Chapter 87 Oxygen Therapy and Respiratory Care

Oxygen Therapy Oxygen A gaseous element that is essential to life Therapeutic oxygen Necessary when a client is unable to obtain sufficient oxygen for the body’s needs because of a breathing or blood deficiency Excess oxygen can be harmful and thus oxygen is prescribed as a medication and is administered under controlled conditions.

Goals of Oxygen Therapy Increasing the concentration (or percentage) of oxygen the client inhales helps to Reverse hypoxemia Decrease the work of the respiratory system Decrease the heart’s work in pumping blood

Hazards of Oxygen Therapy Oxygen toxicity, manifested as changes in lung tissue Causes vision difficulties in newborns Affects ventilatory drive control mechanisms, weakening the stimulus to breathe Contact with any combustible material can ignite an explosive (flash) fire. Please review nursing care guidelines

Determination of Respiratory Status Use of the pulse oximeter Convenient monitor that measures the amount (percentage) of oxygen saturation in the blood Noninvasive; it can be used continuously or intermittently. The oximeter is read as percent oxygen saturation (O2 sat). Where can you place a pulse ox? The sensor measures the amount of O2 attached to hemoglobin by monitoring signals generated by the probe beam of light

Pulse ox Limited accuracy Normal range Multiple variables that may make the reading inaccurate What are they?

Sources of Oxygen Wall outlets-bullets Oxygen cylinders Oxygen strollers- bullets Oxygen concentrators-1-5L Hyperbaric chamber-promotes healing

Oxygen Delivery Devices Low-flow devices Do not provide exact oxygen concentrations. The client’s breathing pattern influences the concentration of oxygen obtained. High-flow devices The oxygen percentage is constant.

Low-Flow Delivery Systems Nasal cannula – 24-44% -1-6L depends on rate and depth of respirations Simple mask -40-60% ;6-10L minimum 6L Partial-rebreathing mask –no valves 60-90% 8-11L Nonrebreathing mask –has valves outside of the mask and inside90-100% 12-15 L- bage must remain at least 1/3 inflated Toxicity with in 72 hours ; risk of suffocating

Question Is the following statement true or false? A nurse must always be aware of exactly what type of oxygen delivery system is being utilized.

Answer True A healthcare facility may stock only one type of multipurpose mask, which is adapted according to specific needs of the client. A three-in-one mask setup can be established to become a simple mask, a partial- rebreathing mask, or a nonrebreathing mask. Therefore, it is important that the nurse be aware of exactly what type of oxygen delivery system is being utilized.

Question Is the following statement true or false? Both the partial-rebreathing and the nonrebreathing masks are classified as high-flow system oxygen administration devices because they can deliver high concentrations of oxygen.

Answer False Both the partial-rebreathing mask and the nonrebreathing mask can deliver high concentrations of oxygen; however, they are both classified as low-flow system oxygen administration devices because it is difficult to get the mask to fit tightly enough to ensure 100% oxygen delivery.

High-Flow Delivery Systems Venturi mask- most reliable and consistent Oxygen enrichment -24-50% 4,6,8 L- DO not use humidifier WHY?????????????????????????? Intermittent positive pressure breathing- goal is to assist the client to breathe more easily by liquefying mucus Aerosol mist treatment-Purpose –Bullets Mini-nebulizer-traditional NEB

Question Is the following statement true or false? It is important to use a humidifier with a Venturi mask and ensure that the windows of the mask are not exposed to room air.

Answer False A humidifier must not be used with a Venturi mask, as 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. The nurse must also 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 to prevent occlusion of the oxygen flow, which would alter the desired oxygen concentration.

The Client Who Is Unable to Breathe The AMBU-bag or manual resuscitator or manual resuscitation bag- C_E method-4-6 minute window Endotracheal tubes- how do yo verify placement?/Oral care how often? Ventilatory support Negative pressure ventilator-lowers pressure around the chest causes chest to expand and air to flow into the lungs seldom used Positive pressure ventilator-terms>>>>>>>>>

Vent Terms Volume ventilation delivers a constant pressre volume of air with each breath Pressure ventilation pushes air into the lungs until a preset pressure is achieved Assisted breath ventilation assist the client that can take some breaths on his or her own Controlled breath ventilation breaths for the Clint forcing a breath as set intervals- prevents patient’s own breath

Contiued SIMV- synchronized intermittent mandatory ventilation- give a preset of breaths and volume but allows client to breathe on their own as well PSV- pressure support constant pressure is applied as the person inspires, which lessens the inspiratory effort of work needed Ventilator alarms: High?-pressure-kinks in the circuit, water in circuit from exhalation; increased mucus; bronchospasm; Coughing; breathing over or fight the vent; pneumonia or other changes in the lungs LOW?

Vent settings Ventilator alarms: HIGH -pressure-kinks in the circuit, water in circuit from exhalation; increased mucus; bronchospasm; Coughing; breathing over or fight the vent; pneumonia or other changes in the lungs- pain; anxiety LOW- decrease lung pressure; increase demand for O2,resistance in lungs; disconnection; improper inflation of the ETT tube; improper fit; lose circuit; worsening condition

Vent modes Assist control; vent delivers same breath and volume Pressured control: set the pressure used in SIMV and A/C Peep- pressure applied at the end of exhalation prevent the lungs from emptying

Vent settings FIO2=measure of oxygen delivery\ Rate _ #breaths Tidal volume= volume of gas/air delivered with each breath Sensitivity= picks up when the client takes their own breath to either proved a breath or to assist Peak flow the flow of air/gas used to deliver each mechanical breath

The Client Who Is Unable to Breathe (cont’d) Positive pressure ventilator Volume ventilation Pressure ventilation Assisted-breath ventilation Controlled-breath ventilation Care for the client receiving mechanical ventilation Assisting the client on a mechanical ventilator Weaning the client from the ventilator

The Client Who Is Unable to Breathe (cont’d) Tracheostomy Insertion of the tracheostomy tube- must have humidification for temporary Care of the tracheostomy tube Home care of the mechanically ventilated client Please see the nursing care guidelines on page 1446

Question Is the following statement true or false? A nurse should provide the client on ventilator with communication aids.

Answer True Clients on ventilators are usually sedated, which will decrease their responsiveness and ability to communicate. Sedation may also depress respiratory effort. In addition, artificial airways prevent clients from speaking. The nurse should be sensitive to the needs of these clients. For clients on long-term ventilation, use various communication aids (e.g., chalkboard, letter-pointing board, Magic Slate) and continue to talk to the clients, explaining everything that is being done.

Points to Ponder Be familiar with hazards of 02 therapy Pain can cause hypo-hyperventilation O2 cylinders must be kept away from heat Tanks must be kept upright Primary concern in delivery of o2 is the desired concentration of O2 Venturi mask must have good ventilation by ensuring the adapter and window openings remain clear Goal of IPPB? Nursing alerts …..pay attention Endotracheal intubation placement conformation? Misplacement- causes (abdominal distention) Know SIMV/CPAP/-position for trach suction and why do we clean with hydrogen peroxide

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