ATI Oxygen Therapy - ati notes PDF

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ATI Oxygen Therapy •

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Oxygen therapy is indicated for clients who are at risk for developing hypoxia o Recovering from surgery o In pain or still sedated o Respiratory illness that causes secretions to accumulate in lungs or conditions that reduce circulation of blood through the lungs o Cardiac conditions Age, health, current disease process and history of illness play role in how client responds to hypoxia Early stages: restless and confused, anxious, hr, rr, bp elevated Late stages: hypotension, bradycardia, metabolic acidosis, cyanosis Chronic hypoxia: manifestations differ and develop over time; clubbing of fingers and toes, peripheral edema, right side heart failure, ox saturation below 87 % Untreated: dec activity level, inc confusion, dec consciousness, coma

NASAL CANNULA • • • • • • • • • • • • • • • •

Privacy Introduce self Hand hygiene 2 acceptable identifiers Verify order, delivery device, flow rate Remove nasal cannula and tubing if needed and connect two pieces of tubing Flow meter attached to oxygen Connect extension to flow meter Adjust flow rate to prescribed flow rate in l/m Insert prongs to nose and up and around patients' ears Bring tubing down under chin to secure to plastic slide Provide skin care every 4 hours using water soluble products only No petroleum-based products Leave in place till doctor discontinues Hand hygiene Document patient's response to therapy, flow rate, and response, condition

SIMPLE MASK • • • • • • • • • •

Verify everything Remove mask and tubing if needed connect two pieces Make sure flow meter attached and connect to wall Connect humidifier to flow meter if oxygen flow rate is more than 4l/m Adding humidification, client doesn't become dry Adjust flow rate Place mask on face from nose down Elastic around head Document response to ox therapy, device used, flow rate, assess for changes in condition Prevent irritation: provide skin care to face, change mask tubing and humidifier according to facilities policy

NONREBREATHER MASK • • • • •

Remove mask and connect tubing Flow meter attached to ox source, connect extension to flow meter Adjust flow rate in L/m High enough to keep bag partially inflated Place nose down and band around head

FACE TENT • •

Remove face tent and extension tubing and connect two pieces Add humidifier to wall

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Connect humidifier to flow meter Adjust flow rate Place face tent under chin and over mouth and nose Band around head Fit loosely around face

VENTURI MASK • • • •

Attach tubing to color coded adaptor and to mask Attach extra tubing and connect to flow meter Adjust flow rate to high flow Place mask from nose downward

PREPARING OXYGEN CYLINDER • • • • • • • • • • • •

Sit on top of something secure like metal Hand hygiene Remove protective seal and the O ring gasket from neck of oxygen cylinder Use wrench to release small amount of oxygen Place ring on top pin on regulator Attach reg to cylinder by sliding neck of cylinder lining with pins Tighten it to make sure it is well secured With ox cylinder wrench slowly turn cylinders release valve to open tank Check pressure gauge to determine how full/pressure in tank Attach oxygen delivery device into regulator Open regulate to and adjust to prescribed flow rate in lpm Then position on to patient

Oxygen Therapy Supplies and Equipment •

Flow meter, extension tubing, oxygen delivery device and sterile water for humidification if flow rate more than 4L/min

Oxygen flow meter • • • • • • • • • • • • • •

Flow meter attaches to oxygen outlet and regulates amount of oxygen delivered to client Two prongs fit into wall outlet Green collar behind prongs twists to release flow meter from wall outlet Cylinder portion has numbers and lines indicating how many L of oxygen being delivered per min Knob opposite of prongs and collar adjust flow rate As you turn knob, ball size of small pea moves up and down cylinder indicating flow rate Setting up flow rate: align middle of ball w number corresponding to amount of ox being administered Client gets 2 L/min, line up middle of ball with the line next to number 2 Bottom of flow meter is adapter that connects extension tubing and oxygen delivery device to flow meter Use min 6 ft length of tubing to move in bed Extending tubing up to 97 ft can be used for clients at home for flow rate up to 5 l/min As oxygen bubbles through water, picks up moisture and keeps client's mucous membranes from becoming dry Replace sterile water at least every 24 hrs. High flow rates FiO2 or 4 L/min, humidification required

