Oxygen Therapy (Oxygenation)

Inhalation

Stages of Act of breathing: The intake of air into the lungs through expansion of chest volume

partial obstruction

*blank* of the upper airway passages is indicated by low pitched snoring sound during inhalation

1-3L/min

A client with COPD should receive oxygen at low flow rates usually *blank* to prevent inhibition of hypoxic respiratory drive

Non-rebreather (95-100%)

Delivers the highest concentration - Client breathes only the source gas from the bag - Prevents the room air and clients exhaled air from entering the bag Oxygen Concentration delivered: 60-90% Liter flow: 6-15L/min Note: IT IS IDEAL FOR SEVERE HYPOXIA BUT CLIENT MAY COMPLAIN FEELINGS OF SUFFOCATION

Minute ventilation

Determined by the rrspiratory rate and tidal volume. RR of 10-15 breaths/min is appropriate. Close monitoring is required to achieve desired PaCo2

Pressure cycled (Type of positive pressure ventilators)

Gas flows into the client until a predetermined airway pressure is reached. Tidal volume is not constant

Diffusion

Gas movement from an area of greater go lesser concentration through a semipermeable membrane

Cannula (Nasal Prongs)

- Common device used - Consists of rubber or plastic tube around the face with 0.6 to 1.3 cm curved prongs - One end connects to the oxygen tubing and supply - Elastic band futs around the client's head or under chin - Deluvers 25-40% oxygen at FR 4-6 L/min NOTE: It is difficult to keep in position unless the client is alert and cooperative

Face mask

- Simple mask (40-60%) - Partial rebreather (60-90%) - Non rebreather (95-100%) -- delivers the highest concentration - Venturi mask has color coded adapters for patients with COPD Liter flow: 5-8L/min

Factors affecting the Respiratory system

1. Health status 2. Medications 3. Environment 4. Age 5. Lifestyle 6. Stress

Cannula (Nasal prongs): Limitations

1. Inability to deliver higher oxygen concentration 2. Can be drying to the mucus membrane 3. Irritation on top of the ears

Cannula (nasal prongs): Equipments

1. Oxygen supply w/flow meter 2. Humidifier w/sterile distilled water 3. Nasal Cannula and tubing 4. Tape (optional)

Three components of respiration

1. Pulmonary ventilation or breathing 2. Gas exchange 3. Transport of oxygen from lings to the tissues and carbon dioxide from tissues to lungs

Assessing the clients for s/s of respiratory changes:

1. Shortness of breath (dyspnea) 2. Bluish or cyanotic appearsnce of the nail beds, lips, mucous membranes and skin 3. Restlessness, irritability, confusion, decreased level of consiousness 4. Pain during inspiration and expiration 5. Labored or difficult breathing 6. Ortophnea 7. Use of accessory muscle 8. Abnormal breath sounds such as wheezes, rhonchi or rales 9. Inability to breathe spontaneously 10. Thick, frothy, blood tingednor copious sputum production 11. Paradoxical chest wall movement

Purpose of Oxygen Therapy

1. increase oxygen saturation in tissues where the saturation levels are too low due to illness or injury 2. increases the amount of oxygen in the blood 3. reduces the extra work of the heart decreases shortness of breath

Surfactant

A lipoprotein produced by specialised alveolar cells, reduces the surface tension of alveolar fluid. Without this, lung expansion is difficult and the lungs collapsed. premature infants whose lungs are not yet capable of producing adequate *blank* often develop respiratory distress syndrome.

Peripheral control (carotid and aortic bodies)

Act to reduce oxygen level

oxygen therapy

Administration of oxygen at concentrations greater than that in room air to treat or prevent hypoxemia

Cannula (Nasal prongs)

Advantages: - Easy to apply - Do not interfere with ability to eat or talk - Comfortable/Freedom of movement Low oxygen concentration 23-44% at flow rate of 2-4 L/min

Partial Rebreather (60-90%)

An oxygen reservoir bag is attached which allow clients to rebreathe about first third of exhaled air Oxygen concentration delivered: 35-60% Liter Flow: 6-15L/min

Intermittent mandatory ventilation (ventilators mode)

Breaths are delivered bybthe machine but the client may also breathe spontaneously w/o machine assistance

Ataxic breathing

Biots breathing, Irregularly irregular ex: Brain medullary injury

Pulmonary perfusion

Blood flow from the right side if the side, through the pulmonary circulation, and into the left side of the heart

Pressure support (ventilators mode)

Client breathes spontaneously and determines ventilator rate. Tidal volume determined by inflation pressure and clients lung-thorax compliance

