Oxygen Therapy. oxygen greater than what %? what purpose does it serve?
Administration of oxygen at greater than 21% (the concentration of oxygen in room air) to provide adequate transport of oxygen in the blood, to decrease the work of breathing, and to reduce stress on the myocardium
during the use of oxygen therapy what should be assessed? what is it used for?
-Assess for signs and symptoms of hypoxia, arterial blood gas results, and pulse oximetry.
-hypoxemia and hypoxia
hypoxemia. how does it manifest itself?
a decrease in the arterial oxygen tension in the
blood, is manifested by changes in mental status (progressing
through impaired judgment, agitation, disorientation, confusion,
lethargy, and coma), dyspnea, increase in blood pressure,
changes in heart rate
hypoxia
a decrease in oxygen supply to the
tissues, which can also be caused by problems outside the
respiratory system
what is the normal spo2 and pa02. does adding more oxygen inspired help at all if both are normal?
oxygen therapy only to increase the arterial oxygen pressure
(PaO2) back to the patient's normal baseline, which may
vary from 60 to 95 mm Hg. In terms of the oxyhemoglobin
dissociation curve (see Chapter 21), the blood at these levels
is 80% to 98% satur
oxygen toxicity. when does it occur? what is it the cause of?
Oxygen toxicity may occur when too high a concentration of
oxygen (greater than 50%) is administered for an extended
period (longer than 48 hours)
-overproduction of oxygen free radicals, which are by-products of cell metabolism.
-Antioxidants such as vit
to reduce the likelihood of oxygen toxicity what is used for oxygen therapy?
-Often, positive end-expiratory pressure (PEEP IS THE BEST) or
continuous positive airway pressure (CPAP) is used with
oxygen therapy to reverse or prevent microatelectasis, thus
allowing a lower percentage of oxygen to be used.
-or use lower o2 percentag
a patient shows the following symptoms Symptoms include substernal discomfort, paresthesias, dyspnea, restlessness, fatigue, malaise, progressive respiratory difficulty, refractory hypoxemia, alveolar atelectasis, and alveolar infiltrates on x-ray. what d
oxygen toxicity
peep and cpap can also reverse?
atelectasisis: the collapse of part or (much less commonly) all of a lung. Symptoms: Breathing difficulty; Chest pain; Cough.
Incentive Spirometer: what does it ensure? what does it prevent?
Device ensures that a volume of air is inhaled and the patient takes deep breaths.
Used to prevent or treat atelectasis
nursing care for incentive spirometer. what position should the patient be seated in?
Positioning of patient, teach and encourage use, set realistic goals for the patient, and record the results.
Ideally, the patient
assumes a sitting or semi-Fowler's position to enhance diaphragmatic
excursion; however, this procedure may be performed
wit
Simple masks. used for?
are used to administer low to moderate concentrations of oxygen. The body of the mask itself gathers and stores oxygen between
breaths. The patient exhales directly through openings or
ports in the body of the mask. If oxygen flow ceases, the patient can
Partial-rebreathing masks
have a reservoir bag that must
remain inflated during both inspiration and expiration. The
nurse adjusts the oxygen flow to ensure that the bag does
not collapse during inhalation. A high concentration of
oxygen can be delivered because both the mask and
Non-rebreathing masks
are similar in design to partialrebreathing
masks except that they have additional valves. A
one-way valve located between the reservoir bag and the base
of the mask allows gas from the reservoir bag to enter the
mask on inhalation but prevents gas in the
The Venturi mask. who is it used for? how should it fit? when should it be removed and what should be placed on patient if it is?
is the most reliable and accurate method
for delivering precise concentrations of oxygen through noninvasive
means. The mask is constructed in a way that allows
a constant flow of room air blended with a fixed flow of oxygen.
It is used primarily for pati
The T-piece
connects to the endotracheal tube and is
useful in weaning patients from mechanical ventilation.
tracheostomy
collars, and face tents
all of which are used with
aerosol devices (nebulizers) that can be adjusted for oxygen
concentrations from 27% to 100% (0.27 to 1.00).
what is the purpose of the incentive spirometer?
The purpose of an incentive spirometer
is to ensure that the volume of air inhaled is increased gradually
as the patient takes deeper and deeper breaths.
what are the two types of incentive spirometers?
Incentive spirometers are available in two types: volume or
flow. In the volume type, the tidal volume is set using the manufacturer's
instructions. The patient takes a deep breath
through the mouthpiece, pauses at peak lung inflation, and
then relaxes an
Intermittent Positive-Pressure Breathing:indicated for? monitor for which side effects?
-Indicated for patients who need to increase lung expansion
-Rarely used
-Monitor for side effects, which may include pneumothorax, increased intracranial pressure, hemoptysis, gastric distention, psychological dependency, hyperventilation, excessive oxyg
Mini-Nebulizer Therapy
A hand-held apparatus that disperses a moisturizing agent or medication such as a bronchodilator into the lungs. The device must make a visible mist.
mini nebulizer nursing instructions: what rate should the breath? what do coughing exercises encourage?
-Patient is to breathe with slow, deep breaths through mouth and hold a few seconds at the end of inspiration.
-Coughing exercises may be encouraged to mobilize secretions after a treatment.
where should the head be if lower lung drainage is needed? if upper? when should medication be taken? why?
lower and middle lobe bronchi drain more effectively
when the head is down, while the upper lobe
bronchi drain more effectively when the head is up. The secretions
then are removed by coughing. The nurse instructs
the patient to inhale bronchodilators and
when doing vibrations when is the patient asked to cough? why is percussion in elderly important?