Oxygen delivery devices

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Nasal Cannula

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Simple Fraction of inspired oxygen (FiO2) varies depending on flow of oxygen and clients breathing Common Tubing 7-14 ft Prongs to insert into nares Plastic piece at neck slides up under chin to tighten Range of sizes for age groups Delivers ox concentrations of 24% to 44% with flow rates from 1-6 L/min through cannula Noncritical; minor breathing problems, cannot wear mask Doesn’t exceed 4L/min

o Simple face mask o High ox flow to prevent rebreathing of co2 o 75& of inspired vol is room air breathed through the holes in the side of mask o For clients who need moderate flow rate for short period of time o Mask, vents, adjustable strap, tubing that connects to ox source o Ox concentrations of 40-60% flow rates from 5-8 L/min o Co2 can build up in mask at low flow rates, do not use a flow rate lower than 6 L/min o Humidification

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o Nonrebreather face mask o Bag allows higher Fi02 o Flow rates slower than 6L/min, risk of rebreathing co2 inc o Valve closes during expiration so exhaled air does not enter bag and rebreathed o Valves on side port allow exhalation but close on inspiration to prevent inhalation of room air o High flow rates o Bag inflated with pure ox o One way valve that allows client to breath in oxygen supplied by source as well as oxygen from reservoir o Ox concentration of 100% o Deliver ox concentration of 80-95 percent with flow rates 10-15 L/min o Do not allow reservoir bag to deflate or oxgyen source to deplete o If bag deflates, client breathes in co2 o Partial rebreather delivers FI of 60-75 percent with flow rate of 6-11 L/min ▪ Has ports so expired are leaves ▪ No inspiratory valve, so some of exhaled air returns to bag and mixes with inspired air

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o Venturi mask o Different adaptors to deliver a fixed amount of FIO2 o Depends on flow rate/port size o COPD: when accurate FiO2 is essential and CO2 buildup must be small o No humidifiers o Critically ill patients who require administration of specific conc of oxygen o Mask with holes on each side that allow exhaled air to escape o Base of mask and connected to tubing are color coded adaptors o Ox concentrations 24-50 % flow rates from 4-10 L/min o Most accurate form o Delivers precise ox conc, co2 buildup minimal o COPD o Interferes with talking and eating so prescription for ox via nasal canula may be necessary for meals

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o Face tent o Soft aerosol mask loose o Claustrophobic o Ox conc cant be controlled o Used after nasal and oral surgery o Delivers ox conc 24%-100% with flow rates of 10 L/min o Humidification

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o Manual resuscitation bag o High conc ox prior to procedure (suctioning, intubating, resp or cardiac arrest) o Maks, bag composted to ventilate client, and oxygen port where tubing connected o Adapter that fits on to ox port o Adapter that fits onto endotracheal tube when used for intubated client o Forms airtight seal o Bag has port where oxygen tubing can be connected o Set at 10/15 L/min when performing manual resuscitation o Valve that ensures one way pressure into mask and allows bag to reinflate from air

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o Tracheostomy masks o Collor o Fits over site o Strap holds into place o Exhalation port that remains patent at all times and port that connects to ox source with large tubing o Set at 10 l/min with nebulizer set at appropriate ox concentration o Artificial airways require continuous humidification since airway bypasses normal filtering and humidification process of nose and mouth o Two devices most commonly used are T piece and trach mask o T tube is t shaped device with piece that connects ox source to artificial airway (endotracheal tube or tracheostomy) recommended flow rate when using t tube is 10 L/min with nebulizer set at appropriate ox conc o Noninvasive ventilation is alternative to mechanical ventilation o Maintain positive airway pressure and to improve alveolar ventilation without need odor artificial airway o Used for clients who have CHF, sleep disorders, pulmonary diseases to improve oxygenation, reduce and reverse atelectasis, reduce pulmonary edema, improve cardiac function o Two types of noninvasive ventilation are continuous positive pressure ventilation and bilevel positive airway pressure o CPAP provides set positive airway pressure throughout clients breathing cycle ▪ Sleep apnea due to continuous positive pressure keeps airway open and prevents upper airway from collapsing ▪ Pressure between 5-20 cm of water

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BiPAP assistance during inspiration and keeps airway from closing during expiration ▪ Inc in amount of air in the lungs at the end of exp and reduced airway closure and improved oxygenation

