OXYGEN THERAPY Fluid, Electrolyte & Acid-Base Balance

Oxygen is a colorless, odorless, tasteless gas that is essential for the body to function properly and to survive. WHAT IS MEANING OF O2 THERAPY Oxygen therapy is the administration of oxygen at a concentration of pressure greater than that found in the environmental atmosphere The air that we breathe contain approximately 21% oxygen the heart relies on oxygen to pump blood.

OXYGEN THERAPY IS USED TO TREAT Documented hypoxemia Severe respiratory distress (acute asthma or pneumonia) Severe trauma Chronic obstructive pulmonary disease (COPD, including chronic bronchitis, emphysema, and chronic asthma) Pulmonary hypertension Acute myocardial infarction (heart attack) Short-term therapy, such as post-anesthesia recovery Oxygen may also be used to treat chronic lung disease patients during exercise .

SOURCES OF OXYGEN: Wall outlets Cylinder Oxygen is moistened by passing it through a humidification system to prevent the mucous membranes of the respiratory tree from becoming dry. The oxygen is supplied from a central source through a pipeline. Only a flow meter and a humidifier are required

USING OXYGEN CYLINDERS: The oxygen cylinder is delivered with a protective cap to prevent accidental force against the cylinder outlet. To release oxygen safety and at a desirable rate, a regulator is used. It consists of two parts. A reduction gauge that reduces the pressure to a working level and shows the amount of oxygen in the tank. A flow meter that regulates the control of oxygen in liters per minutes.

PREPARATION A physician's order is required for oxygen therapy, except in emergency use. Clinical observations. Oxygen supplemental is determined by inadequate oxygen saturation indicated in Artial Blood Gas measurements,(ABGs ) . Pulse Oximetry.

CAUTIONS FOR OXYGEN THERAPY Oxygen toxicity – can occur with FIO2 > 50% longer than 48 hrs Suppression of ventilation – will lead to increased CO2 and carbon dioxide narcosis Danger of fire Infection

CLASSIFICATION OF OXYGEN DELIVERY SYSTEMS Low flow systems contribute partially to inspired gas client breathes do not provide constant FIO2 Ex: nasal cannula, simple mask , non-re breather mask , Partial rebreather mask High flow systems deliver specific and constant percent of oxygen independent of client’s breathing Ex: Venturi mask,, trach collar, T-piece

NASAL CANNULA (PRONGS): It is a disposable. plastic devise with two protruding prongs for insertion into the nostrils, connected to an oxygen source. Used for low-medium concentrations of Oxygen (24-44%).

F1o2 (Fraction Inspired Oxygen) Disadvantages Advantages Priority Nursing Interventions Amount Delivered F1o2 (Fraction Inspired Oxygen) Method may cause irritation to the nasal and pharyngeal mucosa if oxygen flow rates are above 6 liters/minute Variable FIO2 Client able to talk and eat with oxygen in place Easily used in home setting Check frequently that both prongs are in clients nares Never deliver more than 2-3 L\min to client with chronic lung disease Low flow 24-44 % 1 L\min=24% 2 L\min=28% 3 L\min=32% 4 L\min=36% 5 L\min=40% 6 L\min=44% Nasal Cannula

FACE MASK The simple Oxygen mask The partial rebreather mask: The non rebreather mask: The venturi mask:

THE SIMPLE OXYGEN MASK Simple mask is made of clear, flexible , plastic or rubber that can be molded to fit the face. It is held to the head with elastic bands. Some have a metal clip that can be bent over the bridge of the nose for a comfortable fit. It delivers 35% to 60% oxygen . A flow rate of 6 to 10 liters per minute. It has vents on its sides which allow room air to leak in at many places, thereby diluting the source oxygen. Often it is used when an increased delivery of oxygen is needed for short periods (i.e., less than 12 hours).

F1o2 (Fraction Inspired Oxygen) Disadvantages Advantages Priority Nursing Interventions Amount Delivered F1o2 (Fraction Inspired Oxygen) Method Tight seal required to deliver higher concentration Difficult to keep mask in position over nose and mouth Potential for skin breakdown (pressure, moisture) Wasting Uncomfortable for pt while eating or talking Expensive with nasal tube Can provide increased delivery of oxygen for short period of time Monitor client frequently to check placement of the mask. Support client if claustrophobia is concern Secure physician's order to replace mask with nasal cannula during meal time Low Flow 6-10 L\min 35%-60% Simple mask

THE PARTIAL REBREATHER MASK: The mask is have with a reservoir bag must romaine inflated during both inspiration & expiration It collection of the first parts of the patients' exhaled air.\ It is used to deliver oxygen concentrations up to 80%. The oxygen flow rate must be maintained at a minimum of 6 L/min to ensure that the patient does not rebreathe large amounts of exhaled air. The remaining exhaled air exits through vents.

THE NON REBREATHER MASK This mask provides the highest concentration of oxygen (95-100%) at a flow rate6-15 L/min. It is similar to the partial rebreather mask except two one-way valves prevent conservation of exhaled air. The bag is an oxygen reservoir When the patient exhales air. the one-way valve closes and all of the expired air is deposited into the atmosphere, not the reservoir bag. In this way, the patient is not rebreathing any of the expired gas.

