Fundamentals - Practice & Skills, part 26: Hypoxemia, Hypoxia, Techniques to Improve Oxygenation
by Meris Shuwarger BSN, RN, CEN, TCRN August 20, 2021 Updated: August 09, 2023 4 min read
Hi. I'm Meris, and in this video, we're going to be talking about hypoxemia, hypoxia, and techniques to improve oxygenation. I'm going to be following along with our Fundamentals of Nursing flashcards. These are available on our website, leveluprn.com. And if you already have a set of your own and you want to follow along with me, I'm starting on card number 130. Let's get started. So first up, a quick review of some terms. This is going to be on card 130. Ventilation. Ventilation is moving air in and out of the alveoli or in and out of the lungs. Diffusion is the exchange of gases, carbon dioxide and oxygen, from the alveoli to the capillaries, the intravascular space. And perfusion is the exchange of gases, carbon dioxide and oxygen, between the blood and the tissues. So first, I ventilate, then I diffuse, and then I perfuse.
So moving on to card 131. Really important stuff here. And look, there is so much red and bold text here. That means this is an incredibly important card. I would say this is maybe one of the most important cards in the deck just because this is so fundamentally important to all of nursing practice and so many different disorders that we cover. So hypoxemia. What is hypoxemia? So hypo-, meaning low, and then ox, meaning oxygen, and -emia, meaning blood, so low oxygen in the blood. So this means specifically in the arterial blood. And key point here is that you have to have an arterial blood gas, an ABG, to diagnose hypoxemia. Definitely check out the lab values and ABG interpretation deck for more on that.
Now, hypoxia is a word that is sometimes used interchangeably in clinical practice, but it has a different meaning. It means decreased oxygen in the tissues. So decreased oxygenation at the tissue level. This is not good, right? If we have hypoxia, generalized symptoms of oxygen deficiency, it's really, really not good. We do have some early versus late signs here. And I just want to point out the most important ones. Early signs of decreased oxygenation are going to be restlessness, irritability, or anxiety. Think about if I made you breathe through a straw. Before you develop any other symptoms, you're going to panic, right? You're going to feel restless and anxious because you're not oxygenating properly. Now, late symptoms would be a change in level of consciousness, cyanosis, anything like that. We've gone way past the early stages into late stages.
Oxygen toxicity is also possible. Now, I'm not going to get oxygen toxicity just breathing at atmospheric pressure, normal air around me, but this is going to happen when I receive above-normal percentages of oxygen. So when does this happen? It's mainly going to be with your patients who are receiving 100% oxygen or high levels of oxygen, such as with oxygen therapy or ventilation. So these patients need to be-- you need to be thinking about oxygen toxicity with these patients. Important key point for this is that you should use the lowest flow rate, meaning the fewest number of liters per minute as is clinically appropriate for your patients to avoid putting them at risk for oxygen toxicity.
Okay. So last card we're going to talk about - I'm going to say that this goes with the other as one of the most important cards in the deck just as it relates to nursing practice - techniques to improve oxygenation. I would say learn it, love it, get a necklace that says it. Everything on this card you've got to know, and you need to know it forever. So deep breathing, coughing, positioning, incentive spirometry, all of those are going to be techniques to increase oxygenation. Quick question. Pause it after I ask you. What is the best position to improve oxygenation in a conscious patient? Pause and think about it. All right. I hope you said High Fowler's. High Fowler's position, which we talked about in an earlier video, is the best to improve oxygenation in a patient who is alert and oriented and otherwise doing okay. However, prone positioning can be useful in inflating the posterior lower lobes of the lung in a patient who's really sick with ARDS. So deep breathing and coughing exercises, you want to educate your patients to do those frequently. What are we trying to prevent there? Think about it. We're trying to prevent atelectasis, right? We're trying to inflate those alveoli and also use the respiratory pump to get blood moving from our extremities back to the heart to prevent DVT.
Incentive spirometry. We have a lot on here, so I want to point it out. Incentive spirometry. That's using a device called an incentive spirometer, and it's going to help to inflate the lungs through deep breathing, but it's controlled deep-breathing exercises. Important patient teaching would be that you breathe in. Don't blow; breathe in. So it's an incentive spirometer, so you breathe in. That's our cool chicken hint there. Super-duper important. And we want our patients to use this about 10 times an hour every hour that they're awake. They don't need to wake up to do this, but it is important that while they are awake, they be using the incentive spirometer. You'll hear a lot of the time that nurses will tell their patients to use it during the commercial breaks if they're watching TV.
Okay. So that is it for hypoxemia, hypoxia, and techniques to improve oxygenation. I hope you liked it. If you did, please go ahead and like this video so that I know. If you have a great way to remember something, I want to hear it, so please leave it in the comments below. And be sure to subscribe to the channel because we have great stuff coming your way very soon. The next video in this series is going to be on oxygen delivery devices, oxygenation interventions, and suctioning. I hope to see you there. Thanks so much, and happy studying.
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