Oxygen, Circulation, Perfusion & CBC

Patient education for administering bronchodilators, mucolytics, and corticosteroids

• Proper technique and use 

• Rinsing mouth out after use 

• Cleaning nebulizer and inhalers 

• Keep track of amount of medication left 

• Provides visual reinforcement for deep breathing and encourages the patient to maximize lung inflation to prevent atelectasis

• You tell the patient to inhale slowly and deeply through the mouth piece and move the piston to the prescribed amount

• Hold their breath for 3-5 seconds; Exhale normally

Incentive spirometer

• Creates smaller opening which slows and prolongs expiration which allows the air to be emptied from the lungs; prevents the collapse of the small airways

• Inhale through the nose counting to 2; purse/pucker their lips like they're going to whistle; exhale slowly and gently counting to 4

Pursed-lip breathing

• Encourage patient to make each breath deep enough to move the bottom of the rib

• Breathe in through the nose and slowly exhale through the mouth

Deep breathing

Have patient place hand on stomach and other on their chest, breathe in and allow stomach to protrude as far as it will go, breathe out with pursed-lips and contract abdominal muscles

Diaphragmatic breathing

Promoting Optimal Function of respiratory system (interventions)

• Healthy lifestyle

• Maintaining good nutrition

  • Small meals may help (reduce risk of aspiration)

  • Nasal cannula during meals if needed

• Adequate hydration

• Vaccination

• Pollution-free environment

Breathing exercises (interventions) 

• Deep breathing

• Incentive spirometer

• Pursed-lip breathing

• Diaphragmatic breathing

Interventions that promote lung expansion

• Breathing exercises

  • Deep breathing

  • Incentive spirometer

  • Pursed-lip breathing

  • Diaphragmatic breathing

• Controlling pain

• Ambulation (prevent atelectasis)

• Positioning (tripod for COPD)

Promoting and controlling cough (interventions)

• Promoting and controlling cough 

  • Voluntary coughing vs involuntary coughing 

  • Productive vs nonproductive cough 

  • Cough medications:

    • Expectorants 

    • Suppressants 

    • Lozenges

Loosen and mobilize secretions (interventions)

• Chest physiotherapy (CPT)

• Percussion

• Vibration

• Postural drainage

Meeting oxygen needs with medications (interventions)

• Administering inhaled medications

  • Bronchodilators

  • Mucolytic agents

  • Corticosteroids 

Oxygen (intervention)

• Considered a medication and requires order

• DON'T DELAY O2 ADMINISTRATION IN EMERGENCY SITUATIONS

• Highly flammable 

What happens when excessive O2 is administered to COPD patients?

The administration of excessive oxygen causes them to hypoventilation

Why does administration of excess O2 cause COPD patients to hypoventilate?

These patients have adapted to a high CO₂ level, therefore their stimulus to breathe is a decreased arterial oxygen level. This causes retention of CO2 which can lead to respiratory acidosis and respiratory arrest

What is the target SpO2 for COPD patients?

88-92%

• Low Flow:1-6 L/min (24%-44%) O2

• High Flow: Up to 60 L/min (65%-90%) O2

Flow rate of O2 for nasal canula

6-12 L/min 35%-50% O2

Flow rate of O2 for simple face mask

4-6 L/min 24%-50% O2

Flow rate of O2 for venturi mask

10-15 L/min 60%-90% O2

Flow rate of O2 for partial/non-rebreather mask

Nursing consideration for nasal canula

• Flow rates ≥4 L/min dries mucosa and needs humidification

• Unable to use with nasal obstruction, less effective if patient is a mouth-breather

Oxygen delivery device C/I for patients who retain CO2 (COPD patients)

Simple face mask

Nursing considerations for simple face mask

• Contraindicated for patients who retain CO2 (COPD),

• May induce feelings of claustrophobia, interrupts eating/drinking

O2 delivery device has flow-control meter on the mask

Venturi mask

Nursing consideration for partial/non-rebreather mask

Allow reservoir bag to fill up with O2, should never be deflated

Artificial airways

• Oral airway

  • Prevents obstruction of the trachea by displacement of the tongue into the oropharynx

• Endotracheal airways

  • Short-term use to ventilate, relieve upper airway obstruction, protect against aspiration, clear secretions

• Tracheostomy

  • Long-term assistance, surgical incision made into trachea

It’s okay if the O2 bag of a partial/non-rebreather mask is deflated. True or false?

