concepts of care for pt. requiring oxygen therapy or tracheostomy Flashcards
oxygen therapy purpose
relieves hypoxemia and hypoxia
hypoxemia
low levels of oxygen in blood
hypoxia
decreased tissue oxygenation
goal of oxygen therapy
use the lowest fraction of inspired oxygen for acceptable blood oxygen level without causing harmful side effects
ABG snslysis
an abg sample reports the status of oxygenation and acid-base balance in the blood
ABG measures
ph pa02 paco2 hco3 sa02
ph
amount of free hydrogen ions in the arterial blood
range 7.35-7.45
pa02
partial pressure of oxygen
normalL 80-100
paco2
partial pressure of carbon dioxide
range: 35-45
hco3
the concentration of bicarbonate in arterial blood
range: 21-28
sao2
% of oxygen bound to hgb as compared with total amount that can be possibly carried
range: 95-100
how is an abg be obtained
arterial puncture of through an aterial line
arterial puncture
- perform using surgical aseptic technique and collect into a heperinized syringe
- place in basin of ice and water to preserve ph and oxygen pressure
- hold pressure for 5 min over puncture site& make sure bleeding has stopped
- monitor abg sampling site for bleeding, loss of pulse and change in temp color
arterial line
- verify line can be used
- obtain heparinized syringe
- collect and waste specimen
transport on ice - flush arterial line with preconnected flushing system
- assess for complications such as hematoma or air embolism
pulse oximetry
noninvasive and painless test that measures your oxygen saturation level, or the oxygen levels in blood, rapidly detects small changes
capnography
measurement of carbon dioxide in a patients exhaled breath over time
oxygen therapy interventions
- recognize oxygen hazards
- check prescription
- use humidification if delivered at 4l/min or more
- check skin for pressure points around mouth and ears
- provide mouthcare; lubricate nostrils, face, lips
- clean cannula, mask
- collaborate respiratory therapist
oxygen therapy complications
- combustion- no smooking/ candles
- oxygen toxicity: consider concentration, how much lungs can handle
- absorption atelectasis: collapsed alveoli, crackles, pt dry
- drying of mucous membranes
- infection: cause bacteria and fungus to grow
type and use of oxygen depends on
- required oxygen concentration
- oxygen concentration that can achieved by a delivery system
- importance of accuracy and control of the oxygen concentration
low flow oxygen delivery system
- easy to use
- comfortable
- amount of oxygen delivered varies
- nasal cannula (1-6l)
low flow oxygen delivery system devices
- simple
- partial rebreather
- non-rebreather
nasal cannula
Flow rate: 1-6L
- O2 concentration of 24%-44%
- flow rate >6l does not increase gas exchange because anatomical dead space is full
nasal cannula used for
chronic lung disease or long term therapy
sample facemask
- delivers o2 up to 40% to 60% for short term therapy
- minimum of 5L
- ensure appropriate fit
partial rebreather mask
- provides 60% to 75% with flow rate of 6-11l
- patient rebreathes one third exhaled tidal
non-rebreather mask
- delivers highest o2 level
- can deliver fio2 greater than 90%
- ensure valves are patent and functional
non-rebreather mask used for
- used for unstable clients who may require intubation
high flow nasal cannula
- 30l-60l
- combination of heat and humidity minimizes damage to mucous membranes
- tube connect to a machine
- less risk of skin breakdown
venturi mask
- adaptor located between bottom mask and o2 sources
- pull in a proportional amount of room air for each liter flow of oxygen
t-piece
delivers desired fio2 to clients with trachestomy, laryngectomy, et tube
- aerosol should appear on exhalation side
noninvasive positive pressure ventilation (NPPV)
uses positive pressure to keep alveoli open, improves gas exchange
noninvasive positive pressure ventilation (NPPV) used for
manage:
- dyspnea
- hypercarbia
- acute exacerbations of chronic obstructive pulmonary disease
- pulmonary edema
- acute asthma attacks
noninvasive positive pressure ventilation (NPPV): CPAP
- delivers a set of positive airway pressure throughout each cycle on inhalation and exhalation
noninvasive positive pressure ventilation (NPPV): volume- limited or flow limited