F1o2 (Fraction Inspired Oxygen) Disadvantages Advantages Priority Nursing Interventions Amount Delivered F1o2 (Fraction Inspired Oxygen) Method Requires tight seal (eating and talking difficult, uncomfortable Not as drying to mucous membranes Clinet can inhale room air through openings in mask if oxygens supply is briefly interrupted Set flow rate so mask remains tow-thirds full during inspiration Keep reservoir bag free of twists or kinks Low Flow 6 L\min 75%-80% oxygen Partial Rebreather Mask

rebreather MASK Non Impractical for long term Therapy Disadvantages Advantages Priority Nursing Interventions Amount Delivered F1o2 Method Impractical for long term Therapy Malfunction can cause CO2 buildup suffocation Expensive Feeling of suffocation Uncomfortable Costly Delivers the highest possible oxygen concentration Suitable for pt breathing spontaneous with sever hypoxemia Maintain flow rate so reservoir bag collapses only slightly during inspiration Check that valves and rubber flaps are function properly (open during expiration ) Monitor SaO2 with pulse oximeter Low Flow 6-15 L \min 80%-100% Non rebreather MASK

VENTURI MASK The narrower the jet adapter, It is high flow concentration of oxygen. Oxygen from 40 - 50% At liters flow of 4 to 15 L/min. The mask is so constructed that there is a constant flow of room air blended with a fixed concentration of oxygen Is designed with wide- bore tubing and various color - coded jet adapters. Each color code corresponds to a precise oxygen concentration and a specific liter flow. The narrower the jet adapter, the greater the air dilution, and the lower the concentration of oxygen. It is used primarily for patients with chronic obstructive pulmonary disease ,

Venturi Mask Disadvantages Advantages Priority Nursing Interventions Amount Delivered F1o2 Method uncomfortable Risk for skin irritation produce respiratory depression in COPD patient with high oxygen concentration 50% Delivers most precise oxygen concentration Doesn’t dry mucous membranes (humidity Requires careful mointoring to verify F1O2 at flow rate ordered Check that air intake valves are not blocked Oxygen from 40-- 50% of 4 to 15 L/min. Venturi Mask

SIDE EFFECT & COMPLICATION OF OXYGEN THERAPY Oxygen toxicity Retrolental fibroplasia Absorption atelectasis OXYGEN TOXICITY It is a condition in which ventilator failure -occurs due to inspiration of a high concentration of oxygen for aprolonged period of time. -oxygen concentration greater than 50% over 24 to 48 hours can cause pathological changes in the lungs

OXYGEN TOXICITY Signs and symptoms: It is a condition in which ventilator failure: -occurs due to inspiration of a high concentration of oxygen for aprolonged period of time. -oxygen concentration greater than 50% over 24 to 48 hours can cause pathological changes in the lungs Signs and symptoms: Non-productive cough. Nausea and vomiting. Substernal chest pain. Fatigue. Nasal stuffiness. Headache. Sore throat. Hypoventilation. Nasal congestion. Dyspnea. Inspiration pain.

Retrolental fibroplasia Absorption atelectasis -blindness due to vasoconstriction & ischemia ( premature infants ) Absorption atelectasis 100 % FLO2 breathing associated with decrease ventilation ( obstruction ) Hypoventilation (increase 30 /M ) Effect ( lung collapse )

EVALUATION: DOCUMENTATION: Breathing pattern regular and at normal rate. pink color in nail beds, lips, conjunctiva of eyes. No confusion, disorientation, difficulty with cognition. Arterial oxygen concentration or hemoglobin Oxygen saturation within normal limits. DOCUMENTATION: Date and time oxygen started. Method of delivery. Oxygen concentration and flow rate. Patient observation. Add oronasal care to the nursing care plan

Fluid, Electrolyte & Acid-Base Balance Body Fluids Your body is 66% water Not evenly distributed – separated into compartments Able to move back and forth thru the cell membranes to maintain an equilibrium

Fluid Compartments Intracellular fluid – fluid inside cells [ICF] Extracellular fluid – fluid outside cells and all other body fluids --- ¼ is plasma [intravascular fluid], remaining ¾ is interstitial fluid. Small amount is localized as CSF, serous fluid, synovial fluid, humors of eye & endo/perilymph of ears

EDEMA Condition in which fluid accumulates in the interstitial compartment. Sometimes due to blockage of lymphatic vessels or by a lack of plasma proteins or sodium retention

FLUID BALANCE Amount in = amount out Average daily intake is 2500 ml [ fluids, food and metabolic water] Average daily output is 2500 ml [ urine, feces, perspiration, insensible perspiration] What can throw off these numbers?

ELECTROLYTE BALANCE Def: - concentration of individual electrolytes in the body fluid compartments is normal and remains relatively constant. Electrolytes are dissolved in body fluids Sodium predominant extracellular cation, and chloride is predominant extracellular anion. Bicarbonate also in extracellular spaces Potassium is the predominant intracellular cation and phosphates are the predominant intracellular anion Cations are actively reabsorbed, anions passively follow by electrochemical attraction Aldosterone works at kidney tubules to regulate sodium & potassium levels

ACID - BASE BALANCE Blood - normal pH of 7.2 – 7.45 < 7.2 = acidosis > 7.45 = alkalosis 3 buffer systems to maintain normal blood pH Buffers Removal of CO2 by lungs Removal of H+ ions by kidneys

Buffers Protein Buffer Systems Amino Acid buffers Hemoglobin buffers Plasma Protein buffers Phosphate Buffer Systems Carbonic Acid – Bicarbonate Buffer System

Maintenance of Acid-Base Balance Respiratory System: removal of CO2 by lungs – stabilizes the ECF, has direct effect on Carbonic Acid – Bicarbonate Buffer System Urinary System: removal of H+ ions by kidneys Disturbances to Acid-Base Balance Respiratory Acidosis Respiratory Alkalosis Metabolic Acidosis [ lactic acidosis, ketoacidosis] Metabolic Alkalosis