TERM 4 Ch 28 Care of Patients Requiring Oxygen Therapy or Tracheostomy

Changing the mask to a non-rebreather mask Clients receiving oxygen by mask are prone to rebreathing exhaled air containing carbon dioxide and room air that has a lower oxygen concentration. A non-rebreather mask can deliver an Fio2 greater than 90% and a flow rate of 10-15 L/min. The partial rebreather only allows an oxygen flow rate of 6-11 L/min.

The nurse assesses a client who is receiving oxygen using a partial rebreather facemask at a flow rate of 12 L/min. The nurse notes the client's oxygen saturation level is 90%. What is the nurse's next action? 1 Increasing the oxygen flow rate to 15 L/min 2 Changing the mask to a non-rebreather mask 3 Notifying the Rapid Response Team 4 Obtaining arterial blood gases

Oral care is indicated to decrease the accumulation of organisms Oral care helps decrease the accumulation of organisms present in the mouth that can contribute to pneumonia and should be a regular part of postoperative care. Good oral care is important even if the client is not eating, which actually serves to facilitate cleansing of the oral cavity. Protein will aid healing, but does not negate the need for oral care.

Which principle should guide the nurse's decision regarding oral care for a client with a tracheostomy during the first 24 hours postoperative? 1 If the client is not taking oral nutrition, it is not a concern at this time. 2 Oral care is indicated to decrease the accumulation of organisms. 3 High protein intake is indicated to promote optimal healing. 4 Oral care is not indicated if the client is being suctioned on a regular basis

Maintain proper cuff pressure. A TEF is a hole created between the trachea and the anterior esophagus due to excessive cuff pressure. Three methods of preventing this complication are to progress to a deflated cuff or cuffless tube as soon as possible, maintain proper cuff pressure, and monitor the amount of air needed for inflation for any change. Manually administering oxygen by mask is an appropriate intervention once the fistula has formed, but it does not prevent the formation. Applying direct pressure is an intervention for a trachea-innominate artery fistula.

Which technique or action does the nurse use to prevent a tracheoesophageal fistula (TEF) in a client after a tracheotomy has been performed? 1 Manually administer oxygen by mask. 2 Maintain proper cuff pressure. 3 Prevent pulling or tugging on the tube. 4 Apply direct pressure to the stoma site

Ventilate with a resuscitation bag and mask. The highest priority is to oxygenate the client with a bag and facemask while another nurse calls the Rapid Response Team. Assessing for bilateral breath sounds is done after the tube is replaced to ensure proper tube placement. The nurse should not attempt to replace the tube himself or herself because damage may occur.

While performing care for a client who had a tracheostomy placed 24 hours ago, the tube is accidentally dislodged. What action is the highest priority for the nurse? 1 Assess for bilateral breath sounds. 2 Attempt to replace the tube. 3 Call the Rapid Response Team. 4 Ventilate with a resuscitation bag and mask.

Use of a heated humidifier or nebulizer Use of an oral suction catheter in the endotracheal tube (Humidifiers and nebulizer containers can harbor organisms, which can lead to infections in patients receiving oxygen therapy. Organisms in the oral cavity can cause respiratory infections when transferred to the trachea via a suction catheter. Although oxygen tubing tension on an airway can cause pressure and potential breakdown, the more immediate concerns are the heated fluid in the containers and transference via suction catheters. The nonpetroleum lotions are preferred for dry skin that can result from oxygen therapy. A rise in the white blood cell count may indicate the presence of an infection, but it is not a source of infection.)

A client is receiving oxygen therapy. What are potential sources of infection the nurse should address? Select all that apply. 1 Oxygen tubing pulling on the airway 2 Use of nonpetroleum lotion for dry skin 3 Use of a heated humidifier or nebulizer 4 Use of an oral suction catheter in the endotracheal tube 5 Rising white blood cell count noted on recent blood work

Aerosol mask Face tent A Venturi mask can deliver 34% to 50% Fio2 with flow rates of 4-10 L/min. An aerosol mask or face tent could deliver the ordered 80% Fio2 with a flow rate of at least 10 L/min. If the client had a tracheostomy, he or she could use a tracheostomy collar, or could use a T-piece with an endotracheal tube, but would not have had a Venturi mask.

