Supporting Oxygen Needs

• Oxygen is a basic need for life
• Brain damage and serious illnesses can occur quickly without enough oxygen

Supporting Oxygen Needs

• PSWs do not administer oxygen; they only assist
• A PSW should never adjust oxygen levels

Altered Respiratory Function

• Respiratory function consists of air moving in and out of the lungs, oxygen and carbon dioxide being exchanged at the alveoli, and blood carrying oxygen to cells while removing carbon dioxide
• Cells, tissues, and organs require oxygen to live
• Inability to excrete carbon dioxide results in death
• The respiratory and cardiovascular systems work together to deliver oxygen and excrete carbon dioxide
• Both the respiratory and cardiovascular systems must function optimally for proper oxygenation and carbon dioxide excretion
• All body systems need to be working correctly to have proper oxygenation

Factors Affecting Oxygen Needs

• The airway must be open for the respiratory system to function effectively
• There must be an adequate number of alveoli to absorb oxygen and excrete carbon dioxide
• The circulatory system requires adequate red blood cell count
• Hemoglobin is required to pick up and carry oxygen
• Bone marrow produces red blood cells
• The nervous system needs to be intact for respiratory muscles to function correctly
• Brain deterioration can affect signals to the rest of the body to breathe
• Asthma, upper respiratory infections, iron deficiency anemia, blood loss, and cancers of the blood all affect oxygen needs
• Aging can weaken muscles, make lungs less elastic, and cause difficulty coughing
• More oxygen is required during exercise
• Oxygen needs increase in the event of a fever
• Pain increases oxygen needs
• Chest or abdominal surgery can make meeting oxygen needs difficult
• Good nutrition is necessary for red blood cell production
• Certain drugs, like morphine and other narcotics, depress the respiratory center or cause respiratory arrest
• People with substance abuse problems are at risk for respiratory depression or arrest
• Smoking can damage lung tissue and cause lung cancer and COPD
• Allergies can cause swelling of the upper airway, resulting in chronic bronchitis, asthma, and death
• Pollutant exposure damages lungs
• Alcohol depresses the cough reflex and increases the risk of aspiration

Signs and Symptoms of Altered Respiratory Function

• Shortness of breath (SOB) can be acute (short term) or chronic (long term)
• Clients may feel anxious or panic when they are unable to breathe
• Struggling to breathe is exhausting
• Shortness of breath on exertion (SOBOE) means with activity
• Orthopnea occurs when a client wants to sit up in bed or a chair because it's difficult to breathe when lying flat
• Observe clients for abnormal breathing, cough, sputum, noisy respirations, chest pain, cyanosis, changes in vital signs, and body position

Abnormal Respiratory Patterns

• Tachypnea is rapid breathing with more than 24 respirations per minute
• Bradypnea is slow breathing with fewer than 12 respirations per minute
• Apnea is the lack or absence of breathing
• Kussmaul respirations are deep and rapid respirations, characteristic of diabetic acidosis
• Hypoventilation is slow, shallow, and sometimes irregular breaths
• Hyperventilation involves respirations that are rapid and deeper than normal
• Dyspnea is difficult, labored, or painful breathing
• Cheyne-Stokes respirations gradually increase in rate and depth and then become shallow and slow and breathing may stop for 10 to 20 seconds
• Cheyne-Stokes respirations are common when death is near
• Orthopnea is breathing deeply and comfortably only when sitting

Hypoxia

• Hypoxia is a deficiency of oxygen in the cells
• Cells are unable to function properly if they don't have enough oxygen
• Factors affecting respiratory function can cause hypoxia
• The brain is very sensitive to an inadequate oxygen supply
• Early signs of hypoxia include restlessness, dizziness, and disorientation
• Hypoxia is life-threatening, so symptoms must be reported immediately

Promoting Oxygenation

• Air must reach the alveoli for enough oxygen; O2 and CO2 are exchanged there.
• Disease and injuries can prevent air from reaching the alveoli.
• Pain and immobility interfere with deep breathing and coughing.
• Narcotics interfere with deep breathing and coughing.
• The care plan will outline measures to promote oxygenation

