CHAPTER 36

Oxygen Needs

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OXYGEN

Oxygen (O2) is a gas. It has no taste, odor, or color. It is a basic need required for life.

Death occurs within minutes if breathing stops. Brain damage and serious illnesses can occur

without enough oxygen. The amount of oxygen in the body is affected by

Illness Surgery Injury

You assist in the care of persons with oxygen needs.Slide 2

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FACTORS AFFECTING OXYGEN NEEDS

The respiratory and circulatory systems must function properly for cells to get enough O2. Disease, injury, or surgery involving these

systems affects the intake and use of O2. Altered function of any system affects

oxygen needs. Oxygen needs are affected by:

Respiratory system Function—an open airway is needed.

Circulatory system Function—blood must flow to and from the heart.

Red blood cell count—RBCs contain hemoglobin. Nervous system Function—diseases and injuries can

affect respiratory muscles, making breathing difficult or impossible.

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FACTORS AFFECTING OXYGEN NEEDS (CONT’D)

Aging—respiratory muscles weaken. Exercise—O2 needs increase. Fever—O2 needs and respiratory rate and depth increase. Pain—respirations increase to meet increased needs for O2. Drugs—some depress the respiratory center in the brain. Smoking—causes lung cancer and COPD. Allergies—severe swelling can close the airway. Pollutants—damage the lungs. Nutrition—iron and vitamins are needed to produce RBCs. Alcohol in excess reduces cough reflex, which increases risk

of aspiration.Slide

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ALTERED RESPIRATORY FUNCTION

Respiratory function involves three processes. Air moves into and out of the lungs. O2 and CO2 are exchanged at the alveoli. The blood carries O2 to the cells and removes CO2

from them. Hypoxia means that cells do not have enough

oxygen. Cells cannot function properly. Anything that affects respiratory function can

cause hypoxia. Early signs of hypoxia are restlessness, dizziness,

and disorientation. Hypoxia threatens life.

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ALTERED RESPIRATORY FUNCTION (CONT’D)

Normal adult respirations are 12 to 20 per minute.

Infants and children have faster rates. Normal respirations are quiet, effortless, and

regular. Both sides of the chest rise and fall equally.

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ALTERED RESPIRATORY FUNCTION (CONT’D)

These breathing patterns are abnormal. Tachypnea—rapid breathing

Respirations are more than 20 per minute. Bradypnea—slow breathing

Respirations are fewer than 12 per minute. Apnea—lack or absence of breathing

Occurs in sudden cardiac arrest and respiratory arrest Hypoventilation—respirations are slow, shallow,

and sometimes irregular. Hyperventilation—respirations are rapid and

deeper than normal.Slide

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ALTERED RESPIRATORY FUNCTION (CONT’D)

Dyspnea—difficult, labored, or painful breathing Cheyne-Stokes respirations—respirations gradually

increase in rate and depth, and then they become shallow and slow. Breathing may stop for 10 to 20 seconds. Cheyne-Stokes respirations are common when death is near.

Orthopnea—breathing deeply and comfortably only when sitting

Biot’s respirations—rapid and deep respirations followed by 10 to 30 seconds of apnea

Kussmaul respirations—very deep and rapid respirations They signal diabetic coma.

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ASSISTING WITH ASSESSMENT AND DIAGNOSTIC TESTS

Altered respiratory function may be an acute or chronic problem. Report your observations promptly and

accurately. Quick action is needed to meet the person’s

oxygen needs. Measures are taken to correct the problem and to

prevent it from becoming worse.

