interference with ventilation oxygen therapy indications: indications: treat: respiratory; cv; cns...
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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