Chapter 36 Oxygen Needs Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Factors Affecting Oxygen Needs Aging—respiratory muscles weaken, lung tissue is less elastic, and coughing strength decreases. Exercise—O2 needs increase. Fever—O2 needs and respiratory rate and depth increase. Pain—respirations increase to meet increased needs for O2. Drugs (narcotics) —some depress the respiratory center in the brain. Smoking—causes lung cancer and COPD. Allergies—severe swelling can close the airway. Pollutants—damage the lungs. Nutrition—iron and vitamins are needed to produce RBCs. Alcohol-in excess reduces cough reflex, which increases risk of aspiration-this is why drunk people drown on their own vomit With aging, lung tissue is less elastic. Respiratory depression means slow, weak respirations (fewer than 12 per minute). Respiratory arrest is when breathing stops. An allergy is a sensitivity to a substance that causes the body to react with signs and symptoms. Mucous membranes in the upper airway swell. A pollutant is a harmful chemical or substance in the air or water. Pollutants damage the lungs. Alcohol depresses the brain. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Altered Respiratory Function Respiratory function involves three processes. Air moves into and out of the lungs. O2 and CO2 are exchanged at the alveoli. The blood carries O2 to the cells and removes CO2 from them. Hypoxia means that cells do not have enough oxygen. Early signs of hypoxia are restlessness, dizziness, and disorientation. Cyanosis-bluish color in the skin, lips, mucous membranes and nails Respiratory function is altered if even one process is affected. The brain is very sensitive to inadequate O2. Report the signs and symptoms in Box 36-1 on p. 616 in the Textbook to the nurse at once. All organs need O2 to function. Oxygen is given to treat hypoxia. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Cyanosis Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Altered Respiratory Function (cont’d) Normal adult respirations are 12 to 20 per minute. Infants and children have faster rates. Normal respirations are quiet, effortless, and regular. Both sides of the chest rise and fall equally Abnormal sounds should be reported to the nurse https://www.youtube.com/watch?v=gOB0nM0PRTc Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Altered Respiratory Function (cont’d) These breathing patterns are abnormal. Tachypnea—rapid breathing Respirations are more than 20 per minute. Bradypnea—slow breathing Respirations are fewer than 12 per minute. Apnea—lack or absence of breathing Occurs in sudden cardiac arrest and respiratory arrest Hypoventilation—respirations are slow, shallow, and sometimes irregular. Hyperventilation—respirations are rapid and deeper than normal. Common causes of tachypnea are fever, exercise, pain, pregnancy, airway obstruction, and hypoxemia (a reduced amount of oxygen in the blood). Drug overdose and nervous system disorders are common causes of bradypnea. Common causes of hypoventilation include lung disorders that affect the alveoli, obesity, airway obstruction, drug side effects, and nervous system and musculo-skeletal disorders that affect the respiratory muscles. Hyperventilation causes include asthma, emphysema, infection, fever, nervous system disorders, hypoxia, anxiety, pain, and some drugs. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Altered Respiratory Function (cont’d) *Dyspnea —difficult, labored, or painful breathing Cheyne-Stokes respirations —respirations gradually increase in rate and depth, and then they become shallow and slow. Breathing may stop for 10 to 20 seconds. Cheyne-Stokes respirations are common when death is near. *Orthopnea —breathing deeply and comfortably only when sitting- sitting over the table to breathe is the orthopneic position Respiratory arrest-breathing has stopped Biot’s respirations —rapid and deep respirations followed by 10 to 30 seconds of apnea Kussmaul respirations —very deep and rapid respirations They signal diabetic coma. Heart disease and anxiety are common cases of dyspnea. Common causes of Cheyne-Stokes respirations include drug overdose, heart failure, renal failure, and brain disorders. Common causes of orthopnea include emphysema, asthma, pneumonia, angina, and other heart and respiratory disorders. Biot’s respirations occur with nervous system disorders. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Assisting with Assessment and Diagnostic Tests (cont’d) Pulse oximetry measures the oxygen concentration in arterial blood. The normal range is 95% to 100%. A sensor attaches to a finger, toe, earlobe, nose, or forehead. A good sensor site is needed- no fingernail polish or fake nails, patient should be still Oxygen concentration (called pulse ox or O2 sat) is often measured with vital signs-it will also record the pulse as well. Reduced oxygen in the blood is called hypoxemia Hypoxia is when cells do not get enough oxygen Oxygen concentration is the amount (percent) of hemoglobin that contains oxygen. Avoid swollen sites and sites with skin breaks. Bright light affects measurements. Place a towel over the sensor to block bright light. Do not use a finger site if the person has fake nails. If using a finger site, do not measure blood pressure on that side. Review the Focus on Children and Older Persons: Pulse Oximetry Box on p. 618 in the Textbook. Review the Delegation Guidelines: Pulse Oximetry Box on p. 618 in the Textbook. Review the Promoting Safety and Comfort: Pulse Oximetry Box on p. 619 in the Textbook. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