A prescription for oxygen therapy for a client who has been on a Venturi mask indicates a need for 80% Fio2. What do the options to fulfill this order include? Select all that apply. 1 T-piece adapter 2 Tracheostomy collar 3 Increased flow rate 4 Aerosol mask 5 Face tent

Increase the oxygen flow rate to 5 L/min and review the provider's orders. A minimum flow rate of 5 L/min is needed for clients receiving oxygen via facemask to prevent the rebreathing of exhaled air. The nurse should increase the flow rate to this minimum level and then check the order. The nurse will assess the client at regular intervals after ensuring the safe delivery of oxygen. If the client can be weaned from oxygen, a nasal cannula will be used to prevent rebreathing of exhaled air. Asking the client to sit up and take deep breaths is not necessary since the client has an adequate respiratory rate and oxygen saturation.

A client receiving oxygen via a simple facemask has a pulse oximetry level of 96% and a respiratory rate of 14 breaths per minute. Oxygen is being delivered at a flow rate of 4 L/min. What is the correct action by the nurse? 1 Assess the client at 30- to 60-minute intervals for evaluation of oxygenation status. 2 Increase the oxygen flow rate to 5 L/min and review the provider's orders. 3 Request an order to decrease the flow rate to see if the client can wean from oxygen. 4 Suggest that the client sit up straight and take several deep, slow breaths

A fenestrated tube is necessary to facilitate talking Fenestrated tubes allow airflow across the vocal cords, thus allowing the client to talk. Simply telling the client that the tube is necessary does not offer the client information as to why. Clients with cuffless tubes can also talk. Unless there is permanent damage to the vocal cords, clients will be able to speak.

A client who has a long-term tracheostomy communicates frustration to the nurse about not being able to talk. What does the nurse tell this client? 1 "A fenestrated tube is necessary to facilitate talking." 2 "Cuffed tracheostomy tubes are necessary." 3 "Until the tube is out, you will not be able to speak." 4 "You may never be able to speak again."

Do you have a scarf or a large loose collar that you could place over it? Suggesting strategies to cover the tracheostomy recognizes client concerns and explores options for dealing with the effects of the procedure. Reiterating the reason for the tracheostomy, suggesting that the client's loved ones won't care, and telling the client that he or she will learn to live with the tracheostomy are insensitive responses and minimize the client's concerns.

A client who is concerned about getting a tracheostomy says, "I will be ugly, with a hole in my neck." What is the nurse's best response? 1 "But you know you need this to breathe, right?" 2 "Do you have a scarf or a large loose collar that you could place over it?" 3 "Your family and friends probably won't even care." 4 "It won't take you long to learn to manage."

You are right, the damage has been done. But lets talk about why smoking around oxygen is dangerous. The nurse should use this opportunity to educate the client about the dangers of smoking in the presence of oxygen, as well as the benefits of quitting. Telling the client it is OK to quit when ready, or that it's never too late to quit, do not address the safety issue of smoking in the presence of oxygen. Recommending that the client turn off the oxygen when smoking encourages the client to remove his or her oxygen source, which could harm the client.

A client who smokes is being discharged home on oxygen. The client states, "My lungs are already damaged, so I'm not going to quit smoking." What is the discharge nurse's best response? 1 "You can quit when you are ready." 2 "It's never too late to quit." 3 "Just turn off your oxygen when you smoke." 4 "You are right, the damage has been done. But let's talk about why smoking around oxygen is dangerous."

- Maintain the client upright for 30 minutes after eating. - Provide small, frequent meals. - Teach the client to "tuck" the chin down in the forward position to swallow At least 30 minutes is required for thinner liquids in the stomach to be thickened in combination with stomach contents and/or removed from the stomach; this reduces the chance of aspiration. Eating requires significant time and energy; when the client becomes tired, he is more likely to aspirate. Shorter and more frequent intervals of eating tire the client less and reduce the chance of aspiration. Tucking the chin downward helps to open the upper esophageal sphincter. Liquids should not be given frequently and should be taken using a spoon to ensure that the client is attempting to swallow only small volumes of liquid; thin liquids such as water are easily aspirated. The tracheostomy cuff should be deflated because an inflated tube narrows the upper esophageal sphincter opening, which increases the risk for aspiration.