Collapsed alveoli (Atelectasis)

Clinical Indications: A. Any client who is likely to have a significant shunt from: 1. Airway obstruction - Any client who is unconscious - Choking 2. Failure to take deep breaths - Pain (rib fracture) - Paralysis of the respiratory muscle (spine injury)

Depression of the respiratory center (head injury, drug overdose)

Clinical Indications: A. Any client who is likely to have a significant shunt from: 1. Collapse of an entire lung (pneumothorax) 2. Other gasses in the alveoli 3. Toxic inhalations 4. Carbon monoxide poisoning

Fluid in the alveoli

Clinical Indications: A. Any client who is likely to have a significant shunt from: 1. Pulmonary edema 2. Pneumonia 3. Near drowning 4. Chest trauma

During inhalation - muscle contract

Contraction of the diaphragm muscle - causes the diaphragm to flatten, thus enlarging the chest cavity. Contraction of the rib muscles - causes the ribs to rise, thus increasing the chest volume. The chest cavity expands, thus reducing air pressure and causing air to be passively drawn into the lungs. Air passes from the high pressure outside the lungs to the low pressure inside the lungs.

Reflex control

Cough reflex

true

Excess O2 can be harmful

Retrolental fibroplasia and blindness in infants

Excessive amounts of oxygen for prolonged periods of time will cause?

1 3 2 5 4 7 6

Flow of air from environment through respiratory system during inpiration sequence: Choose the correct order 1. Nose/mouth 2. Larynx 3. Pharynx 4. Right/Left bronchi of the lung 5. Trachea 6. Alveoli of the lungs 7. Bronchioles of the lungs

Oxygen (O2)

Gaseous element essential to life that makes up 21% of the air. It passes into the bloodstream at the lungs and travels to all body cells; Prescribed as a medication and administered under controlled conditions

Stridor

Harsh or high-pitched respiratory sound heard during inspiration

Venturi Mask

Has colored adapters for patients with COPD - Wide bore tubing and color coded adapters that corresponds to a precise oxygen concentration and specific loter flow - Room air dilutes the oxygen entering the tubing to a certain concentration Note: IT IS USEFUL IN LONG TERM TREATMENT OF COPD

crackles (rales)

High pitched, fine, short, crackling sounds Best heard: Inspiration-Inspiration-Expiration Cause: Air passing through fluid or mucus

rib muscle and diaphragm muscle

Inhalation and exhalation muscles

Lower airway obstruction

Is not always easy to observe

Respiration

Is the act of breathing - Process of gas exchange between the individual and environment - Supply body with oxygen for metabolic activity and to remove carbon dioxide

Hypoxia

Low oxygen saturation of the body, not enough oxygen in the blood

Gurgles (rhonchi)

Low pitched, gurgling, with a moaning or snoring quality Best heard: expiration-inspiration-expiration Cause: Narrowed air passages

Controlled (Ventilators mode)

Machine delivers a breath at a fixed rate regardless of clients effort or demands

Assist controlled (ventilators mode)

Machine senses a clients efforts to breathe and delivers a fixed tidal volume with each effort

Posituve end expiratory (PEEP)

Maintenance of positive airway pressure at the end of expiration

Inspiratory reserve volume (IRV)

Maximum volume of air that can be inhaled after a normal inhalation Normal Value: 3000 mL

Pons

Moderates the rhythm of inspiration and expiration

Volume cycled (Type of positive pressure ventilators)

Most common ventilators used. Tidal volume is determined and a fixed volume is delivered with each breath

Respiratory arrest

Other clinical Indications: 1. Cardiac arrest 2. Shock 3. Shortness of breath 4. signs of respiratory insufficiency 5. Breathing fewer than 10x/min 6. Chest pain 7. Stroke 8. Anemia

Drying and irritation of respiratory mucosa, decreased ciliary action and thickening of the respiratory secretions

Oxygen delivered w/o humidification will result in?

A drug

Oxygen is considered a *blank* and must be carefully prescribed based on individual client conditions

21%

Oxygen, a clear, odorless gas that constitutes approximately ____ of the air we breathe, is necessary for proper functioning of all the living cells.

