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Week 6 Oxygenation

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by

Greg Carter

on 24 February 2016

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Transcript of Week 6 Oxygenation

Week 6: Oxygenation
Oxygen Delivery
Why do patients need supplemental oxygen?
Incentive Spirometry (IS)
Encourages voluntary deep breathing by providing visual feedback/goals for patient.
Breathing Exercises
Cough and deep breathing
Pursed lip breathing
Diaphragmatic breathing
Chest Tubes
inserted through the thorax to remove air or fluids from the pleural space, prevent air or fluid from reentering, or reestablish normal interpleural and intrapulmonic pressure
Oxygen is a medical gas, is highly combustible, and the 6 rights of med. administration apply.
Nasal Cannula (NC)
Two slightly curved prongs
inserted into patients nostrils
goes over ears
secured under chin
Potential skin breakdown?
1-6 L/minute
humidified O2 considerations?
Face Masks
Simple face mask
Partial nonrebreather
Nonrebreather
Venturi mask
Simple face mask
flow rate should be 5L or more to avoid re breathing exhaled carbon dioxide
Partial re breather
face mask with reservoir bag
flow rate 6-10 L/min
Non-rebreather
mask with reservoir bag
minimum of 10L/min
one-way valves prevent exhaled air from reentering the bag
What patient population would this benefit and why?
Patient
inhales
slowly and evenly to elevate a ball and keep it floating as long as possible.
AARC recommend 5-10 breaths per session every hour while awake
Cough and deep breathing
opens air passages
improves circulation
moves air to bottom of lungs
patients require instruction
how could you teach someone to cough
and deep breathe?
Pursed-lip breathing
Deep inspiration
prolonged expiration through pursed lips
as if blowing through a "straw"
exhalation longer than inhalation
Breathe in through your nose (with mouth closed)
Breathe out through pursed lips
Keeps pressure up in airways to prevent collapse of larger airways
Diaphragmatic Breathing
Good for: pulmonary disease, postoperative, and active labor
"belly breathing"
more difficult than other techniques
one hand on breastbone, the other on the abdomen
inhale: abdomen goes "out"
exhale: abdomen goes "in"
Why is patient education and return demonstration so important with breathing exercises?
Suctioning
Why do patients need suctioning?
Trachea is considered sterile, what does this mean to you?
Mouth is considered "clean"
Oropharyngeal
patient is able to cough
unable to clear
Orotracheal
unable to manage secretions by coughing
last no longer than 15 seconds
Replace oxygen source when "resting" between passes
Tracheal suctioning
in lab this week
read module
practice skill
Airways
Oral
Nasal
ET
Oral airway
prevents obstruction of the trachea by displacement of the tongue
measure from corner of mouth to angle of jaw just below the ear
Nasal airway/trumpet
measure from nostril to ear lobe
post surgery
lubricate before insertion

Endotracheal tube (ET)
short term airway
ventilated patients
relieve obstruction
protects airway
Passes through mouth, past the pharynx, and into the trachea
COPD is a progressive disease that makes it hard to breathe.
In COPD, less air flows in and out of the airways because of one or more of the following:
The airways and air sacs lose their elastic quality.
The walls between many of the air sacs are destroyed.
The walls of the airways become thick and inflamed.
The airways make more mucus than usual, which can clog them.

What is the leading cause of COPD?
COPD is the third leading cause of death in the US
Millions are diagnosed millions more may not know
Develops slowly and gets worse over time
No cure, no reversal, but can address symptoms
Asthma is a chronic lung disease that inflames and narrows the airways. Asthma causes recurring periods of wheezing, chest tightness, shortness of breath, and coughing. The coughing often occurs at night or early in the morning.
Asthma affects people of all ages, but it most often starts during childhood. In the United States, more than 25 million people are known to have asthma. About 7 million of these people are children.
People who have asthma have inflamed airways. This makes them swollen and very sensitive. They tend to react strongly to certain inhaled substances.

When the airways react, the muscles around them tighten. This narrows the airways, causing less air to flow into the lungs. The swelling also can worsen, making the airways even narrower. Cells in the airways might make more mucus than usual. Mucus is a sticky, thick liquid that can further narrow the airways.
Common signs and symptoms of asthma include:

Coughing. Coughing from asthma often is worse at night or early in the morning, making it hard to sleep.
Wheezing. Wheezing is a whistling or squeaky sound that occurs when you breathe.
Chest tightness. This may feel like something is squeezing or sitting on your chest.
Shortness of breath. Some people who have asthma say they can't catch their breath or they feel out of breath. You may feel like you can't get air out of your lungs.
Triggers can include:

Allergens from dust, animal fur, cockroaches, mold, and pollens from trees, grasses, and flowers
Irritants such as cigarette smoke, air pollution, chemicals or dust in the workplace, compounds in home décor products, and sprays (such as hairspray)
Medicines such as aspirin or other nonsteroidal anti-inflammatory drugs and nonselective beta-blockers
Sulfites in foods and drinks
Viral upper respiratory infections, such as colds
Physical activity, including exercise
You go to assess a new patient who is lying supine in bed. The patient tells you he feels SOB. Which nursing action should be first?

1. Raise HOB 45 degrees
2. Take oxygen sat. with pulse ox
3. Take BP and respiratory rate
4. Notify care provider of SOB and respiratory rate
A patient has been newly diagnosed with emphysema. in discussing his condition, which comment by the patient would indicate a need for further education?

1. "I'll make sure to rest between activities so I don't get SOB
2. I'll rest for 30 minutes before I eat my meal
3. If I have trouble breathing at night, I'll use two to three pillows to prop up
4. If I get short of breath, I'll turn up my oxygen
to 6 L/min
Venturi Mask
Uses different adapters
adjust the concentration Oxy. delivered
delivers a fixed Fio2 (fraction of inspired oxy.)
used with COPD patients
minimize carbon dioxide build up
humidifiers not typically needed
Concentrations 24-60%
4-12 L flow rate
(oxymask has been shown to be more effective)
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