A client with a tracheostomy is at increased risk for aspiration. Which nursing interventions will reduce this risk? Select all that apply. 1 Encourage frequent sipping from a cup. 2 Encourage water with meals. 3 Inflate the tracheostomy cuff during meals. 4 Maintain the client upright for 30 minutes after eating. 5 Provide small, frequent meals. 6 Teach the client to "tuck" the chin down in the forward position to swallow

Change the nasal cannula to a Venturi mask. The client is not getting enough oxygen through the nasal cannula because the nares are narrowed and full of secretions. The nurse should change the delivery system to see if this improves. Increasing the flow rate will not help if the delivery route is compromised. Arterial blood gases may be performed if the client does not improve after changes in oxygen delivery. Suctioning the nares will increase irritation and narrowing of the nares.

A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen at a flow rate of 2 L/min via nasal cannula. The nurse notes an oxygen saturation of 89% after a previous level of 92%, and assesses swelling of both nares along with copious nasal discharge. What is the nurse's next action? 1 Change the nasal cannula to a Venturi mask. 2 Increase the oxygen flow rate to 4 L/min. 3 Request an order for arterial blood gases. 4 Suction the nares to clear nasal passages

Decrease the oxygen to 2 L/min to improve respiratory rate. Clients with chronic hypercarbia are at risk for oxygen-induced hypoventilation. Clients with COPD are more likely to have chronic hypercarbia. This client has a slowed respiratory rate and an altered level of consciousness indicating hypoventilation, which can occur within the first 30 minutes of oxygen therapy. The nurse should reduce the oxygen flow to see if the respiratory rate improves. Although many clients with COPD become anxious with a facemask, this client is currently not demonstrating signs of anxiety. Increasing the oxygen flow will only increase the risk for hypoventilation. An arterial blood gas will be a part of the ongoing assessment, but will not distinguish between acute and chronic hypercarbia.

A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen with a Venturi mask at a rate of 3 L/min. Prior to initiating oxygen therapy, the client appeared anxious with gray skin, a respiratory rate of 24 breaths/min, and an oxygen saturation of 87%. After 15 minutes of oxygen therapy, the nurse observes the client resting with closed eyes, pink coloration, a respiratory rate of 12 breaths/min, and an oxygen saturation of 95%. Which action by the nurse is correct? 1 Change the Venturi mask to a nasal cannula to further reduce anxiety. 2 Decrease the oxygen to 2 L/min to improve respiratory rate. 3 Increase the oxygen to 4 L/min to improve oxygen saturation. 4 Request an order for arterial blood gases to evaluate for hypercarbia

NPPV should be used only in clients with intact mental status who can protect their airway. Both the ventilator and NPPV have advantages and risks. A major concern in clients on NPPVs is that they must be alert enough to protect their own airway; mental status would be a key determining factor. Either system can be used to treat dyspnea or hypercarbia. The need for PEEP is not known at this time.

A client's family is asking about the comparative risks with a ventilator versus noninvasive positive pressure ventilation (NPPV). Which principle should guide the nurse's response? 1 A ventilator is preferred; it will be required if the problem is dyspnea or hypercarbia. 2 The positive pressure aspect of NPPV will provide for the client's current oxygenation. 3 The client most likely requires positive end-expiratory pressure (PEEP), and would need a ventilator for adequate response. 4 NPPV should be used only in clients with intact mental status who can protect their airway.

Chest x-ray Chest x-ray is the recommended standard to verify placement. Noting asymmetry of lung sounds and chest expansion gives valuable information, but is not definitive for tracheostomy placement. A bronchoscopy is not used to verify placement of a tracheostomy tube.

After surgical placement of a tracheostomy tube, what is the recommended method to verify placement? 1 Auscultation of bilateral lung sounds 2 Symmetrical chest expansion 3 Chest x-ray 4 Bronchoscopy

Decreased sensitivity to increased Paco2 levels Hypoxia (decreased oxygen levels in the blood) serves as the main driver for ventilation in the client with chronic lung disease; administering increased levels of oxygen can interfere with this stimulus. Consequently, carbon dioxide levels will increase; this can then cause the increased sleepiness and decreased responsiveness seen in this client. Although pain medications can lead to sleepiness and alter responsiveness, that is not the concern with this client at this time.

