Without adequate oxygen, major organ systems begin to fail within minutes or hours. Oxygen is essential for cellular respiration and is delivered to tissues through a multi-step process involving ventilation, diffusion, transportation, and perfusion. Factors like development, physiology, behavior, lifestyle, and medication can impact oxygenation. It can be measured using tools like pulse oximetry, arterial blood gases, and capnography. Conditions resulting from inadequate oxygen delivery and utilization include hypoxemia, hypoxia, anoxia, respiratory failure, and cyanosis. Prompt treatment focuses on restoring adequate oxygen supply and ventilation.

2. Without food……..
2-3 Weeks…….

3. Without water……
2-3 Days….

4. Without breathing…….
Only 3-5
minitues

5. APARNA.A
I MSc. Nursing

6. Oxygenation
 Oxygenation means the
delivery of oxygen to the
body’s tissues and cells
to maintain life

7. Process of Oxygenation
 Ventilation = the exchange of air between the
environment and the lungs
 Diffusion = the exchange of oxygen from the alveoli
into the blood and CO2 in the opposite
direction
 Transportation= movement of oxygen, CO2, other
nutrients, metabolic wastes etc in the blood.
 Perfusion = the process of delivering blood to
a capillary bed in its biological tissue

8. FACTORS AFFECTING
OXYGENATION
Developmental Factors
Physiological Factors
Behavioral Factors
Life Style Factors
Medication

9. MEASUREMENT OF OXYGENATION
 Oxygen saturation (SO2)
 Arterial oxygen saturation (SaO2)
 Venous oxygen saturation (SvO2)
 Tissue oxygen saturation (StO2
 Saturation of peripheral oxygen (SpO2)
HbO2 – amount of oxygenated hemoglobin
Hb – total Hb in blood

10. GAS EXCHANGE: LUNGS& BLOOD

11. GAS EXCHANGE: BLOOD & TISSUES

12. OXYGEN–HAEMOGLOBIN
DISSOCIATION CURVE

13. VENTILATION – PERFUSION RATIO
(PULMONARY GAS VARIABILITY)
V/Q
ratio
Term Consequences
1 V-Q match Normal PaO2
>1 Dead space
ventilation
Decreased
PaO2
Increased
PaCO2
<1 Venous
admixture
Decreased
PaO2
Normal/
decreased
PaCO2

16. asthma, chronic bronchitis, obstructive emphysema, fibrosis,
edema
VA/ Q↓ part alveolar ventilatory ↓
functional shunt↑>30% respiratory failure
1) type and cause of ventilation-perfusion-mismatching
(1) decreased ratio of VA/Q
underventilated in relation to their perfusion

17. (2) increased ratio of VA/Q
poor perfusion in relation to their ventilation with air
pulmonary artery embolization, DIC in lung, vessels contract, pulmonary
arteritis,
dead space like ventilation VA/Q↑ poor perfusion↓
respiratory failure
· ·

18. BLOOD GAS VARIABILITY
 Arterial blood gas can vary spontaneously without
change in the clinical condition of the patient. So
routine monitoring of ABG can be misleading and
is not justified.

19. 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.

20.  In practice, respiratory failure is defined as a PaO2
value of less than 60 mm Hg while breathing or a
PaCO2 of more than 50 mm Hg.
Normal reference values ：PaO2 < 60mmHg
with or without PaCO2 > 50mmHg

21. CAUSES OF OXYGEN INSUFFICIENCY
 Carbon monoxide inhalation
 Contact with certain chemicals
 Self-induced hypocapnia
 A seizure which stops breathing activity
 Sleep apnea
 Drug overdose
 central alveolar hypoventilation syndrome, or primary
alveolar hypoventilation

22. CAUSES OF OXYGEN INSUFFICIENCY
 Acute respiratory distress syndrome.
 Exposure to extreme low pressure or vacuum
 Hanging
 Respiratory diseases
 Drowning
 Anemia
 Cyanide poisoning

