CHAPTER 6 OXYGENATION NEEDS

1. CHAPTER 6 OXYGENATION NEEDS LANCASTER HIGH SCHOOL MRS. CARPENTER

2. OBJECTIVES • FACTORS AFFECTING OXYGEN STATUS • IDENTIFY SIGNS OF HYPOXIA • PERFORM • SETTING UP FOR OXYGEN ADMINISTRATION • COUGH AND DEEP BREATHE EXERCISES • COLLECTING A SPUTUM SPECIMEN • PERFORMING PULSE OXIMETRY

3. Oxygen status • factors affecting oxygen needs • Respiratory system status • all structures must be intact and functioning • open airway • exchange of o2 and co2 in alveoli

4. FACTORS AFFECTING OXYGEN STATUS • Cardiovascular system function • good blood flow to and from the heart. • narrowed vessels decrease O2 to cells and cause excess CO2 in capillaries

5. FACTORS AFFECTING OXYGEN STATUS • Red blood cell count • RBC’s carry oxygen, insufficient amount causes decrease in the cells. • blood loss reduces # • production by the bone marrow affected by: • poor diet • chemotherapy

6. FACTORS AFFECTING OXYGEN STATUS • Intact Nervous system • disease of nervous system affect respiration and respiratory muscle function • breathing is difficult

7. FACTORS AFFECTING OXYGEN STATUS • affects of disease in nervous system: brain damage=decreased rate, depth, and rhythm • narcotics=slowing of respirations • lack of O2 and CO2 in the blood=increased respirations to get more

8. FACTORS AFFECTING OXYGEN STATUS • Aging • muscles weaken and lung tissue less elastic • less strength for coughing to remove secretions leading to pneumonia

9. FACTORS AFFECTING OXYGEN STATUS • Exercise • demand for O2 increases • those with diseases have enough at rest but unable to get with increase

10. FACTORS AFFECTING OXYGEN STATUS • Fever • increases need for O2 • rate and depth of respirations must increase to meet need.

11. FACTORS AFFECTING OXYGEN STATUS • Pain • increases need for O2, rate and depth o • may not be able to do this is chest or abdominal injury or surgery

12. FACTORS AFFECTING OXYGEN STATUS • Medication • may depress respiratory center in the brain two ways: • respiratory depression=slow, weak respirations, >12/minute • too shallow to get enough air into lungs

13. FACTORS AFFECTING OXYGEN STATUS • respiratory arrest • =breathing stops • medications that can cause respiratory depression and respiratory arrest

14. FACTORS AFFECTING OXYGEN STATUS • narcotics • morphine • Demerol • Opium • Heroin • Methadone • depressants • barbiturates

15. FACTORS AFFECTING OXYGEN STATUS • Smoking • causes lung cancer and COPD • at risk for CAD • Allergies • respiratory system response to allergen • symptoms cause swelling

16. FACTORS AFFECTING OXYGEN STATUS • Pollutant exposure • pollutants in the air or water cause damage to the lungs. • Nutrition • iron and vitamin B, c, and folic acid to produce new RBC • live only 3-4months then are replaced

17. FACTORS AFFECTING OXYGEN STATUS • Substance abuse • alcohol can depress brain function, decrease cough reflex which increases risk of aspiration

18. Altered respiratory function • Three processes involved with respiration • if one process is affected the respiratory process is altered.

19. -types of respiratory alteration • hypoxia • deficiency of oxygen in the cells • cause cells to function abnormally, and brain function to decrease • caused by : • illness • disease • injury • surgery affecting respiratory function

20. signs and symptoms restlessness dizziness disorientation confusion behavior and personality changes apprehension anxiety fatigue agitation increased pulse rate increased rate and depth R leaning forward, constantly sitting cyanosis dyspnea signs and symptoms

21. abnormal respirations • 12 to 20 times per minute • increased in infants and children • should be quiet, effortless, and regular • both sides of chest rise and fall equally.

22. types of abnormal respirations • tachypnea-above 24/minute • caused by: pregnancy, pain, exercise, airway obstruction, hypoxemia • bradypnea-less than 10 /minute • caused by:drug overdoses, CNS disorders

23. types of abnormal respirations • apnea • hypoventilation • hyperventilation • dyspnea • Orthopnea • Biot’s • Kussmauls

24. chest x-ray lung scan Bronchoscopy Thoracentesis pulmonary function test arterial blood gases pulse oximetry* normal =95%-100% Sputum culture tests ordered to determine cause

25. choosing a site for pulse oximetry. • Based on • condition of the person • breaks in the skin • poor circulation • don’t use fingers or toes • Dark nail polish will distort the reading • Movements can alter the reading • ( tremors, shivering, seizures) • Children attach to sole of foot, palm of hand , finger, toe or earlobe • Older person use ear, nose and forehead d/t poor circulation

