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

O XYGEN Oxygen (O 2 ) is a gas. It has no taste, odor, or color. It is a basic need required for life. Death occurs within minutes if breathing stops. Brain damage and serious illnesses can occur without enough oxygen. The amount of oxygen in the body is affected by Illness Surgery Injury You assist in the care of persons with oxygen needs. Slide 2 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

F ACTORS A FFECTING O XYGEN N EEDS The respiratory and circulatory systems must function properly for cells to get enough O 2. Disease, injury, or surgery involving these systems affects the intake and use of O 2. Altered function of any system affects oxygen needs. Oxygen needs are affected by: Respiratory system Function—an open airway is needed. Circulatory system Function—blood must flow to and from the heart. Red blood cell count—RBCs contain hemoglobin. Nervous system Function—diseases and injuries can affect respiratory muscles, making breathing difficult or impossible. Slide 3 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

F ACTORS A FFECTING O XYGEN N EEDS ( CONT ’ D ) Aging—respiratory muscles weaken. Exercise—O 2 needs increase. Fever—O 2 needs and respiratory rate and depth increase. Pain—respirations increase to meet increased needs for O 2. Drugs—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. Slide 4 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

A LTERED R ESPIRATORY F UNCTION 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. Cells cannot function properly. Anything that affects respiratory function can cause hypoxia. Early signs of hypoxia are restlessness, dizziness, and disorientation. Hypoxia threatens life. Slide 5 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

A LTERED R ESPIRATORY F UNCTION ( 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 6 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

A LTERED R ESPIRATORY F UNCTION ( 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. Slide 7 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

A LTERED R ESPIRATORY F UNCTION ( 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 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. Slide 8 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

A SSISTING WITH A SSESSMENT AND D IAGNOSTIC T ESTS Altered respiratory function may be an acute or chronic problem. Report your observations promptly and accurately. Quick action is needed to meet the person’s oxygen needs. Measures are taken to correct the problem and to prevent it from becoming worse. Slide 9 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

A SSISTING WITH A SSESSMENT AND D IAGNOSTIC T ESTS ( CONT ’ D ) The doctor may order the following tests: Chest x-ray (CXR) Lung scan Bronchoscopy Thoracentesis Pulmonary function tests Arterial blood gases (ABGs) Slide 10 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

A SSISTING WITH A SSESSMENT AND D IAGNOSTIC T ESTS ( 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. pulse oximetry or pulse ox O 2 Saturation or O 2 Sat SpO 2 (Saturation of peripheral oxygen) Slide 11 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

A SSISTING WITH A SSESSMENT AND D IAGNOSTIC T ESTS ( CONT ’ D ) 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 specimens are studied for blood, microbes, and abnormal cells. Slide 12 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

M EETING O XYGEN N EEDS To get enough oxygen, air must move deep into the lungs. Air must reach the alveoli where O 2 and CO 2 exchange. Disease, injury, and surgery prevent air from reaching the alveoli. Pain, immobility, and narcotics interfere with deep breathing and coughing. Secretions collect in the airway and lungs. Secretions provide a place for microbes to grow and multiply. Infection is a threat. Slide 13 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

M EETING O XYGEN N EEDS ( 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. Deep breathing and coughing Deep breathing moves air into most parts of the lungs. Coughing removes mucus. Exercises promote oxygenation. Slide 14 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

M EETING O XYGEN N EEDS ( CONT ’ D ) 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. Atelectasis is prevented or treated. 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 15 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

A SSISTING WITH O XYGEN T HERAPY 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. Others need it for symptom relief. Chest pain Shortness of breath You do not give oxygen. You help provide safe care. Slide 16 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

A SSISTING WITH O XYGEN T HERAPY ( CONT ’ D ) Oxygen sources Wall outlet O 2 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. Slide 17 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

A SSISTING WITH O XYGEN T HERAPY ( CONT ’ D ) Oxygen devices The doctor orders the device for giving O 2. These devices are common: Nasal cannula 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. Slide 18 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

A SSISTING WITH O XYGEN T HERAPY ( CONT ’ D ) 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 O 2 per minute. The nurse or respiratory therapist sets the flow rate with a flow meter. The nurse and care plan tell you the person’s flow rate. When giving care and checking the person: Always check the flow rate. Tell the nurse at once if the flow rate is too high or too low. A nurse or respiratory therapist will adjust the flow rate. Slide 19 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

A SSISTING WITH O XYGEN T HERAPY ( CONT ’ D ) Oxygen administration set-up If not humidified, oxygen dries the airway’s mucous membranes. Distilled water is added to the humidifier. Bubbling in the humidifier means that water vapor is being produced. Oxygen safety You assist the nurse with oxygen therapy. You do not give oxygen. You do not adjust the flow rate unless allowed by your state and agency. You must give safe care. Slide 20 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.