Chapter 87 Oxygen Therapy and Respiratory Care

Oxygen

is necessary for anything to burn, and increasing oxygen allows common flammable materials to burn faster and hotter.

• Reverses hypoxemia (low oxygen concentration in the blood)

• Decreases the work of the respiratory system

• Decreases the heart's work in pumping blood.

Increasing the concentration (or percentage) of oxygen the client inhales accomplishes three goals:

Oxygen toxicity, manifested as changes in lung tissue. In newborns, excess oxygen can cause vision difficulties and blindness.

Oxygen given in high concentration over many days can result in?

• Explain about the dangers of lighting matches or smoking cigarettes, cigars, or pipes. Be sure the client has no matches, cigarettes, or smoking materials in the bedside table.

• Do not use oil on oxygen equipment. Be sure no traces or oil on hands before adjusting oxygen apparatus.

• Be aware of all potential sources of sparks, especially when administering oxygen by means of a containment device (e.g., a tent or isolate). Note: items that appear innocuous (e.g., friction toys, electric razors) have caused explosive fires.

• Instruct client not to change the position of the mask, cannula, or any of the equipment after it is in place.

• Encourage or assist the client to move about in bed. Many clients are reluctant to move because they are afraid of the oxygen apparatus.

• Monitor, document, and report the client's condition regularly.

• Discontinue oxygen use only after a healthcare provider has evaluated the client.

Nursing care guidelines in providing oxygen:

• Observe the client's respirations. Determine their rate, depth, and character.

• Measure the client's pulse rate often. In respiratory distress, the pulse rate often rises.

• Check pulse oximeter readings frequently.

Respiratory status of a client who is receiving oxygen:

pulse oximeter

is a convenient monitor that measures the amount (percentage) of oxygen saturation in the blood.

fingertip, forehead, bridge of the nose, or an earlobe via specially designed clips or tape.

Pulse oximeter commonly referred to as a "pulse ox," the probe (sensor) is attached to a?

95%-100%

Normal pulse oximeter levels range from?

rapid intervention, usually supplemental oxygen.

Pulse oximeter values less than 90% need?

immediate intervention.

Pulse oximeter values less than 85% generally need?

Moderate to severe anemia

High carbon monoxide (CO) levels, and those in cardiac arrest or in various types of shock do not have accurate readings.

Just received dyes, such as methylene blue for diagnostic testing purposes, or who are being treated for hypotension with vasoconstrictor medications.

The pulse oximeter has limited accuracy. Readings are unreliable for a client who has?

Wall outlets

with bulk storage and in-room piping systems, it is installed next to each bed.

Oxygen concentrators

are widely used in home and extended care settings. They compress room air and extract oxygen, providing concentrated oxygen flows in the range of 1 to 5 LPM.

it requires periodic maintenance by a technician and electricity to operate.

An oxygen concentrator is much safer and more convenient to use than an oxygen tank. It also does not need to be refilled with oxygen. However?

delivery of the desired concentration (percentage) of oxygen.

When administering oxygen to an individual who is having difficulty breathing, the type of device that is used is critically important. The primary concern is?

Nasal cannula (nasal prongs)

is a device used to deliver small to moderate increases in oxygen concentration.

Humidification

should be provided in nasal cannula with flow rates greater than 4 LPM to prevent dryness of the mucosa.

they are less confining and do not interfere with eating or talking.

Most people prefer cannulas because?

6 LPM to flush expired carbon dioxide from the mask so that the client does not rebreathe it.

The simple mask requires a minimum oxygen flow rate of?

Partial-rebreathing mask (PRM)

is a low-flow device that can be identified by the presence of a bag and the absence of valves

75 % of oxygen concentration.

PRM of 10 LPM will provide?

inspiration and expiration, with special attention given to ensure that the bag does not collapse during inhalation

The bag of PRM must remain inflated during?

Nonrebreathing Mask

is used only in an intensive care unit or in one-to-one client care situations. Rationale: Insufficient or interrupted oxygen flow will seal the mask against the person's face, potentially suffocating him or her. The client needs constant monitoring.

