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Fundamentals of Nursing Unit 3 Chapter 50: Oxygenation Skills Lab Key Points

Oxygen Delivery Systems

-low flow & high flow systems are available to deliver oxygen to client

Low Flow Systems

-deliver oxygen via small bore tubing
-low flow administration devices include nasal cannulas, face masks, oxygen tents, & transtracheal catheters
-room air & supplemental oxygen is inhaled with these devices so fraction of inspired oxygen (FiO2) will vary

High Flow Systems

-supply all oxygen required during ventilation in precise amounts, regardless of client's respirations
-high flow system used to deliver a precise & consistent FiO2 is Venturi Mask with large bore tubing

Nasal Cannula

-also known as nasal prongs
-most common & inexpensive devise used to administer oxygen
-easy to apply
-does not interfere with client's eating or talking ability
-relatively comfortable & permits freedom
-delivers low concentration of oxygen (24% to 45%)
-flow rates of 2 to 6 L/min
-limitations include inability to deliver high concentrations of oxygen & can be drying & irritating

Reservoir Nasal Cannulas

-also known as oxymizer oxygen conserving devices
-oxygen conserving devices
-stores oxygen in reservoir while client breathes out & delivers 100% oxygen bolus when client breathes in
-delivers higher oxygen concentration at a lower flow rate than plain nasal cannula because it conserves oxygen
-can deliver FiO2 of 0.5 or greater
-two styles of reservoir nasal cannulas (oxymizers): mustache & pendant styles
-humidification is not necessary with reservoir nasal cannula because it collects water vapor while client breathes out & returns it when the client breathes in

Face Mask

-face masks that cover the client's nose & mouth may be used for oxygen inhalation
-exhalation ports on sides of mask allow exhaled CO2 to escape
-variety of oxygen masks
-client's facial skin must be kept dry

Simple Face Mask

-delivers O2 concentrations from 40% to 60%
-liter flows of 5 to 8 L/min
-higher concentration of O2
-covers nose & mouth
-advantages: simple to use & inexpensive
-disadvantages: seal is poor, no precise accuracy, must remove before eating, claustrophobia

Partial Rebreather Mask

-delivers O2 concentration of 40% to 60%
-liter flows of 6 to 10 L/min
-reservoir bag inflated partially at all times
-partial rebreather bag must not totally deflate during inspiration to avoid CO2 buildup
-for short term use
-increases FiO2 by recycling expired O2
-advantages: moderate O2
-disadvantages: warm & uncomfortable, remove to eat

Non Rebreather Mask

-delivers highest O2 concentration possible
-95% to 100%
-liter flows of 10 to 15 L/min
-one way valves on mask
-only oxygen in bag is inspired
-bag must not totally deflate during inspiration

Venturi Mask

-delivers O2 concentration 24% to 40% or 50%
-liter flows of 4 to 10 L/min
-most accurate & reliable method for giving precise O2 concentration
-constant flow of room air blended with fixed O2 flow
-does not rely on respiratory depth or rate
-has wide bore tubing & color coded jet adapters that correspond to precise O2 concentration & liter flow
-turning the O2 source flow rate higher than specified will not increase concentration to client
-initiating O2 by mask is similar to cannula
-advantages: snug fit, lower levels of supplemental O2, precise FiO2, additional humidity
-disadvantage: remove to eat

Face Tent

-can replace O2 mask
-provide varying concentrations of O2
-30% to 50%
-4 to 8 L/min
-frequently inspect client's facial skin for dampness or chafing
-client's facial skin must be kept dry

Transtracheal Catheter

-placed through surgically created tract in lower neck directly into trachea
-once tract has healed, client removes & cleans catheter two to four times per day
-O2 applied to catheter greater than 1L/min, should be humidified
-high flow rates, 15 to 20 L/min can be administered

Noninvasive Positive Pressure Ventilation (NPPV)

-mechanical assistance to maintain adequate breathing
-assistance may be accomplished by use of noninvasive ventilation
-CPAP & BiPap

Noninvasive Ventilation

-delivery of air or oxygen under pressure without need for invasive tube such as endotracheal tube or tracheostomy tube
-nurse's primary role is to ensure optimal functioning & use of device by client

Continuous Positive Airway Pressure (CPAP)

-most common type of noninvasive positive pressure ventilation mask & pump system
-variation of CPAP is BiPap

Bilevel Positive Airway Pressure (BiPap)

-variation of CPAP
-pressure delivered during exhalation is less than pressure delivered during inhalation

