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Oxygen Therapy

Physiological Factors affecting Oxygenation Cardiac: S1-mitral:tricuspid. S2-aortic & pulmonic. Respiratory: Decreased oxygen-carrying capacity (hemoglobin carries 99% of O2 to tissues). Decreased inspired O2 concentration.
Hypovolemia Reduced circulating blood volume. Decrease in blood volume.
Increased metabolic rate Increases O2 demand. Ex. Infection, exercise.
Conditions affecting chest wall movement Obesity and pregnancy, musculoskeletal abnormalities- reduce oxygenation e.g. kyphosis, lordosis, or scoliosis. Trauma- multiple rib fractures. Neuromuscular disease- Myasthenia gravis, or gullian-Barre syndrome. CNS alterations: cervical/spinal damage
Myasthenia Gravis Autoimmune condition. Fluctuating muscle weakness. Shown in eyes, face, talking, swallowing, breathing.
Gullian-Barre Syndrome Acute inflammatory response. Post op. Starts at bottom of body, works its way up. Paralysis.
Pulmonary Function Diagnostic Study assess how well lungs take in and release air. The severity of a disease.
ABGs Arterial Blood Gases. Precise information about blood levels. Ex. O2, CO2, and Ph
Oximetry Noninvasive approximation of oxygen. No nail polish
Bronchoscopy direct picture of airway. Monitor pt's gag reflex post op
Thoracentesis needle inserted into chest wall into pleural cavity. Remove fluid to test or remove excess fluid. Monitor for bleeding and lung function
Sputum cultures Pt needs to cough up sputum from lungs to test, or insert suction into nose to lungs to get specimen
Sputum Assessment Normal- clear, white, no odor. Asthma- stringy like hardened egg white. Pulmonary edema (fluid in lungs)- frothy, pink. Infection- green or yellow, musty odor. Hemoptysis- bloody, red mucous.
Hypoxemia A deficiency of arterial blood oxygen
Hypoxia Insufficient oxygen to meet metabolic demands of tissues and cells. RESULTS from hypoxemia.
Cyanosis The bluish discoloration of skin and mucous membranes. A LATE sign of hypoxia.
Acute signs and symptoms of Hypoxia Apprehension, anxiety, decreased level of consciousness, decreased lung sounds, increased pulse rate, increased rate of depth of respiration, increased BP, dyspnea, use of accessory muscles for breathing, cardiac dysrhythmias.
Insidious signs and symptoms of Hypoxia Pallor, increased fatigue, decreased ability to concentrate, dizziness, behavioral changes, cyanosis, clubbing, adventitious lung sounds.
Nursing Diagnosis Ineffective airway clearance, ineffective breathing pattern, ineffective tissue perfusion, decreased cardiac output, impaired gas exchange, impaired spontaneous ventilation, activity intolerance, risk for infection, fear, anxiety, impaired communication
Nursing interventions for altered respiratory function Oxygen therapy, aerosol therapy, hand held nebulizer, cough and deep breathe, incentive spirometry, chest tube and trach care, BiPAP and CPAP
Oxygen Safety Guidelines The level of oxygen is determined by a physician's order. "Oxygen in use" sign should be posted on outside entrances of home. System should be kept at least 10 feet away from any open flame. Oxygen supports combustion (fuel for fire)- will not explode
Oxygen Safety Guidelines cont No one should be smoking when there is O2 in use. Oxygen tanks should be stored up right and secured so they do not fall. Limit the use of electrical equipment. No use of wool blankets. Check regulator & flowmeters for accuracy before initiating treatment
Oxygen for COPD Pts Only administer low dose oxygen. 2-3 Ls. Take away their drive to breathe.
Low flow oxygen system Provides only part of the total inspired air. More comfortable. O2 delivery varies with breathing pattern.
High flow oxygen system Provides total inspired air. O2 delivery does not vary with breathing pattern.
Flowmeter Attaches to the O2 outlet to adjust the amount of O2 being delivered. Always know your pts meter is set at: check each time you enter the room
Humidifier Container of sterile water which provides moisture to the oxygen. Sterile water prevents infection. Moisture prevents drying, cracking, and bleeding of nasal mucosa
Nasal Cannula Most common method of delivery. Effective, easy to apply, most comfortable, can be used with mouth breathers. Clients can eat, talk, drink, talk, and perform ADL's with NC in place. 1-6 L/minutes. 24-44% O2
Nasal Cannula considerations An excess of 6L/min does not increase oxygen delivery. Tends to dry out mucous membranes. Skin breakdown possible: nares and ears. Usually used in flow rates of 2-3 L/min. Check adequacy with pulse oximeter.
Simple Face Mask Covers the mouth and nose. Provides the most consistent effective delivery of O2. Interferes with talking, eating and drinking. May cause claustrophobic reaction. Not suitable for COPD pts. 40-60%. 6-10L/min
Non-rebreather (reservoir) mask High flow system with a bag attached to the bottom of the mask. Delivers 80-90% 02 10-15L/min. High concentration oxygen supply flows into reservoir bag. Has a valve that largely prevents the inhalation of room or exhaled air.
Rebreather High flow system with a bag attached to the bottom of the mask. Similar to non-rebreather except has a two-way valve between mask and reservoir bag allowing pt to rebreathe exhaled air. Up to 70% O2 concentration. Contraindicated for CO2 retaining clients
Venturi High flow system. Delivers 24-50% oxygen. 3-8L/min. The oxygen mixes with the air. Clients receive constant O2 concentration regardless of rate or depth of respirations.
Respirator Mechanical ventilation. Used to breathe for a client unable to breathe independently.
Ambu bag Used during CPR until a client is placed on a respirator. Used prior to and after suctioning. May provide temporary artificial ventilation during transport. May be attached to an O2 source.
Artificial Airways Oral and nasal.
Bilevel Positive Airway Pressure Mechanical ventilator to assist aspiration. Pushes air into lungs. Positive pressure helps to prevent atelectasis. Client's inspiratory effort triggers the ventilator.
Continuous Positive Airway Pressure Oxygen under constant pressure. Used at night to decrease periodic hypoxemia. For clients with sleep apnea.
Endotracheal (ET) tubes Placed down the throat of a client to deliver oxygen directly to the lungs. Intubation.
Tracheostomy Opening into the tracheal through which oxygen can be delivered. Used when the upper airway is blocked due to trauma or illness.
Deep breathing exercises Serves to fully expand the alveoli and mobilize the removal of secretions. Position client for maximum lung expansion. Client inhales slowly and then exhale twice as long. Watch for chest and ABD expansion. Repeat for 10 breaths.
Incentive Spirometry Encourages deep breathing. Measures inspiratory volume. Encourage client to breath in deeply. Should be used ten times an hour.
Monitoring Oxygen Therapy Pulse Ox: Noninvasive. % of hemoglobin carrying O2 to peripheral tissues. 92-100%. Used to titrate O2. ABGs: pH 7.35-7.45. CO2 35-45. HCO3 22-26
Chest Tubes Drain fluid, air, or blood. Placed in pleural cavity Painful Used to restore the negative pressure in lungs Water seal in collection device to prevent air from entering during inspiration. Nurse needs to maintain site & monitor fluid in drainage container
Created by: senmark