26. reporting pulse oximetry results • *Write as SpO2 • S=saturation, p=pulse, O2=oxygen • Date and time • Activity of the person • O2 rate if in use • Reason for measurement • Other observation=difficulty breathing, cyanosis, slow pulse

27. APPLICATION #1 PROCEDURE: PULSE OXIMETRY

28. sputum specimens* • sputum = secretion from trachea, lungs, and bronchi, expectorated through the mouth • saliva is from salivary glands in the mouth “spit” • studied for blood, microbes, and abnormal cells. • painful and difficult for patient • rinse mouth to remove food particles and decrease saliva • never use mouthwash, can destroy microbes

29. special needs-sputum specimens • children • breathing treatments and suctioning to produce sputum • elderly • lack strength to cough up sputum • use of postural drainage (RN or RT)

30. Oxygenation • Positioning • usually easier in Semi-Fowler’s or Fowlers position • may prefer to sit up in bed or lean on overbed table=Orthopneic position • changes of position q2hr to prevent pooling of fluids

31. Coughing and Deep breathing • removal of mucous and expansion of lungs from the respiratory tract • pneumonia • atelectasis • routine after surgery and pts on bed rest problems to look for • pain • if post op or injured • fear • breaking open an incision • increased pain

32. Incentive Spirometry • measure the amount of air a person inhales and increase intake in the lungs. • uses • post operatively • pneumonia • respiratory disease • bedridden patient • elderly that have been hospitalized • how often and amount of breaths is determined by RN and facility policy

33. APPLICATION #2 PROCEDURE: COUGH AND DEEP BREATHING PROCEDURE: COLLECT A SPUTUM SPECIMEN

34. Oxygen Therapy • used for hypoxemia • treated as a drug needs MD order with device and amount

35. OXYGEN THERAPY • types. • Continuous • never stopped or interrupted for any reason • intermittent • used for symptom relief of chest pain and SOB • PCT is responsible for safe care to pt receiving O2

36. oxygen sources • wall outlet • O2 piped into each room from central oxygen supply • may only use in the room • extension is often needed to reach restroom, etc. • oxygen tank • portable • filled by a company and brought to the facility for storage • gauge to determine how much O2 in the tank

37. oxygen sources Oxygen concentrator no source of oxygen is needed • takes oxygen from the air • limits movement of the patient • useless in a power failure • flammability

38. devices to administer oxygen nasal cannula • two prongs from tubing inserted into nostrils • pressure from ears, nasal irritation face mask • covers nose and mouth with small holes in the sides

39. devices to administer oxygen partial rebreathing face mask • reservoir bag added to the face mask for exhaled air • inhales room air, exhaled air and oxygen • bag should never totally deflate nonrebreathing face mask • prevents exhaled air from entering the reservoir bag • inhales air and oxygen from the reservoir bag • bag should never totally deflate

40. devices to administer oxygen • Venturi mask • precise amount delivered indicated by color code

41. administering oxygen • special care of patient with mask • communication • skin integrity • food intake

42. administering oxygen • O2 delivered in Liters/minute set by RT or RN, should be checked frequently • AP’s may adjust in some states check facility policy • patient name/room number/bed number/device ordered • may assist not responsible for administering O2

43. APPLICATION #3 PROCEDURE: SETTING UP FOR OXYGEN ADMINISTRATION

44. Artificial Airways • Intubation=insertion of an artificial airway to help it remain patent • airway is obstructed d/t disease, injury, secretions, aspiration • semiconscious or unconscious state of patient • recovering from anesthesia • needs mechanical ventilation

45. care of the patient with artificial airway • *vitals signs checked often • *observe for hypoxia and respiratory distress • *maintain the airway and notify the RN if dislodged • *oral hygiene • *encourage communication • *comfort and reassurance by use of touch and compassion

46. common airways • oropharyngeal • inserted through the mouth into the pharynx • can be done by RN • nasopharyngeal • inserted through a nostril and into the pharynx • can be done by RN

47. common airways endotracheal • inserted through mouth or nose and into the trachea • by a MD or RN with special training using a lighted scope. • kept in place by a balloon at the end of the tube tracheostomy • inserted through a surgical incision into the trachea • some types have cuffs that are inflated to keep in place • done by MD

48. common airways-Tracheostomies • vary depending on the need and the condition of the pt. • permanent • when airway structures are removed d/t disease or trauma • children from congenital defects • temporary • conditions requiring mechanical ventilation • usually removed when the condition returns to normal and pt can breathe on their own.

49. Trach tubes • made of plastic or metal and consists of three parts • vary depending on their function and need of the pt • outer cannula-secured in place by ties or a Velcro collar around the neck • never removed • inner cannula-inserted through the outer and locked into place • removed for cleaning and mucus removal for patency • obturator-used to insert the outer cannula, then removed • taped to wall or bedside table incase outer cannula comes out