Oxygenation & Perfusion – Nursing Student Notes

Learning Outcomes (What you should be able to do)

●​ Explain respiratory and cardiovascular anatomy & physiology.

●​ Describe how both systems work together for oxygenation.
●​ Identify factors affecting respiratory & cardiovascular function.
●​ Perform a cardiopulmonary assessment (interview + physical exam).
●​ Identify actual and potential nursing diagnoses related to oxygenation/perfusion.
●​ Describe nursing interventions, strategies, and rationales.
●​ Plan, implement, and evaluate nursing care for oxygenation/perfusion problems.

Big Picture: Oxygenation

●​ Life depends on oxygen.

●​ Oxygenation = delivering oxygen to body cells and removing carbon dioxide.
●​ Requires a functioning cardiopulmonary system:
○​ Respiratory system → brings oxygen into lungs.
○​ Cardiovascular system → transports oxygen to tissues.

Respiratory System- Functions

●​ Move air in and out of lungs (ventilation)

●​ Exchange gases (respiration)
●​ Regulate oxygen, carbon dioxide, and acid–base balance

Anatomy of the Airway

Upper Airway (warms, filters, humidifies air)

●​ Nose ●​ Larynx
●​ Pharynx ●​ Epiglottis

Lower Airway (Tracheobronchial Tree)

●​ Trachea ●​ Segmental bronchi

●​ Right & left main bronchi ●​ Terminal bronchioles

Key functions:

●​ Air conduction
●​ Mucociliary clearance
●​ Surfactant production
Mucociliary System

●​ Mucus traps dust, microbes, debris

●​ Cilia move mucus upward to be coughed out
●​ Adequate hydration keeps mucus thin

Lungs & Alveoli

●​ Lungs sit in the thoracic cavity

●​ Right lung: 3 lobes | Left lung: 2 lobes
●​ Alveoli = site of gas exchange
●​ ~300 million alveoli
●​ Thin walls allow easy diffusion

Surfactant

●​ Detergent-like substance
●​ Prevents alveolar collapse
●​ ↓ Surfactant → stiff lungs, atelectasis

Pleura

●​ Visceral pleura: covers lungs

●​ Parietal pleura: lines chest wall
●​ Pleural fluid:
○​ Lubricates lungs
○​ Helps keep lungs expanded
●​ Negative intrapleural pressure keeps lungs inflated

Gas Exchange Concepts

●​ Pulmonary ventilation: air movement in/out

●​ Respiration: gas exchange in alveoli
●​ Perfusion: blood flow through lungs & tissues

Pulmonary Ventilation (Breathing)

Inspiration (Active)
●​ Chest volume ↑ → pressure ↓ → air
●​ Diaphragm contracts & moves down flows in
●​ Intercostals lift ribs up & out
Expiration (Passive)

●​ Diaphragm relaxes & moves up

●​ Chest volume ↓ → pressure ↑ → air flows out
Factors Affecting Ventilation
●​ Airway resistance
●​ Muscle strength
●​ Lung compliance (stretchability)
Accessory muscle use = sign of respiratory distress (retractions)

Lung Compliance

●​ Ease of lung inflation

●​ ↓ Compliance = stiff lungs
●​ Seen in:
○​ Emphysema
○​ Aging
○​ ↓ Surfactant

Airway Resistance

●​ Any blockage or narrowing

●​ Causes:
○​ Foreign body ○​ Tumors
○​ Secretions ○​ Bronchoconstriction (asthma
○​ Edema
Respiration (Gas Exchange)

●​ Occurs at alveolar–capillary membrane

●​ Gases move by diffusion
○​ High → low concentration

Oxygen & Carbon Dioxide

●​ CO₂ diffuses from blood → alveoli
●​ O₂ diffuses from alveoli → blood
Factors Affecting Diffusion

●​ Surface area (↓ with lung damage)

●​ Thickness of membrane (↑ in pneumonia, edema)
●​ Partial pressure of gases

Atelectasis

●​ Collapse of alveoli
●​ Prevents gas exchange
●​ Caused by:
○​ Immobility
○​ Obstruction
○​ Compression
Perfusion

●​ Flow of oxygenated blood to tissues

●​ Affected by:
○​ Body areas ↑ ○​ Cardiac
position perfusion) output
(dependent ○​ Activity
level

Regulation of Respiration

●​ Controlled by medulla
●​ Stimulated by:
○​ ↑ CO₂
○​ ↑ H⁺ (acid)
○​ ↓ O₂ (less sensitive)

