Chapter 41: Oxygenation and Respiratory Care

Oxygenation and Respiratory Care begins by establishing the scientific knowledge base regarding ventilation, perfusion, and diffusion, explaining how gases move in and out of the lungs and across the alveolar-capillary membrane. The text analyzes the critical relationship between cardiac output, stroke volume, preload, afterload, and myocardial contractility in delivering oxygenated blood to body tissues. Significant attention is given to factors affecting oxygenation, including physiological variables like anemia and hypovolemia, developmental stages from infancy to geriatrics, lifestyle choices such as smoking and nutrition, and environmental pollutants. The chapter categorizes alterations in respiratory functioning, specifically hypoventilation, hyperventilation, and hypoxia, alongside cardiac alterations including conduction disturbances, impaired valvular function, myocardial ischemia (angina and myocardial infarction), and heart failure. The nursing process serves as the framework for care, emphasizing assessment techniques that include physical examination, pulse oximetry, capnography, and diagnostic testing such as pulmonary function tests and thoracentesis. Clinical judgment is applied to identify nursing diagnoses such as Impaired Gas Exchange and Ineffective Airway Clearance. A major portion of the chapter is dedicated to evidence-based interventions for promoting lung expansion and airway maintenance. These interventions include hydration, humidification, nebulization, and specific coughing techniques like the huff, cascade, and quad coughs. The text details chest physiotherapy methods including postural drainage, percussion, and vibration to mobilize secretions. It further explores complex nursing skills such as suctioning via oropharyngeal, nasotracheal, and artificial airway routes, as well as the management of artificial airways including endotracheal and tracheostomy tubes. The chapter outlines the use of noninvasive ventilation strategies like CPAP and BiPAP, the management of chest tubes for pneumothorax and hemothorax, and the administration of oxygen therapy using various delivery devices from nasal cannulas to Venturi masks. Finally, it covers restorative care through breathing exercises like pursed-lip and diaphragmatic breathing, home oxygen safety, and emergency cardiopulmonary resuscitation.