Foundation

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Author:
alyn217
ID:
160749
Filename:
Foundation
Updated:
2012-07-02 13:26:45
Tags:
FT4 Oxygen Therapy
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Description:
Oxygen Therapy
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  1. Diagnositc Pulmanary Function Tests
    • Usually done by MD or respiratory therapist:
    • Tidal volume
    • Residual volume
    • Functional Residual Capacity
    • Vital Capacity
    • Total Lung Capacity
  2. What is OSA and how can you prevent/monitor it?
    • Obstructive Sleep Apnea
    • Monitor O2 sats
    • Heart rate
    • Snoring
    • Respiration
    • Intermitant snoring
    • Read more about this!
  3. What is PND
    Paraxismal Nocturnal Dyspnea.
  4. PE for Oxygenation Status
    • Breathing pattern
    • Respiratory effort
    • Cough
    • Pulse oximetry
    • Cardiac functioning
    • Using inspection, palpation, percussion, and auscultation
  5. Diagnostic Pulmanary Lab tests
    • Complete Blood Count (CBC)
    • ABG (Arteriol Blood Gas
  6. Other Diagnostic Pulmanry Tests
    • Pulse oximetry: nail polish will alter values. May be able to check @ ear lobe.
    • Chest x-ray/Scans
    • Peak Flow Monitoring
    • Bronchoscopy
  7. Sputum Specimens
    • Not pleasant for pt or nurse
    • Gets sucked out of lungs.
    • Gets collected over time.
  8. Hypoxemia
    • Room air is ~21%O2
    • Low alveolar oxygen tension (ambient, hypoventilation)
    • Ventilation-perfusion mismatch
    • Right to left shunt (venous admixture)
    • Impaired oxygen diffusion (uncommon)
  9. Symptoms of Hypoxemia
    • Restlessness
    • Anxiety
    • Disorientation, confusion,  and listlessness
    • Headaches
  10. Symptoms of Acute Hypoxemia
    • Cyanosis
    • Cheyne-Stokes respiration
    • Increased blood pressure initially, then may progress towards hypotension.
    • Apnea
    • Tachycardia
    • Hypotension
    • Ventricular fibrillation
    • Asystole: Cardiac arrest
    • Polycythemia Coma: abnormal ^RBCs.
  11. Hypoxia
    • Deficient Oxygen availability
    • Inadequate pulmonary ventilation
    • Accumulation of abnormal hemoglobin in blood
    • Ischemia
    • Does not necessarily have a pathologic cause. Could also just be high altitude-> diminished O2 supply.
  12. SnSs of Generalized Hypoxia
    • Headaches
    • Shortness of breath
    • Fatigue
    • Nausea
    • Cyanosis
  13. SnSs of Severe Hypoxia
    • Changes in level of consciousness
    • Uncoordinated movements
    • Coma
  14. Sample Pulmanary related Nursing Diagnoses
    • Ineffective breathing pattern
    • Ineffective airway clearance
    • Ineffective tissue perfusion
    • Ineffective gas exchange
  15. Oxygen Therapy
    ndkn: Any illness or condition that affects ventilation  or oxygen transport can cause alterations in respiratory function

    • Hyperventilation
    • Hypoventilation
    • Hypoxia
    • Respiratory physiology
    • Maintenance of a patent airway important
  16. Specific ndkns for O2 therapy.
    • Low ambient O2
    • Hypoxemia
    • Suspected hypoxemia
    • Increased work-of-breathing
    • FlaringTachypnea
    • Increased myocardial work
    • Acute head injury
  17. Interventions for Optimal Oxygenation
    (Med Surg1 stuff)
    • Use of a mechanical ventilator
    • Use of chest tube drainage 
systems
    • Promoting circulation
    • Administering respiratory medications
    • ^HOB (Head of Bed)
  18. Interventions for Optimal Oxygenation
    • Immunizations/prevent URIs(preventing disease prevents symptoms of the disease, genius!)
    • Positioning: (elevate the Head of the Bed), tripod position w/pursed lip breathing, prone position.
    • Incentive spirometry (the lab device thing). Should be sucking in like a straw. "Use 10 times during commercials," and then see if you can get your pt to increase the number on the IS.
    • Aspiration precautions
    • Mobilizing secretions
    • Deep breathing and coughing
    • Hydration
    • Chest physiotherapy
  19. Artificial airways
    • Oropharyngeal
    • Nasopharyngeal
    • Endotracheal tubes
    • Tracheostomy tube
  20. Airway patency
    suctioning
    • Nasopharyngeal
    • Nasotracheal
    • Tracheal
  21. Airway Patency
    Suctioning
    • Purpose: open airway, remove secretions.
    • Aseptic technique
    • Education
    • Baseline assessment
    • Positioning: Head at least 30degrees.
    • Hyperoxygenation: Removing O2 from airway, O2 will drop temperarily as a response. ^O2 sat all the way (hyperoxegenate) with each pass of suction.
    • Do NOT apply suction during insertion
  22. Suctioning Basics
    • appply suction for no longer than 15 seconds during a single pass
    • Reapply O2 between suctioning passes as needed.
    • Gently rotate the suction catheter as you remove it.
  23. Naso-Pharangeal Suction Process
    • STERILE procedure!
    • Set suction level between 110-120 mm hg
    • Use sterile lubricant
    • Traumatic experience
    • Must have MD order
    • Know contraindications
    • Oxygenate!
    • May use nasal trumpet
    • May suction each nostril with same catheter
    • Post suctioning nasal pharynx, may suction mouth
    • No longer than 15 seconds
    • Suction with removal
  24. O2 Delivery Systems
    Low flow
    • Nasal cannula (24-35% O2)
    • Simple masks
    • Partial rebreathing masks
    • Non-rebreathing masks
    • Biggest problem in administration is pt compliance
  25. O2 Delivery Systems
    High Flow
    • Venti-masks (air entrainment masks)
    • Mechanical aerosol systems
    • High-flow humidifier systems
  26. Hazards of O2 therapy
    • Flammable-post signs electrical equipment safety, know fire procedures
    • Check oxygen level of portable tanks prior to transport
    • Hypercapneic vs Hypoxic Drive
    • Oxygen Toxicity
    • Mucosal damage due to lack of humidity b/c O2 is typically not humidified. Can hook up to humidifier.
  27. Evaluation
    • O2 sats improve
    • cap refill improves
    • R normalizes
    • turn pink again
    • LOC improves

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