CHAPTER 6 OXYGENATION NEEDS LANCASTER HIGH SCHOOL MRS. CARPENTER.

CHAPTER 6 CHAPTER 6 OXYGENATION NEEDSOXYGENATION NEEDS

LANCASTER HIGH SCHOOLLANCASTER HIGH SCHOOL

MRS. CARPENTERMRS. CARPENTER

OBJECTIVESOBJECTIVES FACTORS AFFECTING OXYGEN STATUSFACTORS AFFECTING OXYGEN STATUS IDENTIFY SIGNS OF HYPOXIAIDENTIFY SIGNS OF HYPOXIA PERFORMPERFORM

SETTING UP FOR OXYGEN SETTING UP FOR OXYGEN ADMINISTRATIONADMINISTRATION

COUGH AND DEEP BREATHE EXERCISESCOUGH AND DEEP BREATHE EXERCISES COLLECTING A SPUTUM SPECIMENCOLLECTING A SPUTUM SPECIMEN PERFORMING PULSE OXIMETRYPERFORMING PULSE OXIMETRY

Oxygen statusOxygen status

factors affecting oxygen needsfactors affecting oxygen needs Respiratory system statusRespiratory system status

all structures must be intact and all structures must be intact and functioningfunctioning

open airwayopen airway exchange of o2 and co2 in alveoliexchange of o2 and co2 in alveoli

FACTORS AFFECTING FACTORS AFFECTING OXYGEN STATUSOXYGEN STATUS

Cardiovascular system Cardiovascular system functionfunction

good blood flow to and from the heart.good blood flow to and from the heart. narrowed vessels decrease O2 to cells narrowed vessels decrease O2 to cells

and cause excess CO2 in capillariesand cause excess CO2 in capillaries


Red blood cell countRed blood cell count RBC’s carry oxygen, insufficient amount RBC’s carry oxygen, insufficient amount

causes decrease in the cells. causes decrease in the cells. blood loss reduces #blood loss reduces # production by the bone marrow affected production by the bone marrow affected

by:by: poor dietpoor diet chemotherapychemotherapy


Intact Nervous systemIntact Nervous system disease of nervous system affect disease of nervous system affect

respiration and respiratory muscle respiration and respiratory muscle functionfunction

breathing is difficultbreathing is difficult


affects of disease in nervous system:affects of disease in nervous system:

brain damage=decreased rate, brain damage=decreased rate, depth, and rhythmdepth, and rhythm narcotics=slowing of respirationsnarcotics=slowing of respirations lack of O2 and CO2 in the blood=increased lack of O2 and CO2 in the blood=increased

respirations to get morerespirations to get more


AgingAging muscles weaken and lung tissue less muscles weaken and lung tissue less

elasticelastic less strength for coughing to remove less strength for coughing to remove

secretions leading to pneumoniasecretions leading to pneumonia


ExerciseExercise demand for O2 increasesdemand for O2 increases those with diseases have enough at those with diseases have enough at

rest but unable to get with increaserest but unable to get with increase


FeverFever increases need for O2increases need for O2 rate and depth of respirations must rate and depth of respirations must

increase to meet need.increase to meet need.


PainPain increases need for O2, rate and depth oincreases need for O2, rate and depth o may not be able to do this is chest or may not be able to do this is chest or

abdominal injury or surgeryabdominal injury or surgery


MedicationMedication may depress respiratory center in the may depress respiratory center in the

brain two ways:brain two ways: respiratory depression=slow, weak respirations, respiratory depression=slow, weak respirations,

>12/minute>12/minute

too shallow to get enough air into lungstoo shallow to get enough air into lungs


respiratory arrestrespiratory arrest =breathing stops=breathing stops

medications that can cause respiratory medications that can cause respiratory depression and respiratory arrestdepression and respiratory arrest


narcoticsnarcotics morphinemorphine DemerolDemerol OpiumOpium HeroinHeroin MethadoneMethadone

depressantsdepressants barbituratesbarbiturates


SmokingSmoking causes lung cancer and COPDcauses lung cancer and COPD at risk for CADat risk for CAD

AllergiesAllergies respiratory system response to allergenrespiratory system response to allergen

symptoms cause swelling symptoms cause swelling


Pollutant exposurePollutant exposure pollutants in the air or water cause pollutants in the air or water cause

damage to the lungs.damage to the lungs.

NutritionNutrition iron and vitamin B, c, and folic acid to iron and vitamin B, c, and folic acid to

produce new RBCproduce new RBC live only 3-4months then are replacedlive only 3-4months then are replaced


Substance abuseSubstance abuse alcohol can depress brain function, alcohol can depress brain function,

decrease cough reflex which increases decrease cough reflex which increases risk of aspirationrisk of aspiration

Altered respiratory Altered respiratory function function

Three processes involved with respirationThree processes involved with respiration if one process is affected the respiratory if one process is affected the respiratory

process is altered.process is altered.

