BN CH. 87 Oxygen Therapy and Respiratory Care

Question 1

The pressure in the oxygen cylinder is measured in terms of pounds per square _________.

Answer 1

inch

Question 2

The percentage of oxygen that reaches the lungs depends on the __________ and depth of respirations.

Answer 2

rate

Question 3

_________ mist treatment refers to the suspension of microscopic liquid particles in
the air.

Answer 3

Aerosol

Question 4

The ________ pressure ventilator causes the chest to expand and air to flow into the lungs by lowering the pressure around the chest.

Answer 4

negative

Question 5

_________ positive airway pressure helps to keep the client’s lungs inflated and tends to improve lung function, even though breathing is spontaneous.

Answer 5

Continuous

Question 6

When are Oxygen cylinders used?

Answer 6

Short-term emergencies

Question 7

When are Hyperbaric chambers used?

Answer 7

Carbon monoxide poisoning

Question 8

When are Oxygen concentrators used?

Answer 8

Home and extended care setting

Question 9

When do you use Oxygen strollers?

Answer 9

When administering portable liquid oxygen

Question 10

Write the correct sequence involved in the application of the Venturi mask for a client
with chronic obstructive pulmonary disease
(COPD).

1. Connect the tubing from the Venturi mask to the tailpiece.
2. Place the mask over the bridge of the client’s nose and down onto the chin.
3. Attach the wing nut and tailpiece to the flow meter’s threaded outlet.
4. Set the flow meter to the manufacturer’s
   recommended flow rate.

Answer 10

3. Attach the wing nut and tailpiece to the flow meter’s threaded outlet.
4. Connect the tubing from the Venturi mask to the tailpiece.
5. Set the flow meter to the manufacturer’s
   recommended flow rate.
6. Place the mask over the bridge of the client’s nose and down onto the chin.

Question 11

What are the goals of oxygen therapy?

Answer 11

• The oxygen concentration increase during oxygen therapy accomplishes three goals: it reverses hypoxemia, it decreases the work of the respiratory system, and it decreases the heart’s effort in pumping blood.

Question 12

Why do clients with severe anemia show unreliable pulse oximeter readings?

Answer 12

• Pulse oximeter readings are unreliable in clients with severe anemia because, even if the hemoglobin is fully saturated, with a resulting pulse oxygen percentage of more than 95%, the clients may not be getting enough total oxygen to the tissues due to an overall lack of hemoglobin.

Question 13

Which precautions must be taken with oxygen cylinders?

Answer 13

The following precautions must be followed when handling oxygen cylinders:

• Secure the cylinder in a cart when it needs to be moved.
• Turn off the valve when the cylinder is not in use.
• Keep cylinders away from heat.
• Ensure that oxygen does not come in contact with any combustible material.
• Avoid smoking, because even a small spark can ignite an explosive fire.

Question 14

At what maximum rate should the nurse ensure flow of oxygen through a nasal cannula?

Answer 14

• The nurse should ensure flow of oxygen at a maximum rate of 6 L/min when administering it through nasal cannula.
• This is done to avoid excessive drying of the nasal mucosa.

Question 15

What is the goal of intermittent positive-pressure breathing (IPPB)? What steps should the nurse perform when providing an IPPB treatment?

Answer 15

The goal of IPPB treatment is to help clients to breathe more easily by liquefying the mucus. The nurse should take care of the following when providing IPPB treatment:

• Obtain specific instructions for operation of the machine being used.
• Use IPPB only with aerosolized medications.
• Check healthcare provider’s orders. The pressure may be ordered by the healthcare provider.
• Instruct the client to take slow, deep breaths seven to ten times per minute.
• Advise the client that each inspiration and expiration should last 2 to 4 seconds.
• Forceful exhalation is unnecessary and may be harmful.
• Encourage the client to cough up mucus.
• Suctioning may be necessary, to ensure that mucus is removed.
• Combine IPPB with postural drainage when instructed, for additional removal of secretions.
• Continue IPPB treatment for 10 to 20 minutes.
• Consider the treatment finished when the prescribed amount of medications is used up or if the client cannot tolerate further therapy.
• Monitor the client carefully for signs of difficulty.