24. Respiratory Failure
 Indicates impairment of lung’s ability to maintain
adequate oxygen and CO2 homeostasis.

25. Types:
 According to PaCO2
 Type 1 (Hypoxemic) respiratory failure: Associated with a
PaCO2 < 60 mmHg on air or O2 with normal or low PaCO2. It
indicates ventilation perfusion mismatch.
 Type 2 (Hypoxemic/ hypercarpnic) respiratory failure: PaO2
<60mmHg and PaCO2 > 50mmHg. It indicates alveolar
hypoventilation.
 `Chronic Respiratory Failure: Respiratory failure can be
diagnosed by detecting a failure of acid base compensation,
ie, pH<7.25
 According to pathogenic mechanism
 Ventilatory disorders
 Gas exchange disorders
 According to primary site
 Central respiratory failure
 Peripheral respiratory failure

26. Pathophysiology
Respiratory
movement
disorder
neuro-muscular disorders
decreased strength,
myasthenia gravis
hypoxia, acidosis
Respiratory movement ↓Depression of CNS
damage of CNS
drug overdose
▲ Disorders of the respiratory muscles
alveolar distensibility
Restrictive
ventilatory
disorders
respiratory failure

27. Hypoxia
 a condition in which the
body or a region of the
body is deprived of
adequate oxygen supply.
 Hypoxia may be
classified as
 generalized, affecting
the whole body,
 local, affecting a region
of the body.

28. 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
tissue
destruction
less O2 supplied to cells resulting in
availability of less energy
for cellular functions
organelle swelling
destruction of
tissues and organs

29. Hypoxemia
 an abnormally low level of oxygen in the blood.
 specifically, it refers to oxygen deficiency
in arterial blood

30. Source A-a PO2
Partial pressure of O2
in alveolar gas and
arterial blood
PvO2
Partial pressure of
venous oxygen
Hypoventilation Normal Normal
V/Q mismatch Increased Normal
DO2/VO2 Increased Decreased
Causes of hypoxemia

31. Hypoventilation
 Alveolar hypoventilation causes both hypoxemia and
hypercapnia as a result of a decrease in the total
volume of air inhaled (and exhaled) each minute.
 No V/Q imbalance in the lungs, so the A-a PO2
gradient is not elevated.
 Common causes include:
 Brain stem respiratory depression: drugs, obesity-
hypoventilation syndrome
 Peripheral neuropathy: critical illness polyneuropathy,
Guilian Barre Syndrome
 Muscle Weakness: critical illness myopathy,
hypophosphatemia, magnesium depletion, myasthenia gravis

32. V/Q abnormality
 Most of the cases hypoxemia results from V/Q
mismatch in the lungs. E.g, pneumonia, ARDS etc.
 The A-a PO2 gradient is almost always elevated in
these conditions, but elevation can be minimal in
severe airway obstruction (which behave like
hypoventilation)

33. DO2/VO2 (oxygen delivery/ oxygen
uptake) imbalance
Systemic oxygen delivery is usually accompanied by an
increase in O2 extraction from capillary blood
maintain constant rate of O2 uptake into the tissue.
This result in a decrease in PO2 of venous blood, and it
affect arterial oxygenation

34. Hypercapnia
 an arterial PCO2 above 46 mmHg that doesnot
represent compensation for a metabolic alkalosis.
 The causes can be identified by considering the
determinants of arterial PCO2 (PaCO2)
 PaCO2 directly related to rate of CO2 production in the
body
 PaCO2 inversely related to rate of CO2 elimination by
alveolar ventilation
 Ie, the causes include increased CO2 production
(VCO2), hypoventilation and increased dead space
ventilation

35. Anoxia
 A total depletion in the level of oxygen, an extreme
form of hypoxia or "low oxygen" in which there is a
complete lack of oxygen supply to the body as a whole
or to a specific organ or tissue region.

