Chapter 87 Oxygen Therapy and Respiratory Care

1. Chapter 87Oxygen Therapy andRespiratory Care

2. Oxygen Therapy and Respiratory Care • Oxygen • Gaseous element essential to life • Prescribed as a medication • Administered under controlled conditions • Therapeutic (supplemental) oxygen • Used when client is unable to obtain sufficient oxygen for the body’s needs • Excess oxygen: can be harmful

3. Oxygen Provision, cont. • **Goals of oxygen therapy • Reverses hypoxemia • Decreases the work of the respiratory system • Decreases the heart’s work in pumping blood • Hazards of oxygen therapy • Oxygen toxicity • Vision difficulties in newborns • Weakens the stimulus to breathe • Ordered in LPM or L/min

4. Oxygen Provision, cont. • Determination of respiratory status • Use of the pulse oximeter (O2 saturation) • Measures the percentage of oxygen saturation in the blood • Measurement is noninvasive • Can be used continuously or intermittently • Normal pulse oximetry levels range from 95% to 100%.

5. Oxygen Delivery Devices • Low-flow devices • Do not provide exact oxygen concentrations. • The client’s breathing pattern influences the concentration of oxygen obtained. • High-flow devices • The oxygen percentage is constant.

6. Oxygen Provision, cont. • Sources of oxygen • Wall outlets • With bulk storage and in-room piping systems, a wall outlet is installed next to each bed. • Be familiar with the wall outlet system used in the facility. • Practice inserting the adapter into the outlet so that it can be done quickly and easily during an emergency.

7. Sources of Oxygen • Oxygen cylinders • Large cylinders: used when high flow rates are essential or when a client requires oxygen for an extended period • Small cylinders: used when transporting clients or for short-term emergencies • Careful handling and use of cylinders provides for safety. • Turn off the valve when the cylinder is not in use. • **Keep all cylinders away from heat.

8. Sources of Oxygen, cont. • Oxygen strollers • Liquid-oxygen portable unit • Nicknamed a “walker” or “companion” • Can carry more oxygen and yet be lighter and more compact than a steel gas cylinder • Liquid oxygen allowed to evaporate into its gaseous state • Metered to the person through tubing connected to an oxygen delivery device • Tank must remain upright at all times

9. Sources of Oxygen, cont. • Oxygen concentrator • Used in home and extended care settings • Compresses room air and extracts oxygen • Provides concentrated oxygen flows in the range of 1 to 5 liters per minute (LPM) • Does not need to be refilled • Requires periodic maintenance, needs electricity to operate • Not portable

10. Sources of Oxygen, cont. • Hyperbaric chamber simulates deep-sea diving by increasing atmospheric pressure • Hyperbaric oxygenation (HBO) is used • To treat air or gas embolism, carbon monoxide poisoning, anaerobic infections, crush injuries, or traumatic ischemias • To administer some types of radiation therapy • To perform heart surgery • To enhance wound healing

11. The Client Who Is Having Difficulty Breathing • Primary concern is delivery of the desired percentage of oxygen • Humidification usually is added • Low-flow devices • Do not provide exact oxygen concentrations; client’s breathing pattern influences the concentration of oxygen obtained • High-flow oxygen devices • Oxygen percentage is constant

12. Low-Flow Delivery Systems • Nasal cannula (nasal prongs) • Device used to deliver small to moderate increases in oxygen concentration • Two short tubes that fit into the nostrils • Use with caution for clients with irregular breathing patterns • Use humidification to prevent drying of nares, will also moisten airways

13. Masks • The simple mask requires a minimum oxygen flow rate of 6 LPM to prevent carbon dioxide buildup. • Document in LPM’s • Simple mask • Delivers 40-60% O2 • Use with 6-10 lpm • PRB • Delivers 60-90% O2 • Use with 8-11 lpm

