Oxygenation Week 10

What should we be mindful of with oxygen?

-No open flames near o2 -electrical appliances should be in good working order to prevent sparks -heat sources at least 8 feet away.

Chronic Lung Disease

-asthma -COPD -Cystic fibrosis -

complications that occur with a trach

-bleeding -pneumothorax: auscultation. Look for SOB, tachycardia -air embolism -apsiration -laryngeal nerve damage -fisutula: airtificial opening btw. espophagus and trach. They start coughing and choking. -necrosis: assessing skin area

Equipment for a trach

-fenestrated trach-allows them to talk -double cuff: alternates pressure on trachea -obturator: what you need to initiate it -cannula -outer tube with flange

why do we use humidification

-o2 dries so this helps the mucous membranes remain moist - usually over 3-4L they put it on, but really depends on the pt.

What are some causes of upper airway obstruction

. Acute upper airway obstruction may be caused by - food particles, -vomitus, -blood clots, -or anything that obstructs the larynx or trachea. It also may occur from enlargement of tissue in the wall of the airway, as in epiglottitis, obstructive sleep apnea, laryngeal edema, laryngeal carcinoma, or peritonsillar abscess, or from thick secretions. Pressure on the walls of the airway, as occurs in retrosternal goiter, enlarged mediastinal lymph nodes, hematoma around the upper airway, and thoracic aneurysm, also may result in upper airway obstruction. The patient with an altered level of consciousness from any cause is at risk for upper airway obstruction because of loss of the protective reflexes (cough and swallowing) and loss of the tone of the pharyngeal muscles, which causes the tongue to fall back and block the airway

Chest tube 3 reasons why patient would have?

1. Pleural effusion: fluid in pleural space 2. hemothorax: blood that develops in pleural space 3.pneumothroax: air in pleural space

What should cuff pressure of tracheostomy be maintained at?

15-20

What concentration of normal air is oxygen?

21%

When is nasal cannula indicated?

A nasal cannula is used when the patient requires a low to medium concentration of oxygen for which precise accuracy is not essential. This method allows the patient to move about in bed, talk, cough, and eat without interrupting oxygen flow. Flow rates in excess of 4 to 6 L/min may lead to swallowing of air or may cause irritation and drying of the nasal and pharyngeal mucosa

Endotracheal tube What is it?

An endotracheal tube is a polyvinylchloride airway that is inserted through the nose or mouth into the trachea, using a laryngoscope as a guide It is used to administer oxygen by mechanical ventilator, to suction secretions easily, or to bypass upper airway obstructions (e.g., tongue or tracheal edema). Although uncomfortable and easy to manipulate with the tongue, orotracheal insertion is often the method of choice, especially in an emergency, because insertion is easier and a larger tube can be used, making ventilation easier. Placement of the tube through the nasotracheal route, although tolerated better by patients, is more difficult and requires the use of a narrower tube. Most commonly, a cuffed endotracheal tube is used This type of tube prevents air leakage and bronchial aspiration of foreign material while allowing more precise control of oxygen and mechanical ventilation. However, careful monitoring of cuff pressure is necessary to decrease the risk for tracheal necrosis. The smallest amount of air that results in an airtight seal between the trachea and the tube is desirable and less likely to result in complications. Patients with endotracheal tubes often require suctioning via the endotracheal tube to remove secretions from the airway. Routine oral suctioning to aspirate secretions that accumulate above the cuff of the tube is also necessary to reduce the risk of pneumonia .

Oropharyngeal airway and nasopharyngeal airway

An oropharyngeal or nasopharyngeal airway is a semicircular tube of plastic or rubber inserted into the back of the pharynx through the mouth (oro) or nose (naso) in a patient who is breathing spontaneously. The oropharyngeal airway is used to keep the tongue clear of the airway. It is often used for postoperative patients until they regain consciousness. Once the patient regains consciousness, remove the oropharyngeal airway. Do not use tape to hold the airway in place because the patient should be able to expel the airway once he or she becomes alert. A nasopharyngeal airway is inserted through the nare and protrudes into the back of the pharynx. The nasal trumpet allows for frequent nasotracheal suctioning without trauma to the nasal passageway. This airway may be left in place, without much discomfort, in the patient who is alert and conscious. Techniques to use when inserting an artificial airway are outlined in Guidelines for Nursing Care 38-4.