36. Anoxia: Environmental Causes
 a lack of oxygen or the presence of other chemicals in the
air that affect the ability of blood to load oxygen.
 These environmental effects may be caused by factors
including:
 Carbon monoxide
 High altitude
 Smoke

37. Anoxia: Underlining diseases/
conditions
 Amyotrophic lateral sclerosis (ALS, also known as Lou
Gehrig’s disease; a severe neuromuscular disease that
causes muscle weakness and disability)
 Cardiac arrest
 Chronic obstructive pulmonary disease
 Heart failure
 Myocardial infarction
 Respiratory failure
 Severe asthma and allergies
 Stroke

38. Anoxia: Other Events
 Choking
 Complications of anesthetics
 Drowning
 Drug overdose
 Low blood pressure (hypotension)
 Strangulation
 Suffocation
 Trauma to a tissue or organ

39. Symptoms
 Bluish coloration of the lips or fingernails
 Confusion or loss of consciousness for even a brief moment
 Dizziness
 Poor decision-making
 Rapid breathing (tachypnea) or shortness of breath
Serious symptoms that might indicate a life-threatening
condition
 Dilated pupils
 Respiratory or breathing problems, such as shortness of
breath, difficulty breathing, labored breathing, wheezing,
not breathing, choking
 Seizures and tremors
 Unconsciousness or coma

40. Treatment
 In general,
 restoring the oxygen supply, through either increasing
the amount of oxygen taken in, such as with an oxygen
mask, or assistance with breathing.
 Other treatment options include:
 Administration of fluids and medication to increase
blood pressure
 Administration of medications to reduce seizure activity
 Administration of medications to regulate heart
function
 Application of life support system

41. Cyanosis
 It is the appearance of a blue or
purple coloration of
the skin or mucous
membranes due to the tissues
near the skin surface having low
oxygen saturation.
 Cyanosis is defined as a bluish
discoloration, especially of the
skin and mucous membranes,
due to excessive concentration of
deoxyhemoglobin in the blood
caused by deoxygenation.
 5.0 g/dL of deoxyhemoglobin or
greater is present

42. Types of cyanosis
 Central (around the core, lips, and
tongue)
 due to a circulatory or ventilatory
problem that leads to poor
blood oxygenation in the lungs. It
develops when arterial saturation drops
to ≤85% or ≤75%
 Peripheral (only the extremities or
fingers)
 It is the blue tint in fingers or extremities,
due to inadequate circulation. The blood
reaching the extremities is not oxygen
rich and when viewed through the skin a
combination of factors can lead to the
appearance of a blue color

43. Causes of central cyanosis
 1. Central Nervous System Disorders (impairing
normal ventilation)
 2. Respiratory Disorders
 3. Cardiac Disorders
 4. Hematological disorders
 5. Others

44. Causes of peripheral cyanosis
 All common causes of central cyanosis
 Reduced cardiac output (e.g. heart
failure, hypovolaemia)
 Cold exposure
 Arterial obstruction (e.g. peripheral vascular
disease, Raynaud phenomenon)
 Venous obstruction (e.g. deep vein thrombosis)

45. Clubbing of fingers
 It is a deformity of
the fingers and fingernails associated with a number of
diseases, mostly of the heart and lungs.

46. Signs and symptoms
 Fluctuation and softening of
the nail bed
 Loss of the normal <165°
angle (Lovibond angle)
between the nail bed and the
fold (cuticula)
 Increased convexity of the
nail fold
 Thickening of the
whole distal (end part of the)
finger (resembling a
drumstick)
 Shiny aspect and striation of
the nail and skin

47. Diagnosis

48. Other conditions
 Acute asthma and COAD
 Ischemic heart disease:
 Myocardial infarction
 Congestive Heart Failure
 Syncope

50. HISTORY AND PHYSICAL
EXAMINATION

51. PFT (Pulmonary Function Test)

52. ABG (Arterial Blood Gas Analysis)
 ABG helps in measurement of blood for patient‘s
arterial oxygen and carbon dioxide tensions. Elevated
levels of CO2 indicate inadequate alveolar ventilation.