Venturi mask

Of all the facial devices, the high-flow ______________ provides the most reliable and consistent oxygen enrichment.

Rationale: Significant back-pressure may activate the safety pressure valve on the humidifier, causing it to burst. The large amount of room air that a Venturi mask uses will humidify the gas adequately.

Do NOT use a humidifier with a Venturi mask.

chronic obstructive pulmonary disease (COPD).

Because the Venturi mask has the ability to provide consistent, low levels of supplemental oxygen, it is often used for a client with?

Rationale: Prevent occlusion of the oxygen flow, which would alter the desired oxygen concentration.

Ensure that the windows of the Venturi mask remain exposed to room air. Sheets or blankets must not cover the windows or the end of the adapter.

Intermittent Positive Pressure Breathing treatment

is ordered for children or adults with chronic lung conditions. Most often used for clients with cystic fibrosis. Assists the client to breathe more easily by liquefying mucus.

• Adds humidity to certain oxygen delivery devices

• Hydrates thick sputum

• Administers bronchodilator medications to relax bronchioles narrowed by bronchospasm

• Administers anti-inflammatory or antiasthma medications

• Delivers antibiotics to the lungs to fight infection

Aerosol mist treatment refers to suspension of microscopic liquid particles in the air. It serves the following purposes:

Call for assistance

is the first nursing intervention after assesment of a non- breathing client.

Endotracheal tube (ET or ET tube)

is a flexible plastic tube used as a temporary device to maintain a patent airway during a process called intubation.

providing oral care every 2 hours, monitoring respiratory status and placement of the ET (it can slip out of position), and repositioning the client to prevent hazards of immobility (e.g., pneumonia).

While the client is intubated, nursing care consists of?

Mechanical ventilator or respirator

Machine that forces air into the lungs.

Continuous positive airway pressure (CPAP) allows inspiratory and expiratory airway pressures to be maintained above atmospheric pressure.

Facilitate weaning from the ventilator.

CPAP

helps keep client's lungs inflated and tends to improve lung function, although breathing is spontaneous

Monitor the site for swelling. Check to see if the client is able to breathe freely or has difficulty swallowing or is bleeding.

Assisting at a Tracheostomy:

• Pre-oxygenate the client with 100% oxygen for 30 to 60 seconds. Use a hand-held resuscitation devise or, if able, ask client to take two to three deep breaths. Rationale: Suctioning decreases oxygen supplies in the lungs. Pre-oxygenating increases the client's oxygen levels in the lungs, thus preventing hypoxia and unnecessary oxygen loss during the procedure.

• Occlude the suction port with the nondominant thumb while rotating and removing the catheter. Ensure that suctioning does not continue for longer than 15-second intervals. Rationale: Rotating the catheter provides effective removal of secretions from the trachea. Limiting suctioning to 15-second intervals reduces the development of hypoxia.

Suctioning and Providing Tracheostomy Care:

inch

The pressure in the oxygen cylinder is measured in terms of pounds per square ______.

rate

The percentage of oxygen that reaches the lungs depends on the _____ and depth of respirations.

Aerosol

______ mist treatment refers to the suspension of microscopic liquid particles in the air.

Negative

The ____ pressure ventilator causes the chest to expand and air to flow into the lungs by lowering the pressure around the chest.

Continuous

_____ positive airway pressure helps to keep the clients lungs inflated and tends to improve lung function, even though breathing is spontaneous.

Oxygen cylinders

What source of oxygen is used in Short-term emergencies?

Hyperbaric chambers

What source of oxygen is used for carbon monoxide poisoning?

Oxygen strollers

What source of oxygen is used when administering portable liquid oxygen?

Attatch the wing nut and tailpiece to the flow meter's threaded outlet.

Connect the tubing from the Venturi mask to the tailpiece.

Set the flow meter to the manufacturer's recommended flow rate.

Place the mask over the bridge of the client's nose and down onto the chin.

