ATI Gas Exchange and Oxygenation

Scope of Practice

PN scope of practice varies by state; PNs assist RNs in care planning under RN supervision.

Airway Clearance Goals

Clear secretions, maintain patency, and use artificial airways when necessary for effective airway management.

Chest Physiotherapy (CPT)

Techniques used to loosen and move secretions for removal; important for conditions like cystic fibrosis.

Percussion

Techniques involving striking congested lung fields with cupped hands or devices for mucus clearance.

Vibration

Technique applied with shaking motion during exhalation to increase air turbulence and aid secretion clearance.

Postural Drainage

Technique utilizing gravity to drain secretions; typically scheduled 2-3 times daily.

Oropharyngeal Airway

Airway device for altered consciousness to prevent tongue obstruction.

Nasopharyngeal Airway

Used for alert clients; does not stimulate the gag reflex.

Endotracheal Tube (ET Tube)

Short-term airway management device for anesthesia or mechanical ventilation.

Tracheostomy Tube

Long-term airway support via a surgically created opening in the trachea.

Emergency Equipment at Bedside

Manual resuscitation bag, extra trach tube, insertion tray, and obturator.

Complications of Airway Management

Dislodgement, obstruction, pneumothorax, and infection associated with tube management.

Suctioning

Technique for clearing secretions in clients unable to expectorate, requires hyperoxygenation beforehand.

Oropharyngeal/Yankauer Suctioning

Used for clearing mouth and throat secretions with a clean technique.

Nasotracheal/Tracheal Suctioning

Involves sterile technique for suctioning the trachea, suctioning the mouth last if applicable.

Closed (Inline) Suctioning

Technique for mechanically ventilated clients that minimizes risks during suctioning.

Suctioning Duration

Only suction for a maximum of 10 seconds while withdrawing the catheter.

Oxygen Therapy

Management of oxygen delivery to clients with hypoxia or respiratory distress.

Early Signs of Hypoxia

Restlessness, confusion, anxiety, elevated blood pressure, increased heart and respiratory rates.

Late Signs of Hypoxia

Hypotension, bradycardia, metabolic acidosis, and cyanosis.

Chronic Hypoxia Manifestations

Clubbing of fingers/toes, peripheral edema, right-sided heart failure, and SpO2 < 87%.

Nasal Cannula

Low flow oxygen delivery device providing 24% to 44% concentration.

Simple Face Mask

Oxygen delivery device with flow rates of 5-10 L/min, providing 35% to 60% concentration.

Nonrebreather Mask

High flow oxygen mask providing up to 95% concentration; must keep reservoir bag inflated.

Venturi Mask

Most accurate oxygen delivery system, providing 24% to 60% concentrations, ideal for COPD patients.

Face Tent

Oxygen device providing high humidification, suitable for claustrophobic clients.

Manual Resuscitation Bag

Provides the highest concentrations of oxygen during emergencies.

Oxygen Safety

Precautions to prevent fire hazards, including no smoking and proper storage of tanks.

Closed Chest Drainage

Restores negative pressure in the pleural space to manage pneumothorax or fluid accumulation.

Collection Chamber

Part of the chest drainage system that collects drainage and requires marking levels every 8 hours.

Water Seal Chamber

Prevents air from re-entering the pleural space; normal tidaling indicates proper function.

Suction Control in Drainage Systems

Can be wet (determined by water height) or dry (using a regulator dial) to facilitate drainage.

Nursing Care for Chest Drainage

Involves positioning, tubing management, and assessing for complications.

Dislodgement Protocol

If a tube disconnects, submerge the end in sterile water; cover site with sterile gauze if tube is out.

Assessment for Subcutaneous Emphysema

Palpate for signs of air leaking into subcutaneous tissue (crepitus).

Documentation Guidelines

Includes documentation of date, time, breath sounds, SpO2, and client tolerance of procedures.

Suctioning Documentation

Note the amount, color, consistency, and odor of secretions following suctioning.

Oxygen Delivery Documentation

Record flow rate, method of delivery, and skin condition at pressure points.

Chest Tube Documentation

Document site status, drainage characteristics, suction amount, and water seal bubbling.