Family members of a client with chronic lung disease report increasing the level of oxygen administration for the client because of increased sleepiness and decreased responsiveness, but it did not seem to help. What is the most likely reason for this? 1 Insufficient pressure of the oxygen delivery 2 Decreased sensitivity to increased Paco2 levels 3 Decreased response to the presence of hypoxia 4 Pain medications the client is receiving

Dilation Tracheomalacia occurs when the constant pressure from the cuff causes tracheal dilation and erosion of the cartilage. Manifestations of this condition are a need for increasing amounts of air in the tracheal tube cuff, food in tracheal secretions, and failure to receive the full tidal volume delivered by the ventilator. Tracheal infection is characterized by prurulent drainage at the stoma site, along with redness, pain, and swelling. Tracheal stenosis involves scar formation caused by tracheal tube pressure and is usually observed after the tracheostomy tube is removed when stridor, difficulty breathing and swallowing, and coughing occur. Tracheal obstruction is characterized by an inability to move air in and out of the lungs.

In a client with a tracheostomy, the nurse notes that the cuff requires increasing amounts of air in order to maintain the seal and observes food particles in the tracheal secretions. Which tracheal complication does the nurse suspect occurred in this client? 1 Dilation 2 Infection 3 Stenosis 4 Obstruction

Folding standard gauze 4 x 4 to fit around the tube It is recommended that intact 4 × 4s be folded and placed around the tube. Cutting the 4 × 4 gauze might release small pieces of gauze that may be aspirated. The stoma site should be assessed every shift. Steri-Strips are not used to stabilize the tube.

In caring for a client during the first few days after tracheostomy placement, what nursing action is included in wound care? 1 Assessing the stoma site every 24 hours for purulent drainage, redness, and swelling 2 Cutting a slit in standard gauze 4 × 4s for ease of placement around tube 3 Folding standard gauze 4 × 4s to fit around the tube 4 Applying Steri-Strips to secure the tube

Simple facemask Nonrebreather mask Both simple and non-rebreather facemasks can deliver a low level of oxygen. The Venturi (or Venti) and aerosol masks are used in high-flow oxygen delivery systems, and are set up to deliver 24% to 50% Fio2 and 24% to 100% Fio2 respectively. The T-piece apparatus is an adapter that is attached to an endotracheal or tracheostomy tube.

Low-flow oxygen delivery systems typically include which types of components? Select all that apply. 1 Simple facemask 2 Venturi mask 3 Nonrebreather mask 4 Aerosol mask 5 T-piece apparatus

Suctioning the client Suctioning the client will likely result in clear lung sounds and lower peak pressure, and the appearance of the sputum will indicate whether bleeding is a concern. Humidifying the oxygen source will help mobilize secretions, but an active cough response is also required to clear the airway; a sedated client has a weak cough. Increasing oxygenation does nothing to clear the airway of whatever is making it noisy and is elevating peak pressures. Removing the inner cannula of a ventilated client is contraindicated.

Respirations of a sedated client with a new tracheostomy have become noisy, and the ventilator alarms indicate high peak pressures. The ventilator tube is clear. What is the best immediate action by the nurse? 1 Humidifying the oxygen source 2 Increasing oxygenation 3 Removing the inner cannula of the tracheostomy 4 Suctioning the client

Thicken all liquids to increase consistency Thickening the consistency of all liquids will facilitate swallowing with a decreased risk of aspiration. The client should actually "tuck" the chin down and move the forehead forward when swallowing. Consecutive swallows of liquid will likely increase the risk of aspiration, as would consuming moisture-producing fruits.

To prevent aspiration during swallowing in a client with a tracheostomy, what does the nurse suggest? 1 Hold the head high when swallowing. 2 Consume consecutive swallows of liquids. 3 Thicken all liquids to increase consistency. 4 Include moisture-producing fruits in the diet.