6) Describe the patient education and home care consideration for patient's receiving oxygen therapy

At times, oxygen must be administered to the patient at home. The nurse instructs the patient or family in the methods for administering oxygen safely and informs the patient and family that oxygen is available in gas, liquid, and concentrated forms. The gas and liquid forms come in portable devices so that the patient can leave home while receiving oxygen therapy. Humidity must be provided while oxygen is used (except with portable devices) to counteract the dry, irritating effects of compressed oxygen on the airway Home visits by a home health nurse or respiratory therapist may be arranged based on the patient's status and needs. It is important to assess the patient's home environment, the patient's physical and psychological status, and the need for further education. The nurse reinforces educational points on how to use oxygen safely and effectively, including fire safety tips. To maintain a consistent quality of care and to maximize the patient's financial reimbursement for home oxygen therapy, the nurse ensures that the prescription given by the primary care provider (PCP) includes the diagnosis, the prescribed oxygen flow, and conditions for use (e.g., continuous use, nighttime use only). Because oxygen is a medication, the nurse reminds the patient receiving long-term oxygen therapy and the family about the importance of keeping follow-up appointments with the patient's PCP. The patient is instructed to see his or her PCP every 6 months or more often, if indicated. Arterial blood gas measurements and laboratory tests are repeated annually or more often if the patient's condition changes

BiPAP

Bilevel positive airway pressure (BiPAP) changes the air pressure while the patient breathes in and out -Fits over nose and mouth.

CPAP

Continuous positive airway pressure (CPAP) provides continuous mild air pressure to keep airways open. -fits over nose and mouth

What wuold your patient look like and act like if they are experiencin hypoxia

Early signs... Restlessness Anxiety Tachycardia: Late signs... Bradycardia Extreme restlessness Dyspnea (severe) This may interfere with eating because they cant breath May have inspiratory stridor Nares may flare Grunting Sternal retractions in hinkle there is a chart with s/sx of hypoxia

When a patient has a chest tube what should the nurse encourage patient to do.

Encourage coughing and deep breathing to promote lung expansion. -Incentive Spirometer

General instructions for breathing excericises diaphragmatic breathing pursed lip breathing

General Instructions • Breathe slowly and rhythmically to exhale completely and empty the lungs completely. • Inhale through the nose to filter, humidify, and warm the air before it enters the lungs. • If you feel out of breath, breathe more slowly by prolonging the exhalation time. • Keep the air moist with a humidifier. Diaphragmatic Breathing Goal: To use and strengthen the diaphragm during breathing • Place one hand on the abdomen (just below the ribs) and the other hand on the middle of the chest to increase the awareness of the position of the diaphragm and its function in breathing. • Breathe in slowly and deeply through the nose, letting the abdomen protrude as far as possible. • Breathe out through pursed lips while tightening (contracting) the abdominal muscles. • Press firmly inward and upward on the abdomen while breathing out. • Repeat for 1 minute; follow with a rest period of 2 minutes. • Gradually increase duration up to 5 minutes, several times a day (before meals and at bedtime). Pursed-Lip Breathing Goal: To prolong exhalation and increase airway pressure during expiration, thus reducing the amount of trapped air and the amount of airway resistance • Inhale through the nose while slowly counting to 3—the amount of time needed to say "Smell a rose." • Exhale slowly and evenly against pursed lips while tightening the abdominal muscles. (Pursing the lips increases intratracheal pressure; exhaling through the mouth offers less resistance to expired air.) • Count to 7 slowly while prolonging expiration through pursed lips—the length of time to say "Blow out the candle." • While sitting in a chair: Fold arms over the abdomen. Inhale through the nose while counting to 3 slowly. Bend forward and exhale slowly through pursed lips while counting to 7 slowly. • While walking: Inhale while walking two steps. Exhale through pursed lips while walking four or five steps. (