53. Normal Values of ABG analysis
Measurem
ent
Normal Arterial
Values
Clinical Significance
pH 7.35-7.45 Indicates acid-base balance
PCO2 35-45 mm of Hg Indicates adequacy of alveolar
ventilation, represents
respiratory component of acid-
base balance.
HCO3 22-26 mEq/l Bicarbonate level; indicates
metabolic component of acid-
base balance
PaO2 80-100 mm of
Hg
Partial pressure of oxygen;
represents oxygen dissolved in
plasma
SO2 96%-98% Saturation of hemoglobin with
oxygen

54. ABG and oxygenation
 A low PaO2 indicates that the patient is not oxygenating
properly, and is hypoxemic.
 At a PaO2 of less than 60 mm Hg, supplemental oxygen should be
administered.
 At a PaO2 of less than 26 mmHg, the patient is at risk of death and
must be oxygenated immediately
 The carbon dioxide partial pressure (PaCO2) is an indicator of
CO2 production and elimination
 for a constant metabolic rate, the PaCO2 is determined entirely by
its elimination through ventilation
 A high PaCO2 (respiratory acidosis, alternatively hypercapnia)
indicates underventilation (or, more rarely, a hypermetabolic
disorder), a low PaCO2 (respiratory alkalosis,
alternatively hypocapnia) hyper- or overventilation.

55. Oximetry
 Pulse oximetry is a non-invasive method for
monitoring a patient's O2 saturation.

56. Working principle

57. Advantages
 useful in any setting where a patient's oxygenation is
unstable
 determining the effectiveness of or need for
supplemental oxygen
 used to detect abnormalities in ventilation.
 Simple to use and the provide continuous and
immediate oxygen saturation values
 Portable pulse oximeters are also useful for mountain
climbers and athletes whose oxygen levels may
decrease at high altitudes or with exercise.

58. Limitations
 Pulse oximetry measures solely hemoglobin
saturation, not ventilation and is not a complete
measure of respiratory sufficiency.
 It is not a substitute for blood gases checked in a
laboratory, because it gives no indication of base
deficit, carbon dioxide levels, blood pH,
or bicarbonate (HCO3
-) concentration.

59.  In severe anemia, the blood will carry less total oxygen,
despite the hemoglobin being 100% saturated.
 Erroneously low readings may be caused
by hypoperfusion of the extremity being used for
monitoring incorrect sensor application;
highly calloused skin; or movement (such as
shivering), especially during hypoperfusion.
 Pulse oximetry also is not a complete measure of
circulatory sufficiency

61. Limitations ….
 In cases of carbon monoxide poisoning, the inaccuracy
may delay the recognition of hypoxia
 Cyanide poisoning gives a high reading, because it
reduces oxygen extraction from arterial blood.
 Methemoglobinemia characteristically causes pulse
oximetry readings in the mid-80s.
 The only noninvasive method allowing continuous
measurement of the dyshemoglobins is a pulse CO-
oximeter. It provides clinicians a way to measure the
dyshemoglobins carboxyhemoglobin and
methemoglobin along with total hemoglobin.

62. Capnography
 It is the monitoring of the
concentration or partial
pressure of carbon dioxide (CO2) in
the respiratory gases
 It is usually presented as a graph of
expiratory CO2 plotted against time,
or, less commonly, but more usefully,
expired volume.
 The plot may also show the
inspired CO2
 Direct monitor of the inhaled and
exhaled concentration or partial
pressure of CO2, and an indirect
monitor of the CO2 partial pressure in
the arterial blood

63. Principle of capnography
 CO2 absorbs infra-red
radiation.
 A beam of infra-red light is
passed across the gas
sample to fall on a sensor.
The presence of CO2 in the
gas leads to a reduction in
the amount of light falling
on the sensor, which
changes the voltage in a
circuit.

