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Study Notes 10/13/2008

Chapter 44

Oxygen Needs

Copyright © 2009 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.

Oxygen Needs
 You must know the following:
 Does your province or territory allows you to
perform the task?
 Is the task in your job description?
 Do you have the necessary training?
 Have your reviewed the task with a nurse?
 Have you been supervised by a nurse or
technician for the task?

Copyright © 2009 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. Slide 2

Oxygen Needs (Cont’d)


 Oxygen (O2) is:
• A gas with no taste, odour, or colour
• Most important basic need for life
 Death occurs within minutes if breathing stops.
 Brain damage and serious illnesses can occur
without enough oxygen.
 You assist in the care of persons with oxygen
needs.

Copyright © 2009 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. Slide 3

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Factors Affecting Oxygen Needs


 Altered function of any system affects oxygen
needs.
 Oxygen needs are affected by:
• Respiratory system function
 Airway must be open, adequate number of alveoli to
absorb oxygen, and excrete carbon dioxide.
• Circulatory system function
• Red blood cell count
 Hemoglobin picks up and carries oxygen.
 Bone marrow produces RBC.

Copyright © 2009 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. Slide 4

Factors Affecting
Oxygen Needs (Cont’d)
 Oxygen needs are affected by (cont’d):
• Nervous system function
 Disease/injury affect respiratory muscles
• Aging
 Muscles weaken/lung becomes less elastic/difficulty
coughing
• Exercise
 Requires more oxygen
• Fever
 Oxygen needs increase, body working harder to fight
infection
• Pain
 Oxygen needs increase, chest /abdominal surgery make
this difficult

Copyright © 2009 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. Slide 5

Factors Affecting
Oxygen Needs (Cont’d)
 Oxygen needs are affected by (cont’d):
• Drugs
 Depress the respiratory centre or cause respiratory arrest
 Substance abusers at risk for respiratory depression/arrest
• Smoking
 Can damage lung tissue, cause lung cancer and COPD
• Allergies
 Swelling of upper airway can result in chronic bronchitis, asthma
and death
• Pollutant exposure
 Damage lungs
• Nutrition
 Good nutrition necessary for RBC production
• Alcohol
 Depresses the cough reflex, increase risk of aspiration

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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.

Copyright © 2009 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. Slide 7

Altered Respiratory Function (Cont’d)

 Signs and symptoms


 Shortness of breath (SOB) – may be acute or
chronic
• When unable to breath client may feel very anxious,
panic.
 Client often wants to sit up in bed or chair as
difficult to breathe when lying flat (orthopnea).
• Struggling to breathe is exhausting.
 Never turn up the oxygen level.

Copyright © 2009 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. Slide 8

Signs and Symptoms


 Support Worker need to observe client for:
 Cough
• Frequency
• Productive/non
Productive/non--productive
 Sputum
• Colour, odour, consistency bloody hemoptysis
 Noisy respirations
 Chest pain
 Cyanosis
• Lips, nail beds, skin, mucous membrane
 Changes in vital signs
 Body position

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Abnormal Respiratory Patterns


 Adults normally have 12 to 20 respirations
per minute.
 Infants and children have faster rates.
 Normal respirations are quiet, effortless, and
regular.
 Both sides of the chest rise and fall equally.
 Medical term for normal respirations –
eupnea

Copyright © 2009 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. Slide 10

Abnormal Respiratory
Patterns (Cont’d)
 These breathing patterns are abnormal:
 Tachypnea is rapid breathing.
• Respirations are more than 24 per minute.
 Bradypnea is slow breathing.
• Respirations are fewer than 12 per minute.
 Apnea is lack or absence of breathing.
• Sleep apnea and periodic apnea of newborns are other
types of apnea.
 Hypoventilation
• Respirations are slow, shallow, and sometimes irregular.
 Hyperventilation
• Respirations are rapid and deeper than normal.

