Oxygen

Early signs of hypoxia

• restless, anxiety, confusion

• tachypnea

• tachycardia

• pallor

• use of accessory muscles, nasal flaring

• elevated BP

• adventitious lung sounds

Late signs of hypoxia

• stupor

• bradypnea

• bradycardia

• cyanosis

• cardiac dysrhythmias

• hypotension

• clubbing

hypoxemia

low oxygen in blood

hypoxia

oxygen deficiency in tissues and body

When do you use pulse oximetry

• increased WOB

• Wheezing, coughing

• cyanosis

• Changes in respiratory pattern/rhythm

• adventitious breath sounds

• restlessness, irritability, confusion

When may pulse ox not be accurate

• hypothermia

• poor peripheral flow

• too much light

• low hemoglobin levels

• jaundice

• movement

• edema

• NAIL POLISH

what should you do if pulse ox is low

• confirm probe placement

• confirm that oxygen delivery device is functioning

• place client in semi fowlers or fowlers

• encourage deep breathing

• remain with client and provide emotional support

chest PT

uses percussion and vibration to loosen secretions

positioning for chest PT

prone

what position after chest pt

high fowlers to drain secretions

when should you do chest pt

1 hour after meals or inhaled medication administration

orthopnea

difficulty breathing when lying down

paroxysmal nocturnal dyspnea

waking up due to shortness of breath

yellow/green sputum

infection

rust color

pneumonia

pink/frothy

pulmonary edema

what to do if tracheostomy is dislodged within 72 hours of placement

ventilate pt with bag-valve-mask and get help

what to do if tracheostomy is dislodged after 72 hours of placement

1. hyperextend the neck with obturator in place

2. reinsert tube and then assess for breath sounds to ensure placement

What do you keep at bedside for tracheostomy patient

• 2 extra tracheostomy tubes: one client’s size and one smaller

• obturator

• oxygen source

• suction

• bag-ventilate-mask

how often do you do oral care for trach patient

every 2 hours

how often do you do tracheostomy care

every 8 hours

cuffed tracheostomy

• mechanical ventilation

• prevents aspiration of oropharyngeal secretions

• does not hold tube in place

• airflow goes in and bypasses focal cords: so no speech

uncuffed trach

• client has long term airway needs

• must be at low risk for aspiration

• can breathe around tube

• can be off mechanical ventilation

• can use a speech valve

oropharyngeal and nasopharyngeal suction

used when the patient can cough effectively but is not able to clear secretions

orotracheal and nasotracheal

used when the pt is unable to manage secretions by coughing and does not have an artificial airway

Why may a patient have a tracheostomy in place

• acute or chronic airway obstruction

• edema

• anaphylaxis

• head/neck injury

• copious secretions

• long term ventilation

• reconstruction after laryngeal trauma/cancer

A 17 year old patient with exercise induced asthma who arrives at the emergency
department with audible wheezing, RR of 28, and an O2 sat of 84% on room air:

Nonrebreather mask

83 year old with history of COD with 02 stat of 91 and states breathing feels like normal

none

a 72 year old with pneumonia who reports feeling a little winded after ambulating back from bathroom. RR 26 and 02 sat is 90

nasal canula

32 year old patient who became unresponsive after reportedly taking drugs. Weak pulse, RR is 6 and o2 is 70

bag-ventile-mask

Nasal cannula L and fio2

1-6L 24-44%

Simple face mask L and fio2

5-10L 35-60 or 40-60%

Venturi mask L and fio2

4-8L 24-35%, or 4-12L 24-60%

Nonrebreather mask L and fio2

10-15L, 80-95%

Partial rebreather L and fio2

4-12L, 24-50%

nasal cannula

• most common

• minor breathing issues

• causes cracks in mucosa

• skin irritation

• doesn’t cover mouth: can eat and talk

Simple face mask

• moderate flow

• used for short periods of time

• goes over nose and mouth: can’t eat and talk

• claustrophobia

• Consistent flow rate and stays secure

Partial rebreather

• allows some exhaled air to return to bag

• high level of oxygen but doesn’t help patient breathe

• Oxygen therapy in patients who need high concentrations of oxygen but can still breathe on their own

• some expired air can get back in

nonrebreather

• high flow rate and high concentration

• reservoir bag is inflated 2/3 with pure oxygen

• exhaled air is not rebreathed

Venturi mask

• delivers oxygen concentrations for critically ill patients

• most accurate

Oropharyngeal and nasopharyngeal suction

used when patient can cough effectively but is not able to clear secretions

Orotracheal and nasotracheal suction

used when pt is unable to manage secretions by coughing and does not have an artificial airway