65. Types of capnometry
 Colorimetric CO2
detection
 Infra red Capnography
 Modified nasal cannula
for nonintubated
patients
 Transcutaneous PCO2

66. Colorimetric CO2 detection
 A pH-sensitive chemical indicator is
enclosed in a plastic housing and is
connected to the gas stream between
the endotracheal tube and the
anesthesia circuit. The pH sensitive
indicator changes color when exposed
to C02. The color varies between
expiration and inspiration, as C02 level
increases or decreases. The color
changes from purple (when exposed to
room air or oxygen) to yellow (when
exposed to 4% C02). The response
time of the device is sufficiently fast to
detect changes of C02 breath-by
breath.1 However, this device is not
very sensitive when CO2 output is low
as is during CPR. Easy cap II is a an
example of such pH sensitive indicator
devices.

67. Diagnostic usage:
 provides information
about CO2 production, pulmonary (lung)
perfusion, alveolar ventilation, respiratory patterns, and
elimination of CO2 from the anesthesia breathing circuit
and ventilator.
 used to measure carbon dioxide production, a measure of
metabolism.
 Capnography in emergency medical services:
 assessment and treatment of patients in the prehospital
environment.
 verifying and monitoring the position of an endotrachael
tube or a blind insertion airway device.

68. Other measures
 Chest Xrays and CT scan
 Sputum Studies
 Blood Studies
 Thoracentesis
 Pulmonary Angiography
 Bronchoscopes

69. ACUTE CARE OF PATIENT WITH
OXYGEN INSUFFICIENCY
 Dysponea Management
 Airway Maintenance
 Mobilization of secretions
 Humidification
 Nebulization
 Chest Physiotherapy
 Postural Drainage
 Suctioning
 Maintenance and promotion of lung expansion
 Positioning
 Incentive Spirometry
 Chest tubes in case of pneumothorax/ hemothorax

70. ACUTE CARE OF PATIENT WITH
OXYGEN INSUFFICIENCY
 Maintenance and Promotion of Oxygenation
 Oxygen Therapy
 Mechanical Ventilation
 Restoration of Cardiopulmonary Function
 Cardiopulmonary Resuscitation
 Restoring and Continuing Care
 Hydration
 Coughing and Breathing Exercise
 Respiratory Muscle Training

71. OXYGEN ADMINISTRATION

72. Need for supplemental oxygen
 Tissues are normally hypoxic
 The tissues of human body normally operate in a low
oxygen environment
 Tolerance to arterial hypoxemia
 Severe clinical hypoxemia due to pulmonary
insufficiency are tolerated without evidence of
inadequate oxygenation

73. Oxygen delivery
 FiO2 : fraction of inspired oxygen
% of O2 participating in gas exchange
Natural air FiO2- 20.9% (≈ 21%) = .21
So supplemental oxygen should have high FiO2 than
atmospheric air, ie, > 0.21 upto 1
Typically it is maintained below 0.5 even in
ventilator

74. Low flow delivery systems
Device Reservoir capacity O2 flow (L/min) ≈FiO2 (if
TV=500ml,
RR=20/min, I:E=
1:2
Nasal Cannula 50ml
1 0.21- 0.24
2 0.24-0.28
3 0.28-0.34
4 0.34-0.38
5 0.38-0.42
6 0.42-0.46
Oxygen face mask 150-250ml 5-10 0.40-0.60
Mask-reservoir bag
750-1250ml Partial
rebreather
5-7 0.35-0.75
 nonrebreather 5-10 0.40-1.0

75. Methods of Oxygen Delivery
 Low flow delivery systems
 It provide variable FiO2
 e.g, Nasal prongs, face masks, and mask with reservoir.
 High flow oxygen masks
 It provide complete control of the inhaled gas mixture
and deliver a constant FiO2 regardless of changes in the
ventilatory pattern