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o Oygen and tent hood o Encloses patient to provide oxygen, humidification, and/or cool environment to control temp o Pediatric clients: airway inflammation, croup, resp infection o Ox conc up to 30 perc with flow rates 10-15 L/min o Disposable vinyl box overhead, warm humidified oxygen at specific temp o Ensure space between curve of hood and child's neck to allow co2 to leave

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Delivers 28-85 percent ox conc

o Preparing ox cylinder o Home: compressed ox system used, supplied in gas cyl as nonliquid gas and under high pressure measured as pounds per square inch o Hospital: bulk liquid ox system used, stored outside of building and safe temp and delivered as gas through walls o Different pressure capacities o E cylinder most common size o Compressed ox system ▪ Key made ▪ Slide hexagon opening on key over valve and turn it to either start or stop flow of oxygen ▪ Ox cyl empty needle on gauge will be in red zone ▪ Flow meter controls rate of ox Lpm • Left: inc, right: dec • All the way to the right: stops Hazards o Fire, equipment malfunction, pressure hazards o Not used around fire/sparks o 10ft from open flames o Caution around Eletric razors, radio (spark) o Oxygen signs o Upright and secured with chain

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Clients who have COPD risk for developing hypercapnia (inc levels of arterial CO2) and hypoxemia (dec levels of arterial ox saturation) o Monitor resp rate and SpO2 (between 90-93% on lowest flow rate possible) o Lie in semi or high fowlers position (lung expansion) o Turning, repositioning, coughing and deep breathing promote ventilation o Not getting better: make sure equipment functioning properly Perform resp assessment along with vital signs Document skin color, level of consciousness, other signs and manifestations of hypoxia Skin assessment where ox delivery device comes in contact with client's skin Consider padding pressure areas Home oxygen use o Unable to maintain 88% or greater o COPD, emphysema, advanced cardiac disease requires home ox therapy o Liquid oxygen ▪ 6 lpm ▪ Large vessel ▪ Expensive, evaporation occurs ▪ Good for active clients o Compressed and liquid 100% oxygen which deliver ox in percentages based on flow meter rate o Oxygen concentrator takes nitrogen, water vapor, hydrocarbons from room air and delivers ox that is concentrated from room air ▪ Least expensive ▪ Good choice to homebound clients ▪ Not ambulatory ▪ 4-5 lpm Can use of oxygen help dyspnea o Subjective sensation of difficult or uncomfy breathing o Even when ox sat normal o Exaggerated resp effort o Adress underlying conditions o Medications, ox therapy, physical techniques, psychosocial approaches Replace water in ox nebulizer when low level or 24 hours Tap water can be used in nebulizer, but sterile water is best Assessment findings indicate oxygen therapy is effective: o Vital signs, pulse ox o Arterial blood gas analysis o Pulmonary function tests, ecg tracings, physical exam findings, functional status Oxygen toxicity o Cns ▪ Pallor, sweating, nausea, vomiting, seizures, muscle twitching, vertigo, tinnitus, hallucinations, visual changes, anxiety, resp changes, dec levels of consciousness o Pulmonary signs ▪ Substernal chest pain, sob, dry, cough, pulmonary edema or fibrosis

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Documentation o Date and time o Method delivered o Flow rate o Condition of client's skin where delivery device rests o Resp assessment findings before and after oxygen therapy initiated o Clients' response to ox therapy and reactions o Client and family teaching

57 year old client, 30 smoking year, possible malignant tumor lower lobe of right lung Scheduled for tumor resection and lower lobe lobectomy in morning. Diagnosed with mild chronic bronchitis but never used ox therapy, educate client about diagnosis and likely effects of planned surgery •

Which of the following statements should you make to the client to describe the effects of the planned surgery on the client's oxygen demand? • You will be short of breath the rest of your life and you will need to greatly decrease you daily activities • Your left lung will compensate after the surgery and you will breath much easier • Removing a section of your right lung will dec oxygen your body receives, but we can provide extra oxygen if you need it

You discuss the effects of the surgery on the client's ability to take in sufficient amounts of oxygen and help him identify the signs and symptoms that warrant the administration of supplemental oxygen •

Which of the following statements indicates that the client understands how to identify when he needs supplemental oxygen therapy? o When I feel anxious and have to work at breathing, I will know I need oxygen o i will use my oxygen when I know I'll be walking for any long distances o When I can't sleep at night, I'll put on my oxygen ▪ This statement shows an understanding of physical and psychological effects of hypoxemia ▪ Possible trigger, does not reflect understanding of physical indicators of condition ▪ Inability to sleep at night is not necessarily an indication for oxygen therapy, it is possible that the client could be awake due to a need for oxygen, other manifestations would also be present to alert him to the need for oxygen therapy

