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

2. Oxygen Oxygen (O2) 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.
Respiratory complications are risks after surgery.
You must give safe and effective care.
Review the Body Structure and Function Review Box on p. 615 in the Textbook.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

3. Factors Affecting Oxygen Needs
The respiratory and circulatory systems must function properly for cells to get enough O2.
Disease, injury, or surgery involving these systems affects the intake and use of O2.
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.
Body systems depend on each other.
Respiratory system structures must be intact and function properly. Alveoli (air sacs) must exchange oxygen (O2) and carbon dioxide (CO2).
Capillaries and cells must exchange O2 and CO2.
The bone marrow must produce enough RBCs. Hemoglobin picks up O2 in the lungs and carries it to the cells.
Brain damage affects respiratory rate, rhythm, and depth. Narcotics and depressant drugs affect the brain and slow respirations.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

4. Factors Affecting Oxygen Needs (cont’d)
Aging—respiratory muscles weaken.
Exercise—O2 needs increase.
Fever—O2 needs and respiratory rate and depth increase.
Pain—respirations increase to meet increased needs for O2.
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.
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.

5. 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.
Cells cannot function properly.
Anything that affects respiratory function can cause hypoxia.
Early signs of hypoxia are restlessness, dizziness, and disorientation.
Hypoxia threatens life.
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.

6. 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.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

7. 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.

8. 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
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.

9. Assisting with Assessment and Diagnostic Tests
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.
Review the contents of Box 36-2 on p. 617 in the Textbook.
Review the Focus on Communication: Assisting With Assessment and Diagnostic Tests Box on p. 617 in the Textbook.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

10. Assisting with Assessment and Diagnostic Tests (cont’d)
The doctor may order the following tests:
Chest x-ray (CXR)
Lung scan
Bronchoscopy
Thoracentesis
Pulmonary function tests
Arterial blood gases (ABGs)
Chest x-ray: An x-ray is taken of the chest to study lung changes.
Lung scan: The lungs are scanned to see what areas are not getting air or blood. A radio-isotope is injected.
Bronchoscopy: A scope is passed into the trachea and bronchi. Airway structures are checked for bleeding and tumors. Tissue samples are taken, or mucous plugs and foreign objects are removed.
Thoracentesis: The pleura is punctured. Air or fluid is removed from it.
Pulmonary function tests: These tests measure the amount of air moving into and out of the lungs (volume) and how much air the lungs can hold (capacity).
Arterial blood gases: Laboratory tests measure the amount of oxygen in the blood.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

11. 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.
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
O2 Saturation or O2 Sat
SpO2 (Saturation of peripheral 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.

12. Assisting with Assessment and Diagnostic Tests (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.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

13. Meeting Oxygen Needs
To get enough oxygen, air must move deep into the lungs.
Air must reach the alveoli where O2 and CO2 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.
Secretions also interfere with air movement and lung function.
Oxygen needs must be met.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

14. 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.
Deep breathing and coughing
Deep breathing moves air into most parts of the lungs.
Coughing removes mucus.
Exercises promote oxygenation.
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.

15. Meeting Oxygen Needs (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 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.

16. Assisting with Oxygen Therapy
Oxygen is treated as a drug.
The doctor orders:
When to give O2
The amount of O2 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.
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.

17. 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.
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.

18. Assisting with Oxygen Therapy (cont’d)
Oxygen devices
The doctor orders the device for giving O2.
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.
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.

19. Assisting with Oxygen Therapy (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 O2 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.
Some states and agencies let nursing assistants adjust O2 flow rates. Know your agency’s policy.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

20. Assisting with Oxygen Therapy (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.
Oxygen is a dry gas. Distilled water is used in humidifiers because it is pure; dissolved salts are removed by a chemical process.
Low flow rates (1 to 2 L/min) by cannula are not usually humidified.
Review the Delegation Guidelines: Oxygen Administration Set-Up Box on p. 628 in the Textbook.
Review the Promoting Safety and Comfort: Oxygen Administration Set-Up Box on p. 628 in the Textbook.
Review the Teamwork and Time Management: Oxygen Administration Set-Up Box on p. 628 in the Textbook.
Follow the rules in Box 36-3 on p. 629 in the Textbook. Also, follow the rules for fire and the use of oxygen in Chapter 12 in the Textbook.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.