2. CHAPTER 6 OXYGENATION NEEDS LANCASTER HIGH SCHOOL MRS. CARPENTER

3. OBJECTIVES  FACTORS AFFECTING OXYGEN STATUS  IDENTIFY SIGNS OF HYPOXIA  PERFORM  SETTING UP FOR OXYGEN ADMINISTRATION  COUGH AND DEEP BREATHE EXERCISES  COLLECTING A SPUTUM SPECIMEN  PERFORMING PULSE OXIMETRY

4. Oxygen status  factors affecting oxygen needs  Respiratory system status  all structures must be intact and functioning  open airway  exchange of o2 and co2 in alveoli

5. FACTORS AFFECTING OXYGEN STATUS  Cardiovascular system function  good blood flow to and from the heart.  narrowed vessels decrease O2 to cells and cause excess CO2 in capillaries

6. FACTORS AFFECTING OXYGEN STATUS  Red blood cell count  RBC’s carry oxygen, insufficient amount causes decrease in the cells.  blood loss reduces #  production by the bone marrow affected by:  poor diet  chemotherapy

7. FACTORS AFFECTING OXYGEN STATUS  Intact Nervous system  disease of nervous system affect respiration and respiratory muscle function  breathing is difficult

8. FACTORS AFFECTING OXYGEN STATUS  affects of disease in nervous system: brain damage=decreased rate, depth, and rhythm  narcotics=slowing of respirations  lack of O2 and CO2 in the blood=increased respirations to get more

9. FACTORS AFFECTING OXYGEN STATUS  Aging  muscles weaken and lung tissue less elastic  less strength for coughing to remove secretions leading to pneumonia

10. FACTORS AFFECTING OXYGEN STATUS  Exercise  demand for O2 increases  those with diseases have enough at rest but unable to get with increase

11. FACTORS AFFECTING OXYGEN STATUS  Fever  increases need for O2  rate and depth of respirations must increase to meet need.

12. FACTORS AFFECTING OXYGEN STATUS  Pain  increases need for O2, rate and depth o  may not be able to do this is chest or abdominal injury or surgery

13. FACTORS AFFECTING OXYGEN STATUS  Medication  may depress respiratory center in the brain two ways:  respiratory depression=slow, weak respirations, >12/minute  too shallow to get enough air into lungs

14. FACTORS AFFECTING OXYGEN STATUS  respiratory arrest  =breathing stops  medications that can cause respiratory depression and respiratory arrest

15. FACTORS AFFECTING OXYGEN STATUS  narcotics  morphine  Demerol  Opium  Heroin  Methadone  depressants  barbiturates

16. FACTORS AFFECTING OXYGEN STATUS  Smoking  causes lung cancer and COPD  at risk for CAD  Allergies  respiratory system response to allergen  symptoms cause swelling

17. FACTORS AFFECTING OXYGEN STATUS  Pollutant exposure  pollutants in the air or water cause damage to the lungs.  Nutrition  iron and vitamin B, c, and folic acid to produce new RBC  live only 3-4months then are replaced

18. FACTORS AFFECTING OXYGEN STATUS  Substance abuse  alcohol can depress brain function, decrease cough reflex which increases risk of aspiration

19. Altered respiratory function  Three processes involved with respiration  if one process is affected the respiratory process is altered.

20. -types of respiratory alteration  hypoxia  deficiency of oxygen in the cells  cause cells to function abnormally, and brain function to decrease  caused by :  illness  disease  injury  surgery affecting respiratory function

21. signs and symptoms  signs and symptoms  restlessness  dizziness  disorientation  confusion  behavior and personality changes  apprehension  anxiety  fatigue  agitation  increased pulse rate  increased rate and depth R  leaning forward, constantly sitting  cyanosis  dyspnea

22.  abnormal respirations  12 to 20 times per minute  increased in infants and children  should be quiet, effortless, and regular  both sides of chest rise and fall equally.