Receptors

●​ Chemoreceptors (aortic arch, carotid bodies)

●​ Proprioceptors (movement/exercise)

Chronic CO₂ retention → desensitized receptors

Alterations in Respiratory Function

Hypoxia

●​ Inadequate oxygen at cellular level

Signs & Symptoms

●​ Dyspnea ●​ Pallor, cyanosis ●​ Anxiety,

●​ Tachypnea restlessness,
●​ Tachycardia confusion

Chronic Hypoxia Effects

●​ Clubbing
●​ Enlarged heart
●​ Fatigue
●​ Muscle weakness
●​ Cognitive changes
Cardiovascular System

Functions
●​ Remove waste
●​ Transport oxygen ●​ Maintain perfusion
& nutrients
Anatomy

●​ Heart + blood vessels

Heart Chambers

●​ Atria: receive blood ●​ Ventricles: pump blood out

Valves

●​ Tricuspid ●​ Pulmonary
●​ Mitral ●​ Aortic

Blood Vessels

●​ Arteries → arterioles → capillaries

●​ Capillaries = exchange site
●​ Venules → veins → heart

Cardiac Output & Oxygen Transport

Cardiac Output (CO)

●​ CO = Stroke Volume × Heart Rate

●​ Normal adult: 5–6 L/min

Oxygen Transport

●​ 2% dissolved in plasma
●​ 98% carried by hemoglobin

Internal Respiration

●​ Exchange of gases between blood & tissues

Problems affecting oxygen delivery

●​ Hemorrhage
●​ Anemia
●​ ↓ CO
Cardiac Conduction System

●​ SA node = pacemaker
●​ AV node
●​ Bundle of His
●​ Right & left bundle branches
●​ Purkinje fibers

Autonomic Control

●​ Sympathetic: ↑ HR & force

●​ Parasympathetic (vagus): ↓ HR

Coronary Circulation

●​ Right & left coronary arteries

●​ Supply heart muscle
●​ Fill during ventricular relaxation

Alterations in Cardiovascular Function

Dysrhythmias

●​ Abnormal heart rate/rhythm

●​ Causes:
○​ Heart disease
○​ Hypoxia
○​ Drugs

Symptoms: dizziness, palpitations, hypotension, syncope

Myocardial Ischemia

●​ ↓ Oxygen to heart muscle

●​ Common cause: atherosclerosis

Conditions

●​ Stable angina
●​ Myocardial infarction (heart attack)

Heart Failure

●​ Inadequate pumping ability

●​ Symptoms:
○​ Dyspnea ○​ Edema ○​ Fatigue
Nursing Focus (Tie to NCLEX)

●​ Assess airway, breathing, circulation (ABCs)

●​ Monitor oxygenation & perfusion
●​ Identify early signs of hypoxia
●​ Implement oxygen therapy safely
●​ Promote lung expansion & circulation
●​ Evaluate response to interventions

Factors Affecting Cardiopulmonary Functioning

(Easy reading + VERY important clinically)

Big idea

Anything that interferes with air moving, oxygen exchange, or blood flow will affect
oxygenation & perfusion.

Major factors (know these):

●​ Acute & chronic illness​

○​ Heart failure → fluid backs up into lungs → ↓ gas exchange​

○​ Kidney disease → fluid overload → respiratory compromise​

●​ Muscle weakness / wasting​

○​ Weak respiratory muscles → shallow breathing​

○​ ↓ chest expansion → ↓ ventilation​

●​ Anemia​

○​ ↓ hemoglobin → ↓ oxygen delivery​

○​ ↓ CO₂ transport back to lungs​

●​ Myocardial infarction​

○​ Damaged heart muscle → ↓ cardiac output → ↓ tissue perfusion​

●​ Structural problems​

○​ Scoliosis / kyphosis → altered chest expansion​

 ●​ Obesity​

○​ ↑ work of breathing​

○​ ↓ alveolar expansion (especially lung bases)​

○​ ↑ risk for asthma & COPD​

⚠️ Clinical link: Shortness of breath + fatigue ≠ just lungs → think heart, blood, muscles
👵 Focus on the Older Adult (Box on 1595) — TEST GOLD ⭐
Age-related respiratory changes

●​ ↓ lung elasticity​

●​ ↓ diaphragm & chest wall movement​

●​ Airways collapse more easily​

●​ ↓ cough effectiveness​

➡️Higher
Result:​
risk for:

