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Pediatric > Oxygen and Inhalation Therapy > Flashcards

Oxygen and Inhalation Therapy Flashcards

1
Q

Oxygen

A

used to maintain adequate cellular oxygenations. Used in the treatment of many acute and chronic respiratory problems.

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2
Q

Pulse Oximetry

A

used to monitor the effectiveness of inhalation therapies

  • non invasive measurement of the oxygen saturation of arterial blood
  • operated by battery or electricity and has a sensor probe that is attached securely to the childs fingertip, toe, earlobe, or around the foot with a clip or band
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3
Q

Indications for Pulse Oximetry

A

used for a variety of situations in which quick assessments of a child’s respiratory status is needed

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4
Q

Procedure for Pulse Oximetry

A
  • find an appropriate probe site. The probe site but be dry and have adequate circulation. Remove polish from nails or remove earrings if using the earlobe
  • be sure the child is in a comfortable position and that the arm is supported if a finger is being used as a probe site
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5
Q

Intraprocedure for Pulse Oximetry

A
  • not the pulse reading and compare with with the child’s radial use. Any discrepancy between the values warrants further assessment
  • if continuous monitoring is required, making sure the alarms are set for a low and high limit, the alarms are functioning, and he sound is audible. Move the probe every 4-8 hours or per facility policy to prevent pressure necrosis in infants who have disrupted skin integrity or poor perfusion
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6
Q

Postprocedure for Pulse Oximetry

A

Report unexpected findings to the provider.
If the childs SaO2 is less than the expected range (90-92%)
- confirm that the sensor probe is properly placed with the light-emitting diode (LED) placed on the top of the nail when digits are used
- confirm that the oxygen delivery system is functioning and that the child is receiving the prescribed oxygen flow rate. Increase oxygen rate as prescribed.
- place the child in a semi-fowlers or Fowlers position to maximize ventilation
- encourage deep breathing
- report significant finding to the provider
- remain with the child and provide emotional support to decrease anxiety

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7
Q

Interpretation of Pule Oximetry Findings

A
  • the expected range for SaO2 is 95-100%. Acceptable levels can range from 91% to 100%. Some illnesses can allow for a SaO2 of 85-89%
  • results less than 91% require RN intervention to assist the child to regain acceptable SaO2 levels. A SaO2 of less than 86% is a life-threatening emergency. The lower the SaO2 level, the less accurate the value
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8
Q

Nebulized Aerosol Therapy

A

The process of nebuization breaks up the medications into minute particles that are then dispersed throughout the respiratory tract These droplets are much finder than those created by inhalers

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9
Q

Indications for Nebulized Aerosol Therapy

A

Respiratory conditions that necessitate bronchodilators, corticosteroids, mucolytics, or antibiotics

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10
Q

Preparation for Nebulized Aerosol Therapy

A
  • instruct the client and the family that the treatment can take 10-15 minutes
  • determine if the child should use a mouthpiece, mask, or blow by
  • perform preprocedure assessment, including vital signs and oxygen saturation
  • pour the medication into the small container and attach the device to an air or oxygen source
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11
Q

Ongoing care with Nebulized Aerosol Therapy

A
  • encourage the child to take slow, deep breaths by mouth
  • monitor the child during the treatment, watching carefully for indications of local tracheal or bronchial effects (Spasms, edema)
  • assess vital signs, oxygen saturation, and lung sounds at the completion of treatment
  • assist the family with obtaining a nebulizer for home use if needed
  • enforce recommendations for aerosol medication
  • monitor for adverse reactions to medications
  • teach the family how to operate a home nebulizer
  • teach the family about adverse effects of the prescribed medication
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12
Q

MDI ( meter dosed inhaler )

A

these are handheld devices that allow children to self-administer mediations on a intermittent basis

