oxygenation

hypoxia

insufficient O2 reaching tissue

disease that interfere with lung’s ability to absorb O2

pneumonia

chronic bronchitis

emphysema

sleep apnea

is O2 a medication

yes, need providers order

what’s in oxygen set up

oxygen source

deliver device

flow meter

humidifier

oxygen sources

wall outlet - connected to wall, O2 from central supply

oxygen tank - portable, risk for explosion

liquid oxygen system - looks like a purse

oxygen concentrator - need power supply

oxygen concentrator

is an oxygen source

pulls in air from atmosphere

remove nitrogen

usually preferred at home or healthcare facility for patients that need it occasionally

flow meter

all oxygen sources are connected to a flow meter

indicates the L/min of O2

typically between 1-15

humidifier

high flow oxygen deliver can dry mucous membranes

O2 goes through humidifier → deliver device

distilled water humidifier

has distilled water → water vapor → picked up by O2 → makes bubbles → bubbles = vapor so humidified O2 is delivered to patient

delivery devices

nasal cannula (2 prongs) - can eat and drink but no high flow rate

face masks

• partial rebreather

• non-rebreather

• venturi mask

partial rebreather mask

face mask

bag holds exhaled air + O2

non-rebreather mask

only O2 is breathed in

exhaled air escapes through holes in mask

venturi mask

accessory devices

secure an open airway

tubes that go through nose or mouth, into the throat (nasopharyngeal or oropharyngeal airways)

how far to keep oxygen sources

10 feet away from heat sources

providing care

wear mask/nasal canula

store oxygen in well ventilated area

check humidity

ensure no kinks in tubing

ensure nasal cannula is comfortable

observe bag remains inflated

regular oral care

skin care

oxygen system setup

gather O2 deliver device (mask or nasal cannula) + tubing

flow meter

humidifier (if ordered)

distilled water

connect flow meter to oxygen source, pour water into humidifier bottle, connect bottle to flow meter + delivery device

what to report

abrupt onset of chest pain

shortness or breath

coughing up white, foamy, green, yellow or brown phlegm

ventilation

movement of O2 and CO2 in/out of the lungs

perfusion

cardiovascular system pumps oxygenated blood to tissues + returns deoxygenated blood to lungs

diffusion

exchange of CO2 and O2 between capillaries (body tissue) and alveoli (lungs)

physiological factors that affect oxygenation

hypovolemia

decreased O2 concentration

increased metabolic rate

decreased O2 carrying capacity

anemia

low RBC level (hemoglobin / hematocrit)

want to see 10 or above for adults

leads to decreased oxygenation

hypovolemia

decreased volume of blood circulating in body

means hard to get oxygen to tissues

hypoventilation

decreased inhale/exhale

respiration rate below 12 = not getting enough O2

breathing slow = increased CO2 in the body

metabolic rate

is increased when exercising and when pregnant

so need more O2

conditions affecting chest wall movement

pregnancy

obesity

musculoskeletal abnormalities

trauma

neuromuscular diseases

CNS alterations

chronic lung disease

pregnancy and obesity on chest wall

both put pressure onto the diaphragm making it hard for the lungs to expand

less O2 makes it to the tissues

trauma on chest wall

if pain is so bad, patient might not want to breath if it irritates the incision site

if medications are working too well, opioids could lead to respiratory depression

hyperventilation

breathing fast → get rid of a lot of CO2 = less CO2 in the blood

alteration in cardiac function

disturbances in conduction (electrical signal)

• dysrhythmia - abnormal heart rhythm

altered cardiac output (L or R sided heart failure)

• decreased output = less O2 to tissues

impaired valve function

• can effect how much blood/O2 that goes to tissues

myocardial ischemia

• decreased blood flow to heart muscle

ischemia

can be reversed with nitroglycerin (vasodilator)

infarction

death of some of the heart muscle

not necessarily reversible

developmental factors influencing oxygenation

age of patient

• kids get a lot of upper respiratory infections (b/c decreased immunity)

• kids get exposed to smoke (damages cilia, affects airway, leads to URI)

lifestyle things that impact oxygenation

nutrition

• poor diet (common with chronic lung disease and respiratory muscle weakness) — get short of breath when eating so they stop

• hydration - dehydration slows metabolism

• exercise - increased metabolism (need more O2)

• smoking - vasoconstriction = decreased blood flow + increased BP

• substance abuse - you bring you up or bring you down

overall assessment

health risks or family history

are you pain

fatigue

dyspnea

cough production (mucus or dry)

environmental exposure (irritants)

smoking

respiratory infections

allergies

medications

dyspnea

shortness of breath

assessment “pain”

lot of pain - maybe hyperventilating (not enough CO2 in blood)

good pain management - opioids can lead to hypoventilating (respiratory depression)

mental status - is this a side effect or is there too much CO2 in blood

physical assessment

inspect

palpate

percuss

auscultate

diagnostic test

inspection assessment

look at skin

mucus membranes

level of consciousness (awake/alert)

nails (clubbing - not enough O2)

respiratory rate (normal 12-20)

palpation assessment

palpate for pulses

• pulse - are they even, present, how strong

  • 0 - no pulse

  • 1 - weak and hard to find

  • 2 - normal

  • 3 - bounding

• chest - does it hurt when we palpate, is the skin warm/cold

  • cold = poor perfusion

auscultation assessment

lung - want to be clear bilaterally

heart - want to hear S1/S2

asthma

hear some wheezing

pneumonia

hear crackling

health promotion

vaccinations

healthy lifestyle - eat right, exercise, no risk factors

environmental pollutants

• second hand smoke, chemicals

acute care interventions

airway maintenance - want a productive cough to get rid of bad stuff (can use suction)

reposition - to move secretions and get them out

hydration - thins out secretions (1500-2000ml/day)

humidify - amounts of 4L/min (avoid drying out mucus membranes)

cough/deep breath technique - force mucus out

acute care meds

nebulizer

inhaler

steroid - decreases inflammation

antibiotics

cough suppressants

O2 administration

chest physiotherapy

vibrating external chest wall to break up mucus

used for cystic fibrosis patients

lung physiotherapy

positive expiratory pressure - put pressure behind mucus to blow it out

ambulation - movement post op (opens lungs, encourages deeper breath)

positioning - gravity drains mucus

incentive spirometry - promote lung expansion by encouraging to take slow/deep breath

O2 safety

keep away from flame (10 feet)

keep away from flammable items

don’t let cylinder fall over

check level before transporting with patient

ensure correct tube length

O2 volumes

nasal cannula — 1-6L/min (≥4 humidify)

oxygen mask — 6-12L/min

• want >6 to avoid the rebreather masks exhaled CO2 from staying in mask

• simple

• partial rebreather and non-rebreather (reservoir bags 10-15L/min)

• venturi high flow — 4-12L/min for COPD (no bag)

breathing exercises

pursed-lip breathing

• in through nose, out through pursed lips

diaphragmatic breathing

• belly breathing, use diaphragm to breath

home oxygen

O2 is 88% or less = qualify for home oxygen

atelectasis

alveoli collapse - avoid by doing breathing exercises

safety guidelines

get baseline

4 suction rules

high flow O2 to COPD patient - could lead to dependency on high flow

most serious tracheotomy complication

airway obstruction

suction rules

deeper suction first, move shallower

suction creates intercranial pressure

do Not put fluid into airway before suction

do not strip or milk chest tube for drainage

normal vs COPD

normal - high CO2 in blood makes us breath

COPD - low O2 in blood makes them breath