23.  types of abnormal respirations  tachypnea-above 24/minute  caused by: pregnancy, pain, exercise, airway obstruction, hypoxemia  bradypnea-less than 10 /minute  caused by:drug overdoses, CNS disorders

24. types of abnormal respirations  apnea  hypoventilation  hyperventilation  dyspnea  Orthopnea  Biot’s  Kussmauls

25. tests ordered to determine cause  chest x-ray  lung scan  Bronchoscopy  Thoracentesis  pulmonary function test  arterial blood gases  pulse oximetry*  normal =95%-100% Sputum culture

26. choosing a site for pulse oximetry.  Based on  condition of the person  breaks in the skin  poor circulation  don’t use fingers or toes  Dark nail polish will distort the reading  Movements can alter the reading  ( tremors, shivering, seizures)  Children attach to sole of foot, palm of hand, finger, toe or earlobe  Older person use ear, nose and forehead d/t poor circulation

27. reporting pulse oximetry results  *Write as SpO2  S=saturation, p=pulse, O2=oxygen  Date and time  Activity of the person  O2 rate if in use  Reason for measurement  Other observation=difficulty breathing, cyanosis, slow pulse

28.  APPLICATION #1  PROCEDURE: PULSE OXIMETRY

29. sputum specimens*  sputum = secretion from trachea, lungs, and bronchi, expectorated through the mouth  saliva is from salivary glands in the mouth “spit”  studied for blood, microbes, and abnormal cells.  painful and difficult for patient  rinse mouth to remove food particles and decrease saliva  never use mouthwash, can destroy microbes

30. special needs-sputum specimens  children  breathing treatments and suctioning to produce sputum  elderly  lack strength to cough up sputum  use of postural drainage (RN or RT)

31. Oxygenation  Positioning  usually easier in Semi-Fowler’s or Fowlers position  may prefer to sit up in bed or lean on overbed table=Orthopneic position  changes of position q2hr to prevent pooling of fluids

32. Coughing and Deep breathing  removal of mucous and expansion of lungs from the respiratory tract  pneumonia  atelectasis  routine after surgery and pts on bed rest problems to look for  pain  if post op or injured  fear  breaking open an incision  increased pain

33. Incentive Spirometry  measure the amount of air a person inhales and increase intake in the lungs.  uses  post operatively  pneumonia  respiratory disease  bedridden patient  elderly that have been hospitalized  how often and amount of breaths is determined by RN and facility policy

34.  APPLICATION #2 PROCEDURE: COUGH AND DEEP BREATHING PROCEDURE: COLLECT A SPUTUM SPECIMEN

35. Oxygen Therapy  used for hypoxemia  treated as a drug needs MD order with device and amount

36. OXYGEN THERAPY  types.  Continuous  never stopped or interrupted for any reason  intermittent  used for symptom relief of chest pain and SOB  PCT is responsible for safe care to pt receiving O2

37. oxygen sources  wall outlet  O2 piped into each room from central oxygen supply  may only use in the room  extension is often needed to reach restroom, etc.  oxygen tank  portable  filled by a company and brought to the facility for storage  gauge to determine how much O2 in the tank

38. oxygen sources Oxygen concentrator no source of oxygen is needed  takes oxygen from the air  limits movement of the patient  useless in a power failure  flammability

39. devices to administer oxygen nasal cannula  two prongs from tubing inserted into nostrils  pressure from ears, nasal irritation face mask  covers nose and mouth with small holes in the sides

40. devices to administer oxygen partial rebreathing face mask  reservoir bag added to the face mask for exhaled air  inhales room air, exhaled air and oxygen  bag should never totally deflate nonrebreathing face mask  prevents exhaled air from entering the reservoir bag  inhales air and oxygen from the reservoir bag  bag should never totally deflate

41. devices to administer oxygen  Venturi mask  precise amount delivered indicated by color code

42. administering oxygen administering oxygen  special care of patient with mask  communication  skin integrity  food intake

43. administering oxygen  O2 delivered in Liters/minute set by RT or RN, should be checked frequently  AP’s may adjust in some states check facility policy  patient name/room number/bed number/device ordered  may assist not responsible for administering O2

44.  APPLICATION #3 PROCEDURE: SETTING UP FOR OXYGEN ADMINISTRATION

45. Artificial Airways  Intubation=insertion of an artificial airway to help it remain patent  airway is obstructed d/t disease, injury, secretions, aspiration  semiconscious or unconscious state of patient  recovering from anesthesia  needs mechanical ventilation

46. care of the patient with artificial airway  *vitals signs checked often  *observe for hypoxia and respiratory distress  *maintain the airway and notify the RN if dislodged  *oral hygiene  *encourage communication  *comfort and reassurance by use of touch and compassion