Simple O2 mask

Poorly torelated —used for short periods of time; feeling of suffocation - Delivers 50-60% oxygen at FR 8-12 L/min - Significant rebreathing of carbon dioxide at low oxygen FR - Hot—may produce pressure sores around nose and mouth

Medulla oblongata

Primary respiratory system - Rate and depth of respirations

Hyperypnea

Rapid, deep breathing, hyperventilation, kussmaul breathing (metablic acidosis)

Cheyne-Stokes

Regular pattern of irregular breathing rate ex: heart failure

Exhalation

Stages of Act of breathing: The expulsion of air from the lungs through contraction of chest volume

500mL of air is inspired and expired w/each breath

The degree of chest expansion during normal breathing is? It is also known as Tidal volume

Inspiratory Capacity (IC)

The maximum volume of air inhaled after normal expiration IC = TV + IRV Normal Value: 2,300mL Significance: A decrease in inspiratory capacity may indicate restrictive disease

During exhalation - the muslce relax

The muscles are no longer contracting, they are relaxed. The diaphragm curves and rises, the ribs descend - and chest volume decreases. The chest cavity contracts thus increasing air pressure and causing the air in the lungs to be expelled through the upper respiratory tract. Exhalation, too, is passive. Air passes from the high pressure in the lungs to the low pressure in the upper respiratory tract

Total Lung Capacity (TLC)

The volume of air in the lungs after a maximum inspiration TLC= TV+IRV+ERV+RV Normal Value: 5,800mL Significance: May decreased w/restrictive disease (atelectasis pneumonia) and increase in COPD

Residual Volume (RV)

The volume of air remaining in lungs after maximum exhalation. Normal Value: 1,200mL Signifance: May increased with obstructive disease

Functional residual capacity (FRC)

The volume of air remaining in the lungs after a normal expiration FRV = ERV + RV Normal Value: 2,300mL Significance: Functional residual capacity may be increased with COOD and decreased in ARDS

True

True or False Muscle movement - the diaphragm and rib muscles are constantly contracting and relaxing (approximately 16 times per minute), thus causing the chest cavity to increase and decrease.

True

True vs False: 1. Oxygen Therapy needs MDs order 2. RNs can administer Oxygen Therapy only for emergency

Face Tent

Used when mask is poorly tolerated - Frequently inspect clients facial skin for dampness, chaffing and dryness Management: Should be kept dried

To relieve hypoxia and provide adequate tissue oxygenation

What is the purpose of respiratory treatment?

Orthopnea

ability to breathe only in an upright position or sitting position

upper respiratory tract

consists of the nose, mouth, pharynx, epiglottis, larynx

hypoxemia

decreased level of oxygen in the blood

Hyperventilation

deep, rapid respiration due to excessive amount of air in lungs

Dyspnea

difficult or labored breathing

Time cycled

gas flows for a certain percentage of time during ventilatory cycle

Wheeze

high-pitched, musical, squeaking adventitious lung sound Best heard: Expiration Cause: Air passing through constricged bronchus

emphysema

hyperinflation of air sacs with destruction of alveolar walls

comple obstruction

is indicated by extreme inspiratory effort that produces no chest movement and an inability to cough or speak

lung compliance

is the expansibility or stretchability of lung tissue, plays a significant role in the ease of ventilation. At birth, the fluid filled lungs are stiff and resistant to expansion, much as a new balloon is difficult to inflate. With subsequent breath, the alveoli become more compliant and easier to inflate, just as balloon becomes easier to inflate after several tries. It tends to decrease with aging, making it more difficult to expand the alveoli and increasing the risk of atelectasis or collpase portion of lung

Diaphgram

major breathing muscle of the body at the level of the first rib of the body

Expiratory Reserve Volume (ERV)

maximum amount of air that can be exhaled forcibly after a normal exhalation Normal Value: 1,100mL Significance: Decreased with restrictuve conditions such as obesity, ascites and pregnancy

Ventilation

movement of air in and out of the lungs Involves 3 forces: 1. Compliance 2. Surface tension 3. Muscular effort

eupnea

normal breathing Adult: 12-20/min Infant: 44/min

T-tube

provides humidification and enriched oxygen mixturesnto tracheostomy or endotracheal tube - Delivers up to 100% oxygen at FR at least twice the minute ventilation

tachypnea

rapid, shallow breathing

bradypnea

slow breathing

Hypoventilation

slow respiration and causes of retention of carbon dioxide

Friction rub

superficial grating or creaking sounds Best heard during: inspiration and expiration Cause: Rubbing together of inflamed pleural surfaces

Lung recoil

the continual tendency of the lungs to collapse away from the chest wall

lower respiratory tract

trachea, bronchi, lungs and alveoli

Therapeutic (supplemental) Oxygen

used when client is unable to obtain sufficient oxygen for the body's needs

Tidal Volume (TV)

volume of air inhaled or exhaled in a normal breath Normal Value: 500 mL or 5-10mL/kg Significance: may not vary even with severe disease