oxygen

oxygen

what it is: colorless, odorless, tasteless gas; basic need for life

no oxygen(hypoxia) = cell metabolism slows → cells die → brain damage & death in minutes if breathing stops

oxygen therapy: ordered by health care provider (amount given, device given on, and when given), it helps prevent/relieve hypoxia and must be closely monitored by the nurse, or any licensed specialist

hypoxia signs/symptoms

definition: reduced oxygen content in tissues and cells; cell metabolism slows and cells begin to die

key signs and symptoms:

apprehension, anxiety, restlessness (EARLY!!)

tachycardia, dysrhythmias, increased BP (early); later → bradycardia

dyspnea, increased rate & depth of respirations; later → shallow, slow, apnea

cyanosis, pallor

decreased ability to concentrate, increased loss of consciousness

increased fatigue

digital clubbing (with chronic hypoxia)

vertigo

nursing interventions for hypoxia and positioning

position: high-fowlers or semi-fowlers

orthopneic position = difficultly breathing patients

apply oxygen as ordered, check device and flow rate

encourage deep breathing and coughing; use incentive spirometer if ordered

monitor pulse oximeter, respirations, lung sounds, and mental status

suction if needed to clear airway (trach/oral/nasopharyngeal)

abnormal respiratory patterns

tachypnea: RR > 20/min – EARLY sign of hypoxia

bradypnea: RR < 12/min – LATE sign of hypoxia

apnea: no breathing – code blue!

hypoventilation: slow, shallow, sometimes irregular respirations

hyperventilation: rapid, deeper than normal respirations

dyspnea: difficult, labored, or painful breathing

cheyne-stokes: gradual increase rate & depth → then become shallow & slow → period of apnea (10–20 sec)

orthopnea: difficulty breathing when lying flat

kussmaul’s respirations: very deep and rapid; often seen with metabolic acidosis

cyanosis: bluish discoloration due to low oxygen

thick secretions: nursing interventions and prevention

ensure adequate hydration = non caffeinated, low sugar, avoid dairy excess

humidify oxygen to prevent drying and thin mucus; only use distilled water and fill every 24 hours

encourage cough deep breath

use incentive spirometer

ambulte/sit the patient out of bed and elevate head of bed

suction (nasopharyngeal,trach,oral) as needed using sterile technique for invasive suctioning

use bronchodilators/steroids as ordered = COPD or asthma

pulse oximetry

measures oxygen saturations = percentage of hemoglobin that is carrying oxygen in arterial blood

normal is 95%-100%

(for most patients COPD often have a lower goal percentage per order)

sensor sites: finger,toe,earlobe,nose,forehead

- avoid swollen/edema or open skin sores

- if poor circulation to fingers/toes → use earlobe, nose, forehead

- set alarms for continuous monitoring

patient problem statements

inability to clear airway

inability to maintain adequate breathing pattern

inability to tolerate activity

anxiousness, fearfulness, and despair

compromised verbal communication

interventions to help clear airway

cough, deep breathe

raise head of bed as tolerated

get patient out of bed and ambulate

incentive spirometer = help patient take slow deep breaths

bronchodilator, steroid use, and humidifier as ordered

airway clearance devices (vibration vest and acapella)

percussion and postural drainage as ordered

fraction of inspired oxygen

FiO2: flow rate of oxygen is ordered in liters per minute, determines how much oxygen the patient will recieve; however there are different percentages of oxygen

nasal cannula: 1-6 L/min = 24%-44% (low concentration rate)

simple face mask: 5-8 L/min = 35%-55%

non-rebreather 6-15L/min = 70%-100%

1 liter/min = 0.24 it moves in 4s per liter -- 1-6 liters/min

tracheostomy tube

tracheostomy = tube dislodgement and accidental decannulations

keep an extra trach tube at bedside! observe for blood or purulent drainage around stomach

#1 goal is maintain patent airway

trach care: suctioning requires sterile technique intremintently while withdrawling and secure new tracheostomy ties before removing old ones

yankauer

used for oral suction; have unresponsive patient lie on side when oral suctioning

trach suctioning and more care

nursing priority: prevent hypoxia

preoxygenate with 100% FI02!

suction is performed if necessary, but no longer than 10 intermintently while withdrawling seconds causes hypoxia!

monitor pulse oximetry

tracheostomy care continued

prevent infection in buildup of exudate

suction patient first before trach care

insert catheter = no suction

withdrawling catheter = suction

suction catheter discarded after each use!

CLEAN ONLY INNER CANNULA = HYDROGEN PEROXIDE

NORMAL SALINE FOR CLEANING TRACH SITE

complications of oxygen therapy

respiratory drive = increase in C02 levels

patients with COPD = hypoxic drive (given oxygen the presipratory drive may be diminished)

oxygen should be carefully titrated around 88%-94%

oxygen toxicity: causes scarring of respiratory tract and even blindness with prolonged high FiO2

safety measures of oxygen

oxygen does not burn or explode = avoid smoking use of electrical appliances

avoid and restrict flammable products

patient safety and comfort for oxygen

ventilation: semi-fowlers and high-fowlers

check for skin breakdown where tubing or mask touches

use padding or change devices if needed

provide mouth care and humidification to prevent dryness

ensure patient can communicate needs with trach

aspiration precautions: nursing interventions

raise head of bed

check ability to swallow; consult speech therapy

thickened liquids or special diets

small bites, slow sips, no talking while eating

suction equipment at bedside for high-risk patients

monitor for coughing, wet voice, drooling, or pocketing food

assessment and interventions

assessment: respirations, pattern, depth, abnormal breathing problems

pulse oximetry, heart rate, and blood pressure

skin color = palor/cyanosis

mental status and fatigue

breathe sounds (clear or adventitious)

prescence of secretions/ cough effectivness

devices in use and flow rate

interventions:

postioning, cough/deep breathe, incentive spirometry

apply/titrate oxygen per order/check equipment

suction when needed --pre oxygenate with 100% of Fi02, limit to less than 10 seconds

provide humidification, fluids, and mouth care

reasess and document

adventitious lung sounds

crackles (rales): popping, bubbling; fluid in alveoli (CHF, pneumonia)

wheezes: high-pitched musical; narrowed airways (asthma, COPD)

rhonchi: low-pitched snoring; thick secretions in larger airways

stridor: harsh, upper airway obstruction: EMERGENCY