Brunner & Suddarths Ch 21

Nutrition

Gas-producing foods such as beans, legumes, broccoli, cabbage, and brussels sprouts should be avoided to prevent gastric distress. Because many patients lack the energy to eat, they should be instructed to rest before and after meals to conserve energy.

Oxygen Delievery Systems Tracheostomy Collar

High Flow System Good humidity, comfortable, fairly accurate FiO2

Postural Drainage

positioning the patient to allow drainage from all lobes of the lungs and airways

Oxygen Delievery Systems Nonrebreathing mask

similar in design to partial rebreathing masks except that they have additional valves. A one-way valve located between the reservoir bag and the base of the mask allows gas from the reservoir bag to enter the mask on inhalation but prevents gas in the mask from flowing back into the reservoir bag during exhalation.

Oxygen Delievery Systems Venturi Mask

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.

Oxygen Therapy

• Administration of oxygen at greater than 21% (the concentration of oxygen in room air) to provide adequate transport of oxygen in the blood, to decrease the work of breathing, and to reduce stress on the myocardium, • Assess for signs and symptoms of hypoxia, arterial blood gas results, and pulse oximetry

Mini Nebulizer Therapy

• Handheld apparatus that disperses a moisturizing agent or medication into the lungs, make a visible mist • Nursing care: - Slow, deep breathes through mouth and hold a few seconds at the end of inspiration - Coughing exercises to mobilize secretions • Assess patent before treatment and evaluate patient response after treatment

Chest Physiotherapy

• Includes postural drainage, chest percussion and vibration, breathing retraining, and effective coughing, • Goals: remove secretions, improve ventilation, and increased efficiency of respiratory muscles

Endotracheal Intubation

• Provides patent airway, access for mechanical ventilation, facilitates removal of secretions

Patient Teaching: Home Oxygen

• Safety • Flow rate and adjustment • Maintenance of equipment • Identification of malfunction • Airway obstruction • Humidification • Ordering of supplies and oxygen • Signs and symptoms • Diet, activity, travel • Electrical outlets

Complications of Oxygen Therapy

• Suppressed respiratory drive and low O2 tension • Fire • Oxygen toxicity: O2 concentrations of greater than 50% for extended periods of time (longer than 48 hours) can cause an overproduction of free radicals, which can severely damage cells

Oxygen Toxicity

• Symptoms include substernal discomfort, paresthesias, dyspnea, restlessness, fatigue, malaise, progressive respiratory difficulty, refractory hypoxemia, alveolar atelectasis, and alveolar infiltrates on x-ray • Prevention: - Use lowest effective concentrations of oxygen - PEEP or CPAP prevent or reverse atelectasis and allow lower oxygen percentages to be used

Incentive Spirometry

• Two types: volume or flow • Device encourages patient to inhale slowly and deeply to maximize lung inflation and alveoli expansion • Used to prevent or treat atelectasis • Nursing care: Positioning of patient,encourageuse,setrealistic goals, and record outcomes.