andposition,anddetermineifanorganissolidorfilledwithfluidorgas.

21. Assessingpatientseffectively
4.Auscultation
Auscultationinvolveslisteningforvariouslung,heart,andbowelsoundswithastethoscope.
Gettingready
Provideaquietenvironment.
Makesuretheareatobeauscultatedisexposed(agownorbedlinenscaninterferewithsounds.)
Warmthestethoscopeheadinyourhand.
Closeyoureyestohelpfocusyourattention.
Howtoauscultate
Usethediaphragmtopickuphigh-pitchedsounds,suchasfirst(S1)andsecond(S2)heartsounds.
Holdthediaphragmfirmlyagainstthepatient’sskin,usingenoughpressuretoleaveaslightringon
theskinafterward.
Usethebelltopickuplow-pitchedsounds,suchasthird(S3)andfourth(S4)heartsounds.Holdthe
belllightlyagainstthepatient’sskin,justhardenoughtoformaseal.Holdingthebelltoofirmly
causestheskintoactasadiaphragm,obliteratinglow-pitchedsounds.
Listentoandtrytoidentifythecharacteristicsofonesoundatatime.

26. What will we evaluate in auscultation?
RespiratoryRate
BreathingDepth
RespiratoryRhythm

29. 29
Photo byAndreas Hendrik
https://commons.wikimedia.org/wiki/File:Seifenblasen.jpg
Conditions Affecting Diffusion

30. 30
Respiratory Definitions
Eupnea-normalbreathing
Bradypnea-decreasedbreathingrate
Tachypnea–breathingveryfast.Ptnotalwaysawareofit.
Apnea–notbreathingatall
Hyperpnea-fasterand/ordeeperbreathing
Hyperventilation-rapidbreathingwithhypocarbia

31. 31
Hypoxemia and Hypoxia
Hypoxemiaisaconditioninwhichthereisinsufficient
oxygenintheblood.
Hypoxiaisaconditioninwhichthereisinsufficientoxygen
inthecells.
Patientswhoareimmobileandthoseonbedrestareatrisk.

32. Hypoventilation:
Itoccurswhenalveolarventilationisinadequatetomeetthe
oxygendemandofthebodyoreliminatesufficientcarbondioxide.
Breathingatanabnormallyslowrate,resultinginanincreased
amountofcarbondioxideintheblood.
Hypoventilation-decreasedrate&depthofrespiration

34. Hyperventilation:
Itisastateofventilationinwhichthelungsremove
carbondioxidefasterthanitisproducedbycellulermetaboism.
Increasedmovementofairinandoutoflungs.Suchas
Kussmaul'sbreathing(deep&rapid)happensasaresultof
metabolicacidosis

36. DyspneaDyspnea
36
Dyspnea–from Latin ‘dyspnoea’
Dyspnea (also Shortness of breath (SOB), air hunger)
subjective symptom of breathlessness.
normal in heavy exertion
pathological if it occurs in unexpected situations.

37. 37 What is NOT Dyspnea?
NottheO2saturationofHemoglobin
NotthetotalamountofO2attachedtoHemoglobin
NottheamountofO2insolutionintheblood(thePaO2)
Nottherespiratoryrate,(notalltachypneaisdyspnea)
But:asubjectivesensationofairhunger.

38. BreathSounds
Whatarebreathsounds?
Breathsoundscomefromthelungswhenyoubreatheinandout.Thesesoundscanbeheard
usingastethoscopeorsimplywhenbreathing.
Breathsoundscanbenormalorabnormal.Abnormalbreathsoundscanindicatealungproblem,
suchas:
obstruction
inflammation
infection
fluidinthelungs
asthma
Listeningtobreathsoundsisanimportantpartofdiagnosingmanydifferentmedicalconditions.