pulse ox Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Assisting with Assessment and Diagnostic Tests (cont’d) Pain, immobility, and narcotics interfere with deep breathing and coughing. Secretions collect in the airway and lungs and interfere with air movement and lung function. Secretions provide a place for microbes to grow and multiply. Respiratory disorders cause the lungs, bronchi, and trachea to secrete mucus. Mucus from the respiratory system is called sputum when expectorated (expelled) through the mouth. Sputum that contains blood is hemoptysis-tell the nurse at once Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Meeting Oxygen Needs (cont’d) The following measures are common in care plans. Positioning Breathing is usually easier in the semi-Fowler’s and Fowler’s positions. Frequent position changes are needed-turn q 2. Deep breathing and coughing-use pillow for support Deep breathing moves air into most parts of the lungs. Coughing removes mucus. Exercises promote oxygenation. Remind pt to cover mouth and nose when sneezing, use tissues and throw tissues into waste bucket, and wash hands frequently Persons with difficulty breathing often prefer sitting up and leaning over a table to breathe. This is called the orthopneic position. Unless the doctor limits positioning, the person must not lie on one side for a long time. Secretions pool and the lungs cannot expand on that side. Position changes are needed at least every 2 hours. Deep breathing and coughing exercises are done after surgery or injury and during bedrest. They are done every 1 to 2 hours while the person is awake. They prevent pneumonia and atelectasis (collapse of a portion of the lung). Review the Focus on Communication: Deep Breathing and Coughing Box on p. 621 in the Textbook. Review the Focus on Children and Older Persons: Deep Breathing and Coughing Box on p. 621 in the Textbook. Review the Delegation Guidelines: Deep Breathing and Coughing Box on p. 621 in the Textbook. Review the Promoting Safety and Comfort: Deep Breathing and Coughing Box on p. 621 in the Textbook. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Meeting Oxygen Needs (cont’d) Incentive spirometry. IS means inhaling as deeply as possible and holding the breath for at least 3 seconds. The goal is to improve lung function. Atelectasis (collapse of a portion of the lung) is prevented or treated. This exercise: Moves air deep into the lungs Loosens secretions Promotes the exchange of O2 and CO2 between the alveoli and capillaries With incentive spirometry, the person inhales until reaching a pre-set volume of air. Balls or bars in the device (spirometer) move as the person inhales. The spirometer is placed upright. The person exhales normally. He or she seals the lips around the mouthpiece. A slow, deep breath is taken until the balls rise to the desired height. The breath is held for 3 to 6 seconds to keep the balls floating. The person removes the mouthpiece and exhales slowly. The person may cough at this time. After some normal breaths, the device is used again. Review the Delegation Guidelines: Incentive Spirometry Box on p. 624 in the Textbook. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Incentive Spirometer Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Assisting with Oxygen Therapy Oxygen is treated as a drug-ordered by MD. The doctor orders: When to give O2 The amount of O2 to give The device to use Some people need oxygen constantly. If not humidified, oxygen dries the airway’s mucous membranes-remember mouth care Bubbling in the humidifier means that water vapor is being produced. Oxygen flow rates The flow rate is the amount of oxygen given. It is measured in liters per minute (L/min). The doctor orders 2 to 15 liters of O2 per minute. Disease, injury, and surgery often interfere with breathing. The nurse and respiratory therapist start and maintain oxygen therapy. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Humidified O2 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Assisting with Oxygen Therapy (cont’d) Oxygen sources Wall outlet O2 is piped into each person’s unit. Oxygen tank The oxygen tank is placed at the bedside. Oxygen concentrator The machine removes oxygen from the air. Liquid oxygen system A portable unit is filled from a stationary unit. The portable unit can be worn over the shoulder for ambulatory or mobile patients. Small tanks are used during emergencies and transfers. They are also used by persons who walk or use wheelchairs. A gauge on oxygen tanks tells how much oxygen is left. A power source is needed when an oxygen concentrator is used. Portable liquid oxygen systems have enough oxygen for about 8 hours of use. Review the Focus on Long-Term Care and Home Care: Oxygen Sources Box on p. 625 in the Textbook. Review the Safety and Comfort: Oxygen Sources Box on p. 625 in the Textbook. Review the Teamwork and Time Management: Oxygen Sources Box on p. 625 in the Textbook. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Types of Oxygen Delivery Methods Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Assisting with Oxygen Therapy (cont’d) Oxygen devices The doctor orders the device for giving O2. These devices are common: Nasal cannula-two prongs inserted into nostrils Simple face mask Partial-rebreather mask Non-rebreather mask Venturi mask Moisture can build up under the mask. Keep the face clean and dry. Oxygen is given by cannula during meals. The nurse changes the oxygen mask to a cannula. Remember to check behind ears, under and on bridge of nose for breakdown A cannula allows eating and drinking. Tight prongs can irritate the nose. Pressure on the ears and cheekbones is possible. Review the Focus on Children and Older Persons: Oxygen Devices Box on p. 627 in the Textbook. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Overview of Mask Delivery Devices https://www.youtube.com/watch?v=4OUEPvcAyRM Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

BiPap-usually worn at night for sleep apnea Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Safety with Oxygen Remember that O2 is highly flammable! No smoking sign should be posted No smoking materials should be in room No candles are allowed Make sure electrical items are turned off prior to unplugging them to prevent sparks Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.