Sequence of steps involved in the application of the Venturi mask for a client with chronic obstructive pulmonary disease (COPD)

Because even if the hemoglobin is fully saturated, with a resulting pulse oxygen percentage of more than 95% the clients may not be getting enough total oxygen to the tissues due to an overall lack of hemoglobin.

Why do clients with severe anemia show unreliable pulse oximeter readings?

Secure the cylinder in a cart when it needs to be moved, turn off the valve when the cylinder is not in use.

Keep cylinders away from heat.

Ensure that oxygen does not come in contact with any combustible material, avoid smoking because even a small spark can ignite an explosive fire.

What precautions must be taken with oxygen cylinders?

6 LPM. This is done to avoid excessive drying of the nasal mucosa.

At what maximum rate should the nurse ensure flow of oxygen through a nasal cannula?

To help clients to breathe more easily by liquefying the mucus.

What is the goal of IPPB treatment?

aerosolized

You use IPPB only with what type of medications?

a. Open the sterile tracheostomy suctioning kit and cleaning supplies on the bedside tray or table.

b. Pick up the sterile container, open it, and pour sterile saline into it.

c. Put on sterile gloves.

d. Pick up the sterile suction catheter with your dominant hand.

e. Use your nondominant hand to connect the wall or portable suction catheter tubing to the sterile suction catheter. Rationale: Surgical asepsis decreases the potential for introducing organisms into the client's respiratory tract. The nondominant hand is unclean after it touches the nonsterile tubing.

What steps should the nurse perform when preparing the suction equipment?

a. Have an assistant hold the tracheostomy tube in place with a sterile hand. If unassisted, leave the soiled tapes in place until new ones are inserted and secured. Rationale: Keeping the tracheostomy tube secure while changing the tape prevents the client from accidentally coughing up the tube.

b. Pass the ends of the tape through the opening on the faceplate and bring them behind the client's neck to the other opening on the opposite side of the faceplate.

c. Insert tape through the opening, pull securely, and tie or Velcro into place.

d. If necessary, remove the soiled tape.

How should the nurse change the tracheostomy tube tape?

Cleanse around the tracheostomy stoma and under the tracheostomy tube faceplate with sterile cotton-tipped swabs dipped in normal saline. Rationale:Normal saline aids in the removal of accumulated and encrusted secretions.

How should the nurse clean around the tracheostomy stoma and under the tracheostomy tube faceplate?

Attatch the pulse oximetry probe to the clients fingertip

A nurse is performing pulse oximetry on a client in order to measure the oxygen saturated in the blood. What intervention should the nurse perform?

Dizziness, Headache, Nausea

A nurse is caring for a client who is receiving IPPB. What should the nurse assess for in this client?

Attatch the cannula with the connecting tube to the adapter on the humidifier.

A nurse is caring for an asthmatic client who is receiving oxygen via a nasal cannula. What is the first step the nurse should take before administering oxygen?

Connect the mask tubing to the humidifier outlet.

A nurse is caring for a client who is receiving oxygen with a simple mask. What measures should the nurse undertake when caring for this client?

Perform airway suctioning

A nurse is caring for a client who is receiving IPPB treatment. What measure should the nurse employ to ensure that mucus is removed?

Insert the catheter until the client coughs

A nurse is suctioning the airways in a client who recently underwent tracheostomy. What measure should the nurse employ when inserting the suction catheter?

Practice inserting the adapter into the outlet.

A nurse who is new to the healthcare facility is becoming familiar with the wall outlet system used in the facility. What measure should the nurse employ?

Change the window openings.

A nurse is caring for a client who is receiving oxygen via a Venturi mask. What measure should the nurse employ to change oxygen concentrations?

10 seconds

A nurse has been providing suctioning and Tracheostomy care in a client receiving mechanical ventilation. What should be the maximum duration for each interval of suctioning?

Manual breathing bag, extra tracheostomy tube, a 10-mL syringe

A nurse is caring for a client who is receiving mechanical ventilation. What supplies are necessary at the clients bedside?