-types of respiratory -types of respiratory alterationalteration

hypoxiahypoxia deficiency of oxygen in the cellsdeficiency of oxygen in the cells cause cells to function abnormally, and brain cause cells to function abnormally, and brain

function to decreasefunction to decrease caused by :caused by : illnessillness diseasedisease injuryinjury surgery affecting respiratory functionsurgery affecting respiratory function

signs and symptoms signs and symptoms

signs and signs and symptomssymptoms restlessnessrestlessness dizzinessdizziness disorientationdisorientation confusionconfusion behavior and personality behavior and personality

changeschanges apprehensionapprehension anxietyanxiety

fatiguefatigue agitationagitation increased pulse rateincreased pulse rate increased rate and depth increased rate and depth

RR leaning forward, leaning forward,

constantly sittingconstantly sitting cyanosiscyanosis dyspneadyspnea

abnormal respirationsabnormal respirations 12 to 20 times per minute12 to 20 times per minute increased in infants and childrenincreased in infants and children should be quiet, effortless, and regularshould be quiet, effortless, and regular both sides of chest rise and fall equally.both sides of chest rise and fall equally.

types of abnormal respirationstypes of abnormal respirations tachypnea-above 24/minutetachypnea-above 24/minute

caused by: pregnancy, pain, exercise, caused by: pregnancy, pain, exercise, airway obstruction, hypoxemiaairway obstruction, hypoxemia

bradypnea-less than 10 /minutebradypnea-less than 10 /minute caused by:drug overdoses, CNS caused by:drug overdoses, CNS

disordersdisorders

types of abnormal types of abnormal respirations respirations

apnea apnea hypoventilation hypoventilation hyperventilation hyperventilation dyspneadyspnea Orthopnea Orthopnea Biot’s Biot’s Kussmauls Kussmauls

tests ordered to tests ordered to determine cause determine cause

chest x-raychest x-ray lung scanlung scan BronchoscopyBronchoscopy ThoracentesisThoracentesis

pulmonary function pulmonary function test test

arterial blood gasesarterial blood gases pulse oximetry*pulse oximetry*

normal =95%-100% normal =95%-100% Sputum cultureSputum culture

choosing a site for pulse choosing a site for pulse oximetry.oximetry.

Based onBased on condition of the personcondition of the person breaks in the skinbreaks in the skin poor circulation poor circulation

don’t use fingers or toesdon’t use fingers or toes Dark nail polish will distort the readingDark nail polish will distort the reading

Movements can alter the reading Movements can alter the reading ( tremors, shivering, seizures)( tremors, shivering, seizures)

Children attach to sole of foot, palm of hand , finger, Children attach to sole of foot, palm of hand , finger, toe or earlobetoe or earlobe

Older person use ear, nose and forehead d/t poor Older person use ear, nose and forehead d/t poor circulationcirculation

reporting pulse oximetry reporting pulse oximetry resultsresults

*Write as SpO2 *Write as SpO2 S=saturation, p=pulse, O2=oxygenS=saturation, p=pulse, O2=oxygen

Date and timeDate and time Activity of the personActivity of the person O2 rate if in useO2 rate if in use Reason for measurementReason for measurement Other observation=difficulty breathing, Other observation=difficulty breathing,

cyanosis, slow pulsecyanosis, slow pulse

APPLICATION #1APPLICATION #1 PROCEDURE: PULSE OXIMETRYPROCEDURE: PULSE OXIMETRY

sputum specimens*sputum specimens*

sputum = secretion from trachea, lungs, and sputum = secretion from trachea, lungs, and bronchi, expectorated through the mouthbronchi, expectorated through the mouth

saliva is from salivary glands in the mouth saliva is from salivary glands in the mouth “spit”“spit”

studied for blood, microbes, and abnormal studied for blood, microbes, and abnormal cells.cells.

painful and difficult for patientpainful and difficult for patient rinse mouth to remove food particles and rinse mouth to remove food particles and

decrease salivadecrease saliva never never use mouthwash, can destroy microbesuse mouthwash, can destroy microbes

special needs-sputum special needs-sputum specimensspecimens

childrenchildren breathing treatments and suctioning to produce breathing treatments and suctioning to produce

sputumsputum

elderlyelderly lack strength to cough up sputumlack strength to cough up sputum use of postural drainage (RN or RT)use of postural drainage (RN or RT)

