Ventilation and Hypoxia, modes of ventilator, respiration

1. By
MS. Sonam Patode

2.  At the end of the seminar 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.

3. 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.

4.  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.

6.  All living things use oxygen or depend on
organisms that use oxygen in some way.

7.  We use oxygen to break down simple sugar
and release energy.
 This can be done through respiration or
fermentation.
 Animals mainly use respiration.

8.  The process that breaks apart simple food
molecules to release energy.
 It occurs inside cells.
 What YOU do with the oxygen you take in.

9. The molecule most living things use for
energy — including us!
 We break down food into smaller
molecules during digestion. One of the
small molecules is glucose.
 Glucose leaves your intestines, goes into
your blood and is taken to every cell in
your body.

10.  In your cells, oxygen is used to split glucose
apart — releasing energy, water and carbon
dioxide.

11.  Plants take in carbon dioxide and water and
use them to make food. Their food is simple
sugar — glucose.

12.  Plants pull the carbon off Co2 and use the
carbon in glucose. (They do not need the
oxygen for this. They get that from water, H2O.)
 Plants release the oxygen (O2) back into
the atmosphere.
 Other organisms use the free oxygen for
respiration.

13.  We keep destroying natural areas, especially
forested areas with many plants and replacing
them with buildings, parking lots, lawns, etc.
 Fewer plants mean less oxygen and more carbon
dioxide.
 This disturbs the balance of the natural cycle.

14.  Every time something burns (combustion),
more carbon dioxide is released into the
atmosphere.
 We add more and more Co2 and destroy more
and more of the plants that clean the air for
us.

15.  Stop destroying and promote regrowth of
natural areas — especially forests.
 Burn less (fossil fuels, forest fires, etc.)

16.  Oxygen insufficiency means “ deficient in
oxygen”.
 The normal range of oxygen in the external
blood should be 80-100 mm of Hg.
 For treating Oxygen insufficiency effectively,
early diagnosis and correct cause should be
ruled out.
 The only management for Oxygen
insufficiency is Oxygen administration.

17.  Oxygenation means the delivery of
oxygen to the body’s tissues and cell
it is necessary to maintain life and
health

18.  Oxygenation results from the co-
operative function of 3 major system
1.Pulmonary
2.Hematological
3.Cardiovascular system

19.  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.

20.  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.

21.  Transference of
1.Oxygen from the atmosphere to the
tissues.
2.And carbon dioxide from the tissues
to the atmosphere.

22.  External respiration:-
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.
 Internal respiration:
or tissue respiration O2 is
transferred from blood to the tissue
which gives up Co2

23.  Ventilation
 Pulmonary diffusion or gaseous
exchange at the alveolar level
 Transport of gases between lungs
and tissues through blood
 Gases exchange at tissue level
 Utilization of oxygen and production
of Co2 by the tissues(cellular
respiration)

24.  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.

25.  The space between parietal pleura
and visceral pleura is filled with the
pleural fluid, which lubricates the
lungs movements which is called as
intrapleural pressure.
 IPP is the pressure in the lungs.

26.  Easily determined by a water filled
spirometer attached to a
kymograph.

27. 1.TIDAL VOLUME(TV):
Is the volume of air that moves into the
lunges with each inspiration or that amount
that moves out with each expiration. It is
about 0.5 liters In an adult.
2.INSPIRATORY RESERVE VOLUME(IRV)
It is the air inspired with a maximal
inspiratory effort in excess of the tidal
volume.
It is about 3.3l in male and 1.9l in females

28.  DURING INSPIRATION:
 DURING EXPIRATION:

29.  PULMONARY VENTILATION:-
Is the amount of air inspired per minute.
i.e. 500ml/breath/minute which is about
6lit/minute.
 ALVEOLAR VENTILATION:-
It is the volume of gas that participates in
the exchange of O2 and Co2 out of the
500ml of air entering the lungs, during
inspiration only 350 reaches the alveoli.