The respiratory system changes throughout the aging process, and it is important for nurses to be aware of these changes when assessing patients who are receiving oxygen therapy. As the respiratory muscles weaken and the large bronchi and alveoli become enlarged, the available surface area of the lungs decreases, resulting in reduced ventilation and respiratory gas exchange. The number of functional cilia is also reduced, decreasing ciliary action and the cough reflex. As a result of osteoporosis and calcification of the costal cartilages, chest wall compliance is decreased. Patients may display increased chest rigidity and respiratory rate and decreased PaO2 and lung expansion. Nurses should be aware that the older adult is at risk for aspiration and infection related to these changes. In addition, patient education regarding adequate nutrition is essential because appropriate dietary intake can help diminish the excess buildup of carbon dioxide and maintain optimal respiratory functioning

Gernetological considerations with oxygenation

Venturi

High Flow 4-10 L/min = 24%-40% Requires careful monitoring to verify FiO2 at flow rate ordered. Check that air intake valves are not blocked. The Venturi mask gets its name from the Venturi effect, which allows the mask to deliver the most precise concentrations of oxygen. This mask has a large tube with an oxygen inlet. As the tube narrows, the pressure drops, causing air to be pulled in through side ports. These ports are adjusted according to the prescription for oxygen concentration. Be sure that the ports are always open. If these are occluded by linens, clothing, or a patient rolling on the mask, the oxygen delivered might be at an unsafe (too high or too low) concentration. The Venturi mask is the most reliable and accurate method for delivering precise concentrations of oxygen through noninvasive means. The mask is constructed in a way that allows a constant flow of room air blended with a fixed flow of oxygen. It is used primarily for patients with COPD because it can accurately provide appropriate levels of supplemental oxygen, thus avoiding the risk of suppressing the hypoxic drive

What can high cuff pressure cause?

High cuff pressure can cause tracheal bleeding, ischemia, and pressure necrosis, whereas low cuff pressure can increase the risk of aspiration pneumonia. Routine deflation of the cuff is not recommended because of the increased risk of aspiration and hypoxia. .

Hypoxia

Hypoxemia usually leads to hypoxia, a decrease in oxygen supply to the tissues and cells which can also be caused by problems outside the respiratory system. Severe hypoxia can be life threatening.

Hypoxemia

Hypoxemia, a decrease in the arterial oxygen tension in the blood, is manifested by changes in mental status (progressing through impaired judgment, agitation, disorientation, confusion, lethargy, and coma), dyspnea, increase in blood pressure, changes in heart rate, dysrhythmias, central cyanosis (late sign), diaphoresis, and cool extremities

Signs a patient is getting inadequate oxygen

It is important to observe for subtle indicators of inadequate oxygenation when oxygen is administered by any method. Therefore, the nurse assesses the patient frequently for confusion, restlessness progressing to lethargy, diaphoresis, pallor, tachycardia, tachypnea, and hypertension. Intermittent or continuous pulse oximetry is used to monitor oxygen levels *assess- vitals, respiratory pattern, rate, depth change in mental status breath sounds presence of cough or excess secretions in airway change in skin color

Nurse should monitor for what with inadequate oxygen?

It is important to observe for subtle indicators of inadequate oxygenation when oxygen is administered by any method. Therefore, the nurse assesses the patient frequently for confusion, restlessness progressing to lethargy, diaphoresis, pallor, tachycardia, tachypnea, and hypertension. Intermittent or continuous pulse oximetry is used to monitor oxygen levels. .

