week 3 lecture notes

Oxygen Therapy

  • Oxygen (O₂) is a therapeutic gas that is utilized in the treatment of hypoxemia, which is defined as low levels of arterial oxygen.

Signs and Symptoms of Hypoxemia (Early)

  • Inadequate Oxygen:
      - Patient may exhibit restlessness.
      - Increased respiratory rate leads to work of breathing (TWB) resulting in retractions (sinking in of skin and muscles).

  • Physiological Responses:
      - Increased heart rate.
      - Confusion and anxiety.
      - Pale mucous membranes.
      - Increased blood pressure (B/P).
      - Use of accessory muscles for breathing.

Nursing Considerations for Oxygen (O₂)

  • Monitoring Physical Indicators:
      - Normal color of mucous membranes is pink.
      - Capillary refill time should be less than 2 seconds.
      - Assessment of intact mental status.
      - Monitoring oxygen (O₂) saturation levels.

Long-term Hypoxemia Manifestations

  • Physical Changes:
      - Clubbing of fingers due to chronic hypoxia.
      - Heart failure leading to dependent edema (swelling in lower extremities caused by gravity), associated with a weakening heart that pumps inefficiently, leading to increased pressure in veins.
      - Cyanosis, or bluish skin.
      - Hypotension (low blood pressure).
      - Bradypnea (slow respiratory rate) and bradycardia (slow heart rate), leading to stupor.

Hypoxemia Interventions

  • If O₂ Saturation drops below 90%:
      - Encourage the patient to take deep breaths.
      - Advise coughing every 2 hours to enhance lung expansion and clear secretions.
      - Elevate the head of the bed.
      - Closely monitor opioid use due to effects on respiratory rate and oxygen saturation.

Home Oxygen Therapy Guidelines

  • Storage of Oxygen Tanks:
      - Store tanks upright and at least 5 feet away from any heat sources such as candles, heaters, and electric stoves.
      - Avoid use of petroleum-based products, oils, or greases near the face/chest to reduce fire risks.
      - Use cotton blankets only.

Oxygen Delivery Systems

  • Nonrebreather O₂ Mask:
      - Should fit snugly over the patient's face.
      - The reservoir bag should be partially inflated.
      - Delivers high-flow O₂.
      - Added humidity helps prevent dryness.

  • Low-flow and High-flow Oxygen Delivery Systems:
      - Nasal Cannula: 1-6 L/min, delivering FiO₂ of 24-44% (provides a minor boost).
      - Simple Face Mask: 5-10 L/min, FiO₂ of 35-60% (covers the face, offering more O₂).
      - Venturi Mask: 4-15 L/min, FiO₂ of 24-60% (controls O₂ concentration).
      - Nonrebreather: Minimum 10 L/min, FiO₂ of 80-95% (the bag serves as a reservoir of pure O₂).
      - Face Tent: Minimum 10 L/min, FiO₂ ranging from 24-100% (provides variable O₂ concentrations).

Nursing Considerations for Oxygen Delivery

  • Nasal Cannula: Provides 21-28% O₂; requires a humidifier if delivering 4 L/min or greater.

  • Simple Face Mask: Generally delivers 5-10 L/min at FiO₂ of 40-60%; secure the mask to clothing.

  • Nonrebreather: Minimum 10 L/min ensures an FiO₂ of 60-80%; apply water-soluble lubricant to prevent skin irritation.

Oxygen Toxicity Symptoms

  • Muscle twitching in hands.

  • Tinnitus (ringing in the ears).

  • Nausea and potential convulsions.

  • Local anesthetic toxicity presenting as a metallic taste in the mouth.

Tracheostomy Care

  • Suctioning Procedure:
      - Suction duration of 10 seconds with negative pressure of 100-150 mmHg.
      - Suctioning should occur while inserting the catheter.
      - Use lubrication to prevent clogging.

  • Utilization of Suctioning:
      - An assistant may take specimens to the lab but cannot perform unrelated tasks.

Cardiopulmonary System Overview

  • Hemoglobin (Hgb) serves the primary role of transporting O₂ via red blood cells.

  • Increased lymphocyte counts (white blood cells) enhance survival against infections.

  • Platelets are essential for clotting processes.

  • Neutrophils (another type of WBC) play a crucial role in fighting acute infection.

  • Body compensates for decreased respiratory rate by increasing heart rate (HR) to maintain adequate cardiac output (CO).

Relationship Between Respiratory Rate and Cardiac Output

  • A drop in respiratory rate leads to a drop in cardiac output, as the heart must work harder (increased HR) to compensate for decreased stroke volume.

Promoting Sleep

  • Sleep Assessment Questions:
      - Limit naps to 20-30 minutes per day to avoid interfering with night-time sleep.
      - Discuss and identify causes of sleep disturbances, including stress.
      - Encourage regular exercise, suggesting cessation at least 2 hours before bedtime.
      - Recognize the importance of sleep deprivation treatment to promote feelings of being well-rested.
      - Advise against going to bed when not tired to mitigate nocturia effects.
      - Propose avoiding TV or work items in the bed to improve sleep quality.
      - Maintain a cool room temperature to enhance sleep environment.

Nursing Interventions for Sleep Improvement

  • Sleep Diary: Maintain records regarding activity, diet, and sleep patterns.

  • Encourage avoidance of heavy meals 2-3 hours prior to bedtime.

  • Assess the nature of sleep issues, focusing on signs and symptoms.

  • Limit caffeine and alcohol intake, especially before bedtime.

  • Establish a consistent sleep/wake schedule to regulate sleep onset and duration.

  • Incorporate relaxation activities to manage stress.

  • Promote a dark environment conducive to melatonin production.

Predisposing Factors to Difficulty Sleeping

  • External disturbances such as noise may negatively affect the patient’s sleep.

  • Consider the impact of medications and food intake on sleep quality, including the influence of alarms, phones, and pagers on restfulness.