47. common airways  oropharyngeal  inserted through the mouth into the pharynx  can be done by RN  nasopharyngeal  inserted through a nostril and into the pharynx  can be done by RN

48. common airways endotracheal  inserted through mouth or nose and into the trachea  by a MD or RN with special training using a lighted scope.  kept in place by a balloon at the end of the tube tracheostomy  inserted through a surgical incision into the trachea  some types have cuffs that are inflated to keep in place  done by MD

49. common airways- Tracheostomies  vary depending on the need and the condition of the pt.  permanent  when airway structures are removed d/t disease or trauma  children from congenital defects  temporary  conditions requiring mechanical ventilation  usually removed when the condition returns to normal and pt can breathe on their own.

50. Trach tubes  made of plastic or metal and consists of three parts  vary depending on their function and need of the pt  outer cannula-secured in place by ties or a Velcro collar around the neck  never removed  inner cannula-inserted through the outer and locked into place  removed for cleaning and mucus removal for patency  obturator-used to insert the outer cannula, then removed  taped to wall or bedside table incase outer cannula comes out

52. Trach tubes  patient education  no loose gauze or lint on dressings  keep the stoma or tube covered when outside  no showers  don’t get shampoo into the stoma  cover the stoma when shaving  do not swim  wear a medical alert bracelet

53. Trach tubes Tracheostomy care  cleaning the inner cannula, stoma, and application of clean ties or collar  Why?  removes mucus from the inner cannula to keep airway patent  prevent infection at the tracheostomy site  decrease incidence of skin breakdown

54. Trach tubes  CALL THE RN IF SIGNS/SYMPTOMS OF HYPOXIA OR RESPIRATORY DISTRESS OCCUR OR THE OUTER CANNULA COMES OUT DURING

55. Suctioning  for pts who cannot cough or the cough is too weak to remove secretions  the process of withdrawing or sucking up fluid (secretions)  tube connected to a suction source and to a suction catheter inserted into the airway

56. Suctioning  purpose  removal of secretions that obstruct airflow  decrease incidence of microbes  prevent hypoxia

57. Suctioning  Suction routes  oropharyngeal and nasopharyngeal  used for person who cannot expectorate after coughing  tracheal  for tracheal tube or tracheostomy tube

58. Suctioning  oropharyngeal  -suction through the mouth and into the pharnyx  -a complete cycle involves inserting the catheter, suctioning, and removing the catheter  -should be no longer than 10-15 seconds  -type of suction catheter will depend on the secretions  *Yankauer  *Standard

59. Suctioning  Nasopharyngeal  - suction catheter is passed through the nose and into the pharynx

60. Suctioning  Tracheostomy  usually hooked to mechanical ventilation  may be performed by AP  if condition of the patient is stable and not likely to change suddenly  tracheostomy is healed  hypoxia is a risk d/t no oxygen while the suction catheter is inserted  must hyperventilate before suctioning **for infants and children suction is no longer than 5 seconds

61.  APPLICATION #5: PROCEDURE: OROPHARYNGEAL SUCTION

62. Mechanical ventilation  used if can’t breathe on their own or cannot maintain enough oxygen in the blood  use of a machine to move air in and out of the lungs  always have artificial airways  most common: endo tracheal and tracheostomy

63. Mechanical ventilation  reactions to ventilation  most are seriously ill and may be dying 1.confusion and disorientation 2.fear of the machine 3.fear of dying 4.relief that they are getting oxygen 5.restricted in movements

64.  Care of the person on ventilation  See text

65. Chest tubes  air, blood, or fluid can collect in the pleural space from surgery or injury  pneumothorax  collection of air in the pleural space  hemothorax  collection of blood in the pleural space  pleural effusion  collection of fluid in the pleural space

66. care of the person with a chest tube  keep the drainage system below the level of the chest.  measure vital signs and report any changes  note and report signs and symptoms of hypoxia  keep connecting tubing coiled on the bed with slack

67. care of the person with a chest tube  prevent the tubing from becoming kinked  observe chest drainage and report  increased amount  bright red drainage  bubbling activity increase, decrease or stopping

68. care of the person with a chest tube  record drainage  turn and position  assist with coughing and deep breathing  assist with incentive spirometery  note if the system is loose or disconnected  observe that chest tube is still in place  place gauze pad with petrolatum on insertion site  stay with patient until the nurse arrives

69. QUESTIONS ????