What kind of devices might be

Liquid oxygen and oxygen concentrators, rather than cylinders, are used more commonly in the home setting. Liquid oxygen is kept inside a small thermal container that can be refilled from a larger storage tank kept in the home. An oxygen concentrator removes nitrogen from the room air and concentrates the oxygen left in the air. The oxygen concentrator needs a power source such as an electrical outlet or battery pack. Oxygen concentrators are portable, cost-effective, and easy to use but cannot deliver oxygen flow at greater than 5 L/min (fraction of inspired oxygen [FiO2] of about 40%; Stoller, 2011). Patients using continuous supplemental oxygen therapy in the home have another alternative: transtracheal oxygen delivery (Fig. 38-13). With this type of delivery system, a small catheter is inserted into the trachea under local anesthesia, then the catheter is attached to the oxygen source. A transtracheal catheter does not interfere with talking, eating, or drinking and delivers oxygen throughout the respiratory cycle rather than just at inspiration. The patient or family must assume responsibility for daily catheter care. Patients usually report improved mobility, comfort, and appearance, and lower cost with this delivery system .

Nasal Cannula -suggested flow rate -FiO2 -Advantages -Disadvantages

Low Flow 1-2 L/min = 23%-30% 3-5 L/min = 30%-40% 6 L/min = 42% Check frequently that both prongs are in the patient's nares. For patients with chronic lung disease, limit rate to the minimum needed to raise arterial oxygen saturation to a level that provides adequate oxygen delivery to tissues (88%-92%), and no higher; usually 2-3 L/min. via nasal cannula Nasal Cannula. A nasal cannula, also called nasal prongs, is the most commonly used oxygen delivery device. The cannula is a disposable plastic device with two protruding prongs that are inserted into the nostrils. The cannula is connected to an oxygen source with a flow meter and, many times, a humidifier. The cannula does not impede eating or speaking and is used easily in the home. Disadvantages of this system are that it can be dislodged easily and can cause dryness of the nasal mucosa. In addition, if a patient breathes through the mouth, it is difficult to determine the amount of oxygen the patient is actually receiving. Skill 38-3 describes oxygen administration by nasal cannula (Taylor 1426) .

Nonrebreather mask

Low Flow 12 L/min = 80%-100% Maintain flow rate so that the reservoir bag collapses only slightly during inspiration. Check that the valves and rubber flaps are functioning properly (open during expiration and closed during inhalation). Monitor SaO2 with pulse oximeter. The nonrebreather mask delivers the highest concentration of oxygen via a mask to a spontaneously breathing patient. It is similar to the partial rebreather mask except that two one-way valves prevent the patient from rebreathing exhaled air. The reservoir bag is filled with oxygen that enters the mask on inspiration. Exhaled air escapes through side vents. A malfunction of the bag could cause carbon dioxide buildup and suffocation. This mask can also be used to administer other gases, such as heliox. Heliox is a mixture of helium and oxygen, used to reduce the work of breathing, deliver aerosols, and reduce fear and anxiety for patients in respiratory distress. Helium has a very low density that allows it to flow easily into narrow or twisty air passages, delivering nebulized medications into the lower airways. In addition, carbon dioxide diffuses through helium at four to five times the rate it diffuses through room air, thus it can exit the body faster and easier (Taylor 1427-1428)

Simple Mask

Low Flow 6-8 L/min = 40%-60% (5 L/min is minimum setting) Monitor the patient frequently to check placement of the mask. Support the patient if claustrophobia is a concern. Secure a medical order to replace the mask with a nasal cannula during mealtime. The simple face mask is connected to oxygen tubing, a humidifier, and a flow meter, just like the nasal cannula. This mask has vents on its sides that allow room air to leak in at many places, thereby diluting the source oxygen. The vents also allow exhaled carbon dioxide to escape. Often a simple mask is used when an increased delivery of oxygen is needed for short periods (e.g., less than 12 hours). The mask should fit closely to the face to deliver this higher concentration of oxygen effectively. Patients may have difficulty keeping the mask in position over the nose and mouth, and because of this pressure and the presence of moisture, skin breakdown is a possibility. Eating or talking with the mask in place can be difficult. Because of the risk of retaining carbon dioxide, never apply the simple face mask with a delivery flow rate of less than 5 liters per minute (Taylor 1427).