Positioning

• Breathing is usually easier in semi-Fowler's and Fowler's positions
• Clients with difficulty breathing often prefer the orthopneic position
• Frequent position changes are needed at least every 2 hours
• The client should never lie on one side for long periods unless there are positioning restrictions

Coughing and deep breathing

• Deep breathing moves air into most parts of the lungs
• Coughing removes mucus
• Deep breathing and coughing help prevent pneumonia and atelectasis (lung collapses)
• Clients may be reluctant to do exercises as painful after injury or surgery, afraid of breaking open an incision
• Postsurgical period, bed rest, lung disease, and paralysis are factors for atelectasis
• Deep breathing and coughing may be done every 1–2 hours or four times a day, as ordered.

Incentive Spirometry

• Incentive spirometry, or sustained maximal inspiration (SMI), is a machine that measures the amount of air inhaled
• It is a visual guide for the client with the goal to improve lung function
• The client takes a slow, deep breath until the balls rise to the desired height, holds his breath for at least 3 seconds, and exhales slowly
• The care plan or supervisor should provide instructions on how often to use it, the desired height, and the number of breaths needed

Assisting With Oxygen Therapy

• Oxygen is treated as a drug
• Some clients need oxygen constantly, while others need it for symptom relief
• PSWs do not administer oxygen, they assist and support the nurse in providing safe care
• PSWs may be trained to transfer oxygen and provide oral suction

Oxygen Sources

• The three main delivery systems are oxygen concentrator, oxygen cylinder, and liquid oxygen system
• Oxygen concentrators filter oxygen from the air in the room and need to be plugged into a grounded electrical outlet
• Oxygen cylinders contain compressed oxygen and the tank is placed at the bedside
• In hospitals and some continuing care facilities, oxygen is piped directly into a person's unit through a wall oxygen outlet
• Liquid oxygen systems have portable units filled from stationary containers that can be worn over the shoulder

Oxygen Therapy and Safety

• You only assist with oxygen therapy
• You are responsible for giving safe care to clients receiving oxygen and have to follow safety guidelines

Oxygen and Fire Safety

• Oxygen is flammable, keep the source away from heat and open flame
• The physician, nurse, or respiratory therapist is responsible for teaching the client and family members about oxygen safety
• Warn the client of dangers and the safety hazard
• Report concerns to the supervisor

Oxygen Administration Devices

• Oxygen is commonly delivered by nasal cannula or masks
• Masks include simple face masks, partial-rebreather masks, non-rebreather masks, and Venturi masks
• Moisture can build up under the mask and cause skin breakdown under the mask
• Ensure the face is clean and dry
• Masks are typically removed for eating and oxygen is given by cannula during meals
• Masks are often changed from mask to nasal cannula

Oxygen Administration

• If not humidified, oxygen dries the airway’s mucous membranes
• Distilled water is often added to the humidifier

Oxygen Flow Rates

• The O2 flow rate is measured in liters per minute (L/min) and is the amount of oxygen given
• The doctor orders the flow rate or orders a range for the nurse to adjust according to the patient's condition
• The nurse or respiratory therapist sets the flow rate
• The nurse and care plan determine the flow rate
• Your role is to knowOrdered flow rate, check if the flow rate is correct, tell the supervisor at once if the flow rate is too high or too low, and a nurse or respiratory therapist will adjust the flow rate.

