Interference with Interference with VentilationVentilation

Oxygen TherapyOxygen Therapy IndicationsIndications::

TreatTreat: Respiratory; CV; CNS disturbances: Respiratory; CV; CNS disturbances Oxygen AdministrationOxygen Administration: High or low flow systems: High or low flow systems

High FlowHigh Flow — delivers fixed concentrations independent — delivers fixed concentrations independent of the patient’s respiratory patternof the patient’s respiratory pattern

Venturi Mask – up to 50%Venturi Mask – up to 50% Low FlowLow Flow — amount delivered varies with patient’s — amount delivered varies with patient’s

respiratory pattern respiratory pattern Nasal cannula 2L/min = 28% oxygenNasal cannula 2L/min = 28% oxygen Face tent or trach collar – Increased humidityFace tent or trach collar – Increased humidity Non-re-breathing mask – delivers 80-90% Non-re-breathing mask – delivers 80-90%

HumidityHumidity: : 1-4L low flow – use of “bubble-through” 1-4L low flow – use of “bubble-through”

controversialcontroversial NebulizerNebulizer

Interferences with Interferences with VentilationVentilation

Oxygen Therapy- Oxygen Therapy- ComplicationsComplications CO2 NarcosisCO2 Narcosis – –

two chemoreceptors – O2 CO2two chemoreceptors – O2 CO2 CO2 accumulation – major stimulusCO2 accumulation – major stimulus COPD patient –COPD patient –

Develops tolerance to high CO2Develops tolerance to high CO2 Respiratory Center loses sensitivity to elevated CO2Respiratory Center loses sensitivity to elevated CO2

O2 Drive “Hypoxemia” O2 Drive “Hypoxemia” Concern about administering O2 to COPD patients ??Concern about administering O2 to COPD patients ?? Bigger Concern: not providing adequate O2Bigger Concern: not providing adequate O2

Goal: Titrate O2 to the lowest effective dose Goal: Titrate O2 to the lowest effective dose based on arterial blood gas monitoringbased on arterial blood gas monitoring

Interferences with VentilationInterferences with VentilationOxygen Therapy- Oxygen Therapy-

ComplicationsComplications O2 ToxicityO2 Toxicity

Prolonged exposure to high level O2Prolonged exposure to high level O2 Determined by patient tolerance, exposure Determined by patient tolerance, exposure

time, and effective dosetime, and effective dose High level Manifestations – High level Manifestations –

Initial -- Inactivate surfactant and lead to ARDS : Initial -- Inactivate surfactant and lead to ARDS : reduced vital capacity, cough, substernal chest pain, reduced vital capacity, cough, substernal chest pain, N&V, paresthesia, nasal stuffiness, sore throat, N&V, paresthesia, nasal stuffiness, sore throat, malaise malaise

Later – affects alveolar-capillary gas exchange: Later – affects alveolar-capillary gas exchange: pulmonary edema with copious sputumpulmonary edema with copious sputum

End Stage – lung fibrosisEnd Stage – lung fibrosis O2 Administration Goal: enough O2 to maintain O2 Administration Goal: enough O2 to maintain

PaO2 within normal or acceptable limitPaO2 within normal or acceptable limit O2 administration > 50% for > 24 hours potentially O2 administration > 50% for > 24 hours potentially

toxic toxic

Chronic Obstructive Lung Chronic Obstructive Lung Disease ComplicationsDisease Complications

Nursing Care ManagementNursing Care ManagementIneffective airway Ineffective airway

clearanceclearance AssessAssess: breath sounds; ability to : breath sounds; ability to

effectively coughingeffectively coughing

Nsg ActionNsg Action: Elevate head of bed; sitting : Elevate head of bed; sitting up; hydration 2-3L/d; chest physiotherapy; up; hydration 2-3L/d; chest physiotherapy; Meds: inhaled bronchodilators & steroids.Meds: inhaled bronchodilators & steroids.

Pt EducationPt Education: Effective breathing & : Effective breathing & coughing techniques; Medications & coughing techniques; Medications & administrationadministration

Nursing Care ManagementNursing Care ManagementImpaired Gas ExchangeImpaired Gas Exchange

AssessAssess: Mental status; VS with Pulse : Mental status; VS with Pulse oximetry; ABGsoximetry; ABGs

Nsg ActionNsg Action: Position – Tripod-supported : Position – Tripod-supported extremities; Administer O2 to effective extremities; Administer O2 to effective level;level;

Pt EducationPt Education: Pursed-lip breathing; signs, : Pursed-lip breathing; signs, symptoms & consequences of hypercapnia; symptoms & consequences of hypercapnia; avoidance of CNS depressants; Medication avoidance of CNS depressants; Medication action; smoking cessationaction; smoking cessation

Breathing ExercisesBreathing Exercises

Orthopnea Positions to Orthopnea Positions to Decrease the Work of Decrease the Work of

BreathingBreathing

Nursing Care ManagementNursing Care ManagementImbalanced NutritionImbalanced Nutrition

AssessAssess: : Weight within normal range for height and Weight within normal range for height and

age; appetite; caloric intact; energy level; age; appetite; caloric intact; energy level; gastric distention; sputum production; affect; gastric distention; sputum production; affect; lack of interest in foods; serum albumin levellack of interest in foods; serum albumin level

Nsg ActionNsg Action: : Hi PRO, HI Calorie foods & liquid Hi PRO, HI Calorie foods & liquid

supplements; small frequent feedings; supplements; small frequent feedings; periods of rest after food intake; Referral—periods of rest after food intake; Referral—financial & nutritional support (Meals-on-financial & nutritional support (Meals-on-wheels; food stamps) wheels; food stamps)

Pt EducationPt Education: : Referrals / Importance of rest / digestion / Referrals / Importance of rest / digestion /

high protein & calorie foods – menu planninghigh protein & calorie foods – menu planning

Nursing Care ManagementNursing Care ManagementDisturbed Sleep PatternDisturbed Sleep Pattern

AssessAssess: : Identify usual patterns; explore reasons for Identify usual patterns; explore reasons for

discomfort, wakefulness, or difficulty sleeping; discomfort, wakefulness, or difficulty sleeping; sleep apneasleep apnea

Nsg ActionNsg Action: : Identify pt-specific relaxation methods; Identify pt-specific relaxation methods;

environment conducive to restenvironment conducive to rest

Pt EducationPt Education: : Balance activity (ADL’s) / rest; avoidance of Balance activity (ADL’s) / rest; avoidance of

alcoholic beverages, caffeine products, & other alcoholic beverages, caffeine products, & other stimulants before bedtime; include family; stimulants before bedtime; include family; sexual activity—positions of comfort; sexual activity—positions of comfort; psychosocial issuespsychosocial issues