●​ Pneumonia​ ●​ Atelectasis​ ●​ Respiratory

infections

-Age-related cardiac changes

●​ Heart maintains CO at rest​

●​ Limited ability to respond to stress​

●​ ↓ valve elasticity​

●​ ↓ vessel elasticity​

➡️Fatigue,
Result:​
SOB with activity, slower recovery
📘 Table 40-1: Respiratory Variations in the Life Cycle (KNOW THE TRENDS)
You do NOT need to memorize every number, but know the patterns:

Infants

●​ Fast RR (30–60)​

●​ Abdominal breathing​

●​ Small airways → aspiration risk​

●​ ↓ ability to increase CO​

Children

●​ Fewer infections as immunity develops​

●​ Asthma risk ↑ with smoke exposure​

Older Adults

●​ Normal RR but ↓ reserve​

●​ Barrel chest common​

●​ Breath sounds may be diminished​

●​ Slower response to hypoxia​

⚠️ NCLEX LOVES age-related respiratory differences.

💊 Medication Considerations
●​ Opioids & sedatives
○​ Depress respiratory center​ ○​ ↓ RR & depth​

●​ Cardiac meds​

○​ ↓ HR → ↓ CO → ↓ perfusion​

⚠️ Nursing priority: Monitor RR, SpO₂, LOC

📘 Pages 1587–1603
Assessment (READ CAREFULLY – this is core nursing)

Nursing History: What you ask

●​ Exercise tolerance​
●​ Breathing patterns​
●​ Medications​
●​ Smoking / vaping​
●​ Social determinants of health
●​ Environmental exposures​

⚠️ If patient is in distress → treat first, assess later

👀 Physical Assessment (ABCD for lungs & heart)
INSPECTION (LOOK)

●​ Level of consciousness​

●​ Anxiety/restlessness​

●​ Skin color (pallor, cyanosis)​

●​ Chest shape & symmetry​

●​ RR, depth, effort​

●​ Retractions, nasal flaring​

⚠️ Cyanosis = late sign

✋ PALPATION (FEEL)
●​ Chest expansion (should be equal)​

●​ PMI (displaced = heart problem)​

●​ Extremities:
○​ Pulses​ ○​ Cap refill​ ○​ Edema
🎧 AUSCULTATION (LISTEN) — VERY TESTABLE
Lung sounds

●​ Crackles → fluid (HF, pneumonia)​

●​ Wheezes → narrowed airways (asthma, secretions)

Heart sounds

●​ S1 = lub → AV valves close​

●​ S2 = dub → semilunar valves close​

●​ Extra sounds = pathology

🧪 Diagnostics (Know PURPOSE, not numbers)

Pulse Oximetry

●​ Normal: 90–100%​

●​ COPD may be 88–92%​

●​ Late sign of hypoxia​

●​ Doesn’t replace ABGs

ABGs

●​ Measures oxygenation, ventilation, acid–base​

●​ Used in COPD, respiratory failure

ECG

●​ Looks at electrical activity​

●​ Detects ischemia, MI, dysrhythmias​

📘 Diagnosis (1603–1604)
Be attentive to BLUE BOX examples

Common nursing diagnoses:

●​ Ineffective airway clearance​

●​ Impaired gas exchange​

●​ Impaired breathing pattern

Know:

●​ Etiology​

●​ Signs & symptoms

⚠️ Diagnosis = assessment + cause + evidence

🧠 NCLEX / Lab Survival Tips
●​ Always think ABCs​

●​ Hypoxia → mental status changes​

●​ Older adults = subtle symptoms​

●​ Crackles ≠ asthma, wheezes ≠ fluid (don’t mix these up!)

How to write outcomes (THIS is what they want)

Outcomes must be:

●​ Patient-centered​

●​ Measurable​

●​ Time-limited​

●​ Linked to oxygenation/perfusion
Common cardiopulmonary outcomes you can use in an NCP:

●​ Patient will maintain SpO₂ ≥ 92% (or 88–92% if COPD) within ___ hours.​

●​ Patient will demonstrate effective breathing pattern with RR –.​

●​ Patient will verbalize understanding of COPD and medications before discharge.​

●​ Patient will demonstrate correct use of inhaler by end of teaching session.​

●​ Patient will report decreased dyspnea with activity.​

●​ Patient will remain free of respiratory infection during hospitalization.​

👉 Key idea: Outcomes describe what improvement looks like, not what the nurse does.

