Oxygen & Inhalation Therapy - PEDI

Define Oxygen (3)

• Maintains adequate cellular oxygenation

• Treats acute & chronic respiratory problems (hypoxemia, cystic fibrosis, asthma)

• Delivered via variety of methods

Pulse Oximetry (5)

• Monitors effectiveness of inhalation therapies

• Measure SaO2 of blood (O2 sat)

• Site must be dry & have adequate circulation, remove polish or earrings (earlobes)

• Be sure arm is supported if finger is used

• Assess probe every 4-8 hrs for continuous pulse ox

If SaO2 is Less than Expected Range (5)

• Confirm probe is placed properly with LED on top of nail

• Assess fingers - Nail polish, cold fingers

• Confirm O2 device is function, it is at the prescribed rate or increase as prescribed

• Place in SF’s or HF’s

• Deep breathing

Pulse Ox - Expected Range (3)

• 95-100%

• Acceptable levels can range from 91% to 100%

• Some illnesses can allow for a SaO₂ of 85% to 89%.

Define Nebulized Aerosol Therapy (2)

• Nebulization breaks up medications into minute particles that are dispersed throughout the respiratory tract

• Droplets much finer than those created by inhalers.

Nebulizer Considerations (4)

• Treatment takes 10-15 minutes

• Determine if mouthpeice, mask, or blow-by should be used

• Preprocedure assessment - Vitals & O2 sat

• Can be administered while parent holds child

Define Metered-Dose Inhaler & Dry Powder Inhaler

Handheld devices that allow children to self-administer on an intermittent basis.

Instructions for Use of MDI (9)

1. Remove cap & shake 5-6 times

2. Attach spacer - Ensures proper inhalation of all medication

3. Open Mouth Method - Hold 3-4 inches away from mouth

4. Closed Mouth Method - Form seal with mouth around MDI

5. Take a deep breath & exhale, then press inhaler

6. Slow deep breath for 3-5 seconds

7. Hold breath for 5-10 seconds & exhale through nose

8. Additional Puffs - Wait 1 minute between puffs

9. Rinse mouth out after use to prevent oral thrush

Define Chest Physiotherapy (3)

• Set of techniques that includes manual or mechanical percussion, vibration, cough, forceful expiration (or huffing), & breathing exercises

• Gravity & positioning loosen respiratory secretions & move them into the central airways, where they can be eliminated by coughing/suctioning

• Rid excessive secretions from specific areas of the lungs.

Chest Physiotherapy Indications

Client presents with thick secretions & inability to clear airway

Chest Physiotherapy - Preprocedure (2)

• Schedule treatments before meals or at least 1 hr after meals & at bedtime to decrease likelihood of vomiting or aspirating.

• Administer a bronchodilator medication or nebulizer treatment prior to postural drainage

Chest Physiotherapy - Postprocedure

• Perform lung auscultation & assess amount, color, & character of expectorated secretions.

Define Oxygen Therapy

• Increases the oxygen concentration of air that is being breathed.

• Delivered via nasal cannula, face mask, face tent, CPAP, BiPAP, tent, hood, or mechanical ventilator

Indications fo Oxygen Use

Hypoxemia

Low oxygen in the blood

Hypovolemia, hypoventilation & interruption of arterial flow can lead to hypoxemia.

Early Manifestations of Hypoxemia (5)

• Tachypnea

• Tachycardia

• Restlessness

• Pallor of skin & mucous membranes

• Evidence of respiratory distress (use of accessory muscles, nasal flaring, tracheal tugging, adventitious lung sounds)

Late Manifestations of Hypoxemia (4)

• Confusion & stupor

• Cyanosis of skin & mucous membranes

• Bradypnea & bradycardia

• Hypotension or hypertension

Oxygen Delivery Systems - Oxygen Hood (3)

• Small plastic hood fits over infants head

• Ensure neck, chin, or shoulders do not rub against hood

• Pulse ox for continuous SaO₂ monitoring.

Oxygen Delivery Systems - Nasal Cannula (6)

• Flow rate - 1 to 6/ 4 to 5 LPM

• FiO2 - 24 - 44%

• Assess patency of nares & proper fit of prongs

• Monitor for skin breakdown & dry mucous membranes (water-soluble gel if dry)

• Humidify at flow rates > 4 LPM

• Monitor child frequently as prongs become easily dislodged

Oxygen Delivery Systems - Pediatric Face Mask (3)

• Short term therapy

• Flow rate - 5-10 LPM (minimizes CO2 rebreathing)

• Used for high O2 flow rate for children who are mouth breathers

Nursing Care - Oxygen Delivery (8)

• Provide oxygen therapy at the lowest liter flow that corrects hypoxemia (Important)

• Assess/monitor lung sounds, RR, rhythm & effort

• Do not allow O2 to directly blow on infants face

• Monitor child’s temp closely in oxygen tent for hypothermia

• Provide oral hygiene as needed.

• Promote turning, coughing, deep breathing, and use of incentive spirometry and suctioning.

• Titrate oxygen to maintain the prescribed oxygen saturation.

• Discontinue oxygen gradually.

Define Oxygen Toxicity

Results from high concentrations of oxygen, long duration of oxygen therapy, & child’s degree of lung disease.

Oxygen Toxicity S/S (8)

1. Nonproductive cough

2. Substernal pain

3. Nasal stuffiness

4. N&V

5. Fatigue

6. Headache

7. Sore throat

8. Hypoventilation

Nursing Actions - Oxygen Toxicity (4)

• Use lowest level of oxygen necessary to maintain an adequate SaO₂.

• Monitor ABGs and notify HCP if PaCO₂ levels rise outside of expected range.

• Continuous pulse ox​​​​​​​

• Decrease oxygen flow rate gradually.

Define Suctioning

Accomplished orally, nasally, endotracheally, or through a tracheostomy tube.

To remove mucus plugs & excess secretions

Clean technique

Endotracheal & Tracheal Suctioning - Preprocedure (3)

• Perform through a tracheostomy or endotracheal tube.

• Hyperoxygenate & hyperventilate child using a bag-valve-mask resuscitator or specialized ventilator function with an FiO₂ of 100%.

• Obtain baseline breath sounds & vitals (spO₂) & monitor continually during procedure.

Endotracheal & Tracheal Suctioning - Intraprocedure (4)

• Surgical aseptic technique

• Ongoing assessment of oxygen status

• Limit suction time to < 5 seconds for infants & < 10 seconds for children.

• Allow child to rest 30-60 seconds after each aspiration for oxygen saturation to return to normal.

Define Tracheotomy - Artificial Airways (2)

• Sterile surgical incision into trachea through skin & muscles to establish an airway.

• Performed as an emergency procedure for epiglottitis, croup, or foreign-body aspiration, or scheduled procedure.

Define Tracheostomy - Artificial Airway (3)

• Stoma/opening that results from a tracheotomy to provide & secure a patent airway.

• Permanent or temporary.

• Artificial airways can be placed orotracheally, nasotracheally, or through a tracheostomy to assist with respiration.

Artificial Airway - Considerations

• Oxygenation, ventilation (RR, effort, SaO₂), & vitals hourly

• Assess stoma & skin for S/S of inflammation or infection (redness, swelling, drainage)

Artificial Airway - Discharge Teaching

Teach on tracheostomy care

Assess skin at tracheostomy site for drainage or breakdown & clean with soap & water

Report s/s of infection or copious secretions asap

Provide written material to reinforce instructions