Oxygen and Respiratory Care

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Oxygen and Respiratory Care

• Oxygen is a tasteless, colorless, and odorless gas used in the body for respiration and is essential in respiratory care.
• Oxygen therapy helps treat hypoxemia, but can have risks if not done correctly.
• Administering oxygen to children requires selecting the right delivery system based on age, size, clinical condition, needs, and therapeutic goals.
• Oxygen delivery systems are either low-flow (variable performance) or high-flow (fixed performance).
• Low-flow systems mix 100% oxygen with room air, causing variability in the delivered oxygen percentage. High-flow systems deliver premixed gas, eliminating the need to inhale room air.
• Supplemental oxygen is recommended for children with a consistent peripheral oxygen saturation below 94%.
• Every year, over 5.9 million children die, mainly from preventable diseases that are easily treatable, with over 95% of these deaths occurring in developing countries.
• Pneumonia is the most common cause of death in children under 5, being responsible for at least 18% of all deaths in this age group.
• Hypoxaemia, or insufficient oxygen in the blood, is the major fatal complication of pneumonia.
• It is estimated that at least 13.3% of children with pneumonia have hypoxaemia, corresponding to 1.86 million cases of hypoxaemic pneumonia each year.
• Inhaled medications are the primary treatment method for many pediatric pulmonary diseases and are given to patients needing respiratory support.
• Many aerosol delivery devices can deliver inhaled aerosols to children, such as nebulizers, pressurized metered-dose inhalers (pMDIs), soft mist inhalers, and dry powder inhalers.
• Many inhaled drugs are utilized off-label as is the case in pediatric patients for either a different indication or a younger age group.
• Nurses must understand respiratory conditions in children to guide and support families.
• Since respiratory illness accounts for most pediatric hospital admissions, nurses need expert assessment and intervention skills.
• Nurses offer key support to the child and family during a respiratory illness and can impact the burden of respiratory illness through education, identification, and prevention.

Nebulization

• In healthcare, a nebulizer is a device which converts a drug from a solution into an aerosol via a compressed gas source.

• Nebulization creates a mist of drug particles inhaled through a face mask or mouthpiece.

• Bronchodilators are the most common nebulized drugs, but others like steroids and antibiotics can also be nebulized.

• A nebulizer turns liquid medication into a fine mist suitable for reaching deep into the bronchial tree, using compressed gas to vaporize the liquid drug.

• Nebulizers are preferred over inhalers for adults in certain situations.

• Large drug doses are needed when when managing chronic lung diseases, severe asthma, or COPD exacerbations

• It is not possible for patients to control their breathing i.e. those who can't coordinate their breathing to use an inhaler

• Specific preparations of antibiotics, and lignocaine are required

• Bronchodilators, steroids, antibiotics, rhDNase, pentamidine, lignocaine, and 0.9% sodium chloride can be nebulized.

• Water should not be nebulized as it may cause bronchoconstriction.

• Nebulizers with masks work better for acutely ill patients.

• Nebulizers with mouthpieces should be used for patients who aren't claustrophobic, when administrating steroids and antibiotics

• The mouth should be rinsed out after nebulizing steroids and antibiotics to prevent oral thrush.

• Nebulization aims to liquefy and remove retained secretions; a nebulizer creates a stable aerosol of fluid and/or drug particles.

• Most aerosol medications have bronchodilating effects and are given by respiratory therapy personnel.

Purpose of Nebulization

• To relieve respiratory insufficiency caused by bronchospasm
• To correct underlying respiratory disorders causing bronchospasm
• To liquefy and remove thick secretions from the lower respiratory tract
• To reduce inflammatory and allergic responses in the upper respiratory tract
• To correct humidity deficit due to mechanical ventilation

Types of Nebulizers

• Jet nebulizers use pressurized gas/air to draw liquid medication through a capillary, converting it into an aerosol.
• They are less expensive, and can nebulize any type of liquid medicine.
• Limitations include being less portable, can be difficult to assemble, with variability in aerosol output, and can cause cooling of the solution.
• Mesh nebulizers use a mesh or aperture plate to generate aerosol with improved efficiency and low drug volume.
• They are small, lightweight, battery-operated, making them portable and handy.
• Limitations include requiring dose adjustment due to its efficiency, inability to deliver viscous solutions, difficult to clean, and is more expensive.
• Ultrasonic nebulizers use high-frequency vibrations from a piezoelectric crystal to produce aerosol and delivers nebulized medicines and saline.
• Limitations include not being suitable for viscous solutions, having a large residual volume, and generating heat when in use.
• Smart nebulizers have sensors that detect breathing and determine aerosol delivery, and some log usage.
• They reduce drug loss, delivery variation, and improve adherence to treatment and limitations can include being more expensive.

Ultrasonic Nebulizers: Key Actions and Rationale

• Checking medication orders ensures correct medication for the client.
• Performing hand hygiene prevents infection.
• Preparing medication per the "Ten Rights" ensures correct dosage and reduces error.
• Explaining the procedure fosters cooperation and reduces anxiety.
• Assisting the client to a comfortable, upright position helps expand the chest.
• Verifying nebulizer settings ensures the correct amount of medication is administered.
• Nursing alert: Side effects includes nausea, vomiting, palpitation, difficult breathing, cyanosis and cold sweat
• Gargling cleanses the mouth and wipes the face, a cream is applied to provide moisture
• Equipment is replaced properly and discarded.
• Document date, time, dose and response, then notify senior staff and teach client how to use it.

