chapter 87 oxygen therapy and respiratory care
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Chapter 87 Oxygen Therapy and Respiratory Care. Oxygen Therapy and Respiratory Care. Oxygen Gaseous element essential to life Prescribed as a medication Administered under controlled conditions Therapeutic (supplemental) oxygen - PowerPoint PPT PresentationTRANSCRIPT
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Chapter 87
Oxygen Therapy andRespiratory Care
Chapter 87
Oxygen Therapy andRespiratory Care
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Oxygen Therapy and Respiratory CareOxygen 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
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Oxygen Provision, cont.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
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Oxygen Provision, cont. 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%.
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Oxygen Delivery DevicesOxygen 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.
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Oxygen Provision, cont. 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.
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Sources of OxygenSources 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.
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Sources of Oxygen, cont.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
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Sources of Oxygen, cont.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
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Sources of Oxygen, cont.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
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The Client Who Is Having Difficulty BreathingThe 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
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Low-Flow Delivery Systems 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
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MasksMasks
• 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
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Key ConceptKey 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.
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Nursing AlertNursing 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.
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Intermittent Positive Pressure Breathing (IPPB) 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
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The Client Who Is Unable to BreatheThe 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
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Endotracheal tubeEndotracheal 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*
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Ventilatory SupportVentilatory 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
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Ventilatory Support, cont.Ventilatory Support, cont.
• Negative pressure ventilator
– Seldom used today
• Positive pressure ventilator
– Volume or pressure ventilator
– Assisted-breath ventilator
– Controlled-breath ventilator
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Positive Pressure VentilatorPositive 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
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Ventilatory Support, cont.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
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Ventilatory Support, cont.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 airway pressure (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
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The Client Who Is Unable to Breathe (cont’d)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
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Trach careTrach 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