-Tight-fitting masks can lead to skin breakdown -Mask leaks can cause pressure around the eyes -There is a risk of aspiration due to gastric inflation -NPPV may require nasal gastric tube placement NPPV masks must fit tightly in order to form a proper seal, which can lead to skin breakdown over the bridge of the nose or other areas of the face. Leaks can cause uncomfortable pressure around the eyes, and gastric insufflation can lead to vomiting and the potential for aspiration. A nasogastric tube may be required for safety. Ventilator-associated pneumonia is a risk associated with intubation, not NPPV.

The health care provider has suggested placing a client with chronic obstructive pulmonary disease (COPD) on noninvasive positive-pressure ventilation (NPPV) to improve gas exchange. What information is important to discuss with the client before starting NPPV? Select all that apply. 1 Tight-fitting masks can lead to skin breakdown. 2 Pneumonia is a common associated risk. 3 Mask leaks can cause pressure around the eyes. 4 There is a risk of aspiration due to gastric inflation. 5 NPPV may require nasal gastric tube placement.

Decreased cardiac output Increased oxygen demand by the body Decreased oxygen-carrying capability of the blood Conditions such as fever, sepsis, heart failure, poisoning, and poor hemoglobin quality alter the body's oxygen and delivery system balance by increasing oxygen demand, decreasing cardiac output, and decreasing the oxygen-carrying capacity of the blood. These conditions typically do not decrease the utilization of the oxygen in the body. The entry of organisms into the bloodstream is related to barrier breakdown.

The normal balance of the body's oxygen intake and delivery system can be altered by nonrespiratory conditions including fever, sepsis, heart failure, poisoning, and poor hemoglobin quality. Which possible situations may result? Select all that apply. 1 Decreased cardiac output 2 Increased oxygen demand by the body 3 Decreased oxygen-carrying capability of the blood 4 Decreased effectiveness of oxygen utilization by the body 5 Major infections entering the client's bloodstream

Oxygen administration will decrease the work of the heart to improve the deliver of oxygen to vital organs Since the problem is with oxygen delivery, the immediate need is supplemental oxygen. Although the heart may work harder to improve delivery of the available oxygen, the administration of oxygen will decrease the stress on the heart. An increase in red blood cells would take longer to accomplish. Hypercarbia is not the stimulus for breathing in individuals without chronic lung disease.

The normal balance of the body's oxygen intake and delivery system can be disrupted when there is a problem with normal oxygen delivery. Which statement is true in these situations? 1 Oxygen administration will decrease the work of the heart to improve the delivery of oxygen to vital organs. 2 Oxygen administration is not needed; the body can adapt with an increase in red blood cells for oxygen delivery. 3 Hypercarbia will provide the necessary stimulus to prevent dangerously low blood oxygen levels. 4 Oxygen will not cure the underlying disease adequately to prevent hypoxia; therefore, oxygen delivery is not indicated.

Change the equipment to a nasal cannula with a flow rate of 4 L/min. A facemask must have a minimum flow rate of 5 L/min, so the nurse should change the equipment to a nasal cannula before slowing the flow rate. Decreasing the flow rate without changing to a nasal cannula can lead to rebreathing of CO2. Weaning from oxygen should be gradual and not abrupt. Clients with chronic obstructive pulmonary disease (COPD) may have oxygen saturations of 94% or greater, so there is no need to wait for higher oxygen saturations before weaning.

The nurse has an order to begin weaning a client from supplemental oxygen. The client is currently receiving oxygen via facemask at a flow rate of 5 L/min, and the oxygen saturation is 97%. Which action by the nurse is correct? 1 Change the equipment to a nasal cannula with a flow rate of 4 L/min. 2 Decrease the flow rate to 4 L/min and assess the client every 15 minutes. 3 Stop the oxygen administration and monitor oxygen saturation every half-hour. 4 Wean the client when the oxygen saturation is greater than 98%

Pad the tubing behind the ears. Because the tubing creates pressure that may lead to skin breakdown (especially behind the ears), padding the tubing prevents this complication. Smoking is prohibited in a room where oxygen therapy is being administered. Petroleum jelly is flammable and should not be used on the client's face, nose, or lips; a nonpetroleum cream should be used.

The nurse is discharging a client with a prescription for continuous oxygen therapy via nasal cannula at home. What does the nurse include in the discharge teaching? 1 Pad the tubing behind the ears. 2 No family members or visitors may smoke within three feet of the client. 3 Petroleum jelly (Vaseline) may be applied to dry nostrils and chapped lips. 4 Provide mouth care daily.