🟦 PAGES 1604–1618 — IMPLEMENTATION (VERY IMPORTANT)

1️⃣ Health Literacy & COPD (Mr. Romanov scenario) ⭐⭐⭐

What the nurse should do (in SIMPLE language):

●​ Explain COPD as:​

“A long-term breathing problem that makes it harder to move air in and out.”
●​ Connect smoking → worsening symptoms
●​ Reinforce:
○​ Daily ○​ Correct ○​ Smoking
medication inhaler cessation
use​ technique​

3 questions to teach EVERY patient:

1.​ What is my main problem?​

2.​ What do I need to do?​

3.​ Why is it important?​

Additional ways to increase health literacy:

●​ Use teach-back (“Show me how you’ll use the inhaler”)​

●​ Use pictures, demos, short sentences​

●​ Avoid medical jargon​

●​ Repeat key points

If patient has language/learning barriers:

●​ Medical interpreter (NOT family)​

●​ Visual aids​

●​ Demonstration instead of reading​

●​ Audio/video education​

●​ Extra time and repetition

💡Diagnosis:
NCP tie-in:​
Deficient knowledge​
Intervention: Teach COPD basics + inhaler use​
Outcome: Patient verbalizes understanding

2️⃣ Healthy Lifestyle Interventions (HIGH-YIELD)

Nursing actions:

●​ Encourage:
○​ Healthy diet​ ○​ Regular exercise (as
tolerated)​
○​ Weight control​

●​ Smoking cessation​

●​ Limit alcohol​

●​ Monitor BP & cholesterol

👉 These are preventive nursing interventions.

3️⃣ Vaccinations (Know WHO & WHY)

Influenza
●​ High risk: older adults, lung disease
●​ Everyone ≥ 6 months​

Pneumococcal
●​ Smokers​ ●​ Chronic lung
●​ Adults ≥ 65​ disease

COVID-19

●​ Higher risk with COPD​

●​ Vaccination ↓ severe illness​

💡 Exam tip: Vaccines = primary prevention

4️⃣ Pollution-Free Environment

Teach patients to:

●​ Avoid smoke, fumes, pollen​

●​ Stay indoors on high-pollution days​

●​ Use air filters / AC​

●​ Wear mask if needed

⚠️ Smoking = biggest COPD risk factor

5️⃣ Reducing Anxiety (VERY NURSING-FOCUSED)

Nursing actions:

●​ Calm environment​ ●​ Explain procedures​

●​ Stay with patient during dyspnea​ ●​ Encourage slow breathing​

●​ Nonjudgmental communication​

💡 Anxiety ↑ oxygen demand → worsens dyspnea

6️⃣ Nutrition (COPD-SPECIFIC)
Key points:

●​ Small, frequent meals​

●​ High-protein, high-calorie​

●​ Rest before meals​

●​ Eat 1–2 hours after breathing treatments​

●​ Wear oxygen during meals

💡 Eating uses oxygen → fatigue is common

7️⃣ Positioning (TEST FAVORITE)

●​ High-Fowler’s = best for dyspnea​

●​ Avoid slumped position​

●​ Prone positioning:​

○​ Used in ARDS/COVID​

○​ Improves oxygenation​

○​ NOT for facial/spinal injuries

8️⃣ Fluids & Humidification

●​ Fluids: 1.5–2 L/day unless contraindicated​

●​ Keeps secretions thin​

●​ Humidified air:​

○​ Prevents dryness​

○​ Helps mucus clearance​

○​ Clean equipment daily​

9️⃣ Breathing Techniques (KNOW THESE)

Deep breathing
●​ Used post-op & with hypoventilation
●​ Prevents atelectasis​

Incentive spirometry

●​ Encourages slow, deep breaths​

●​ Use 5–10 times every 1–2 hours​

●​ NOT routine for all patients

Pursed-lip breathing ⭐⭐⭐

●​ Prevents airway collapse​
●​ Inhale nose (2)​
●​ Best for COPD & anxiety
●​ Exhale pursed lips (4)​

Diaphragmatic breathing

●​ Belly rises, chest stays still​

●​ Decreases work of breathing

🔟 Oxygen Administration (FOCUS AREAS)

Nasal Cannula ⭐⭐⭐

●​ 1–6 L/min​

●​ 24–44% FiO₂​

●​ Allows eating & talking​

●​ COPD target: 88–92%

Simple Face Mask ⭐⭐⭐

●​ Remove for meals → switch to
●​ 5–8 L/min (minimum 5!)​ cannula​
●​ 40–60% FiO₂​

