BN Ch.87 Oxygen Therapy and Respiratory Care Flashcards
(30 cards)
State the three major goals of oxygen therapy.
- 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.
Discuss four key safety factors and hazards in oxygen administration.
- 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.
Describe the use of the pulse oximeter.
It is a convenient monitor that measures the amount (percentage) of oxygen saturation in the blood.
Identify five sources of oxygen and describe how they differ.
- 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.
List eight key points of nursing observations of the client who is receiving oxygen.
- 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.
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.
- 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.
Describe the uses for AMBU-bag, mechanical ventilator, and tracheostomy. State the primary nursing considerations for each.
- 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.
Demonstrate how to set up the equipment for use of basic oxygen, an AMBU-bag, an endotracheal tube, and a tracheostomy.
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.
Discuss nursing considerations for the client receiving oxygen on mechanical ventilation using an ET tube and using a tracheostomy.
- Maintaining a patent airway
- Prevention of infection
- Emotional support
The pressure in the oxygen cylinder is
measured in terms of pounds per square
Inch
The percentage of oxygen that reaches the
lungs depends on the __________ and depth of respirations.
Rate
__________ mist treatment refers to the
suspension of microscopic liquid particles in the air.
Aerosol
The __________ pressure ventilator causes the chest to expand and air to flow into the lungs by lowering the pressure around the chest.
Negative
__________ positive airway pressure helps to keep the client’s lungs inflated and tends to improve lung function, even though breathing is spontaneous.
Continous
Short-term emergencies
Oxygen Cylinder
Carbon Monoxide Poisoning
Hyperbaric Chambers
Home and Extended Care Settings
Oxygen Concentration
Administering Portable Liquid Oxygen
Oxygen Strollers
- Connect the tubing from the Venturi mask to the tailpiece.
- Place the mask over the bridge of the client’s nose and down onto the chin.
- Attach the wing nut and tailpiece to the flow meter’s threaded outlet.
- Set the flow meter to the manufacturer’s
recommended flow rate.
- Attach the wing nut and tailpiece to the flow meter’s threaded outlet.
- Connect the tubing from the Venturi mask to the tailpiece.
- Set the flow meter to the manufacturer’s
recommended flow rate. - Place the mask over the bridge of the client’s nose and down onto the chin.
What are the goals of oxygen therapy?
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
Why do clients with severe anemia show
unreliable pulse oximeter readings?
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.
Which precautions must be taken with
oxygen cylinders?
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.
At what maximum rate should the nurse
ensure flow of oxygen through a nasal
cannula?
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.
What is the goal of intermittent positive-
pressure breathing (IPPB)? What steps should
the nurse perform when providing an IPPB
treatment?
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.
