Oxygenation Flashcards
Evaluating Oxygenation / Nursing Assessment
Color Respiratory rate, depth Use of accessory muscles Patient Complaints (SOB) LOC Pulse Oximeter Breath Sounds
Clinical Signs of Hypoxemia
Tachypnea Tachycardia Restlessness, anxiety Use of Accessory Muscles Nasal Flaring Dyspnea Drowsiness --> Confusion Pale skin & mucous membranes --> cyanosis Adventitious Lung sounds
Tests, Diagnostic studies
Arterial blood gasses (pH, PaO2, PaCO2)
Pulmonary Function Tests
Peak Expiratory Flow Rate (PEFR)
Chest X ray
Lung Scan
Bronchoscopy
Thoracentesis
Sputum CultureOxygen Therapy
-Indications: hypoxemia / decreased SpO2 level
-Caution:
-patients with COPD
-Hypoxia –> drive to breath
-If overcorrected –> suppress drive
to breath
-Neonates - premature infants
- High Fio2 –> lung injury
- High arterial O2 –> retinopathy
-Beneficial: hyperbaric chamber
Oxygen therapy, 2
- Written as an order unless emergency
- Concentration
- Method of Delivery
- Liter flow per minute (L / m)
- May also include titration order (SpO2)
- Humidification
- Skin care and oral hygiene
Oxygen Delivery
- Oxygen gauge flow meter
- (Liters/minute)
- FiO2 (ratio of oxygen in blood to oxygen breathed in)
Oxygen Therapy equip
Combustible, SAFETY, transportation
Oxygen Delivery method depends on
Oxygen needs, comfort, age and developmental stage, equipment available
Method of O2 Delivery, Oxygen Therapy
- Nasal Cannula
- Face Mask
- Venturi Mask
- Partial rebreather mask
- Non-rebreather Mask
Nasal Cannula
- Deliver low concentration of oxygen (22-44%)
- At flow rates of 2-6 L/min
- Each L/min adds approx. 4% more O2
- Humidification / Alternate: Reservoir nasal cannula
Face Mask
Delivers O2 concentrations from 40-60%, at 5-8L/min
Partial Rebreather Mask
-Delivers O2 concentration of 40-60%
-At liter flows of 6-10 L/min
-Oxygen reservoir bag is attached
-allows client to rebreathe about 1/3 of
the exhaled air in conjunction with O2
-Thus it increases the FiO2 by recycling
expired O2
-Rebreather bag must not deflate during inspiration to avoid CO2 buildup
-If it happens, increase liter flow so the
bag remains 1/3 to 1/2 full
Non-rebreather mask
-Delivers the highest O2 concentration possible
-60-100% by means other than
mechanical ventilation, at liter flows
6-15 L/min
-ONE WAY VALVES ON THE MASK
-Between reservoir bag and mask;
-only oxygen enters mask
-Flaps on exhalation ports prevent
room air and client’s expired air from
entering the bag; so only O2 in the
bag
-To prevent CO2 buildup, the bag must not totally deflate during inspiration; if deflates, increase liter flow of O2
Venturi Mask
- Delivers oxygen concentration from 24-60%
- Liter flows 4-12 L/min
- Allows specific amounts of air to mix with oxygen
- Large bore tubing with color-coded adapters
- Or dials
- 24% concentration at 4L/min
- 35% concentration at 8L/min
- Color / concentration vary by Mfgr - Often used for patients with chronic lung disease
- COPD
Face Tent
- Provide varying concentration of O2
- 30-50%
- 4-8 L/min
Nursing Considerations
-Respiratory Assessment
-VS, O2Sat, color, anxiety, respiratory
effect
-Skin assessment
-Hydration (mucous membranes)
-Breakdown
-Chafing, irritation
Infants / Children
- Oxygen Tent
- Oxygen Hood
CPAP
- Continuous Positive Airway Pressure (CPAP)
- Bilevel (BiPAP)
- Purpose: provides air under pressure during inhalation and exhalation to keep airway open; prevent collapse
- Indications: obstructive sleep apnea
Incentive Spirometer
-Designed to mimic natural sighing or yawning
-Objectives:
-Increases transpulmonary pressure
and inspiratory volumes
-Improve inspiratory muscle
performance
-Re-establish or stimulate the normal
pattern of pulmonary hyperinflation
-Encourage patient to take long, slow, deep breaths - 10 x / hour
-When the procedure is repeated on a regular basis, airway patency may be maintained and lung atelectasis prevented and reversed
EVALUATION!!
Peak Flow Meter
-Peak Expiratory Flow Rate
-Measure amount of exhaled air
-Based on age, size
-Peak zones: Traffic light (red, yellow,
green)
-Anticipate early changes in condition
-COPD, Asthma
EVALUATE MEDICATION EFFECTIVENESS
When a patient has respiratory trouble…
- Use your assessment skills
- Determine what the problem is…
Nursing Assessment / Respiratory
- Respiratory rate, depth
- Breath sounds
- Use of accessory muscles
- Color
- Patient complaints (SOB)
- Pulse Oximeter
- LOC
Nursing Diagnosis
-Ineffective breathing pattern
-Inspiration and expiration do not
provide adequate ventilation
-Ineffective airway clearance
-Inability to clear secretions or
obstructions from respiratory tract to
maintain clear airway
-Impaired Gas Exchange
-Excess or deficit in oxygenation and or
CO2 elimination
Nursing Interventions
- Positioning
- Incentive Spirometer
- Turn, cough, and deep breathe
- Hydration
- Chest physiotherapy
- Suctioning
- Medication admin
- Oxygen Therapy
- Activity as tolerated
Discharge Teaching
- Maintenance & promotion of oxygenation: oxygen therapy
- Home O2
- Safety precautions
- Oxygen supply / supplier
- Methods of oxygen delivery
- Comfort tips
- Medication education
Health Promotion & Patient Teaching
- Weight
- Exercise
- Stress reduction
- Occupational safety
- Smoking / Smoke free environment
- Regular physical exams / screening
- Immunizations
- Medications
The last attempt before intubation
Nonrebreather mask
The reservoir bag must remain 1/2 to 1/3 full
partial rebreather mask
Allows specific amounts of air to mix with o2
Venturi mask
Is comprised of one way valves
non rebreather mask
Delivers low conc of O2
nasal cannula