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ASSISTING WITH ASSESSMENT AND DIAGNOSTIC TESTS (CONT’D)

The doctor may order the following tests: Chest x-ray (CXR) Lung scan Bronchoscopy Thoracentesis Pulmonary function tests Arterial blood gases (ABGs)

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ASSISTING WITH ASSESSMENT AND DIAGNOSTIC TESTS (CONT’D)

Pulse oximetry measures the oxygen concentration in arterial blood. The normal range is 95% to 100%. A sensor attaches to a finger, toe, earlobe, nose, or

forehead. A good sensor site is needed. Oxygen concentration is often measured with vital

signs. Report and record according to agency policy. An agency may use one of these terms.

pulse oximetry or pulse ox O2 Saturation or O2 Sat SpO2 (Saturation of peripheral oxygen)

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ASSISTING WITH ASSESSMENT AND DIAGNOSTIC TESTS (CONT’D)

Respiratory disorders cause the lungs, bronchi, and trachea to secrete mucus. Mucus from the respiratory system is called

sputum when expectorated (expelled) through the mouth.

Sputum specimens are studied for blood, microbes, and abnormal cells.

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MEETING OXYGEN NEEDS

To get enough oxygen, air must move deep into the lungs. Air must reach the alveoli where O2 and CO2

exchange. Disease, injury, and surgery prevent air from

reaching the alveoli. Pain, immobility, and narcotics interfere with

deep breathing and coughing. Secretions collect in the airway and lungs. Secretions provide a place for microbes to grow and

multiply. Infection is a threat.

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MEETING OXYGEN NEEDS (CONT’D)

The following measures are common in care plans. Positioning

Breathing is usually easier in the semi-Fowler’s and Fowler’s positions.

Frequent position changes are needed. Deep breathing and coughing

Deep breathing moves air into most parts of the lungs.

Coughing removes mucus. Exercises promote oxygenation.

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MEETING OXYGEN NEEDS (CONT’D)

Incentive spirometry—also called sustained maximal inspiration (SMI). SMI means inhaling as deeply as possible and holding the breath for at least 3 seconds. The goal is to improve lung function.

Atelectasis is prevented or treated. This exercise:

Moves air deep into the lungs Loosens secretions Promotes the exchange of O2 and CO2 between

the alveoli and capillariesSlide

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ASSISTING WITH OXYGEN THERAPY

Oxygen is treated as a drug. The doctor orders:

When to give O2

The amount of O2 to give The device to use

Some people need oxygen constantly. Others need it for symptom relief.

Chest pain Shortness of breath

You do not give oxygen. You help provide safe care.

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ASSISTING WITH OXYGEN THERAPY (CONT’D)

Oxygen sources Wall outlet

O2 is piped into each person’s unit.

Oxygen tank The oxygen tank is placed at the bedside.

Oxygen concentrator The machine removes oxygen from the air.

Liquid oxygen system A portable unit is filled from a stationary unit. The portable unit can be worn over the shoulder.

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ASSISTING WITH OXYGEN THERAPY (CONT’D)

Oxygen devices The doctor orders the device for giving O2. These devices are common:

Nasal cannula Simple face mask Partial-rebreather mask Non-rebreather mask Venturi mask

Moisture can build up under the mask. Keep the face clean and dry.

Oxygen is given by cannula during meals. The nurse changes the oxygen mask to a cannula.

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ASSISTING WITH OXYGEN THERAPY (CONT’D)

Oxygen flow rates The flow rate is the amount of oxygen given.

It is measured in liters per minute (L/min).

The doctor orders 2 to 15 liters of O2 per minute. The nurse or respiratory therapist sets the flow

rate with a flow meter. The nurse and care plan tell you the person’s flow

rate. When giving care and checking the person:

Always check the flow rate. Tell the nurse at once if the flow rate is too high or too

low. A nurse or respiratory therapist will adjust the flow rate.

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ASSISTING WITH OXYGEN THERAPY (CONT’D)

Oxygen administration set-up If not humidified, oxygen dries the airway’s mucous

membranes. Distilled water is added to the humidifier. Bubbling in the humidifier means that water vapor is

being produced. Oxygen safety

You assist the nurse with oxygen therapy. You do not give oxygen. You do not adjust the flow rate unless allowed by your

state and agency. You must give safe care.

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