Practical Nursing Diploma Program - Semester 2 Lab Oxygen therapy, Incentive Spirometry, Pulse Oximetry &Sputum Collection

Oxygen Therapy……... Is a medication and requires an order wall outlet or portable O2 must handle portable tanks carefully as under tremendous pressure (2000 psi) the force through an accidentally partially opened outlet could cause cylinder to take off like a missile- transport carefully

Flow Rate flow rate is measured in litres/min rate is ordered by physician depending on patient’s condition and route of administration check rate at beginning and end of shift and q4h to make sure it is correct rate does not reflect the amount of inspired oxygen due to leakage and mixing with atmospheric air

Caution!!!! COPD patient retain CO2 so they use the O2 chemoreceptor to regulate breathing, if O2 given too high then O2 is high and the receptors are not told to breath and they slow down their breathing too much and may even stop.

Cautions O2 very flammable so must be careful with open flames, smoking, electrical equipment, petroleum products etc. check O2 set up from patient to outlet frequently to make sure connections are secure at least q 4 hours

O2 Delivery Systems……. Nasal cannula - most common type used as doesn’t interfere with eating or talking Disadvantage is that it can dry the nasal membranes and is easily dislodged, also uncomfortable behind the ears where tubing sits Watch skin integrity

Face masks many different types should be snug but not to tight less leakage of O2 talking and eating more difficult can be uncomfortable

Other mask types Simple mask - vents on sides to allow mixing of room air and escape of CO2 Partial rebreather mask - first part of exhaled air collects in bag and mixes with 100% O2 for next inhaled breath

Non rebreather mask similar to partial but provides highest concentration of O2 2 one way valves prevent rebreathing exhaled air, bag is filled with O2 which is inhaled through mask on inspiration

Venturi mask provides the most precise concentration of O2 by allowing room air in through ports at side of tubing, ports are adjusted according to prescription important to ensure that ports are not occluded by linen etc.

Venturi masks

Care of patient all delivery systems can be uncomfortable for patient must remove mask, prongs etc. and clean skin underneath moisture buildup is a problem area behind ears must be checked for signs of breakdown from straps, tubing etc. Remember to change from mask to nasal cannula for meals

Transporting a patient with O2 if a patient requires continuous O2 therapy and they need to be transferred elsewhere in the hospital, make sure you provide portable O2 and that it is working properly!!!!! always check level of O2 left in tank prior to using and after using don’t send patient off unit with <3/4 full tank be careful when using extension tubing

Incentive Spirometer……. keeps alveoli from collapsing so air exchange can take place provides immediate feedback re pts respiratory effort/ability type of pt – post op, COPD, pneumonia, prolonged bed rest have patient sitting upright if possible remove denture if loose

have patient exhale normally instruct patient not to breath through nose ask patient to inhale slowly and as deeply as possible through mouthpiece have patient hold breath and count to 3 document progress

Sputum Collection……... need to know what you’re collecting for and the proper procedure some specimens must be collected early in the morning (AFB- Acid Fast Bacillis) make sure container is labeled and matches name on requisition bring all supplies to bedside ensure you have the correct container

pt lips, facial hair, hands etc. should not touch the inside or tip (or cap) of the container make sure it’s a “good” specimen before sending to lab find out how long specimen can be left at room temperature

Procedure Have the patient take several deep breaths Cough up the sputum from deep within the lungs Expectorate into collection container

Require 1 tsp on sputum If unable to produce at one attempt, cap container between attempts Ensure cap is securely on container to send to lab Ensure current antibiotic use is noted on the lab requisition slip

Pulse Oximetry…….. measures oxygen saturation of arterial blood Uses infrared light records trends in O2 saturation useful for pts on O2, post op patients and those at high risk for hypoxia pt with low Hgb can still have good 02 sats but not enough 02 for tissue needs should be 95 – 100 %

Placement Can be placed on fingers, toes, nose, earlobe or forehead

Readings value less than 85% indicates tissues are not getting enough oxygen Intervention necessary DON’T JUST TRUST THE EQUIPMENT!!!! equipment is not a substitute for your clinical assessment skills

clean site with alcohol wipe and allow to dry remove nail polish and artificial nails if necessary apply to skin (use adhesive if required) check equipment is functioning properly set alarms if present check Hgb status

document all readings accurately if you suspect the equipment is not working correctly, reassess your patient’s vital signs and general condition smaller units are often inaccurate due to general use/abuse use your assessment skills in combination with technology!!!!!

if using continuously, check skin for signs of breakdown at least once per shift bright light may cause equipment malfunction – cover probe with cloth check on healthy person if unsure of accuracy of readings when in doubt, get another one and start again!!!!

Cultural Issue Persons with darker skin colour will read a lower value usually due to pigmentation in the skin.

Case Study Mrs. B is 82 years old and admitted with COPD, fever and generalized weakness. You are assigned to care for her. She tells you that she has been having increasing difficulty breathing over the past few days and that her home O2 at 2L/min doesn’t seem to be helping. Her O2 sats on room air are 85% and rise to 91% once her O2 has been on for 10 mins. During the interview, she coughs productively and produces thick, brown sputum. She tells you that she generally starts to cough when she talks too much and it is worse at night than during the day. Her vital signs are 38.3 – 102 – 26 – 114/85. What nursing interventions would you implement for Mrs. B?

Activities In groups, complete case study nursing interventions using today’s lab skills examine O2 equipment