Copyright © 2009 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. Slide 11

Abnormal Respiratory
Patterns (Cont’d)
 These breathing patterns are abnormal
(cont’d):
 Dyspnea
• Is difficult, laboured, or painful breathing
 Cheyne--Stokes
Cheyne
• Respirations gradually increase in rate and depth, and
then they become shallow and slow.
• Breathing may stop for 10 to 20 seconds.
• Cheyne-
Cheyne-Stokes respirations are common when death is
near.
 Orthopnea
• Is breathing deeply and comfortably only when sitting

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Hypoxia
 Hypoxia a deficiency of oxygen in the cells.
 Cells do not have enough oxygen.
 Cells cannot function properly.
 Anything that affects respiratory function can
cause hypoxia.
 Brain is very sensitive to inadequate supply of
oxygen.
 Early signs of hypoxia are restlessness, dizziness,
and disorientation.
 Hypoxia is life-
life-threatening.
• Report signs and symptoms immediately.

Copyright © 2009 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. Slide 13

Promoting Oxygenation
 To get enough oxygen, air must reach the
alveoli where O2 and CO2 are exchanged.
 Disease and injury can prevent air from reaching
the alveoli.
 Pain and immobility interfere with deep breathing
and coughing.
 Narcotics can interfere with deep breathing and
coughing.
 Measures to meet oxygen needs are
common in care plans.

Copyright © 2009 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. Slide 14

Positioning
 Positioning
 Breathing is usually easier in semi-
semi-Fowler’s and
Fowler’s positions.
 Clients with difficulty breathing often prefer the
orthopneic position.
 Frequent position changes are needed q2h.
 Unless physician has restrictions on positioning
the client, the client should never lie on one side
for long periods.

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Coughing and Deep Breathing


 Deep breathing and coughing
 Deep breathing moves air into most parts of the lungs.
 Coughing removes mucus.
 Helps prevent pneumonia and atelectasis (lung collapses)
 Clients may be reluctant to do exercises as painful after
injury or surgery, afraid of breaking open an incision.
 Post--surgical period, bed rest, lung disease, and paralysis
Post
are factors for atelectasis.
 Deep breathing and coughing may be done every 1 to 2
hours or 4 times a day, as ordered.

Copyright © 2009 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. Slide 16

Incentive Spirometry
 Incentive spirometry (sustained maximal inspiration
[SMI]) – a machine that measures the amount of air
inhaled
 A visual guide for the client
 The goal is to improve lung function.
 Client takes slow, deep breath until the balls rise to
desired height, hold breath 3 to 6 seconds, exhales
slowly.
 Care plan or supervisor gives instructions.
 How often client to use it
 The desired height
 Number of breaths needed

Copyright © 2009 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. Slide 17

Assisting with Oxygen Therapy


 Oxygen is treated as a drug.
 The doctor orders:
• The amount of oxygen to give
• The device to use
• When to give it
 Some clients need oxygen constantly. Others
need it for symptom relief.
 You do not give oxygen.
• You assist the nurse in providing safe care.
• May be trained to transfill oxygen, provide oral suction

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Oxygen Sources
 Three main delivery systems:
 Oxygen concentrator
• The machine filters oxygen from the air in the room.
• Plugged into a grounded electrical outlet
 Oxygen tank
• Contains compressed oxygen
• The oxygen tank is placed at the bedside.
• In hospitals and some continuing care facilities, oxygen is piped
directly into a person’s unit through a wall oxygen outlet.
 Liquid oxygen system
• A portable unit is filled from a stationary container.
• The portable unit can be worn over the shoulder.

Copyright © 2009 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. Slide 19

Oxygen Therapy and Safety


 Remember:
 You ASSIST with oxygen therapy.
 You do not administer oxygen.
 You are responsible for giving safe care to clients
receiving oxygen – always follow safety
guidelines.
• Box 44-
44-4: Safety Guidelines for Oxygen Therapy (p. 846)
• Box 44-
44-5: Oxygen and Fire Safety Guidelines (p. 847)

Copyright © 2009 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. Slide 20

Oxygen and Fire Safety


 Oxygen is flammable.
 Keep oxygen source away from heat and open
flame.
 Physician, nurse, or respiratory therapist is
responsible for teaching client and family
members about oxygen safety.
• Warn client of dangers and the safety hazard.
• Report concerns to supervisor.

