Care Of The Patient With Respiratory/ Oxygen Needs

1. Care Of The Patient With Respiratory/ Oxygen Needs Presented by Moyette Graham R.N., B.S.N

2. ABGs- Arterial Blood Gases • Assess Oxygen status • Invasive. • Wait longer for results

3. ABG Values • The arterial blood gas provides the following values: • Ph • The normal range is 7.35 to 7.45 • PO2 • The normal range is 80 to 100 mm Hg. • SaO2 • The normal range is 95% to 100%. • pCO2 • The normal range is 35 to 45 mm Hg. • HCO3 • The normal range is 22 to 26 mEq/liter • B.E. • The normal range is -2 to +2 mEq/liter. • www.orlandohealth.com/MediaBank/.../2010%20ABG%20SLP.pd

4. Diagnostic Test • Bronchoscopy- pg. 481 FON • C&S Sputum pg. 501 FON Skill 19-9 and 10 • Thoracenthesis- FON pg.. 492

5. Oxygen therapy • Is the administration of supplemental oxygen to a patient to prevent or relieve hypoxia • Requires doctors order • Dangers • Costly

6. Characteristics of Oxygen • Tasteless, colorless, odorless • gas essential to life • 21% of the atmospheric air

7. Disadvantage of use • Flammable • Drying

8. Symptoms Of Oxygen Deficit • Will vary according to the degree of oxygen deficit • See text page 556 box 20-7

9. Safety Measures • Post a “no smoking oxygen in use” sign on pt.'s door or at foot of bed • Avoid materials that generate static electricity such as woolen blanket and synthetic fabrics. (wear cotton fabrics) • Avoid flammable materials such as oils, greases, alcohol, ether, nail polish remover etc. See text! Page 559

10. Nursing measures • Give the amount prescribed by physician; giving too much may lead to oxygen toxicity • Will be prescribed in specific concentration methods and liter flow per minute (L/min) • Nurses may initiate oxygen therapy as an emergency measure

11. Cont.… • Add a humidifying device to prevent drying of the tissues • Give frequent mouth care • Position carefully; do not block outlet in mask, or allow pt. to slump down in bed or chair • TCDB prevents Hypostatic Pneumonia

12. Cont. • Remove and clean nasal cannula prn and check nares for irritation • Monitor activities, space them and provide periods of rest • Take temperature measurements by another route so that an oral thermometer does not impair the patient’s breathing

13. Oxygen Delivery System & Equipment • Nasal Cannula (FON pg.. 557-559) • Face Mask • Venturi Mask • Non-rebreather • Pulse Oximetry

14. AMBU- Air Mask Bag Unit • Resuscitator bag used to assist respiratory ventilation.

15. Triflow / Incentive Spirometry • Used Post –OP • Not an oxygen delivery system • Improve ventilation

16. Mobilization of Pulmonary Secretions • TCBD – Turn, Cough and deep breathe 1) Encourage post-op 2) Teach Splinting • Humidification and Hydration • Thin secretions • Moist Airway

17. Nebulizer or aerosol therapy • Purposes • Relief of edema and spasms • Liquefaction of bronchial secretions • Delivery of medications or liquefying medications in a fine spray or mist ( bronchodilators) • Humidification of respiratory mucosa • Best used in the morning or 45-60 mins before eating

18. IPPB-Intermittent Positive Pressure Breathing • Ventilating machine • Allows for even distribution of air to the alveoli • Aids in removal of CO2 • Makes coughing more effective • Loosens and thins secretions in the lower resp. tract

19. C-PAP • Make sure there is a tight seal so pt. gets maximum benefit

20. Chest physiotherapy (CPT) • Combination of therapies used to mobilize secretions.http://www.youtube.com/watch?v=nqWvolJ0c6Q • Vibration • Chest percussion • Uses a cupping motion of the hands and alternately striking the area of the lung to be drained

21. Postural Drainage • Mobilize drainage-Position patient Nursing care • Do not do procedure after meals. Pt. may aspirate • Observe pt.'s tolerance to procedure • Assess lung sounds before, during and after

22. Tracheostomy- Indications • Airway- Surgical • May be permanent or temporary • Obstruction • Apnea • Altered consciousness

23. Parts of a trach tube • Outer cannula • Inner cannula • Obturator • Cuffed Tubes, uncuffed or fenestrated tubes

24. Nursing care • Maintain patent airway • Provide humidification • Prevent infection • Secure trach tube in stoma • Provide a means of communication

25. Suctioning-Precautions • Position in semi-high fowlers to promote lung expansion • Prevent introduction of pathogen in respiratory tract • Use disposable sets if possible • Hyper-oxygenate with 100% O2 before suctioning • Encourage deep breathing and coughing exercises if possible

26. Chest Tubes: Reasons for a chest tube • Removal of air or fluid from the chest cavity • Commonly used after chest surgery or trauma • Commonly used to relieve pneumothorax and /or hemothorax

27. The chest and abdominal cavities are opened here at autopsy. Pictures

28. The right lung is collapsed. This is atelectasis.

29. bloody fluid filling the right chest cavity as a consequence of trauma. This is a hemothorax.

30. Filled with a cloudy yellowish-tan fluid, characteristic for a chylothorax. The right lung is markedly atelectatic.

31. Pictures chest tube insertion

32. Types • One bottle system-receives both fluid / air • Two bottle system- fluid/ air, creates a water seal • Three bottle system- (Pleur-evac, Atrium) • A- collection chamber • B- water seal chamber • C- suction control chamber

33. Pictures of systems

34. Bubble, Bubble Patient in Trouble…Nursing care • Discuss “POTS” handout

35. The End.