OxygenationOxygenation PositioningPositioning

usually easier in Semi-Fowler’s or usually easier in Semi-Fowler’s or Fowlers positionFowlers position

may prefer to sit up in bed or lean on may prefer to sit up in bed or lean on overbed table=Orthopneic positionoverbed table=Orthopneic position

changes of position q2hr to prevent changes of position q2hr to prevent pooling of fluidspooling of fluids

Coughing and Deep Coughing and Deep breathingbreathing

removal of mucous and expansion of removal of mucous and expansion of lungs from the respiratory tractlungs from the respiratory tract

pneumoniapneumonia atelectasis atelectasis routine after surgery and pts on bed restroutine after surgery and pts on bed rest

problems to look forproblems to look for painpain

if post op or injuredif post op or injured fearfear

breaking open an incisionbreaking open an incision increased painincreased pain

Incentive SpirometryIncentive Spirometry

measure the amount of air a person measure the amount of air a person inhales and increase intake in the lungs.inhales and increase intake in the lungs.

usesuses post operativelypost operatively pneumoniapneumonia respiratory diseaserespiratory disease bedridden patientbedridden patient elderly that have been hospitalizedelderly that have been hospitalized

how often and amount of breaths ishow often and amount of breaths is determined by RN and facility policydetermined by RN and facility policy

APPLICATION #2 APPLICATION #2

PROCEDURE: COUGH AND DEEP PROCEDURE: COUGH AND DEEP BREATHINGBREATHING

PROCEDURE: COLLECT A SPUTUM PROCEDURE: COLLECT A SPUTUM SPECIMENSPECIMEN

Oxygen TherapyOxygen Therapy

used for hypoxemiaused for hypoxemia treated as a drug needs MD order with treated as a drug needs MD order with

device and amountdevice and amount

OXYGEN THERAPYOXYGEN THERAPY

types.types. ContinuousContinuous

never stopped or interrupted for any reasonnever stopped or interrupted for any reason

intermittentintermittent used for symptom relief of chest pain and SOBused for symptom relief of chest pain and SOB

PCT is responsible for safe care to pt PCT is responsible for safe care to pt receiving O2receiving O2

oxygen sourcesoxygen sources

wall outletwall outlet O2 piped into each room from central oxygen O2 piped into each room from central oxygen

supplysupply may only use in the roommay only use in the room extension is often needed to reach restroom, etc.extension is often needed to reach restroom, etc.

oxygen tankoxygen tank portableportable filled by a company and brought to the facility filled by a company and brought to the facility

for storagefor storage gauge to determine how much O2 in the tankgauge to determine how much O2 in the tank

oxygen sourcesoxygen sources

Oxygen concentratorOxygen concentrator

no source of oxygen is neededno source of oxygen is needed takes oxygen from the airtakes oxygen from the air limits movement of the patientlimits movement of the patient useless in a power failureuseless in a power failure

flammabilityflammability

devices to administer devices to administer oxygenoxygen

nasal cannulanasal cannula two prongs from tubing inserted into two prongs from tubing inserted into

nostrilsnostrils pressure from ears, nasal irritationpressure from ears, nasal irritation

face maskface mask covers nose and mouth with small holes covers nose and mouth with small holes

in the sidesin the sides


partial rebreathing face maskpartial rebreathing face mask reservoir bag added to the face mask for reservoir bag added to the face mask for

exhaled airexhaled air inhales room air, exhaled air and oxygeninhales room air, exhaled air and oxygen bag should never totally deflatebag should never totally deflate

nonrebreathing face masknonrebreathing face mask prevents exhaled air from entering the prevents exhaled air from entering the

reservoir bagreservoir bag inhales air and oxygen from the reservoir baginhales air and oxygen from the reservoir bag bag should never totally deflatebag should never totally deflate


Venturi maskVenturi mask precise amount delivered indicated by precise amount delivered indicated by

color codecolor code

administering oxygenadministering oxygen

special care of special care of patient with maskpatient with mask communicationcommunication skin integrityskin integrity food intakefood intake

administering oxygenadministering oxygen

O2 delivered in Liters/minute set by RT O2 delivered in Liters/minute set by RT or RN, should be checked frequentlyor RN, should be checked frequently

AP’s may adjust in some states check AP’s may adjust in some states check facility policyfacility policy

patient name/room number/bed patient name/room number/bed number/device orderednumber/device ordered

may assist not responsible for may assist not responsible for administering O2administering O2

APPLICATION #3 PROCEDURE: APPLICATION #3 PROCEDURE: SETTING UP FOR OXYGEN SETTING UP FOR OXYGEN ADMINISTRATIONADMINISTRATION