39. BreathSounds
Typesofbreathsounds
Anormalbreathsoundissimilartothesoundofair.However,
abnormalbreathsoundsmayinclude:
Rhonchi(alow-pitchedbreathsound)
Crackles(ahigh-pitchedbreathsound)
Wheezing(ahigh-pitchedwhistlingsoundcausedbynarrowingof
thebronchialtubes)
Stridor(aharsh,vibratorysoundcausedbynarrowingoftheupper
airway)

40. AbnormalLungSounds

42. 42
Factors that Affect a Person’s O2 Needs
Red Blood Cells (RBC’s)
Aging
Fever
Pain
Patient’s airway and intact Nervous System
An early sign of risk for hypoxia is restlessness

43. 43 Other high-risk conditions
Cardiac disease-CHF (congestive heart failure)
Pulmonary disease
Postoperative patients (for up to a week after surgery)
Sleep apnea
Decreased level of consciousness
Neuromuscular diseases
Morbid obesity

44. 44
Signs and Symptoms of Decreased
Oxygenation
Noisybreathing
Gaspingbreath
Changesinmentalstatus
Tachycardia
Dusky,pale,blue,orgrayskincolor
Unusualcoloroflips,mucous
membranes,nailbeds,liningorroofof
mouth
Cool,clammyskin
Slow,rapid,orirregularbreathing
Shortnessofbreathordifficultybreathing
Photo by James Heilman, MD

46. Postural drainage:
Posturaldrainageusesgravitytohelpmovemucusfromthe
lungsuptothethroat.
Thepersonliesorsitsinvariouspositionssothepartofthe
lungtobedrainedisashighaspossible.

49. CommonPositionsof PatientforPosturalDranaige:

52. Lateralposition

54. Trendelenburg’s:

55. Oxygen Therapy
Oxygen is necessary for life
colorless, odorless, tasteless gas
O2 in our atmosphere is at 21 %
The red blood cells give blood its red color, carry O2 to cells,
and take away the carbon dioxide (CO2)
Some diseases and conditions prevent enough oxygen from
feeding the body’s tissues
Oxygen is a prescription item and a physician’s order is
necessary to administer it

56. Oxygen Administration Devices
NasalCannula
SimpleMask
NonrebreathingMask
AirEntrainmentMask(VenturiMask)

57. Oxygen cylinder/tank: oxygen is as a gas

62. Flow Meter
http://img.medicalexpo.com/images_me/photo -g/oxygen-flowmeter-pressure-regulator-81490-6353139.jpg
•Oxygenflowisregulatedbyaflowmeter.
•Itshowshowmanylitersofoxygenarebeingdeliveredtothe
patienteachminute.
•Flowmeterscomeindifferentsizesandshapes.
The flow of oxygen is
increased by turning the
knob on the flow meter
clockwise and decreased by
turning it counterclockwise

63. Pressure
Gauge
•The pressure gauge is connected to the flow meter on an oxygen cylinder.
•The gauge shows how much oxygen is left in the cylinder
•Oxygen is measured in pounds.
Do not let the cylinder
run out!!
Many facilities consider cylinders empty when
the pressure reaches 500 pounds.
Pressure Gauge:

64. 64 Oxygen Flow
Check the flow each time you are in the room to be sure it is set at
the proper rate!!

65. 65
Ahumidifierisawaterbottlethatmoistenstheoxygenforcomfort
andpreventsdryingofmucousmembranesinthenose,mouth,and
lungs
Oxygenpassesthroughthewaterinthehumidifier,pickingup
moisture,beforeitreachesthepatient
Steriledistilledwaterisalwaysusedinthehumidifier
Humidifiers

68. Image from CareFusion
Nasal Cannula

69. Nazal Canula:
SimpleNasalCannulaasmalltubewithtwoprongsthatfitintothepatient’s
nostrils
Twosizes—pediatricandadult
Theprongsareslightlycurved;makesurethatthecurvespointinwardwhen
youinsertthenintothenostrils
Twotypesofstraps—singlestrappositionedatthebackofthepatient’shead;
orthinplastictubesthatareplacedovertheearsandadjustedunderthechin
Thedisadvantageofthissystemisthatitcanbeeasilydislodgedandcauses
dryingofthenasalmucosa.