Partial Rebreather mask

Low Flow 8-11 L/min = 50%-75% Set flow rate so that the mask remains two-thirds full during inspiration. Keep the reservoir bag free of twists or kinks The partial rebreather mask is similar to a simple face mask, but is equipped with a reservoir bag for the collection of the first part of the patient's exhaled air. The remaining exhaled air exits through vents. The air in the reservoir is mixed with 100% oxygen for the next inhalation. Thus, the patient rebreathes about one-third of the expired air from the reservoir bag. This type of mask permits the conservation of oxygen. An additional advantage is that the patient can inhale room air through openings in the mask if the oxygen supply is briefly interrupted. The disadvantages are those of any mask: eating and talking are difficult, a tight seal is required, and there is the potential for skin breakdown. Monitor the reservoir bag carefully. It should deflate slightly with inspiration; if it deflates completely, the flow rate should be increased until only a slight deflation is noted. (Taylor 1427).

What are low flow systems? what are high flow systems?

Low flow: Low-flow systems contribute partially to the inspired gas the patient breathes, which means that the patient breathes some room air along with the oxygen. These systems do not provide a constant or precise concentration of inspired oxygen. The amount of inspired oxygen changes as the patient's breathing changes high flow:provide the total inspired air. A specific percentage of oxygen is delivered independent of the patient's breathing. High-flow systems are indicated for patients who require a constant and precise amount of oxygen.

When is an inner cannula of a tracheostomy necessary?

Many tubes also have inner cannulas that may or may not be disposable. The outer cannula remains in place in the trachea, and the inner cannula is removed for cleaning or replaced with a new one. Periodic cleaning or replacement of the inner cannula prevents airway obstruction from secretions that have accumulated on the tube's inner surface. A tube with an inner cannula is necessary when patients have excessive secretions or have difficulty clearing their secretions. It also may be recommended for a patient who will be discharged with a tracheostomy tube in place.

What does Carbon dioxide cause body to do? How is this changed when someone has a chronic lung disease

Normally, excessive levels of carbon dioxide in the blood stimulate the patient to breathe. However, the chemoreceptors of some, but not all, patients with chronic lung disease, such as emphysema, become insensitive to carbon dioxide and respond to hypoxia to stimulate breathing If excessive oxygen is given, the stimulus to breathe is removed; as a result, the patient may stop breathing completely. Monitor respiratory rate and arterial blood gas results closely for changes. Many times, continuous pulse oximetry also is used to monitor the patient receiving oxygen

In case of emergency situations with a tracheostomy, what needs to be in the room?

Preparation for emergency situations is an important part of nursing care for these patients. The tracheostomy is the patient's only airway, and measures to maintain its patency need to be readily available. Standard bedside equipment for emergency use should include the obturator from the current tube, suction equipment, oxygen, a spare tracheostomy tube of the same size, and one a size smaller .

How is the need for o2 assessed?

The need for oxygen is assessed by arterial blood gas analysis, pulse oximetry, and clinical evaluation

Providing tracheostomy care What are the nurse's responsibilities? Why is the inner cannula replaced/cleaned? Why are soiled dressings changed?

The nurse is responsible for replacing a disposable inner cannula or cleaning a nondisposable one. The inner cannula requires cleaning or replacement to prevent accumulation of secretions that can interfere with respiration and occlude the airway. Because soiled tracheostomy dressings place the patient at risk for the development of skin breakdown and infection, regularly change dressings and ties. Use gauze dressings that are not filled with cotton to prevent aspiration of foreign bodies (e.g., lint or cotton fibers) into the trachea. Clean the skin around a tracheostomy to prevent buildup of dried secretions and skin breakdown. Exercise care when changing the tracheostomy ties to prevent accidental decannulation or expulsion of the tube. Have an assistant hold the tube in place during the change or keep the soiled tie in place until a clean one is securely attached. Agency policy and patient condition determine specific procedures and schedules, but a newly inserted tracheostomy may require attention every 1 to 2 hours