14. Key Concept • Both the partial-rebreathing mask and the non-rebreathing mask can deliver high concentrations of oxygen; however, they are both classified as low-flow system oxygen administration devices because it is difficult to get the mask to fit tightly enough to ensure 100% oxygen delivery. Nursing Alert • NRB, NRM delivers highest O2 concentration @ 90-100% with flow rate of 12 lpm • Oxygen toxicity may occur in as little as 72 hours! • High amounts of O2 in infants may cause vision problems • *The NRM is used only in intensive care units or in one-to-one client care situations. • Rationale: Insufficient or interrupted oxygen flow will seal the mask against the person’s face, potentially suffocating him or her. The client needs constant monitoring.

15. Nursing Alert • Venti mask provides the most reliable and consistent O2 flow • *Do NOT use a humidifier with a Venturi mask. • Rationale: Significant back-pressure may activate the safety pressure valve on the humidifier, causing it to burst. The large amount of room air that a Venturi mask uses will humidify the gas adequately. • *Ensure that the windows of the Venturi mask remain exposed to room air. Sheets or blankets must not cover the windows or the end of the adapter. • Rationale: Prevent occlusion of the oxygen flow, which would alter the desired oxygen concentration.

16. Intermittent Positive Pressure Breathing (IPPB) • IPPB treatment is ordered for children or adults with chronic lung conditions. • Most often used for clients with cystic fibrosis • Assists the client to breathe more easily by liquefying mucus

17. The Client Who Is Unable to Breathe • When you first notice that a client is not breathing, immediately call for assistance then initiate chest compressions and respirations • Manual breathing bag • The manual resuscitator or the AMBU bag affords high oxygen concentrations and more effective and sanitary resuscitation than the mouth-to-mouth method. • Do Not hyperextend the neck of a spinal cord injury client

18. Endotracheal tube • Flexible plastic tube used to maintain a patent airway • Bilateral lung sounds are auscultated and usually a CXR is obtained to verify proper placement • Vital to check placement immediately on insertion because incorrect placement prohibits oxygenation and promote gastric distention • Nursing care: oral care q 2 hours, monitor placement of ETT, repositioning*

19. Ventilatory Support • Ventilatory failure • Inability to breathe adequately alone • Mechanical ventilator or respirator • Machine that forces air into the lungs • Connected to a client via a ETT or trach tube

20. Ventilatory Support, cont. • Negative pressure ventilator • Seldom used today • Positive pressure ventilator • Volume or pressure ventilator • Assisted-breath ventilator • Controlled-breath ventilator

21. Positive Pressure Ventilator • Volume • Pressure • Assisted breath • Support clients who are breathing on their own, but inadequately this support may be necessary to avoid ventilatory failure or hypoxia • Controlled breath • Breathes for the client, forcing a breath at set intervals

22. Ventilatory Support, cont. • Care for the client receiving mechanical ventilation • Some clients require chronic mechanical ventilation because of neuromuscular disease (spinal cord injury) • Assist the client to turn from side to side at least every 2 hours. • May sure manual breathing bag, extra trach tubes, 10 ml syringe, trach tape or collar, dressings and normal saline are at bedside

23. Ventilatory Support, cont. • Care for the client receiving mechanical ventilation, cont. • Facilitate weaning from the ventilator. • Pressure support ventilation (PSV): constant pressure is applied as the person inspires—lessens inspiratory effort or work needed • Continuous positive airwaypressure (CPAP) allows inspiratory and expiratory airway pressures to be maintained above atmospheric pressure. • CPAP helps keep client’s lungs inflated and tends to improve lung function, although breathing is spontaneous

24. The Client Who Is Unable to Breathe (cont’d) • Tracheostomy • Insertion of the tracheostomy tube • Care of the tracheostomy tube • Home care of the mechanically ventilated client

25. Trach care • 3 items to keep at bedside • Extra trach set • Suctioning equip. • Humidifier • Trach collar or mask CLEAN trach site q shift-NURSING PROCEDURE 87-6