Question 16

A nurse is caring for a client with chronic obstructive pulmonary disease. The client is receiving supplemental oxygen via a high-flow Venturi mask.

a. Which observations would the nurse make in a client who is receiving oxygen?

Answer 16

The nurse should make the following observations in a client who is receiving oxygen:

• Observe the client’s respiratory rate, depth, and character.
• Document difficulty in breathing: abnormal movements, retractions, irregular breathing patterns, abnormal breathing sounds.
• Auscultate lung sounds and document adventitious (abnormal) lung sounds.
• Determine the client’s level of comfort.
• Monitor the client’s pulse rate and arterial blood gases.
• Check pulse oximeter readings frequently.
• Monitor the oxygen delivery device for proper fit and usage.
• Document the settings of any equipment used.
• Observe for evidence of cyanosis.
• Chart all observations.

Question 17

Which precautions would the nurse take when caring for this client?

Answer 17

The nurse should employ the following precautions when caring for a client receiving oxygen:

• Be sure the client has no matches, cigarettes, or smoking materials in the bedside table. Make sure that warning signs are posted on the client’s door and above the client’s bed.
• Use caution with all electrical devices, such as heating pads, electric blankets, or the ordinary call light.
• Turn the oxygen on before applying the mask with all oxygen delivery systems.
• Instruct the client not to change the position of the mask, the cannula, or any of the equipment after it is in place.
• Maintain a constant oxygen concentration for the client to breathe.
• Watch for respiratory depression or distress.
• Make sure the tubing is patent at all times and that the equipment is working properly.
• Provide frequent mouth care to the client.
• Wear gloves any time there is a possibility of coming into contact with the client’s respiratory secretions.

Question 18

Which steps would the nurse follow when the healthcare provider has recommended discontinuing oxygen?

Answer 18

• The nurse should discontinue oxygen only after a healthcare provider has evaluated the client and recommended discontinuation.
• The nurse should gradually decrease oxygen in stages when it is given in medium-to-high concentrations.
• The nurse should monitor the client’s arterial blood gases or oxygen saturation level to determine whether the client needs continued support.

Question 19

A nurse is caring for a client who underwent
tracheostomy after a motor vehicle accident.
The nurse is instructed to perform suctioning
and provide tracheostomy care to the client.

a. Which steps would the nurse perform
when preparing the suction equipment?

Answer 19

The following steps should be undertaken by the nurse to prepare the suction equipment:

• Open the sterile tracheostomy suctioning kit and cleaning supplies on the bedside tray or table.
• Pick up the sterile container, open it, and pour sterile saline into it.
• Wear sterile gloves.
• Hold the sterile suction catheter with the dominant hand.
• Use the nondominant hand to connect the wall or portable suction catheter tubing to the sterile suction catheter.

Question 20

How would the nurse change the tracheostomy tube tape?

Answer 20

The nurse should carry out the following steps to change the tracheostomy tube tape:

• Have an assistant hold the tracheostomy tube in place with a sterile gloved hand. If unassisted, leave the soiled tapes in place until new ones are inserted and secured.
• Pass the ends of the tape through the opening on the faceplate and bring them behind the client’s neck to the other opening on the opposite side of the faceplate.
• Insert tape through the opening, pull securely, and tie or tape with Velcro into place.
• If necessary, remove the soiled tape.

Question 21

How should the nurse clean around the tracheostomy stoma and under the tracheostomy tube faceplate?

Answer 21

• The nurse should clean around the tracheostomy stoma and under the tracheostomy tube faceplate with sterile cotton-tipped swabs dipped in hydrogen peroxide to remove accumulated and encrusted secretions.
• The area should be rinsed using cotton-tipped swabs moistened in normal saline to remove hydrogen peroxide and additional secretions.
• The nurse should then dry the area with a dry, sterile, gauze pad to remove any moisture, which could contribute to the growth of bacteria.