False

Prevents obstruction of the trachea by displacement of the tongue into the oropharynx

Oral airway

Short-term use to ventilate, relieve upper airway obstruction, protect against aspiration, clear secretions

Endotracheal airways

Long-term assistance, surgical incision made into trachea

Tracheostomy 

Noninvasive mechanical ventilation 

• Continuous positive airway pressure (CPAP)

• Bilevel positive airway pressure (BiPAP)

• Be sure the mask fits and assess for facial injury or skin breakdown

Invasive mechanical ventilation

• Lifesaving intervention via ETT or tracheostomy

• Various ventilator modes

• Generally used with sedation

• Ventilator-associated pneumonia is a concern (mortality rate 20%-50%)

Risk of ETT/mechanical ventilator

Ventilator-associated pneumonia is a concern (mortality rate 20%-50%)

Suctioning (used to clear obstructions/mucus in COPD)

• Might be uncomfortable or distressing

• Can cause hypoxia

• Possible complications include:

  • Infection

  • Cardiac arrhythmias

  • Trauma

Possible complications of suctioning

• Infection

• Cardiac arrhythmias

• Trauma

What to monitor in patient during suctioning procedure

Color, HR, response

One time removal of fluid or air in the pleural space (using needle)

Thoracentesis

Indwelling catheter inserted into the pleural space to relieve pneumothorax, hemothorax, pleural effusion; is connected to drainage unit

Chest tube

Chest tubes relieve

• Pneumothorax

• Hemothorax

• Pleural effusion

Nursing responsibilities for chest tubes:

• Assisting with insertion and removal of chest tube

• Have emergency supplies ready at bedside

• Keep tube below level of thorax (like a catheter)

• Check that drainage tube has no dependent loops or kinks

• Observe the water seal

Why do you never clamp the tubing for chest tubes?

Doesn’t allow for drainage and can cause the lung to collapse

Why do you not "milk" or "strip" the chest tube?

Can damage delicate lung tissue and not necessary to maintain chest tube patency 

You can clamp a chest tube. True or false?

False

Never "milk" or "strip" the chest tube. True or false?

True

When cardiac arrest occurs, oxygen cannot be delivered to tissues resulting in respiratory acidosis. True or false?

True

Cardiac arrest procedure

Permanent heart, brain, and vital organ damage occurs within 4-6 min. A(RWAY IS PRIORITY

• Perform CPR

• Maintain circulation with effective chest compressions

• Establish airway

• Initiate breathing

• Early defibrillation

ABG normal values

• PaO2 → 80-100 mm Hg

• PaCO2 → 35-45 mm Hg

• SpO2 → 95-100%

Effect of obesity on circulation

Decreased lung expansion and increased body weight increases tissue O2 demands, at risk for anemia

Effect of malnourishment on circulation

Respiratory muscle wasting, weak cough results in retained pulmonary secretions, at risk for anemia, high cholesterol endangers CV health

What are the cardioprotective nutrients?

Fiber, whole grains, veggies, fresh fruit, nuts, antioxidants, lean meats, fish, omega-3s

Nutrition for COPD patients

Encouraged to avoid high carb diets (carbs are metabolized by CO2). Implement high protein/high calorie for energy

Smoking effects 

• Linked to heart disease, COPD, and cancer

• Smokers have 10x higher risk of developing lung cancer

• Women taking birth control pills who smoke are at high risk for developing blood clots

• Harm of secondhand smoke

Substance abuse

• Excessive alcohol or drug use impairs tissue oxygenation

• Usually also has poor nutrition intake

• Can depress respiratory center

Stress

• Increases metabolic rate and O2 demands

• People with chronic or life threatening diseases cannot tolerate this demand

Environmental factors that can affect circulation

• Smog, asbestos, talcum powder, dust, secondhand smoke

Condition not relieved by NTG and is a medical emergency

MI

RBC function & normal values

Contains Hgb; 4.2–5.9 × 10^12/L

Low RBCs, Hgb, or hematocrit =

Anemia

High RBCs, Hgb, or hematocrit =

Polycythemia

Hematocrit function & normal values

Ratio: volume of RBCs to total volume of blood (RBCs/total blood volume)

• male = 42–50%

• female = 40–48%

Hgb function & normal values

Proteins responsible for transporting oxygen in blood

• male = 13–18 g/dL

• female = 12–16 g/dL

Leukocyte function & normal values

WBCs (inflammatory/immune defense); 5,000–10,000/mm³

Platelets function & normal values

Involved in clotting and coagulation; 100,000–400,000/mm³

Low leukocytes =

High leukocytes =

Risk for infection; active infection or inflammation present

Low platelets =

High platelets =

Risk for bleeding; risk for hypercoagulability (clotting)

Normal PT and aPTT

9.5–12 sec; 20–45 sec; low = risk for clotting; high = risk for bleeding