Care Of The Patient With Respiratory/ Oxygen Needs

Presented by Moyette Graham R.N., B.S.N

Assess Oxygen status Invasive. Wait longer for results

ABGs- Arterial Blood Gases

The arterial blood gas provides the following values: Ph

◦ The normal range is 7.35 to 7.45 PO2

◦ The normal range is 80 to 100 mm Hg. SaO2

◦ The normal range is 95% to 100%. pCO2

◦ The normal range is 35 to 45 mm Hg. HCO3

◦ The normal range is 22 to 26 mEq/liter B.E. The normal range is -2 to +2 mEq/liter. www.orlandohealth.com/MediaBank/.../2010%20ABG%20SLP.pd

ABG Values

Bronchoscopy- pg. 481 FON C&S Sputum pg. 501 FON Skill 19-9 and 10 Thoracenthesis- FON pg.. 492

Diagnostic Test

Is the administration of supplemental oxygen to a patient to prevent or relieve hypoxia

Requires doctors order Dangers Costly

Oxygen therapy

Tasteless, colorless, odorless gas essential to life 21% of the atmospheric air

Characteristics of Oxygen

Flammable Drying

Disadvantage of use

Will vary according to the degree of oxygen deficit

See text page 556 box 20-7

Symptoms Of Oxygen Deficit

Post a “no smoking oxygen in use” sign on pt.'s door or at foot of bed

Avoid materials that generate static electricity such as woolen blanket and synthetic fabrics. (wear cotton fabrics)

Avoid flammable materials such as oils, greases, alcohol, ether, nail polish remover etc. See text! Page 559

Safety Measures

Give the amount prescribed by physician; giving too much may lead to oxygen toxicity

Will be prescribed in specific concentration methods and liter flow per minute (L/min)

Nurses may initiate oxygen therapy as an emergency measure

Nursing measures

Add a humidifying device to prevent drying of the tissues

Give frequent mouth care Position carefully; do not block outlet in

mask, or allow pt. to slump down in bed or chair

TCDB prevents Hypostatic Pneumonia

Cont.…

Remove and clean nasal cannula prn and check nares for irritation

Monitor activities, space them and provide periods of rest

Take temperature measurements by another route so that an oral thermometer does not impair the patient’s breathing

Cont.

Nasal Cannula (FON pg.. 557-559) Face Mask Venturi Mask Non-rebreather Pulse Oximetry

Oxygen Delivery System & Equipment

Resuscitator bag used to assist respiratory ventilation.

AMBU- Air Mask Bag Unit

Used Post –OP Not an oxygen delivery system Improve ventilation

Triflow / Incentive Spirometry

TCBD – Turn, Cough and deep breathe1) Encourage post-op2) Teach Splinting

Humidification and HydrationThin secretionsMoist Airway

Mobilization of Pulmonary Secretions

Purposes ◦ Relief of edema and spasms◦ Liquefaction of bronchial secretions◦ Delivery of medications or liquefying medications

in a fine spray or mist ( bronchodilators)◦ Humidification of respiratory mucosa

Best used in the morning or 45-60 mins before eating

Nebulizer or aerosol therapy

Ventilating machine◦ Allows for even distribution of air to the alveoli◦ Aids in removal of CO2◦ Makes coughing more effective◦ Loosens and thins secretions in the lower resp.

tract

IPPB-Intermittent Positive Pressure Breathing

Make sure there is a tight seal so pt. gets maximum benefit

C-PAP

Combination of therapies used to mobilize secretions.http://www.youtube.com/watch?v=nqWvolJ0c6Q

Vibration Chest percussion

◦ Uses a cupping motion of the hands and alternately striking the area of the lung to be drained

Chest physiotherapy (CPT)

Mobilize drainage-Position patient Nursing care◦ Do not do procedure after meals. Pt. may aspirate◦ Observe pt.'s tolerance to procedure◦ Assess lung sounds before, during and after

Postural Drainage

Airway- Surgical May be permanent or temporary Obstruction Apnea Altered consciousness

Tracheostomy- Indications

Outer cannula Inner cannula Obturator Cuffed Tubes, uncuffed or fenestrated tubes

Parts of a trach tube

Maintain patent airway Provide humidification Prevent infection Secure trach tube in stoma Provide a means of communication

Nursing care

• Position in semi-high fowlers to promote lung expansion

• Prevent introduction of pathogen in respiratory tract

• Use disposable sets if possible• Hyper-oxygenate with 100% O2 before

suctioning • Encourage deep breathing and coughing

exercises if possible

Suctioning-Precautions

Removal of air or fluid from the chest cavity Commonly used after chest surgery or

trauma Commonly used to relieve pneumothorax

and /or hemothorax

Chest Tubes: Reasons for a chest tube

Pictures The chest and abdominal cavities are opened here at autopsy.

The right lung is collapsed. This is atelectasis.

bloody fluid filling the right chest cavity as a consequence of trauma. This is a hemothorax.

Filled with a cloudy yellowish-tan fluid, characteristic for a chylothorax. The right lung is markedly atelectatic.

Pictures chest tube insertion

One bottle system-receives both fluid / air Two bottle system- fluid/ air, creates a

water seal Three bottle system- (Pleur-evac, Atrium)

◦ A- collection chamber◦ B- water seal chamber◦ C- suction control chamber

Types

Pictures of systems

                             

                                        

Discuss “POTS” handout

Bubble, Bubble Patient in Trouble…Nursing care

The End.