This exam 2 outline consists of oxygen therapy and trach care, noninfectious upper respiratory problems, noninfectious lower respiratory problems, infectious respiratory problems, and chest tubes.
*Essential Study Material!!
Respiratory distress signs
o Dyspnea (shortness of breathing)
o Nasal flaring
o Use of accessory muscles to breathe
o Pursed lip breathing (mostly COPD patients)
o Decreased endurance
o Skin and mucous membrane color changes (pallor, cyanosis)
o Tripod position: allows for diaphragmatic breathing
O2 therapy purpose: relieve hypoxemia/hypoxia
o Hypoxia: low level of oxygen in the tissues
o Hypoxemia: low level of oxygen in the blood
Complications of oxygen therapy
o Combustion
o Oxygen-induced hypoventilation
Hypercarbia: retention of CO2 (acidic)
o Infection
o Oxygen toxicity
PA02: 80-100
If patient says PA02 is 160, oxygen level is too high
If patient is on 8L, DECREASE
o Normal function: patient breaths when CO2 levels rise****
When SPO2 drops and waveform is perfect, person NEEDS OXYGEN***
When SPO2 drops and waveform is NOT perfect, this is just a falty pulse ox
If COPD patient relies on high CO2 level to breath, when you lower this they might not
be able to breath (not used to low levels)
o What causes them to breath: lack of oxygen
o Body switches from hypercapnia drive to hypoxic drive
o Give them too much O2, their drive to breath is reduced
Oxygen delivery systems depend on
o O2 concentration required/achieved
o Importance of accuracy and control of oxygen concentration
o Patient comfort
o Importance of humidity
o Patient mobility
If patient is able to walk, that is important to get them to be mobile***
Low flow O2 systems
o Nasal cannula (1-6 L)
Important to look at patency of nostrils; want to make sure nose is not
bleeding (epistaxis)
Assess for changes in respiratory rate and depth
, Oximyzer: looks like nasal cannula but much thicker; higher flow
o Facemask
Simple: increase oxygen
Minimum of 5 L
Delivers O2 up to 40-60%
Monitor closely for risk of aspiration especially is they have
decreased LOC
Partial rebreather: 6-10 L
FI02: 60-70%
Allow patient to rebreathe some of their exhaled CO2
Non-rebreather: 10-15 L; does not allow patient to rebreath exhaled CO2
One way valves are what differentiate non-rebreather from
rebreather
FI02
Used for unstable patients who require intubation
High-flow O2 systems: Deliver up to 24-100% O2; 8-15 L
o Venturi mask
Titrate different oxygen levels
BEST FOR CHRONIC LUNG DISEASE PATIENTS
Hypercapnic-hypoxic drive
COPD patients will switch to hypoxic drive
If given high amounts of O2, body will not recognize they are
hypoxic and have respiratory arrest
Switch to nasal cannula during meal times
o Face tent
o Aerosol mask
o Trach collar
If you have trach, simple face mask for trach
o T-piece
Connective device to trach
Provides oxygenation and humidification
Mist should be seen during inspiration and expiration
o FOR PATIENTS NEEDING HIGH FLOW O2
Take break from eating if their pulse ox drops
Take small meals
Tracheostomy
o Tracheotomy: surgical incision made into trachea to establish an airway
o Tracheostomy: stoma that results from tracheotomy
o Immediately after surgery, patient may have a trach
If patient is doing fine, decanulate patient and remove trach
Dead-ender cap put on stoma to discontinue it
Complications of trach
o Pneumothorax
, o SUBQ emphysema (crackles in skin, sounds like rice krispy’s)
o Bleeding
o Infection
Trach tubes
o Always have suction device for patient to clear secretions
o Obturator: guide to help put the inner cannula in; does NOT have a hole to
breathe through****
Not used unless emergency or changing size
o Make sure cuff is not overly inflated
o Inner cannula is disposable
Possible issues with a patient with a trach
o Cuff pressure can cause mucosal ischemia or erosion
Check pressure often, make sure you have trach ties
o Prevent hypoxia
o Prevent tube friction and movement
Causes of hypoxia in trach
o Ineffective oxygenation before, during, and after suctioning
o Use of catheter is too large for artificial airway
o Prolonged suctioning time
o Excessive suction pressure
o Too frequent suctioning
Trach care
o Assess patient
o Secure trach tubes in place
o Always make sure you have someone else when changing trach ties so cannula
does not fall out and you can secure placement
o Prior to this: hyperoxygenate*****
Air must be humidified and have proper temp as well for trach
Ensure adequate nutrition
Maintain proper temp
Suctioning
o Maintains patent airway
o Cannot cough adequately; suctioning is needed
o If patient does not have trach, CAN nasotracheal suction
Complications with suctioning
o Hypoxia
o Tissue trauma
o Infection
o Vagal stimulation, bronchospasm
o Cardiac dysrhythmias from prolonged hypoxia
Bronchial and oral hygiene
o Make sure you turn every 2 hours
o Percuss on back and loosen secretions (ordered by doc typically)
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