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13
Q

MDI Indications

A

respiratory conditions that necessitates bronchodilators or corticosteroids

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14
Q

MDI Instructions

A
  • remove cap from the inhaler
  • shake the inhaler 5-6 times
  • attach the spacer (encourage spacer for children to facilitate proper inhalation of the medication)
  • hold the inhaler with the mouthpiece near the bottom
  • hold the inhaler with the thumb near the mouthpiece, and the index and middle fingers at the top
  • instruct the child on a MDI placement technique
  • OPEN MOUTH METHOD: hold the inhaler apron 3-4cm away from the front of the mouth
  • CLOSED MOUTH METHOD: place the inhaler between the lips and instruct the child to form a seal around the MDI
  • take a deep breath and then exhale
  • tilt the head back slightly, and the press the inhaler. While pressing the inhaler, begin a slow, deep breath that lasts for 3-5 seconds to facilitate delivery to the air passages.
  • hold the breath for approx 5-20 seconds to allow the medication to deposit into the airways
  • if an additional puff is needed, wait 1 minute between puffs
  • take the inhaler out of the mouth and slowly exhale through the nose
  • resume normal breathing
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15
Q

DPI Instructions

A
  • do not shake the device
  • take the cover off the mouthpiece
  • follow the directions of the manufacturer for preparing the medication, such as turning the wheel of the inhaler
  • exhale completely
  • place the mouthpiece between the lips and take a deep breath through the mouth
  • hold breath for 5-10 seconds
  • take the inhaler out of the mouth and slowly exhale through pursed lips
  • resume normal breathing
  • if more than one puff is prescribed, wait the length of time directed before administering the second puff
  • remove the canister and rinse the inhaler, cap, and space once a day with warm running water. Dry the inhaler before reuse.
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16
Q

Complications of MDI/DPI: Improper Medication Dosage Related to Improper Use

A
  • inhalation is too rapid
  • inability to coordinate inhalation with spray
  • not holding breath for adequate period
    RN Action: ensure the child uses the inhaler with proper technique
    Edu: reinforce proper technique with client and family
17
Q

Complication with MDI/DPI: Fungal Infections

A

Fungal infection of the oral cavity can occur with corticosteroid use
RN Actions:
- assess mouth for infections
- assist the child with rinsing mouth after administration
Client Edu:
- instruct the child and parents to clean the MDI and spacer after each use and to have the child rinse his mouth and expectorate

18
Q

Chest Physiotherapy

A

is a set of techniques that includes manual or mechanical percussion, vibration, cough, forceful expiration (or huffing), and breathing exercises. Gravity and positioning loosen respiratory secretions and move them into the central airways, where they can be eliminated by coughing or suctioning to rid excessive secretions from specific areas of the lungs.

19
Q

Indications for CPT

A

thick secretions with an inability to clear the airway

20
Q

Contraindications for CPT

A

decreased cardiac reserves, pulmonary embolism, or increased ICP

21
Q

Preprocedure for CPT

A
  • schedule treatments before meals or 1 hr after meals and at bedtime to decrease the likelihood of vomiting or aspiration
  • administer a bronchodilator medication or nebulizer treatment prior to postural drainage if prescribed
  • recombinant human deoxyribonuclease can also be used to decrease the viscosity of the mucus. Offer the child an emesis basin and facial tissues
22
Q

Intraprocedure for CPT

A
  • preform hand hygiene, provide privacy, and explain the procedure to the child and parents
  • ensure proper positioning to promote drainage of specific areas of the lungs
  • APICAL SECRETIONS OF THE UPPER LOBES: Fowlers position
  • POSTERIOR SECRETIONS OF THE UPPER LOBES: sitting position with child leaning forward curled over pillows
  • ANTERIOR SEGMENTS OF BOTH UPPER LOBES: supine and rotated slightly away from side being drained
  • SUPERIOR SEGMENTS OF BOTH LOWER LOBES: prone with hips elevated on pillows.
  • apply manual percussion by using cupped hand or a special device to clap rhythmically on the chest wall to break up secretions
  • electronic percussion is applied by vest device worn by the child
  • have the child remain in each postural drainage position for 20-30 minutes to allow time for percussion, vibration, and postural drainage.
  • individualize the position used and the duration and frequency of position
  • discontinue the procedure if the child reports faintness or dizziness
23
Q