Artificial AirwaysArtificial Airways

Intubation=insertion of an artificial Intubation=insertion of an artificial airway to help it remain patentairway to help it remain patent

airway is obstructed d/t disease, injury, airway is obstructed d/t disease, injury, secretions, aspirationsecretions, aspiration

semiconscious or unconscious state of semiconscious or unconscious state of patientpatient

recovering from anesthesiarecovering from anesthesia needs mechanical ventilationneeds mechanical ventilation

care of the patient with care of the patient with artificial airwayartificial airway

*vitals signs checked often*vitals signs checked often *observe for hypoxia and respiratory distress*observe for hypoxia and respiratory distress *maintain the airway and notify the RN if *maintain the airway and notify the RN if

dislodgeddislodged *oral hygiene*oral hygiene *encourage communication *encourage communication *comfort and reassurance by use of touch and *comfort and reassurance by use of touch and

compassioncompassion

common airwayscommon airways

oropharyngealoropharyngeal inserted through the mouth into the pharynxinserted through the mouth into the pharynx can be done by RNcan be done by RN

nasopharyngealnasopharyngeal inserted through a nostril and into the inserted through a nostril and into the

pharynxpharynx can be done by RNcan be done by RN

common airwayscommon airways

endotrachealendotracheal inserted through mouth or nose and into the tracheainserted through mouth or nose and into the trachea by a MD or RN with special training using a lighted by a MD or RN with special training using a lighted

scope.scope. kept in place by a balloon at the end of the tubekept in place by a balloon at the end of the tube

tracheostomytracheostomy inserted through a surgical incision into the inserted through a surgical incision into the

tracheatrachea some types have cuffs that are inflated to keep in some types have cuffs that are inflated to keep in

placeplace done by MDdone by MD

common airways-common airways-TracheostomiesTracheostomies

vary depending on the need and the vary depending on the need and the condition of the pt.condition of the pt.

permanentpermanent when airway structures are removed d/t disease when airway structures are removed d/t disease

or traumaor trauma children from congenital defectschildren from congenital defects

temporarytemporary conditions requiring mechanical ventilationconditions requiring mechanical ventilation usually removed when the condition returns to usually removed when the condition returns to

normal and pt can breathe on their own.normal and pt can breathe on their own.

Trach tubesTrach tubes

made of plastic or metal and consists of three partsmade of plastic or metal and consists of three parts vary depending on their function and need of the ptvary depending on their function and need of the pt

outer cannula-secured in place by ties or a outer cannula-secured in place by ties or a Velcro collar around the neckVelcro collar around the neck never removednever removed

inner cannula-inserted through the outer and inner cannula-inserted through the outer and locked into placelocked into place removed for cleaning and mucus removal for removed for cleaning and mucus removal for

patencypatency obturator-used to insert the outer cannula, then obturator-used to insert the outer cannula, then

removedremoved taped to wall or bedside table incase outer taped to wall or bedside table incase outer

cannula comes outcannula comes out


patient educationpatient education no loose gauze or lint on dressingsno loose gauze or lint on dressings keep the stoma or tube covered when outsidekeep the stoma or tube covered when outside no showersno showers don’t get shampoo into the stomadon’t get shampoo into the stoma cover the stoma when shavingcover the stoma when shaving do not swimdo not swim wear a medical alert braceletwear a medical alert bracelet


Tracheostomy careTracheostomy care cleaning the inner cannula, stoma, and cleaning the inner cannula, stoma, and

application of clean ties or collarapplication of clean ties or collar Why?Why?

removes mucus from the inner cannula removes mucus from the inner cannula to keep airway patentto keep airway patent

prevent infection at the tracheostomy prevent infection at the tracheostomy sitesite

decrease incidence of skin breakdowndecrease incidence of skin breakdown


CALL THE RN IF SIGNS/SYMPTOMS CALL THE RN IF SIGNS/SYMPTOMS OF HYPOXIA OR RESPIRATORY OF HYPOXIA OR RESPIRATORY DISTRESS OCCUR OR THE OUTER DISTRESS OCCUR OR THE OUTER CANNULA COMES OUT DURING CANNULA COMES OUT DURING

SuctioningSuctioning

for pts who cannot cough or the cough is for pts who cannot cough or the cough is too weak to remove secretionstoo weak to remove secretions

the process of withdrawing or sucking up the process of withdrawing or sucking up fluid (secretions)fluid (secretions)

tube connected to a suction source and tube connected to a suction source and to a suction catheter inserted into the to a suction catheter inserted into the airwayairway


purposepurpose removal of secretions that obstruct removal of secretions that obstruct

airflowairflow decrease incidence of microbesdecrease incidence of microbes prevent hypoxiaprevent hypoxia


