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1. What safety precautions should be observed during oxygen therapy?
- Oxygen is very combustible so no sparks for flames should be near it
- Oxygen must be prescribed and adjusted by dr order only
- Place Oxygen in Use sign on pts door and in room; if used at home put sign on house door. No smoking in premises.
- Keep oxygen-delivery systems 10 ft from any flames
- Determine that all electrical equipment in room I functioning correctly and properly grounded (sparks can cause fire)
- When using oxygen cylinders, secure so they do not fall over. Store upright and either chain or secured in appropriate holders
- Check oxygen level or portable tanks before transporting a pt to ensure there is enough oxygen in tank.
2. What would the nurse teach her client/family regarding the safety precautions for safe use of oxygen devices for home care?
- Do not smoke in the home
- Same as above
3. What are the various oxygen to client delivery devices?
- Nasal cannula: simple, comfortable device used for precise oxygen delivery
- a. Nasal cannula: up to 6 L / min (24%-40% oxygen), usually no more than 4 L /min. Disadvantage - skin breakdown over ears and in nares if cannula is too tight
- b. Simple face mask: short term oxygen therapy, 35% to 50% O2. Contraindicated for clients with CO2 retention because can be worsened. Flow rate should be 5L or more to avoid rebreathing exhaled CO2 in mask.
- c. Mask with reservoir bag:
- As partial rebreather mask, bag should be at least 1/3 to ½ full on inspiration and delivers 40% -70% FIO2 with flow rate 6-10 L/min.
- When used as non-rebreather mask, simple face mask has one-way valve that prevent exhaled air from being trapped in bag, flow rate should be minimum 10 L/min and deliver FIO2 60% to 80% O2 and 6 to 10 L / min. Check bag frequently to make sure inflates, if deflated pt is breathing large amounts of exhaled CO2.
- d. Venturi mask: 24% to 60% and 4 to 12 L/min depending on flow-control meter selected.
Which of the above would be used to deliver maximum oxygen?
Venturi mask 12 L/min and mask with reservoir bag highest % O2
What is the difference between an incentive spirometer and a pulse oximeter and when are each used?
Encourages deep breathing, prevents atelectasis
What is the difference between oropharyngeal suctioning and nasopharyngeal suctioning?
- Oropharyngeal: done via mouth; used to assist with intubation
- Nasopharyngeal: done via nares; used on pts. who retain secretions but do not have an artificial airway but are unable to clear secretions
How and why would the nurse teach her client to deep breathe and cough?
Loosen secretions, prevent atelectasis after surgery
What is the procedure and client preparation for obtaining a sputum specimen
-sputum is secretions from lungs-it contains mucus, cellular debris, and microorganisms, and may contain blood or pus-it must come from deep in bronchial tree-early morning is best time to collect specimen, because patient has not yet cleared respiratory passages-expectoration-to bring up-if patient can't produce sputum or cough deeply, you can use a nasotracheal suction-tracheal suction is very uncomfortable and invasive. This is technique that requires practice to prevent nasopharyngeal bleeding-many test can be performed on sputum-culture(cultivation of microorganismsor cells)-sensitivity (determining effectiveness of antibiotics)-cytology (study of cells)-acid-fast bacillus (organism responsible for TB)
What is the procedure and client preparation for obtaining a throat culture?
-instruct patient to tilt head backward-ask patient to open mouth and say "ahh"-if pharynx is not visualized, depress tongue w/tongue blade and note inflamed area of pharynx and tonsils-insert swab w/o touching lips, teeth, tongue, or cheeks-gently but quickly swab tonsillar area side to side, making contact w/purulent or inflamed area-carefully withdraw swab w/o striking oral structures; immediately place swab in culture tube and crush ampule at bottom bottom of tube-securely attach properly completed label and requisition slip to side of specimen container-enclose in plastic bag-send specimen immediately to lab or refrigerate (specimen integrity)-complete procedure by documenting following (time, type of specimen, sent to lab w/requisition slip, patient response patient teaching
When is a nasopharyngeal airway used?
- insertion of oropharyngeal airway is difficulty or dangerous
- examples include gag reflex, trismus, massive trauma around the mouth or wiring of the jaws.
- who are neurologically impaired with poor phayrngeal tone or coordination leading to upper airway obstruction