Nursing assessment of patient with suspected obstruction

The nurse makes the following rapid observations to assess for signs and symptoms of upper airway obstruction: • Inspection: Is the patient conscious? Is there any inspiratory effort? Does the chest rise symmetrically? Is there use or retraction of accessory muscles? What is the skin color? Are there any obvious signs of deformity or obstruction (trauma, food, teeth, vomitus)? Is the trachea midline? • Palpation: Do both sides of the chest rise equally with inspiration? Are there any specific areas of tenderness, fracture, or subcutaneous emphysema (crepitus)? • Auscultation: Is there any audible air movement, stridor (inspiratory sound), or wheezing (expiratory sound)? Are breath sounds present over the lower trachea and all lobes? As soon as an upper airway obstruction is identified, the nurse takes emergency measures

Small volume nebulizer therapy

The small-volume nebulizer is a handheld apparatus that disperses a moisturizing agent or medication, such as a bron-chodilator or mucolytic agent, into microscopic particles and delivers it to the lungs as the patient inhales. The small-volume nebulizer is usually air driven by means of a compressor through connecting tubing. In some instances, the nebulizer is oxygen driven rather than air driven. To be effective, a visible mist must be available for the patient to inhale. Indications for the use of a small-volume nebulizer include difficulty in clearing respiratory secretions, reduced vital capacity with ineffective deep breathing and coughing, and unsuccessful trials of simpler and less costly methods for clearing secretions, delivering aerosol, or expanding the lungs (Cairo & Pilbeam, 2010). The patient must be able to generate a deep breath. Diaphragmatic breathing (Chart 21-4) is a helpful technique to prepare for proper use of the small-volume nebulizer. Small-volume nebulizers are frequently used for patients with COPD to dispense inhaled medications, and they are commonly used at home on a long-term basis. The nurse instructs the patient to breathe through the mouth, taking slow, deep breaths, and then to hold the breath for a few seconds at the end of inspiration to increase intrapleural pressure and reopen collapsed alveoli, thereby increasing functional residual capacity. The nurse encourages the patient to cough and to monitor the effectiveness of the therapy. The nurse instructs the patient and family about the purpose of the treatment, equipment setup, medication additive, and proper cleaning and storage of the equipment. e.

Disadvantages of endotracheal and tracheostomy

The tubes cause discomfort The cough reflex is depressed because glottis closure is hindered. Secretions tend to become thicker because the warming and humidifying effect of the upper respiratory tract has been bypassed. The swallowing reflexes (glottic, pharyngeal, and laryngeal reflexes) are depressed because of prolonged disuse and the mechanical trauma produced by the endotracheal or tracheostomy tube, increasing the risk of aspiration as well as microaspiration and subsequent ventilator-associated pneumonia (VAP). , ulceration and stricture of the larynx or trachea may develop. Of great concern to the patient is the inability to talk and to communicate needs. Unintentional or premature removal of the tube is a potentially life-threatening complication of endotracheal intubation. Removal of the tube is a frequent problem in intensive care units (ICUs) and occurs mainly during nursing care or by the patient. Nurses must instruct and remind patients and family members about the purpose of the tube and the dangers of removing it. Baseline and ongoing assessment of the patient and of the equipment ensures effective care. Providing comfort measures, including opioid analgesia and sedation, can improve the patient's tolerance of the endotracheal tube