30.  Therefore alveolar ventilation
=350mlx12 breaths/minute
=4.5lit/minute.

31. 3.EXPIRATORY RESERVE
VOLUME(ERV):
It is the volume of expelled by a
forceful expiration and after the end
of the normal tidal expiration.
1lit in males,0.7 in females.

32. 4.RESIDUAL VOLUME(RV)
Air left in the lungs after the
maximal expiratory efforts.
1.2lit in males,1.1lit in females.

33.  VITAL CAPACITY(VT):
4.8lit in male,3.1lit in female
 TOTAL LUNG CAPACITY(TLC):
 INSPIRATORY CAPACITY(IC):
IC=IVR+TV
 FUNCTIONAL RESIDUAL CAPACITY:
FRC=RV+ERV

34.  TRANSPORT OF OXYGEN (O2):
It depends primarily on the amount of
Hb in the RBCs.
METHODS BY WHICH O2 IS CARRIED BY
THE BLOOD
About 97% of the O2 transported from
the lungs to the tissues is by chemical
combination with Hb of RBCs.

35.  The rest 3% is carried in the
dissolved state in plasma.

36.  DEVELOPMENTAL FACTORS:
At birth, fluid filled lungs drains first
and PCO2 rises.
This causes the neonate to take first
breath.
Lungs are gradually expanded till 2weeks
of age.
Change in aging that effect respiratory
system of elders, due to infection physical
or emotional stress.

37.  PHYSIOLOGICAL FACTORES:
 BEHAVIROL FACTORE:
 LIFE STYLE FACTORE:
 ENVIORNMENTAL FACTORE:
 MEDICATION:

38. 3. Inability of the tissue to
extract oxygen from the
blood
4. Decreased diffusion
of oxygen from the
alveoli to the blood

39. 5. Poor tissue perfusion with
oxygenated blood
6. Impaired ventilation

40. TYPES
OF
HYPOXIA

41. Due to reduced oxygen tension in
arterial blood (supply problem)
Causes:-
Low o2 tension in the inhaled air.
Leaking mask, inadequate o2 regulator function
Impaired gas exchange in the lungs e.g. CHRONIC
BRONCHITIS & EMPHYSEMA
Gross ventilation/perfusion mismatch, as occur in
high G forces

42.  DUE TO DECREASED OXYGEN O2 CARRYING CAPACITY OF THE
BLOOD (Transport Problem)
CO poisoning chemicals/ drugs
hemorrhage/ hemolysis Anemia

43. OCCURS WHEN BLOOD CIRCULATION THROUGH
TISSUE IS REDUCED (Distribution Problem)
Causes:-
 High G forces
 Syncope (fainting)
 Heart failure
 Shock

44. DUE TO INABILITY OF THE TISSUES TO MAKE
USE OF THE OXYGEN SUPPLIED TO THEM
(Utilization Problem)
EXAMPLE:
 CYANIDE POISONING
 ALCOHOL & BARBITURATE
 OXYGEN TOXICITY

45. PATHOPHYSIOLOGY

46. ANXIETYAND
TIRED
HEADACHE,
DIZZINESS,
IRRITABILITY AND
MEMORY LOSS

47. NAUSEA
VOMITTING
OLIGURIA /
ANURIA
VISUAL
IMPAIREMENT

48.  Clubbing of finger
 Impairment in
judgement
 Shortness of breath

49. 1. History Collection 2. Physical
Examination

50. 3. Pulmonary
function test
4. Arterial blood
gas analysis

51. 5. SPUTUM STUDIES 6. CHEST X- RAY
AND CT- SCAN
7. BRONCHOSCOPY

52. 8. Thoracentesis 9. Spirometry
10. Pulse Oxymetry 11. Pulmonary
Angiography

53. 1. POSITIONING
2. BREATHING EXERCISES

54. 3. NEBULIZATION
4. CHEST PHYSIOTHERAPY

55. 5. SUCTIONING
6. OXYGEN THERAPY

56.  Nasal canula
 Face mask
 Non breather mask
 Venture mask
 Face tent
 Transtracheal oxygenation

57.  Check the identification data of
the patient.
 Confirm diagnosis and the need
of oxygenation.
 Assess the patient for any sign
of clinical anoxia.

