Chapter 87 Oxygen Therapy and Respiratory Care

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Chapter 87

Oxygen Therapy andRespiratory Care

Chapter 87

Oxygen Therapy andRespiratory Care


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


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


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%.


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.


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.


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.


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



• 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



• 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


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


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


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


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.


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.


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


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


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*


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


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


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



• 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



• 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


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


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

Documents

Chapter 87 Oxygen Therapy and Respiratory Care