Postprocedure for CPT

A
  • perform lung auscultation and assess the amount, color, and character of the expectorated secretions
  • document interventions and repeat the procedure as prescribed (typically 3-4 times a day)
24
Q

Complications of CPT: Hypoxia

A
  • monitor respiratory status during the procedure

- discontinue the procedure if dyspnea occurs

25
Q

Oxygen Therapy

A
  • increases the oxygen concentration of the air that is being breathed
  • oxygen can be delivered via nasal canula, face mask, face tent, CPAP, BiPAP, tent, hood, or mechanical ventilator
  • humidified oxygen moistens the airways, which promoted loosing and mobilization of pulmonary secretions and prevents drying and injury of respiratory structures
26
Q

Indications for Oxygen Therapy: Hypoxia

A

develops when there is an inadequate level of oxygen in the blood. Hypovolemia, hypoventilation, and interruption of arterial flow can lead to hypoxia

27
Q

Early signs of hypoxia

A
  • tachypnea
  • tachycardia
  • restlessness
  • pallor of the skin and mucous membranes
  • evidence of respiratory distress (use of accessory muscle use, nasal flaring, tracheal tugging, adventitious lung sounds)
28
Q

Late signs of hypoxia

A
  • confusion an stupor
  • cyanosis of skin and mucous membranes
  • bradypnea
  • bradycardia
  • hypotension or hypertension
29
Q

Preparation of the Client for Oxygen Therapy

A
  • warm oxygen to prevent hypothermia
  • use a clam, non threatening approach
  • explain all procedures to the child and parents
  • place the client in semi-fowlers or fowlers position to facilitate breathing and to promote chest expansion
  • ensure that equipment is working properly
30
Q

Ongoing care with oxygen therapy

A
  • provide oxygen therapy at the lowest liter flow that correct the hypoxia
  • assess/ monitor lung sounds and respiratory rate, rhythm, and effortless to determine the need or supplemental oxygen
  • do not allow oxygen to blow directly onto infants face
  • change linens and clothing frequently
  • monitor the child’s temperature closely in an oxygen tent for hypothermia
  • assess/monitor oxygenation status with a pule oximetry and ABGs
  • apply the oxygen delivery device as prescribed
  • promote rest and decrease environmental stimuli
  • promote oral hygiene as needed
  • promote turning, coughing, deep breathing, and use of incentive spirometry and suctioning
  • provide emotional support for children who appear anxious
  • assess nutritional status and provide supplements
  • assess/ monitor skin integrity closely for pressure ulcers. Move devices and inspect the skin several times daily. Provide moisture and pressure-relief devices as indicated
  • assess/monitor and document the response to oxygen therapy
  • titrate oxygen to maintain the prescribed oxygen saturation
  • discontinue oxygen therapy gradually
31
Q

Complications of Oxygen Therapy: Combustion

A
  • place “no smoking” or “oxygen in use” signs to alert others of the combustion hazard
  • know where the closest fire extinguisher is located
  • have the child wear cotton gown, because synthetics or wools can create sparks of static electricity
  • ensue that all electrical machinery (monitors, suction machines) are grounded
    -avoid toys that can induce a spark
  • do not use volatile, flammable materials (alcohol, acetone). near children who are receiving oxygen
    CLIENT EDU:
  • educate the child and others about the fire hazards of smoking with oxygen
32
Q

Complications of Oxygen Therapy: Oxygen Toxicity

A
  • can result from high concentrations of oxygen, long duration of oxygen therapy, and the child’s degree of lung disease
  • hypoventilation and increase PaCO2 levels allow for the rapid progression into unconscious state
  • use the lowest level of oxygen necessary to maintain an adequate SaO2
  • monitor ABGs and notify the provider if PaCO2 levels are outside the expected reference range
  • use of an oxygen mask with CPAP, BiPAP, or PEEP while a child is on mechanical ventilator can decrease the amount of oxygen needed
  • decrease the oxygen flow rate gradually
33
Q

Suctioning

A

suctioning can be accomplished orally, nasally, endotracheally, or through a tracheostomy tube

34
Q

Indications for Suctioning

A

to remove mucous plugs and excessive secretions

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Pediatric (16 decks)

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