58.  Monitor for result of ABG.
 Oxygen should be monitored
for toxicity.
 Check that oxygen is properly
humidified.
 Precaution to be taken to
prevent infection.

59.  Discontinue oxygen therapy
gradually.
 Place a calling bell near patient
for emergency.
 Since oxygen supports
combustion, fire precautions to
be taken during oxygen therapy.
 Do proper documentation
including rate of flow of oxygen.

60.  Infection
 Combustion
 Drying of mucous membrane
of respiratory tract.
 Oxygen toxicity

61.  Atelectasis
 Oxygen induced apnea
 Ulceration, edema and
visual impairment
 Asphyxia

62.  It is a positive pressure or
negative pressure breathing
device that can maintain
ventilation and oxygen
delivery for prolonged period.

63.  Positive pressure ventilation
 Negative pressure
ventilation

64. MODES OF
VENTILATOR

65.  Continuous mandatory volume (CMV)
 Assist control ventilation (ACV)
 Pressure support ventilation (PSV)
 Intermittent mandatory ventilation (IMV)
 Continuous positive airway pressure
(CPAP)
 Synchronized intermittent mandatory
ventilation (SIMV)
 Positive end expiratory pressure (PEEP)
MODES OF VENTILATOR

66. Continuous mandatory volume is a mode
of mechanical ventilation where breaths
are delivered based on set variables and
makes no effort to sense patient effort

67. When the patient triggers the ventilator,
he/she receives a breaths of identical
duration and magnitude as the
mandatory breath.

68. The ventilator only provides support of
each breath to a preset amount of pressure,
thus the volume breathed can differ from
breath to breath taken.

69. It refers to any mode where a regular series of
breaths are scheduled but the ventilator
senses patient effort and reschedules
mandatory breaths based on the calculated
need of the patient.

70.  The ventilator adjunct is used with only
spontaneous ventilation; the patient breaths
spontaneously through the ventilator at an
elevated baseline pressure through the
breathing cycle.

71.  It facilitate the liberation from mechanical
ventilation.
 A demand valve is placed in it, so that
patient could take spontaneous breaths
without taking breath through apparatus of
the ventilator.

72.  PEEP is the alveolar pressure above
atmospheric pressure that exist at the end of
expiration
These are of two types
 Extrinsic PEEP
 Intrinsic PEEP

74. 1) Impaired gas exchange related
to broncho- construction and
inflammation of airways.

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

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

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

78. Abstract
It was recently established that supplemental oxygen
administration significantly enhances memory formation in healthy
young adults. In the present study, a double-blind, placebo-
controlled design was employed to assess the cognitive and
physiological effects of subjects' inspiration of oxygen or air
(control) prior to undergoing simple memory and reaction-time
tasks. Arterial blood oxygen saturation and heart rate were
monitored during each of six phases of the experiment,
corresponding to baseline, gas inhalation, word presentation,
reaction time, distractor and word recall, respectively.
The results confirm that oxygen administration significantly
enhances cognitive performance above that seen in the air
inhalation condition. Subjects who received oxygen recalled more
words and had faster reaction times.

79.  Text book of anatomy and physiology
Author-Ashalata
2nd
edition
page no 368-770
 Text book of advance nursing
practice
Author-Shabeer Basheer
1ST
edition
page no 198-208

80.  Text book of medical surgical nursing
Author-Suzanne c and Brenda Bare
11th
edition
page no 723-745
 Book of medical surgical nursing
Author-Usha Nair
page no 965-966
 Medical surgical nursing
Shafer’s
7th
edition
page no 358-359