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Oxygen Administration Devices


 Oxygen devices
 The doctor orders the device to give oxygen.
 These devices are common:
• Nasal cannula
• Simple face mask
• Partial-
Partial-rebreather mask
• Non-
Non-rebreather mask
• Venturi mask
 Moisture can build up under the mask.
• Keep the face clean and dry.
 Masks are removed for eating.
• Usually oxygen is given by cannula during meals.

Copyright © 2009 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. Slide 22

Oxygen Devices
 Oxygen flow rates
 The flow rate is the amount of oxygen given.
• It is measured in litres per minute (L/min).
 The doctor orders 2 to 15 litres of O2 per minute.
 The nurse or respiratory therapist sets the flow rate.
 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 supervisor at once if the flow rate is too high or too low.
 A nurse or respiratory therapist will adjust the flow rate.

Copyright © 2009 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. Slide 23

Preparing for Oxygen Administration

 Oxygen administration set-


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 vapour 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.

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Assisting with Diagnostic Tests


 Doctor orders tests to find the cause of the
problem and to prevent it from becoming
worse.
 These tests are common:
• Chest X-
X-ray
• Lung scan
• Bronchoscopy
• Thoracentesis
• Pulmonary function tests
• Arterial blood gases (ABGs)

Copyright © 2009 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. Slide 25

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. May need to remove nail polish
 A good sensor site is needed.
 Use SpO2 when recording the oxygen concentration value:
• S = saturation
• p = pulse
• O2 = oxygen
 Report and record measurements accurately.

Copyright © 2009 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. Slide 26

Collecting Sputum Specimens


 Sputum – mucus from the respiratory system; not
saliva (spit)
 Studied for blood microbes and abnormal cells
 Client must cough up sputum from the bronchi and
trachea.
 Can be painful/hard to do
 Specimen should be collected in morning.
 Instruct client not to use mouthwash prior to
procedure.
 Provide privacy – procedure can be embarrassing.
 Follow Standard Practices.

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Postural Drainage
 Positioning the client to allow secretions to
drain by gravity.
 Coughing is easier
 Able to raise sputum
 Positioning depends on the lung part that
needs draining.

Copyright © 2009 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. Slide 28

Artificial Airways
 Artificial airways keep the airway patent
(open).
 They are needed:
• When disease, injury, secretions, or aspiration obstruct
the airway
• For mechanical ventilation
• By some clients who are semi-
semi-conscious or unconscious
• When the client is recovering from anaesthesia

Copyright © 2009 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. Slide 29

Artificial Airways (Cont’d)


 Intubation means inserting an artificial airway.
 These airways are common:
 An oro-
oro-pharyngeal airway is inserted through the mouth and
into the pharynx.
 A naso-
naso-pharyngeal airway is inserted through a nostril.
 An endotracheal (ET) tube is inserted through the mouth or
nose and into the trachea.
• A cuff is inflated to keep the airway in place.
 A tracheostomy tube is inserted through a surgically created
opening into the trachea.
• Cuffed tubes are common.

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Care Measures for Client with


Artificial Airway
 Vital signs are checked often.
 Observe for hypoxia and other signs and
symptoms.
 If an airway comes out or is dislodged, tell the
nurse at once.
 Frequent oral hygiene is needed.
• Follow the care plan.
 Comfort and reassure the client.
 Follow the care plan for communication methods.
 Always keep the signal light within reach.

Copyright © 2009 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. Slide 31

Tracheostomy
 A tracheostomy is a surgically created opening into
the trachea.
 Tracheostomies are temporary or permanent.
 A tracheostomy tube has three parts:
• The obturator is used to guide the insertion of the outer
cannula.
• The inner cannula is inserted and locked in place.
• The outer cannula is not removed.
 The tube must not come out (extubation).
 A loose tube can damage the trachea.
 The tube must remain patent.
• If the client is unable to cough up secretions, suctioning is
needed.