76. Nasal Prongs/
Nasal Cannula
 most common inexpensive method
 delivers a relatively low concentration of oxygen (24%
to 45%) at flow rate of 2-6L/min
 delivers a constant flow of oxygen to the nasopharynx
and oropharynx, which act as an oxygen reservoir
(average capacity = 50ml, or anatomical dead space)
 As the O2 flow rate increases from 1-6L/min, the FiO2
increases from 0.24 to 0.46

77. Low flow Oxygen Mask
 The simple face mask delivers oxygen concentrations from
40% to 60% at liter flow of 5 to 8L/min respectively.
 The partial rebreather mask delivers oxygen concentrations
of 60% to 90% at liter flow of 6 to 10L/min, respectively.
 Mask with reservoir bags: In re breather mask the oxygen
reservoir bag that is attached allows the client to re breath
about first third of the exhaled air in conjunction with
oxygen. Thus it increases FiO2 by recycling expired oxygen.
Reservoir increases capacity by 600-1000ml

79. Face Tents
 used in clients who
cannot tolerate masks.
 provide 30% to 50% O2
concentration at a flow
rate of 4 to 8L/min.

80. Non Breather Mask:
 delivers the highest oxygen concentration possible
95% to 100% by means other than intubations or
mechanical ventilation, at liter flow of 10 to 15L/min.

81. Venture Mask:
 delivers oxygen
concentration varying
from 24% to 40% or
50% at flow rate of 4 to
5 L/min.
 It has wide bore tubing
and color coded jet
adaptors that
correspond to a precise
oxygen concentration
and liter flow

83. Trans tracheal Oxygen Delivery
 used for oxygen dependent clients.
 With the method client requires less
oxygen (0.5 to 2L/min) as all of flow is
delivered to lungs directly.
 Special Consideration: The nurse
keeps the catheter patent by injection
1.5 ml of normal saline with it, moving
a cleaning rod in and out and then re-
injecting, 5ml of saline twice or thrice
a day.

84. Methods Used In Case Of
Pediatrics
 In Case of Infants:
 Oxygen Hood: It is a rigid plastic dome that encloses on
infant‘s head
 It provides precise oxygen levels and high humidity.
 In Case of Children:
 Oxygen Tent: 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 minutes. At a rate of 15L/minuets.

85. Nurses Responsibility for
Administration of Oxygen

86. Hazards of Oxygen Inhalation
 Infection
 Combustion
 Drying of mucus membrane of the respiratory tract
 Oxygen toxicity
 Atelectiasis
 Oxygen induced Apnoea
 Retrolental Fibroplasias
 Asphyxia

87. MECHANICAL VENTILATION
 It is a positive or negative pressure breathing device
that can maintain ventilation and oxygen delivery for a
prolonged period.

88. Indications
 Continuous decrease in PaO2.
 Increase in arterial CO2 levels.
 Persistent acidosis
 thoracic or abdominal surgery, drug overdose,
neuromuscular disorders, inhalation injury, COPD,
multiple trauma, shock, multisystem failure, and coma
 A patient with apnea, which is not readily reversible

89. Types
1. Negative Pressure Ventilation:
2. Positive Pressure Ventilation:

90. Nursing Care of Patient on
Ventilator

91. NURSING MANAGEMENT OF
CLIENT WITH OXYGEN
INSUFFICIENCY

92. BIBLIOGRAPHY
 Paul L Mario. The ICU Book. 3rd ed. Delhi: Lippincott
publishers; 2007
 Braunwald, Kasper etal. Harrison’s Principles of
Internal Medicine.15th ed. USA:McGraw Hills
Publishers;2001
 Chintamani. Lewis’s Medical Surgical Nursing.1st ed.
India: Mosby’s Publishers;2011
 Joyce M. Black, Jane Hokason Hawks. Medical Surgical
Nursing. 8th ed. India: Saunders publishers;2010
 Patricia Potter, Anne Griffin Perry. Fundamentals of
Nursing. 6th ed. New Delhi: Elsevier Publications;2006