Suction the client's oropharynx before deflating the cuff. Before deflating a cuff, the nurse should suction the airway above the cuff to remove any secretions that might be aspirated into the lungs. It is not necessary for the client to perform the Valsalva maneuver or for the nurse to insert an oral airway. An incentive spirometer is not indicated.

The nurse is preparing to change a cuffed tube tracheostomy to a fenestrated tracheostomy tube. Which action is most important prior to cuff deflation? 1 Ask the client to perform the Valsalva maneuver. 2 Insert an oral airway to prevent airway obstruction. 3 Suction the client's oropharynx before deflating the cuff. 4 Teach the client how to use an incentive spirometer.

Reoxygenate the client with a 100% oxygen delivery system. If a client becomes hypoxic during suctioning, the nurse should reoxygenate the client with 100% oxygen. Clients are asked to take three to four deep breaths, if possible, prior to beginning suctioning. Continuing suctioning will increase the hypoxia.

The nurse is suctioning a client's tracheostomy and notes a heart rate of 98 and an oxygen saturation of 89% during the procedure. Which action by the nurse is correct? 1 Ask the client to take three or four deep breaths before resuming suctioning. 2 Continue suctioning to fully clear the airway of secretions. 3 Reoxygenate the client with a 100% oxygen delivery system. 4 Stop suctioning until the heart rate and oxygen saturation return to normal.

Preoxygenate for 30 seconds to 3 minutes before suctioning. Applying and/or increasing the oxygen level before suctioning a tracheostomy can improve presuctioning levels and thus decrease hypoxia with the procedure. Suction should be applied to the catheter only during withdrawal, or it increases hypoxia. Suctioning frequently for at least 20 seconds would be a safety risk for the client. Suctioning may trigger coughing; however, this will not decrease hypoxia.

To minimize hypoxia during suctioning of a tracheostomy, which action must the nurse perform? 1 Suction frequently for at least 20 seconds to maximize secretion removal. 2 Preoxygenate for 30 seconds to 3 minutes before suctioning. 3 Apply suction both during insertion and withdrawal to maximize secretion removal. 4 Request that the client cough to aid in secretion removal during suctioning

Proximity of the trachestomy tube to the epiglottis Due to the normal close proximity of the trachea and the esophagus, a tracheostomy tube can potentially interfere with protecting the airway during swallowing. A pressurized cuff on a tracheostomy tube doesn't provide assurance against aspiration during swallowing. Although xerostomia will make eating more challenging, it doesn't directly cause an increased risk of aspiration.

The risk of aspiration during oral intake with a tracheostomy is related to which factor? 1 Presence of a pressurized cuff on the tracheostomy tube 2 Proximity of the tracheostomy tube to the epiglottis 3 Ability of the client to be able to speak clearly 4 Amount of xerostomia experienced by the client

Hold the tracheostomy tube in place with one hand during the process. Do not remove the old ties until the new ones are in place. Holding the tracheostomy tube in place with one hand during the process and not removing the old ties until the new ones are in place are two approaches to ensure that the tracheostomy tube does not become dislodged. Although it is important to know the tracheostomy tube size and type in case of dislodgement, it doesn't prevent decannulation during tie replacement. Having a coworker assist with the tie change is helpful, but does not directly prevent dislodgement like the other actions do. Manipulating the tracheostomy may trigger coughing; a cough suppressant is not likely to prevent this problem.

What actions prevent tracheostomy decannulation during tie replacement? Select all that apply. 1 Always have a coworker assist with the procedure. 2 Hold the tracheostomy tube in place with one hand during the process. 3 Do not remove the old ties until the new ones are in place. 4 Know the tracheostomy tube size and type if replacement is necessary. 5 Give the client a cough suppressant to prevent coughing

Partial pressure of arterial oxygen (Pao2) Pao2 is a measure of the amount of oxygen in the arterial blood. Fio2 is a measure of the inspired oxygen, which may not all be absorbed. PEEP is a measure of positive expiratory pressure for a client on a ventilator. CPAP is a delivery system, not a measure of oxygenation.