You provide the client with appropriate information about the safe storage and appropriate selfadministration of oxygen •

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Which of the following observations indicates that the client is at risk for physical injury related to oxygen-therapy needs? o Pulse ox readings of 94% of 2L/min of oxygen o Clients report of dizziness for a few days before hospitalization o Clients request to leave the unit to smoke a cigarette ▪ Slightly below normal, oxygen saturation within acceptable range given this clients pathophysiology ▪ Symptom might be related to hypoxemia. Risk for dizziness occurred before oxygen therapy was initiated ad not relevant ▪ Alerts you that the client is continuing to smoke, which poses serious risk of injury due to extreme combustibility of oxygen The client asks, “how will you tell if I need oxygen at home after discharge” which of the following is appropriate

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If you feel short of breath while exercising, you will be prescribed oxygen therapy at home If your oxygen saturation when you are resting is below a certain point without oxygen, your provider will know you need home oxygen therapy If your pulse rate and respirations remain higher than normal after walking, oxygen therapy will be required ▪ While shortness of breath is subjective sign that hypoxia may be present, it is not the criterion for prescribing home oxygen therapy ▪ Oxygen saturation of 88% or less at rest is the usually criterion for prescribing home oxygen therapy ▪ May be indicators of hypoxia, they are not the criteria for prescribing home oxygen therapy

Your 57-year-old client is back on the unit after a right lower lobe lobectomy performed to remove a malignant tumor •

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The client is transferred from post anesthesia care unit. Which of the following is the most appropriate action to take in determining postsurgical respiratory needs? o Turn the client and encourage him to cough and deep breathe hourly o Assess vital signs, including oxygen saturation, at least every 2 hours o Evaluate client's ability to identify and report signs of hypoxemia ▪ Minimizing risk for developing respiratory complications, does not help the nurse with planning to meet respiratory needs after surgery ▪ Basis for nursing care interventions you will plan to manage postoperative resp needs ▪ client is still sedated and in post anesthesia recovery To help prevent any decline in client's respiratory function, you should perform which of the following actions? o Initiate postural drainage to help mobilize secretions o Encourage client to rest in bed until healing is well underway o Elevate the head of the client's bed 30-45 degrees ▪ Postural drainage used for clients who have cystic fibrosis and other conditions in which lung secretions need to be mobilized and removed ▪ Early ambulation is better alternative ▪ Positive effect on preventing or minimizing the risk of respiratory distress (semi fowlers position employs gravity to assist with lung expansion and reduce pressure from abdomen on diaphragm)

Client returns to unit with orders for supplemental oxygen, an opioid pain medication, ambulation with help as tolerated, up in a chair as tolerated, and progression to a regular diet •

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After several days, the client is nearing discharge from hospital and is able to ambulate in the hall. Immediately after he ambulates, the nurse finds the client lying bed. He states I'm having trouble catching my breath. Which of the following actions is priority at this time? o Administer supplemental oxygen as prescribed o Assess vital signs, including oxygen saturation o Raise head of the bed to a semi fowlers position ▪ Appropriate but not a priority ▪ Appropriate but should not precede treatment of hypoxemia ▪ Help facilitate breathing and priority action To manage client's risk for dyspnea, which of the following actions should you take? o Have AP walk client around entire unit several times daily to inc stamina o Suggest AP ambulate client right after his bath o Supplemental oxygen available for use if the client develops activity induced dyspnea ▪ Client would need to start with short walks first, inc each time. Does not address risk for dyspnea ▪ Allow rest periods so he does not become exhausted

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Reflects proper planning for possibility of dyspnea triggered by the client's ambulation Which of the following observations is the best indicator that the client does not have an acute need for oxygen therapy after ambulation? o His pulse oximetry reading was 95% after returning to bed o He states “it really felt good to walk a little” o His resp rate is the same both before and after ambulation ▪ Client whose pulse ox reading is within expected range is not experiencing hypoxemia ▪ Not reliable to consider

You are now preparing your client, 6 days post op following right lower lobe lobectomy, for discharge. His wife and son will accompany him to his home, where his wife will be his primary caregiver during his recovery •

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Which of the followin...