Suction routesSuction routes oropharyngeal and nasopharyngeal oropharyngeal and nasopharyngeal

used for person who cannot used for person who cannot expectorate after coughingexpectorate after coughing

tracheal tracheal for tracheal tube or tracheostomy for tracheal tube or tracheostomy

tubetube


oropharyngealoropharyngeal -suction through the mouth and into the pharnyx-suction through the mouth and into the pharnyx -a complete cycle involves inserting the catheter, -a complete cycle involves inserting the catheter,

suctioning, and removing the cathetersuctioning, and removing the catheter -should be no longer than 10-15 seconds-should be no longer than 10-15 seconds -type of suction catheter will depend on the -type of suction catheter will depend on the

secretionssecretions *Yankauer*Yankauer *Standard*Standard


NasopharyngealNasopharyngeal - suction catheter is passed through the - suction catheter is passed through the

nose and into the pharynxnose and into the pharynx

SuctioningSuctioning TracheostomyTracheostomy

usually hooked to mechanical usually hooked to mechanical ventilationventilation

may be performed by AP may be performed by AP if condition of the patient is stable and not if condition of the patient is stable and not

likely to change suddenlylikely to change suddenly tracheostomy is healedtracheostomy is healed

hypoxia is a risk d/t no oxygen while the hypoxia is a risk d/t no oxygen while the suction catheter is insertedsuction catheter is inserted

must hyperventilate before suctioningmust hyperventilate before suctioning

**for infants and children suction is no **for infants and children suction is no longer than 5 secondslonger than 5 seconds

APPLICATION #5: PROCEDURE: APPLICATION #5: PROCEDURE: OROPHARYNGEAL SUCTIONOROPHARYNGEAL SUCTION

Mechanical ventilationMechanical ventilation

used if can’t breathe on their own or used if can’t breathe on their own or cannot maintain enough oxygen in the cannot maintain enough oxygen in the bloodblood

use of a machine to move air in and out use of a machine to move air in and out of the lungsof the lungs

always have artificial airwaysalways have artificial airways most common: endo tracheal and most common: endo tracheal and

tracheostomytracheostomy

Mechanical ventilationMechanical ventilation

reactions to ventilationreactions to ventilation most are seriously ill and may be dyingmost are seriously ill and may be dying

1.confusion and disorientation1.confusion and disorientation

2.fear of the machine2.fear of the machine

3.fear of dying3.fear of dying

4.relief that they are getting oxygen4.relief that they are getting oxygen

5.restricted in movements5.restricted in movements

Care of the person on ventilationCare of the person on ventilation See textSee text

Chest tubesChest tubes

air, blood, or fluid can collect in the air, blood, or fluid can collect in the pleural space from surgery or injurypleural space from surgery or injury pneumothoraxpneumothorax

collection of air in the pleural spacecollection of air in the pleural space

hemothoraxhemothorax collection of blood in the pleural spacecollection of blood in the pleural space

pleural effusionpleural effusion collection of fluid in the pleural spacecollection of fluid in the pleural space

care of the person with a care of the person with a chest tubechest tube keep the drainage system below the keep the drainage system below the

level of the chest.level of the chest. measure vital signs and report any measure vital signs and report any

changeschanges note and report signs and symptoms of note and report signs and symptoms of

hypoxiahypoxia keep connecting tubing coiled on the keep connecting tubing coiled on the

bed with slackbed with slack

care of the person with a care of the person with a chest tubechest tube

prevent the tubing from becoming prevent the tubing from becoming kinked kinked

observe chest drainage and reportobserve chest drainage and report increased amountincreased amount bright red drainagebright red drainage bubbling activity increase, decrease or bubbling activity increase, decrease or

stoppingstopping

care of the person with a care of the person with a chest tubechest tube

record drainagerecord drainage turn and positionturn and position assist with coughing and deep breathing assist with coughing and deep breathing assist with incentive spirometeryassist with incentive spirometery note if the system is loose or disconnectednote if the system is loose or disconnected observe that chest tube is still in placeobserve that chest tube is still in place place gauze pad with petrolatum on insertion place gauze pad with petrolatum on insertion

sitesite stay with patient until the nurse arrivesstay with patient until the nurse arrives

QUESTIONS ???QUESTIONS ?????

CHAPTER 6 OXYGENATION NEEDS LANCASTER HIGH SCHOOL MRS. CARPENTER.

Documents

oxygen status factors

oxygen status medication

oxygen status fever

respiratory system status

respiratory arrest slide

surgery slide

increase slide

oxygen status pain increases