When assessing the adequacy of a client's oxygenation, which information is important for the nurse to note? 1 Fraction of inspired oxygen (Fio2) 2 Partial pressure of arterial oxygen (Pao2) 3 Positive end-expiratory pressure (PEEP) 4 The client's acceptance of the continuous positive airway pressure (CPAP) machine.

A lower arterial oxygen level provides the stimulus to breathe. In the client with elevated arterial carbon dioxide (hypercarbia), the brain becomes less sensitive to high CO2 levels as the stimulus to breathe. Instead, low arterial oxygen levels provide the drive to breathe. If excessive supplemental oxygen is given, the stimulus to breathe is lost and the client will develop oxygen-induced hypoventilation. Carbon dioxide does not alter oxygen's capacity to bind with hemoglobin. Higher levels of oxygen do not affect cellular gas exchange. The client with hypercarbia is more sensitive to changing levels of arterial oxygen.

When caring for the client with hypercarbia who is receiving supplemental oxygen, why must the nurse use caution with the rate of administration? 1 A lower arterial oxygen level provides the stimulus to breathe. 2 Carbon dioxide has a greater affinity to bind with hemoglobin than oxygen. 3 Higher levels of arterial oxygen impair cellular gas exchange. 4 The client with hypercarbia is no longer sensitive to changing levels of arterial oxygen

Oxygen saturation by pulse oximetry is less that 90% Oxygen saturation below 90% indicates hypoxemia and is a reason to stop suctioning. The cough reflex is an expected response to suctioning; it does not preclude the necessity to clear the airway, although excessive coughing would prompt the nurse to allow the client to rest. The suction catheter can be irrigated to empty thick secretions and restore suction. An increased heart rate from 72 to 78 is not substantial to cause concern.

When providing suctioning through an endotracheal or tracheostomy tube, what alerts the nurse to stop suctioning? 1 Oxygen saturation by pulse oximetry is less than 90%. 2 The client coughs uncontrollably during suctioning. 3 Secretions are thick and occluding the suction catheter. 4 The client's heart rate increases from 72 to 78

Preoxygenating the client with 100% oxygen for 30 seconds to 3 minutes before suctioning When suctioning, using a gentle twirling motion of the catheter If needed, repeating suctioning up to three passes Preoxygenation is a proactive strategy to diminish suction-related hypoxemia. The technique of suctioning using a gentle twirling motion diminishes the risk of mucosal injury. No more than three suctioning passes are recommended to minimize hypoxemia, tissue hypoxia, and related complications. The recommended negative pressure for suction is 80-120 mm Hg. Suction should not be applied during catheter insertion, but rather only during removal. The rule is not to suction more than 10-15 seconds to prevent hypoxia and complications.

When suctioning a tracheostomy or endotracheal tube, what nursing actions ensure safe and effective practice? Select all that apply. 1 Adjusting the pressure dial on the suction source to 120-160 mm Hg 2 Preoxygenating the client with 100% oxygen for 30 seconds to 3 minutes before suctioning 3 Applying suction while quickly inserting the catheter and slowly removing it 4 When suctioning, using a gentle twirling motion of the catheter 5 Not suctioning longer than 20 seconds 6 If needed, repeating suctioning up to three passes

Liquid oxygen is available in lightweight, easy-to-carry containers. Liquid oxygen tanks last longer than equal-sized gaseous oxygen tanks. Liquid oxygen can be placed in multiple sizes of containers based on ease and need for portability. Compared to gaseous oxygen in the same size container, liquid oxygen will last longer. Although the oxygen concentrator is large and can be noisy, it doesn't require refilling for use. All people living with the client must be cautioned about open flames in the home, but a family member who smokes should not preclude a client's access to home oxygen. Oxygen in the home will not harm children if proper precautions are taken.

Which factors should be considered when determining which type of oxygen a client will require for home oxygen therapy? Select all that apply. 1 Liquid oxygen is available in lightweight, easy-to-carry containers. 2 An oxygen concentrator is noisy and big, and requires refilling for use. 3 Liquid oxygen tanks last longer than equal-sized gaseous oxygen tanks. 4 There are smokers in the family living in the house with the client. 5 There are young children living in the home with the client.