70. Points to Consider in Oxygen Administration
with Nasal Cannula:
Thecannulashouldbeplacedproperlyinthepatient'snosesothattheoxygen
concentrationdoesnotdecrease.
Thepatientisencouragedtobreathethroughthenose.
Prolongedoxygendeliverywithnasalcannulairritatestherespiratorytractmucosa,and
ahumidifiershouldbeaddedtoflowmeterstopreventthissituation.
Thepatientshouldbeobservedbehindtheearforirritation,thisareashouldbecleaned
andsupportedwithasofteninglotion.
Thenasalcannulamethodofoxygenadministrationshouldnotbepreferredinpatients
whobreathethroughthemouthandhaveablockednose.
Cannulatipscanirritatethenostrils,sothenostrilsshouldbecheckedandcleaned
frequently.
Asterilenasalcannulashouldbeusedforeachpatientandshouldbechangedwhen
visiblysoiled.

71. Nasal Cannulaein Oxygen therapy:

73. Complications:
Canirritatetheskinonthecheeksandbehindtheears
Higherconcentrationsdrynasalandoralmucousmembranes
Rarelycomplicationsareperforationofnasalseptum(long-termuse)

74. Face mask:

76. Spirometer:

77. Incentivespirometer:
Encouragesvoluntarydeepbreathingbyproviding
visualfeedbacktopatientsaboutinspiratory
volume.

78. Venturi mask: forgivinghigher flow rate

79. Diagram fromIgnataviciusandWorkman,2000.
Venturi
Mask

80. http://brainly.co.id/tugas/133042
Nonrebreathing Mask
Should be
inflated at all
times; should
not collapse
more than
halfway during
inspiration
Non-rebreathingmasksareusedto
deliverhighconcentrationsofoxygen
inemergencysituations.Thesemasks
maybeusedfortraumaticinjuries,
aftersmokeinhalation,andincasesof
carbon monoxide poisoning.

81. Caring for a Patient Receiving Oxygen
Therapy
http://commons.wikimedia.org/wiki/File:MR._ROBERT_B._JONES,_78_YEARS_OLD,_IS_TOTALLY_DEPENDENT_ON_H
IS_HOME_OXYGEN_MACHINE_FOR_SURVIVAL._THE_POLLUTED_AIR_IS..._-_NARA_-_545409.jpg

82. Complications of O2 Therapy
•SuppressedrespiratorydriveandlowO2tension
•Fire
•Oxygen toxicity: O2 concentrations of greater than 50% for extended
periods of time (longer than 48 hours) can cause an overproduction of free
radicals, which can severely damage cells
■Symptoms of Oxygen toxicity include substernal discomfort, paresthesias,
dyspnea, restlessness, fatigue, malaise, progressive respiratory
difficulty, refractory hypoxemia, alveolar atelectasis, and alveolar
infiltrates on x-ray.

84. Complications of O2 Therapy
•CO2retention
■ Whenhypoxemiaiscorrected,hypoventilationoccurs
leadingtoCO2retention(CO2narcosis)
• PaCO2mayincreaseseverelytocauserespiratory
acidosis,drowsinessandcoma
•PaCO2increasesecondarytocombinationof:
•Abolition(ending)ofhypoxicdrivetobreathe
•Increaseindeadspace
•Atelectasis:
■HighO2displacesnitrogenthatkeepsthealveoliopen.O2
isabsorbedquicklyintocirculation

85. Caring for a Patient Receiving Oxygen Therapy
Elevatetheheadofthebedwhenthepatientisreceivingoxygen
Apatientwearinganoxygenmaskcannoteatwhilewearingthe
mask;thephysicianmayorderacannulaformeals
Beingunabletobreathecanbefrightening;thepatientmayneed
reassuranceandemotionalsupport.Checkthepatientfrequently
andspendasmuchtimeaspossibleintheroom

86. 86
Nursing Care
Carefullychecktheskinunderthedeviceforsignsofrednessorirritation
ReportanyskinproblemstotheRN
Becauseoxygenisdrying,thepatientsreceivingoxygenmayneedextraliquidsto
drink
Theyalsoneedfrequentcareofthemouthandnose
Somepatientsmayfeelwarmandperspireheavily;extrabathingandlinenchanges
maybenecessary