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Chapter 44
Oxygen Needs
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?
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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
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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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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.
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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.
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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.
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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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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
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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.
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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.
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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.
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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.
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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
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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.
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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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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
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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
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