delivers a set of tidal volume with the patients inspiratory effort
noninvasive positive pressure ventilation (NPPV): BIPAP
cycles different pressures at inspiration and expiration
Transtracheal oxygen delivery (TTO)
- long term delivery of 02 directly into lungs
- small flexible catheter is passed into trachea through small incision
- flow rates prescribed for rest activity
- if needs to be clean pt. would be switched to nasal cannula
homecare management
- stabilize patient prior to sending home on oxygen
- medicare will cover the cost of home oxygen therapy for pt. with hypoxemia
self-management for o2
- pt. family education needed on equipment for oxygen therapy and safety considerations for maintaining and using oxygen therapy
- oxygen will be delivered to pt. home
- follow up care is needed and reevaluation of the need of oxygen therapy
home oxygen therapy is provided in one of three ways:
- compressed gas in tank or cylinder
- liquid oxygen in a reservoir
- oxygen concentrator
trachestomy
surgical incision into trachea to create an airway to maintain gas exchange
tracheostomy
stoma that results from tracheotomy
- may be temporary or permanent
preoperative care for tracheostomy
teach and discuss tracheotomy care, communication, and speech
operative procedures for tracheostomy
- neck is extended and an endotracheal (ET) tube is placed by anesthesia to maintain an airway
- incision are made through neck and tracheal rings to enter trachea
- once trachea in entered, et tube is removed while the tracheostomy tube is inserted, tube is secured with sutures and tracheostomy ties or velcro tube holders
- chest x-ray to determine placement
post op care for tracheostomy: assessment
- ensure pt. airway
- assess for bilateral breath sounds, perform a respiratory assessment at least hourly
- assess for complications from the procedure
tracheostomy complications
- tube obstruction
- tube dislodgement and decannulation
- pneumothorax
- subc emphysema
- bleeding
- infection
trach tubes
- plastic or metal
- most are disposable
- cuffed tube
- inner cannula
- fenestrated tube
preventing tissue injury with trachs
- injury can occur where the inflated cuff presses against the tracheal mucosa
- inflate the cuff to form a seal between the trachea and the cuff using the least amount of pressure
- check the cuff pressure at least once a shift
ensuring air warming and humidification
- if not adequate, trach damage can occur
- inadequate humidity causes thick dry secretions to occlude the airway and increase the risk of infection
- humidity air based on order
suctioning
- maintains a patent airway and promotes gas exchange
providing trach care: assess
- assess for cyanosis
- check o2 stat
- asses the trach site
- asses the skin around the tracheostomy and neck
- auscultate lung sounds
providing trach care: sure tubes in place
- secure using twill tape ties or commercial tube holders
- change devices when soiled or at least daily to keep clean, prevent infection, and assess tissue integrity uder ties
providing trach care: prevent accidental decannulation
use a coworker to stabilize the tube and prevent decannulation when changing the ties of tube holders
bronchial and oral hygiene
- turn pt ever 1-2 hours, early ambulation
- coughing and deep breathing, chest percussion, vibration, and postural drainage promote pulmonary hygiene
- avoid glycerin swabs or mouthwash containing alc for oral care; use sponge tooth cleaenr or soft bristile toothbrush
ensuring nutrition
swallowing can be difficult
- teach pt. to keep head of bed elevated for at least 30 min after eating
- avoid thin liquids
- no straw
- eat slow
- smaller frequent meals
maintaining communication
- writing tablet
- board with pictures and letters
- flash cards
- hand signals
- smartphones
- phrase questions with yes/ no answers
- mark central call light to indicate pt. cannot speak
- SLP
weaning off trach
- gradual decrease in tube size
- cuff is deflated when the pt. can manage secretions
- change from cuffed to uncuffed
- capping
- tracheostomy
- tracheostomy button
pt. teaching trach everyday care activites
- tube care
- shower shield
- cover loosely with small cotton cloth during day
- increase home humidity
- ## wear a medical alert bracelet