Copyright © 2009 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. Slide 32

Safety Measures for Clients


with Tracheostomy
 Call for the nurse/supervisor if:
 You note signs and symptoms of hypoxia or respiratory
distress
 The outer cannula comes out
 Nothing must enter the stoma.
 Follow Standard Precautions when assisting with
tracheostomy care.
 Tracheostomy care involves:
 Cleaning the inner cannula to remove mucus and keep the
airway patent
 Cleaning the stoma to prevent infection and skin breakdown
 Applying clean ties or a Velcro collar to prevent infection

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Safety Measures for Clients


with Tracheostomy (Cont’d)
 Trachea dressing should never have anything
that can be inhaled.
 Stoma or tube should always be covered when
going outside.
 Never cover stoma with plastic or leather.
 Client should take tub baths instead of showers
 Water should never enter the stoma.
 Medical Alert jewellery should always be worn.

Copyright © 2009 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. Slide 34

Suctioning the Airway


 Secretions can collect in the upper airway.
 Retained secretions:
• Obstruct air flow into and out of the airway.
• Provide an environment for microbes.
• Interfere with oxygen (O2) and carbon dioxide (CO2)
exchange.
• Hypoxia can occur.
 Persons who cannot cough or have a cough that
is too weak to remove secretions need suctioning.
 Suction is the process of withdrawing or sucking
up fluid (secretions).

Copyright © 2009 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. Slide 35

Suctioning Sites
 These routes are used to suction the airway:
 Oro--pharyngeal
Oro
• The mouth and pharynx are suctioned.
 Naso--pharyngeal
Naso
• The nose and pharynx are suctioned.
 Lower airway
• The suction catheter is passed through an endotracheal
(ET) or tracheostomy tube.

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Safety Measures for Suctioning


 If not done correctly, suctioning can cause
serious harm.
 Client may be unable to breathe during suctioning.
 Hypoxia, and life-
life-threatening complications can
arise.
 Client’s lungs are hyperventilated prior to
suctioning by use of an Ambu bag.
 It is your responsibility to ensure that
suctioning is within your scope of practice for
your province or agency.

Copyright © 2009 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. Slide 37

Mechanical Ventilation
 Mechanical ventilation is using a machine to
move air into and out of the lungs.
 Mechanical ventilation is needed for a variety
of health care problems, including:
 Weak muscle effort
 Airway obstruction
 Damaged lung tissue
 Nervous system diseases and injuries
 Drug overdose

Copyright © 2009 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. Slide 38

Mechanical Ventilation (Cont’d)


 An ET or tracheostomy tube is needed for
mechanical ventilation.
 Alarms sound when something is wrong.
• One alarm means the client is disconnected from the
ventilator.
• When any alarm sounds, first check to see if the client’s
tube is attached to the ventilator.
 If it is not, attach it to the ventilator.
• Then tell the nurse/supervisor at once about the alarm.
 Do not reset alarms.
 Clients needing mechanical ventilation are
very ill.

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Chest Tubes
 Air, blood, or fluid can collect in the pleural
space (sac or cavity) when the chest has
been penetrated because of injury or surgery.
 Pneumothorax
• Air in the pleural space
 Hemothorax
• Blood in the pleural space
 Pleural effusion
• The escape and collection of fluid in the pleural space

Copyright © 2009 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. Slide 40

Chest Tubes (Cont’d)


 Pressure occurs when air, blood, or fluid collects in
the pleural space.
 The pressure collapses the lung.
 Air cannot reach affected alveoli.
 O2 and CO2 are not exchanged.
• Respiratory distress and hypoxia result.
 Pressure on the heart threatens life.
 The doctor inserts chest tubes to remove the air,
blood, or fluid.
 Chest tubes attach to a drainage system.
• The system must be airtight.
• Water
Water--seal drainage keeps the system airtight.

Copyright © 2009 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. Slide 41

Caring for Chest Tubes


 Keep drainage system below the level of the
chest.
 Keep tubing coiled on the bed.
 Prevent tubing kinks.
 Observe chest drainage.
 Turn and reposition carefully.
 Assist with deep breathing and coughing.
 Assist with incentive spirometry.
 Keep sterile petrolatum gauze at bedside.

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