Collecting Sputum Specimens

• Sputum is mucus from the respiratory system, not saliva
• Samples are studied for blood microbes and abnormal cells
• Clients must cough up sputum from the bronchi and trachea
• The process can be painful or hard to do
• A specimen should be collected in the morning
• You should instruct the client not to use mouthwash prior to the procedure
• Provide privacy because the procedure can be embarrassing

Artificial Airways

• Artificial airways keep the airway open when disease, injury, secretions, or aspiration obstruct the airway
• Needed for mechanical ventilation
• Indicated for semi-conscious or unconscious clients, or clients recovering from anesthesia

Types of Artificial Airways

• Intubation is inserting an artificial airway
• Common airways include an oro-pharyngeal airway inserted through the mouth and into the pharynx
• A naso-pharyngeal airway is inserted through a nostril
• An endo-tracheal (ET) tube is inserted through the mouth or nose and into the trachea
• A cuff is inflated to keep the airway in place
• A tracheostomy tube is inserted through a surgically created opening into the trachea
• Cuffed tubes are common

Artificial Airways Patient Care

• Check vital signs often
• Observe for hypoxia and other signs and symptoms
• Frequent oral hygiene is needed, and the care plan should be followed
• Comfort and reassure the client
• Follow the care plan for communication method, always keep the call bell within reach, and use touch to show you care, if appropriate for your client's culture and ethnicity
• If an airway comes out or is dislodged, tell the nurse at once

Tracheostomy

• Tracheostomies are temporary or permanent
• A tracheostomy tube has three parts: the obturator, inner cannula, and outer cannula
• The obturator guides insertion of the outer cannula
• The inner cannula is inserted and locked in place
• The outer cannula is not removed
• Care must be taken so that the tube must not come out
• A loose tube can damage the trachea
• The tube must remain patent
• Suction is needed if the client is unable to cough up secretions

Tracheostomy Safety Measures

• Call for the nurse or supervisor if you note signs and symptoms of hypoxia or respiratory distress and if the outer cannula comes out
• Nothing must enter the stoma
• Tracheostomy care involves cleaning the inner cannula to remove mucus and keep the airway patent, cleaning the stoma to prevent infection and skin breakdown, and applying clean ties or a Velcro collar to prevent infection
• Trachea dressing should never have anything that can be inhaled
• The stoma or tube should always be covered when the client goes outside
• Never cover the stoma with plastic or leather
• A client should take tub baths instead of showers
• Water should never enter the stoma
• Medical Alert jewellery should always be worn

Suctioning the Airway

• Secretions can collect in the upper airway
• The process of suctioning withdraws or sucks up fluid (secretions)
• Retained secretions obstruct airflow, provide an environment for microbes, interfere with oxygen (O2) and carbon dioxide (CO2) exchange, and cause hypoxia
• Persons who cannot cough or have a cough that is too weak to remove secretions need suctioning

Suctioning Sites

• The routes used to suction the airway are oral-pharyngeal, naso-pharyngeal, and lower airway
• An oral-pharyngeal suction involves suctioning the mouth and the pharynx
• A naso-pharyngeal suction involves suctioning the nose and the pharynx
• A lower airway suction involves passing the suction catheter through an endotracheal (ET) or tracheostomy tube

Safety Measures for Suctioning

• Suctioning can cause serious harm when not done correctly
• Clients may be unable to breathe, or experience hypoxia, and life-threatening complications can arise during suctioning
• Client's lungs are hyperventilated before suctioning using an ambu bag
• Ensure suctioning is within your province or agency’s scope of practice

Mechanical Ventilation

• Mechanical ventilation involves using a machine to move air in and out of the lungs
• Needed for a variety of health care problems, including hypoxia caused by weak muscle effort, airway obstruction, and damaged lung tissue, nervous system diseases and injuries that can affect the respiratory center, interfering with messages between the lungs and the brain, and drug overdoses that can depress the brain's hypothalamus or the breathing control center

Chest Tubes Requirements

• Doctor inserts chest tubes to remove the air, blood, or fluid.
• Chest tubes attach to a drainage system, and the system must be airtight.
• The water-seal drainage keeps the system airtight.

Caring For Chest Tubes

• Keep drainage system below the level of the chest
• Keep tubing coiled on the bed
• Check vital signs as directed
• Prevent tubing kinks
• Observe chest drainage
• Turn and reposition the client carefully
• Assist with deep breathing, coughing, incentive spirometry
• Keep sterile petrolatum gauze at bedside