⚠️⚠️Oxygen is a medication​
Fire risk — no oils, sparks, smoking

🧠 HOW THIS SHOWS UP IN A NURSING CARE PLAN

Example:

Diagnosis: Impaired gas exchange​

Outcome: Patient will maintain SpO₂ ≥ 92% within 24 hrs​
Interventions:

●​ Position in High-Fowler’s​

●​ Teach pursed-lip breathing​

●​ Administer O₂ via nasal cannula​

●​ Encourage fluids​

●​ Monitor SpO₂ & RR

1️⃣ The Concept Map for Tyrone Jacobs

Yes — it DOES outline his plan of care.​

Think of the concept map as a visual nursing care plan (NCP).

What the concept map is doing

It connects:

●​ Assessment data →​

●​ Problems (nursing diagnoses) →​

●​ Interventions →​

●​ Expected outcomes​

How to “decipher” it (this is exam gold ⭐)

Read it from left to right:

1.​ Patient problem

○​ Upper respiratory infection​ ○​ Impaired oxygenation​

○​ Acid–base imbalance
2.​ Assessment cues​

○​ ↑ respiratory rate​

○​ Abnormal ABGs​

○​ Low SpO₂​

○​ Signs of hypoxia (anxiety, dyspnea, tachycardia)

3.​ Nursing diagnoses​

○​ Impaired gas exchange​

○​ Ineffective airway clearance​

○​ Risk for acid–base imbalance

4.​ Interventions​

○​ Oxygen therapy​

○​ Positioning​

○​ Monitor SpO₂ & ABGs​

○​ Encourage coughing/deep breathing​

○​ Administer meds as ordered

5.​ Outcomes​

○​ Improved oxygen saturation​

○​ Normal respiratory rate​

○​ Reduced work of breathing​

○​ Patient comfort & safety​

👉 That is literally the nursing process (ADPIE) in picture form.

If your instructor asks:
 “Does this concept map outline Tyrone’s plan of care?”

Your answer:

Yes. It identifies assessment findings, nursing diagnoses, interventions, and

expected outcomes related to oxygenation and perfusion.

2️⃣ Pages 1632–1636: Skill 40-1 – Pulse Oximetry

This is NOT about memorizing steps word-for-word.

What you must know (high-yield):

●​ Pulse oximetry measures SpO₂​

●​ Normal: 95–100% (unless chronic lung disease)​

●​ Poor readings occur with:

○​ Cold extremities​ ○​ Motion​

○​ Hypotension​ ○​ Poor perfusion​

○​ Nail polish
●​ Always:​

○​ Check pulse & cap refill​

○​ Correlate HR with monitor​

○​ Reassess skin under probe

Delegation 🔑
●​ APs can measure SpO₂​

●​ RN interprets results and acts

3️⃣ Pages 1641–1648: Skills 40-3 & 40-4

Skill 40-3: Nasal Cannula

Know this cold:

●​ Flow rate: 1–6 L/min​

●​ FiO₂: 24–44%​

●​ Used for stable patients

●​ Monitor:
○​ Nares​ ○​ Skin
breakdown​
○​ Ears​

●​ Mouth breathing ❌ does NOT make it ineffective

Skill 40-4: Oxygen by Mask

Includes:

●​ Simple mask ●​ Venturi mask​ ●​ Non-rebreather

Key safety points:

●​ Masks require higher flow rates​ ●​ Remove q2–3 hrs to assess skin​

●​ Reservoir bag must be inflated​ ●​ Eating/talking difficult

👉
If SpO₂ drops:​

👉 Assess first​

👉 Check tubing & flow​

Notify provider if unresolved

4️⃣ Reflective Practice (THIS is not busy work)

Your instructor is testing clinical judgment, not perfection.

You can safely answer reflection questions by tying back to:

●​ Preparation​ ●​ Communication​

●​ Confidence​ ●​ Patient-centered care​

●​ Assessment​
Example sentence you can reuse:

“Through ongoing assessment of oxygen saturation, respiratory effort, and patient

comfort, I was able to recognize changes early and adjust care to promote effective
oxygenation.”

How to study this without burning out 🔥

Tonight:

●​ Focus on concept map flow​

●​ Review:​

○​ Hypoxia signs​

○​ Pulse ox pitfalls​

○​ Oxygen devices + flow rates