BN Ch.87 Oxygen Therapy and Respiratory Care

Question 1

State the three major goals of oxygen therapy.

Answer 1

• Reverses hypoxemia (low oxygen concentration in the blood)
• Decreases the work of the respiratory system: If the client receives supplemental oxygen, the respiratory muscles do not work as hard to pump air in and out of the lungs and to maintain a sufficient blood oxygen supply.
• Decreases the heart’s work in pumping blood: The heart tries to compensate for hypoxemia by increasing output; supplemental oxygen can ease the heart’s load.

Question 2

Discuss four key safety factors and hazards in oxygen administration.

Answer 2

• Oxygen is highly combustible.
• Make those aware when coming into contact with oxygen.
• Oil can ignite if exposed to oxygen.
• Changing position could alter the amount of oxygen being delivered.
• Maintaining the appropriate flow rate enhances effectiveness of oxygen therapy.

Question 3

Describe the use of the pulse oximeter.

Answer 3

It is a convenient monitor that measures the amount (percentage) of oxygen saturation in the blood.

Question 4

Identify five sources of oxygen and describe how they differ.

Answer 4

• Wall outlets: with bulk storage and in-room piping systems, it is installed next to each bed.
• Oxygen cylinders
• Oxygen strollers
• Oxygen concentrators:
  
  • Are widely used in home and extended care settings.
  • They compress room air and extract oxygen, providing concentrated oxygen flows in the range of 1 to 5 LPM.
• Hyperbaric chamber: Simulates deep sea diving by increasing atmospheric pressure.
• In the chamber a person can take oxygen into the body in concentrations higher than is possible at normal atmospheric pressure.

Question 5

List eight key points of nursing observations of the client who is receiving oxygen.

Answer 5

• Observe the client’s respirations.
• Determine their 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.
• Pain may lead to hyper-or hypoventilation.
• Be aware of conditions such as anxiety or restlessness.
• Lack of oxygen may be the cause of these symptoms.
• Measure the client’s pulse rate often.
• In respiratory distress, the pulse rate often rises.
• Monitor results of arterial blood gases (ABGs).
• Check pulse oximeter readings frequently.
• If indicated, monitor the client electronically (pulse, respiration, blood pressure, oxygen saturation).
• Observe for evidence of cyanosis.
• Monitor the oxygen delivery device for proper fit and usage.
• Check for signs of leakage.
• Document the settings of any equipment being used and your observations related to the client’s condition.
• Closely observe the client whose oxygen has been discontinued.
• If the client becomes short of breath, shows signs of cyanosis, or has a markedly increased pulse rate, resume oxygen and call the healthcare provider at once.

Question 6

Differentiate between low-flow and high flow oxygen delivery systems. Describe the nursing interventions needed for the following types of oxygen delivery systems: simple mask, partial- rebreathing mask, nonrebreathing mask, Venturi mask, IPPB, aerosol mist treatments, and manual resuscitation bag.

Answer 6

• Simple mask:
  
  • Low-flow oxygen delivery system that fits over the client’s nose, mouth and chin
• Partial-rebreathing mask:
  
  • Low-flow oxygen delivery sys with a bag attached, and no valves
• Non Breathing mask:
  
  • Oxygen delivery sys that has valves on the outside of the mask as well as valves between the mask and bag
• Venturi mask:
  
  • High-flow oxygen delivery system that provides the most reliable & consistent oxygen enrichment
• IPPB (Intermittent positive pressure breathing):
  
  • Respiratory therapy for individuals who chronically hyperventilate and may need a ventilator.
• Aerosol mist treatments:
  
  • Adds humidity to certain oxygen delivery devices
  • Hydrates thick sputum
• Administers bronchodilator medications to relax bronchioles narrowed by bronchospasm
• Administers anti-inflammatory or anti-asthma medications
• Delivers antibiotics to the lungs to fight infection
• Manual resuscitation bag:
  
  • These devices can deliver room air or be attached to supplemental oxygen.

Question 7

Describe the uses for AMBU-bag, mechanical ventilator, and tracheostomy. State the primary nursing considerations for each.

Answer 7

• AMBU-bag:
  
  • A self inflating handheld device commonly used to provide positive pressure ventilation to individuals who need artificial ventilator support.
• Mechanical ventilator:
  
  • A machine that forces supplemental oxygen, air, or both into the lungs.
  • It is necessary when a client is unable to provide enough oxygen to the lungs or the client is unable to expire adequate amounts of carbon dioxide.
• Tracheostomy:
  
  • An opening for the person who has had the throat incision or anyone who requires long term mechanical ventilation.

Question 8

Demonstrate how to set up the equipment for use of basic oxygen, an AMBU-bag, an endotracheal tube, and a tracheostomy.

Answer 8

Devices that support the airway and provide assistance to the person who is in severe respiratory distress or who has lost the capacity to breathe independently.

Question 9

Discuss nursing considerations for the client receiving oxygen on mechanical ventilation using an ET tube and using a tracheostomy.

Answer 9

• Maintaining a patent airway
• Prevention of infection
• Emotional support

Question 10

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

Answer 10

Inch

Question 11

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

Answer 11

Rate

Question 12

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

Answer 12

Aerosol

Question 13

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

Answer 13

Negative

Question 14

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

Answer 14

Continous

Question 15

Short-term emergencies

Answer 15

Oxygen Cylinder

Question 16

Carbon Monoxide Poisoning

Answer 16

Hyperbaric Chambers

Question 17

Home and Extended Care Settings

Answer 17

Oxygen Concentration

Question 18

Administering Portable Liquid Oxygen

Answer 18

Oxygen Strollers

Question 19

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 19

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 20

What are the goals of oxygen therapy?

Answer 20

The oxygen concentration increase during oxygen therapy accomplishes three goals:

• it reverses hypoxemia
• it decreases the work of the respiratory system
• it decreases the heart’s effort in pumping blood

Question 21

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

Answer 21

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 22

Which precautions must be taken with
oxygen cylinders?

Answer 22

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 23

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

Answer 23

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 24

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

Answer 24

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 25

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

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

Answer 25

The nurse should make the following observa- tions 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 adven- titious (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 26

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

Answer 26

The nurse should employ the following precau- tions 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 equip- ment 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 respira- tory secretions.

Question 27

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

Answer 27

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 28

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 28

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 dom-

inant hand.

Use the nondominant hand to connect the

wall or portable suction catheter tubing to the sterile suction catheter.

Question 29

How would the nurse change the tracheostomy tube tape?

Answer 29

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 unas- sisted, 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 30

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

Answer 30

The nurse should clean around the tracheostomy stoma and under the tracheostomy tube faceplate with sterile cotton-tipped swabs dipped in hydro- gen 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.