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

Aging—respiratory muscles weaken. Aging—respiratory muscles weaken. Exercise—O 2 needs increase. Exercise—O 2 needs increase. Fever—O 2 needs and respiratory rate and depth increase. Fever—O 2 needs and respiratory rate and depth increase. Pain—respirations increase to meet increased needs for O 2 Pain—respirations increase to meet increased needs for O 2. Drugs—some depress the respiratory center in the brain. Drugs—some depress the respiratory center in the brain. Smoking—causes lung cancer and COPD. Smoking—causes lung cancer and COPD. Allergies—severe swelling can close the airway. Allergies—severe swelling can close the airway. Pollutants—damage the lungs. Pollutants—damage the lungs. Nutrition—iron and vitamins are needed to produce RBCs. Nutrition—iron and vitamins are needed to produce RBCs. Alcohol in excess reduces cough reflex, which increases risk of aspiration. Alcohol in excess reduces cough reflex, which increases risk of aspiration. Slide 2 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Factors Affecting Oxygen Needs (cont’d)

Altered Respiratory Function  Respiratory function involves three processes.  Air moves into and out of the lungs.  O 2 and CO 2 are exchanged at the alveoli.  The blood carries O 2 to the cells and removes CO 2 from them.  Hypoxia means that cells do not have enough oxygen.  Early signs of hypoxia are restlessness, dizziness, and disorientation. Slide 3 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. Slide 4 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

 These breathing patterns are abnormal.  Tachypnea—rapid breathing Respirations are more than 20 per minute. Respirations are more than 20 per minute.  Bradypnea—slow breathing Respirations are fewer than 12 per minute. Respirations are fewer than 12 per minute.  Apnea—lack or absence of breathing Occurs in sudden cardiac arrest and respiratory arrest Occurs in sudden cardiac arrest and respiratory arrest  Hypoventilation—respirations are slow, shallow, and sometimes irregular.  Hyperventilation—respirations are rapid and deeper than normal. Slide 5 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. Breathing may stop for 10 to 20 seconds. Cheyne-Stokes respirations are common when death is near. Cheyne-Stokes respirations are common when death is near.  Orthopnea —breathing deeply and comfortably only when sitting  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. They signal diabetic coma. Slide 6 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Altered Respiratory Function (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.  Oxygen concentration is often measured with vital signs. Report and record according to agency policy. An agency may use one of these terms. An agency may use one of these terms.  pulse oximetry or pulse ox  O 2 Saturation or O 2 Sat  SpO 2 (Saturation of peripheral oxygen) Slide 7 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Assisting with Assessment and Diagnostic Tests (cont’d)

Baby pulse ox Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 8

 Pain, immobility, and narcotics interfere with deep breathing and coughing. Secretions collect in the airway and lungs. Secretions collect in the airway and lungs. Secretions provide a place for microbes to grow and multiply. 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. Slide 9 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Assisting with Assessment and Diagnostic Tests (cont’d)

Meeting Oxygen Needs (cont’d)  The following measures are common in care plans. Positioning Positioning  Breathing is usually easier in the semi- Fowler’s and Fowler’s positions.  Frequent position changes are needed. Deep breathing and coughing Deep breathing and coughing  Deep breathing moves air into most parts of the lungs.  Coughing removes mucus.  Exercises promote oxygenation. Slide 10 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

 Incentive spirometry— also called sustained maximal inspiration (SMI). SMI means inhaling as deeply as possible and holding the breath for at least 3 seconds. The goal is to improve lung function. The goal is to improve lung function.  Atelectasis is prevented or treated. This exercise: This exercise:  Moves air deep into the lungs  Loosens secretions  Promotes the exchange of O 2 and CO 2 between the alveoli and capillaries Slide 11 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Meeting Oxygen Needs (cont’d)

Incentive Spirometer Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 12

 Oxygen is treated as a drug.  The doctor orders:  When to give O 2  The amount of O 2 to give  The device to use  Some people need oxygen constantly.  If not humidified, oxygen dries the airway’s mucous membranes.  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). It is measured in liters per minute (L/min).  The doctor orders 2 to 15 liters of O 2 per minute. Slide 13 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Assisting with Oxygen Therapy

Assisting with Oxygen Therapy (cont’d)  Oxygen sources  Wall outlet O 2 is piped into each person’s unit. O 2 is piped into each person’s unit.  Oxygen tank The oxygen tank is placed at the bedside. The oxygen tank is placed at the bedside.  Oxygen concentrator The machine removes oxygen from the air. The machine removes oxygen from the air.  Liquid oxygen system A portable unit is filled from a stationary unit. A portable unit is filled from a stationary unit. The portable unit can be worn over the shoulder. The portable unit can be worn over the shoulder. Slide 14 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. Slide 15

 Oxygen devices  The doctor orders the device for giving O 2.  These devices are common: Nasal cannula Nasal cannula Simple face mask Simple face mask Partial-rebreather mask Partial-rebreather mask Non-rebreather mask Non-rebreather mask Venturi mask Venturi mask  Moisture can build up under the mask. Keep the face clean and dry. Keep the face clean and dry.  Oxygen is given by cannula during meals. The nurse changes the oxygen mask to a cannula. The nurse changes the oxygen mask to a cannula. Slide 16 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Assisting with Oxygen Therapy (cont’d)

Overview of Mask Devices Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 17