Care Of The Patient With Respiratory/ Oxygen Needs
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Transcript of Care Of The Patient With Respiratory/ Oxygen Needs
Care Of The Patient With Respiratory/ Oxygen Needs
Presented by Moyette Graham R.N., B.S.N
Assess Oxygen status Invasive. Wait longer for results
ABGs- Arterial Blood Gases
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
ABG Values
Bronchoscopy- pg. 481 FON C&S Sputum pg. 501 FON Skill 19-9 and 10 Thoracenthesis- FON pg.. 492
Diagnostic Test
Is the administration of supplemental oxygen to a patient to prevent or relieve hypoxia
Requires doctors order Dangers Costly
Oxygen therapy
Tasteless, colorless, odorless gas essential to life 21% of the atmospheric air
Characteristics of Oxygen
Flammable Drying
Disadvantage of use
Will vary according to the degree of oxygen deficit
See text page 556 box 20-7
Symptoms Of Oxygen Deficit
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
Safety 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
Nursing measures
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
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
Cont.
Nasal Cannula (FON pg.. 557-559) Face Mask Venturi Mask Non-rebreather Pulse Oximetry
Oxygen Delivery System & Equipment
Resuscitator bag used to assist respiratory ventilation.
AMBU- Air Mask Bag Unit
Used Post –OP Not an oxygen delivery system Improve ventilation
Triflow / Incentive Spirometry
TCBD – Turn, Cough and deep breathe1) Encourage post-op2) Teach Splinting
Humidification and HydrationThin secretionsMoist Airway
Mobilization of Pulmonary Secretions
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
Nebulizer or aerosol therapy
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
IPPB-Intermittent Positive Pressure Breathing
Make sure there is a tight seal so pt. gets maximum benefit
C-PAP
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
Chest physiotherapy (CPT)
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
Postural Drainage
Airway- Surgical May be permanent or temporary Obstruction Apnea Altered consciousness
Tracheostomy- Indications
Outer cannula Inner cannula Obturator Cuffed Tubes, uncuffed or fenestrated tubes
Parts of a trach tube
Maintain patent airway Provide humidification Prevent infection Secure trach tube in stoma Provide a means of communication
Nursing care
• 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
Suctioning-Precautions
Removal of air or fluid from the chest cavity Commonly used after chest surgery or
trauma Commonly used to relieve pneumothorax
and /or hemothorax
Chest Tubes: Reasons for a chest tube
Pictures The chest and abdominal cavities are opened here at autopsy.
The right lung is collapsed. This is atelectasis.
bloody fluid filling the right chest cavity as a consequence of trauma. This is a hemothorax.
Filled with a cloudy yellowish-tan fluid, characteristic for a chylothorax. The right lung is markedly atelectatic.
Pictures chest tube insertion
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
Types
Pictures of systems
Discuss “POTS” handout
Bubble, Bubble Patient in Trouble…Nursing care
The End.