Nursing Actions

• Teaching how to use personal device ensures adequate self care after discharge
• To decrease risk of vomiting, avoid treatment immediately before and after meals
• Assessment:
  • Respiratory rate, pulse and breath sounds will be used to establish a baseline to determine effectiveness
  • Assess clients medical/medication history
  • Ensure that oxygen stats are assessed prior to medication administration
  • Assess patients understanding

Nebulizer: Planning & Implementation

• Prepare materials, assemble equipment based on directions.
• Hand hygiene with indicated PPE prevents spread of infections.
• Introduce yourself w/ effective comms to foster therapeutic nurse-patient relationships.
• Client verification is done to ensure accuracy.
• Explain procedure to the client & foster assistance
• Private the room if possible
• Ensure allergy assessment is conducted and that there is known sensitivity
• Position patient at an improved angle that expands the chest
• Connect & assemble the nebulizer properly
• Apply necessary measure while observing the patient, follow-up with medical assistance during a severe reaction.

Oxygen Therapy: Nasal Cannula and Oxygen Mask

• Nasal cannulas and face masks deliver oxygen to those who need respiratory relief.
• A nasal cannula is a flexible tube with two prongs placed in the nostrils, while a face mask covers the nose and mouth.
• Both attach to oxygen sources of various sizes. Nasal cannulas and simple face masks deliver low oxygen levels, while Venturi masks deliver higher levels. Cannulas can also deliver high levels.

Definition

• Oxygen may be administered with a nasal cannula, mask, mist tents, or holds when the oxygen level is below normal or the demand is increased.
• The need for oxygen, the delivery system, and the amount of oxygen administered are determined by the physician.
• A nasal cannula is a simple, comfortable device with two tips, about 1.5 cm long, that protrude from a disposable tube and are inserted into the nostrils.

Oxygen Mask

• An oxygen mask is shaped to fit snugly over the client's mouth and nose and is secured in place with a strap.
• Most masks are made of clear, pliable plastic or rubber that can be molded to fit the face

Purpose of Nasal Cannula

• To deliver low and medium oxygen concentrations for short or long-term use
• Prevent or reduce hypoxia, and allows breathing through the nose
• The equipment allows the client to ingest food and fluids

Oxygen Delivery

• Oxygen mask is useful for greater concentration
• Provide moderate O2 support and higher concentration of oxygen and/or humidity than provided by cannula.
• Masks may not be suitable to those that require respiratory therapy due to risk of dioxide retention

Equipment

• Check for oxygen-delivery device, oxygen tubing and humidifier, w/ distilled water along w/ oxygen source
• Ensure to also have oximeter, pulse and PPE as needed

Care Action and Rationale

• To give the correct medication to the correct client. Check the medication order against the original Dr's order
• Perform good hand hygiene because preventing the spread of infection is essential
• Ten rights of med admin must be followed

O2 Delivery

• Explain the procedure and promote cooperation.
• The upright position can promote chest expansion.
• Connect oxygen and set to the prescribed amount and rate
• Adjust setting to ensure no complications
• After treatment is done, cleaning and removal measures can be performed.

Types of Nasal Cannula

• Advantages and Disadvantages to nasal cannulas, simple face mask and non-rebreather mask
• Used short term, must observe and maintain levels as required

O2 Safety

• Complete necessary assessments before administering Check the patient's allergy bracelet or ask the patient about allergies
• semi-fowlers is needed so an upright position can help to expand the chest.
• After a certain usage period the mask can be cleaned to prevent contamination

Evaluation and Nursing Considerations

• Evaluate the patient's response to the medication within an appropriate time frame, Re-assess for improved lung sounds and respiratory effort.
• Teach the client how to use personnel devices. (Rationale: To ensure appropriate self-care after discharge)
• Avoid treatment immediately before and after meals. (Rationale: To decrease the chance of vomiting or appetite suppression

Oxygen Delivery via Croupette

• Hoods are generally used to deliver O2 to infants. 80%-90% O2 supply.
• Easy access to the chest and lower body. Oxygen croupette gives the patient freedom to move in the bed
• O2 croupettes used because they will not leave face mask/ or nasal cannula.

Equipment needs

• To perform the procedure, make sure to have Croupette equipment, humidifier, sterile water and flowmeter
• You also need oxygen hood humidifier, sterile distilled water, oxygen source and analyzer (room must also be available)

More on O2 Administration

• Bring necessary equipment to the bedside and perform proper pre and post procedure.
• Aseptic hand hygiene and gown are needed to ensure patient safety

Implementation with O2 administration

• Position and prepare pt
• Observe and assess pt depending on needs
• Clean the equipment for continued safety reasons

Oropharyngeal and Nasopharyngeal Suctioning

• Suctioning is the removal of airway secretions using negative pressure and is frequently used after the client coughs.

• It is used when the client is able to cough effectively but is unable to clear secretions by expectorating or swallowing.

• Purpose

• Maintain airway, remove obstructing secretions, promote respiratory activity, prevent resulting pneumonia

• Equipment

• Suction cath (variations), secretion apparatus, disposable gloves, googles, sterile water saline, connecting tubes are needed

Implementation is needed

• Confirm patients needs, implement safety and equipment
• Suction must be safe and monitored, make sure to ask as needed