Tracheal suctioning

Tracheal suctioning is an uncomfortable procedure at minimum, and it can be a very painful and/or distressing experience. Therefore, anticipate assessing for the need for the administration of analgesic medication to a patient before suctioning (Arroyo-Novoa et al., 2008). However, only perform suctioning when clinically necessary because there are many potential risks. Risks include hypoxia, infection, tracheal tissue damage, dysrhythmias, and atelectasis. Sterile technique is used for tracheal suctioning, to reduce the risk of introduction of disease-causing organisms. In the home setting, clean technique is used, as the patient is not exposed to disease-causing organisms that may be found in health care settings, such as hospitals (American Association for Respiratory Care [AARC], 1999). Closely assess the patient before, during, and after the procedure to limit negative effects. In order to prevent hypoxia, hyperoxygenate the patient before and after suctioning and limit the application of suction to 10 to 20 seconds. Monitor the patient's pulse frequently to detect potential effects of hypoxia and stimulation of the vagus nerve. Using an appropriate suction pressure (80-150 mm Hg) will help prevent atelectasis related to the use of high negative pressure (Hess, et al., 2012). Research suggests that insertion of the suction catheter should be limited to a predetermined length (no further than 1 cm past the length of the tracheal or endotracheal tube) to avoid tracheal mucosal damage, including epithelial denudement, loss of cilia, edema, and fibrosis (Hess et al., 2012; Pate, 2004). Skill 38-6 describes suctioning a tracheostomy with an open system. The procedure is similar for an endotracheal tube.

Incentive spirometry

a method of deep breathing that provides visual feedback to encourage the patient to inhale slowly and deeply to maximize lung inflation and prevent or reduce atelectasis. The purpose of an incentive spirometer is to ensure that the volume of air inhaled is increased gradually as the patient takes deeper and deeper breaths. Nursing management of the patient using incentive spirometry includes placing the patient in the proper position, educating the patient on the technique for using the incentive spirometer, setting realistic goals for the patient, and recording the results of the therapy (Chart 21-3). Ideally, the patient assumes a sitting or semi-Fowler's position to enhance diaphragmatic excursion; however, this procedure may be performed with the patient in any position The inspired air helps inflate the lungs. The ball or weight in the spirometer rises in response to the intensity of the intake of air. The higher the ball rises, the deeper the breath. • Assume a semi-Fowler's position or an upright position before initiating therapy. • Use diaphragmatic breathing. • Place the mouthpiece of the spirometer firmly in the mouth, breathe air in (inspire) through the mouth, and hold the breath at the end of inspiration for about 3 seconds. Exhale slowly through the mouthpiece. • Coughing during and after each session is encouraged. Splint the incision when coughing postoperatively. • Perform the procedure approximately 10 times in succession, repeating the 10 breaths with the spirometer each hour during waking hours. .

Pulmonary hygiene

any method you use to keep lungs clear -coughing -deep breathing -incentive spirometer -hydration -repositioning -walking

When is a simple mask indicated?

are used to administer low to moderate concentrations of oxygen. The body of the mask itself gathers and stores oxygen between breaths. The patient exhales directly through openings or ports in the body of the mask. If oxygen flow ceases, the patient can draw air in through these openings around the mask edges. Although widely used, these masks cannot be used for controlled oxygen concentrations and must be adjusted for proper fit. They should not press too tightly against the skin, because this can cause a sense of claustrophobia as well as skin breakdown; adjustable elastic bands are provided to ensure comfort and security.

With long standing hypoxia, what are s/s the pt. may exhibit

as seen in chronic obstructive pulmonary disease [COPD] and chronic heart failure), fatigue, drowsiness, apathy, inattentiveness, and delayed reaction time may occur

What would you assess to see if intervention was successful

ausculate breath sounds pulse ox

o2 transport to tissue depends on

cardiac output concentration of hemoglobin arterial oxygen content metabolic requirements

Type of Chest tubes

dry seal: one way valve that allow air to leave chest and not reenter water seal: regulated by water in the system

FIO2

fraction of inspired air. -pateint is not just breath the direct O2 -breathing combination of room air plus 02 from device -some oxygen from device blows by. No o2- receiving .20 from environment 1L 0.24 so with each additional liter that are receiving 0.04 L more of o2

What is an obturator

guides the direction of the outer cannula, is inserted into the tube during placement and removed once the outer cannula of the tube is in place

Nursing interventions to prevent complications

humidfying 02 proper cuff pressure suction only as needed: when there is copious amounts, as prescribed (as needed), adventagious lung sounds, obvious secretion. unnecessary suctioning can cause damage, bronchospasm auscultate lungs monitor for s/s of infection 02 pulse ox monitor for cyanosis sterile technique with dressing change and sx.