Indications for Nasopharngeal Suctioning

-visual: rapid, shallow breathing with an ineffective cough
-auditory: wet, gurgling sounds when breathing
-patient's chest wall has vibrations indicating loose secretions
-auscultation: adventitious breath sounds

Intervention: Positioning

-elevate patient's HOB to facilitate breathing
-turn & reposition patient q 2 hours

Intervention: Effective Coughing

-normal forceful coughing is highly effective
-normal forceful coughing involves client inhaling deeply & coughing twice while exhaling
-alternative cough technique is taught for clients who are unable to perform normal forceful cough, which is forced expiratory technique or huff coughing
-huff coughing is instructed to exhale through pursed lips & to exhale with a huff sound in mid exhalation
-huff cough helps prevent the high expiratory pressures that collapse diseased airways

Client Teaching: Huff Coughing

-after using bronchodilator treatment, inhale deeply & hold your breath for a few seconds
-cough twice while exhaling
-first cough loosens mucus, second expels secretions
-for hough coughing, lean forward & exhale sharply with a huff sound mid exhalation
-this technique helps keep your airways open while moving secretions up & out of lungs
-inhale by taking rapid short breaths in succession (sniffing) to prevent mucus from moving back into smaller airways
-rest & breathe slowly between coughs
-try to avoid prolonged episodes of coughing because these may cause fatigue & hypoxia

Intervention: Incentive Spirometer

-also referred to as sustained maximal inspiration devices (SMIs)
-measure flow of air inhaled through mouthpiece
-designed to mimic natural sighing or yawning by encouraging client to take long, slow, deep breaths
-keep alveoli fully expanded
-increase your inhaled lung volume
-improve removal of mucous or secretions
-avoid serious lung infection
-two general types: flow oriented & volume oriented

Use of Incentive Spirometer

-incentive spirometers are used to:
-improve pulmonary ventilation
-counteract effects of anesthesia or hypoventilation
-loosen respiratory secretions
-facilitate respiratory gaseous exchange
-expand collapsed alveoli

Intervention: Breathing

-controlled breathing techniques:
-pursed lip breathing
-diaphragmatic breathing

Purse Lip Breathing

-may help alleviate dyspnea
-client is taught to purse lips as if about to whistle & blow slowly & purposefully, tightening abdominal muscles to assist with exhalation

Diaphragmatic Breathing

-stomach should move & tighten while breathing
-diaphragmatic breathing is intended to help you use the diaphragm correctly while breathing to:
-strengthen the diaphragm
-decrease the work of breathing by slowing your breathing rate
-decrease oxygen demand
-use less effort & energy to breathe

Interventions: Administering Medications

-MDI (inhalers)
-dry powder inhalers
-nebulizer (aerosol)

Metered Dose Inhaler (MDI)

-medication delivery system
-pressurized container of medications used to release medication through mouthpiece with mist or fine spray
-deliver accurate doses, provide target action at needed sites, & sustain less systemic effects than medication delivered by other routes
-called inhalers, puffers, pumps
-contain a propellant
-can be used with spacers

Dry Powder Inhaler (DPI)

-similar to metered dose inhaler
-breath activated
-do not store in damp place
-do not use with spacer

Nebulizer

-gives medication to lungs in spray
-connected to air compressor or O2
-physician orders amount of medication
-used to deliver humidity & medications
-can be used with O2 delivery systems to proved moistened air directly to client
-purpose: prevent mucous membranes from drying & becoming irritated & help loosen secretions for easier expectoration

Interventions: Oxygen Therapy

-O2 is a medication
-ordered by dr. unless emergency
-too much O2 is toxic, damage/kill cells
-COPD patients: can suppress respiratory & ventilation drive, only use (1-2 L)
-risk of combustion
-risk of bacterial contamination

Manifestations of Hypoxia

-rapid pulse
-rapid, shallow respirations
-dyspnea
-increased restlessness
-light headedness
-flaring of nares
-substernal or intercostal retractions
-cyanosis

Pulse Oximetry

Normal: 95% or higher
Mild Hypoxia: 90-95%
Moderate Hypoxia: 80-90%
Severe Hypoxia: less than 80%
Inaccurate: less than 70% (death)

Oral Suctioning

-mouth & oropharynx
-yankauer tip, least traumatic for oral suctioning (whistle or open tip)
-stimulates cough

Oral Pharyngeal Suctioning

-clean technique
-maintain patent airway through oropharyngeal or nasopharyngeal areas

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