-After three or four vibrations, the patient is encouraged
to cough, contracting the abdominal muscles to increase
the effectiveness of the coug
-Percussion is performed cautiously
in the elderly because of their increased incidence of
osteoporosis and ri
Endotracheal Intubation: provides the patient with what?
Placement of a tube to provide a patent airway for mechanical ventilation and for removal of secretions
Endotracheal Intubation; what pressure should the cuff be at? what are some complications of incorrect cuff pressure? how long should it be in place?
Complications can occur from pressure exerted by the cuff
on the tracheal wall. Cuff pressures should be maintained between
15 and 20 mm Hg
-High cuff pressure can cause tracheal bleeding, ischemia,
and pressure necrosis, whereas low cuff pressure can
inc
what is a frequent problem with Endotracheal Intubation?
Removal of the tube is a frequent problem in intensive
care units and occurs mainly during nursing care or by the patient.
It is important that nurses instruct and remind patients
and family members about the purpose of the tube and the
dangers of removin
Tracheotomy
Bypasses the upper airway to bypass an obstruction, allow removal of secretions, permit long-term mechanical ventilation, prevent aspirations of secretions, or replace an endotracheal tube
Tracheotomy complications
-Complications include bleeding, pneumothorax, aspiration, subcutaneous or mediastinal emphysema, laryngeal nerve damage, posterior tracheal wall penetration
-Long-term complications include airway obstruction, infection, rupture of the innominate artery,
Tracheotomy
A tracheotomy is used to bypass an upper airway obstruction,
to allow removal of tracheobronchial secretions,
to permit the long-term use of mechanical ventilation, to
prevent aspiration of oral or gastric secretions in the unconscious
or paralyzed patien
what is an example of a negative pressure mechanical ventilator?
Negative pressure
"Iron lung," chest cuirass-- polio
Negative-pressure ventilators exert a negative pressure on
the external chest. Decreasing the intrathoracic pressure
during inspiration allows air to flow into the lung, filling its
volume.
positive pressure
\Pressure-cycled-the pressure-cycled ventilator cycles on, it delivers a flow of air (inspiration) until it reaches a preset pressure, and
then cycles off, and expiration occurs passively.
/Time-cycled-Time-cycled ventilators terminate or control inspirat
Noninvasive positive-pressure ventilation (NIPPV
is a method of positive-pressure ventilation that can be given
via face masks that cover the nose and mouth, nasal masks,
or other oral or nasal devices such as the nasal pillow (a
small nasal cannula that seals around the nares to maintain
the prescribed
who uses NIPPV
Patients are candidates for NIPPV if they have acute or
chronic respiratory failure, acute pulmonary edema, COPD,
chronic heart failure, or a sleep-related breathing disorder.
The technique also may be used at home to improve tissue
oxygenation and to res
Continuous positive airway pressure (CPAP): most commonly used for what sleep disorder?
provides
positive pressure to the airways throughout the respiratory
cycle. Although it can be used as an adjunct to mechanical
ventilation with a cuffed endotracheal tube or tracheostomy
tube to open the alveoli, it is also used with a leak-proof
mask to
Bi-level positive airway pressure (bi-PAP)- used for which type of patients.
ventilation offers
independent control of inspiratory and expiratory pressures
while providing pressure support ventilation. It delivers
two levels of positive airway pressure provided via a nasal or
oral mask, nasal pillow, or mouthpiece with a tight sea
nursing diagnosis for patients being mechanically ventialted
Impaired gas exchange
Ineffective airway clearance
Risk for trauma
Impaired physical mobility
Impaired verbal communication
Defensive coping
Powerlessness
how is the ventilator adjusted?
The ventilator is adjusted so that the patient is comfortable
and breathes "in sync" with the machine. Minimal alteration
of the normal cardiovascular and pulmonary dynamics
is desired. if not in sync bucking can occur. this can be corrected by using para
mechanical ventilator: how do cardiovascular problems occur?
Decrease in venous return due to application of
positive pressure to lungs
Assess for adequate volume status by measuring
heart rate, blood pressure, central venous
pressure, pulmonary capillary wedge pressure,
and urine output; notify physician if values
mechanical ventilator:Barotrauma/pneumothorax problems and solutions?
Application of positive pressure to lungs; high
mean airway pressures lead to
alveolar rupture
Notify physician
Prepare patient for chest tube insertion
Avoid high pressure settings for patients with
COPD, ARDS, or history of pneumothorax
mechanical ventilator:Pulmonary infection problems and solutions?
Bypass of normal defense mechanisms; frequent
breaks in ventilator circuit; decreased mobility;
impaired cough reflex
Use meticulous aseptic technique
Provide frequent mouth care
Optimize nutritional status
Impaired Gas Exchange: what are some interventions?
Monitor ABGs and other indicators of hypoxia. Note trends.
Auscultate lung sounds frequently.
Judicious use of analgesics
Monitor fluid balance.
A complex diagnosis that requires a collaborative approach
Impaired Airway Clearance
Assess lung sounds at least every 2-4 hours.
Measures to clear airway: suctioning, CPT, position changes, promote mobility
Humidification
Medications
Risk for Trauma and Infection
Infection control measures
Tube care
Cuff management
Oral care
Elevation of HOB
Weaning
Process of withdrawal of dependence upon the ventilator
Successful weaning is a collaborative process.
Criteria for weaning
Patient preparation
Methods of weaning:The PAV mode of partial ventilatory support allows the ventilator to generate pressure in pr
chest drainage is used for which condition
Used to treat spontaneous and traumatic pneumothorax
Used postop to re-expand the lung & remove excess air, fluid, blood
One-way ______________ valve, a disposable, singleuse
chest drainage system with 30 mL collection volume. Used
when minimal volume of chest drainage is expected.
Heimlich