If trach patient is on a vent what kind of suction will they have

inline suction

Why might the o2 concentration vary from one person to the next

people with COPD or Enphzmea should not be given high concentration of o2 quickly because it will decrease their drive to breath because of elevated levels of Co2 -hypoxia stimulates them to breath keep there o2 stat btw (89-92%) -increase rate very slowly and gradually can be on L greater than 3L -its dependent on the patient -the route of administration

Goal of O2 therapy

provide adequate trasnport of o2

Home care with oxygen therapy

t: • State primary care provider's prescription for oxygen and the manner in which it is to be used.✓✓• Indicate when a humidifier should be used.✓✓• Identify signs and symptoms indicating the need for change in oxygen therapy.✓✓• Describe precautions and safety measures to be used when oxygen is in use.✓✓• Know NOT to smoke while using oxygen.✓✓• Post "No smoking—oxygen in use" signs on doors.✓✓• Notify local fire department and electric company of oxygen use in home.✓✓• Keep oxygen tank at least 15 feet away from matches, candles, gas stove, or other source of flame.✓✓• Keep oxygen tank 5 feet away from television, radio, and other appliances.✓✓• Keep oxygen tank out of direct sunlight.✓✓• When traveling in automobile, place oxygen tank on floor behind front seat.✓✓• If traveling by airplane, notify air carrier of need for oxygen at least 2 weeks in advance.✓✓• State how and when to place an order for more oxygen.✓✓• Describe a diet that meets energy demands.✓✓• Maintain equipment properly:• Demonstrate correct adjustment of prescribed flow rate.✓✓• Describe how to clean and when to replace oxygen tubing.✓✓• Identify when a portable oxygen delivery device should be used.✓✓• Demonstrate safe and appropriate use of portable oxygen delivery device.✓✓• Identify causes of malfunction of equipment and when to call for replacement of equipment.✓✓• Describe the importance of determining that all electrical outlets are working properly

Tracheostomy why are they inserted? What is it?

tracheostomy tube is inserted for a variety of reasons. It may be used to: - replace an endotracheal tube, -to provide a method for mechanical ventilation of the patient, -to bypass an upper airway obstruction, or -remove tracheobronchial secretions an artificial opening made into the trachea, usually at the level of the second or third cartilaginous ring. A curved tube, called a tracheostomy tube, is inserted through the opening. It is inserted in the operating room or intensive care unit under sterile conditions using local anesthesia, and can be temporary or permanent.

Preventing complications with endotracheal and tracheostomy

• Administer adequate warmed humidity. • Maintain cuff pressure at appropriate level. • Suction as needed per assessment findings. • Maintain skin integrity. Change tape and dressing as needed or per protocol. • Auscultate lung sounds. • Monitor for signs and symptoms of infection, including temperature and white blood cell count. • Administer prescribed oxygen and monitor oxygen saturation. • Monitor for cyanosis. • Maintain adequate hydration of the patient. • Use sterile technique when suctioning and performing tracheostomy care.

Suctioning for nasopharyngeal and other artificial airways

•Make sure the suction equipment works properly before starting.•After washing your hands, assemble the equipment needed: •Appropriate-size sterile suction catheter•Sterile gloves•Supplemental oxygen•Sterile water-based lubricant•Sterile normal saline if indicated•Don sterile gloves, keeping dominant hand sterile and nondominant hand clean.•Preoxygenate the infant or child if indicated.•Apply lubricant to the end of the suction catheter.•If indicated for loosening of secretions, instill sterile saline.•Maintaining sterile technique, insert the suction catheter into the child's nostril or airway. •Insert only to the point of gagging if inserting via the nostril.•Insert only 0.5 cm further than the length of the artificial airway.•Intermittently apply suction for no longer than 10 seconds while twisting and removing the catheter.•Supplement with oxygen after suctioning