Oxygenation and Perfusion: Face Masks, Airways, and Respiratory Conditions PDF

Impaired gas exchange: - Caused by destruction of alveolar walls and is associated with an oxygen saturation of less than 90% of dyspnea Impaired airway clearance - Can be caused by bronchoconstriction and increased production of mucus. It is associated with thick sputum, prolonged co...

Impaired gas exchange: - Caused by destruction of alveolar walls and is associated with an oxygen saturation of less than 90% of dyspnea Impaired airway clearance - Can be caused by bronchoconstriction and increased production of mucus. It is associated with thick sputum, prolonged coughing incidents, adventitious breath sounds, and dyspnea Activity intolerance - Related to O2 levels and the need for more O2 with exercise or activity, as evidenced by complaints of fatigue, dropping O2 saturation levels with activity, and slow gait Acute chest pain: - Related to damage to the heart muscle, as evidenced by pain rating 7 out of 10, increased respiratory rate, and diaphoresis Ineffective tissue perfusion - Caused by a decrease O2 levels in the blood and associated with fatigue with exercise and cyanosis Analysis of cues related to oxygenation and perfusion Related cues Analysis Common conditions to consider -------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------- Palpitations Accompanied by chest pain, dyspnea, fatigue, dizziness, loss of consciousness, or ECG changes are most likely to be related to oxygenation and perfusion Hyperthyroidism, anxiety Dyspnea Accompanied by chest pain, exercise intolerance, edema, cough, wheezing, altered breath sounds, changes in lipid panel, cardiac enzyme, ECG, echocardiogram, cardiac catheterization, chest x-ray, and pulmonary function tests is more likely to be related to oxygenation and perfusion Anxiety deconditioning Fatigue Chest pain, edema, exercise intolerance, and changes in lipid panel, cardiac enzyme, ECG, echocardiogram, and cardiac catheterization tests Hypothyroidism, diabetes, infection, cancer, depression Chest pain Radiating pain, diaphoresis, nausea, vomiting, dyspnea, exercise tolerance, and changes in lipid panel, echocardiogram, cardiac catheterization tests Musculoskeletal problems, anxiety, pleuritis, trauma, gastroesophageal reflux disease, peptic ulcer, pancreatitis, tumors Cough Chest pain, dyspnea, exercise intolerance, wheezing, mucus, secretions, abnormal breath sounds, and changes in chest x-ray and pulmonary function tests ACE inhibitor use, allergies, GERD, sinusitis Wheezing Cough, dyspnea, exercise intolerance, mucus, secretions, abnormal breath sounds, and changes in xray and pulmonary function tests GERD Face masks Partial rebreather and nonrebreather masks have a flexible 1 L reservoir bag with O2 inlet. Thay are referred to as reservoir masks because they have a valve system and can deliver higher levels of inspired O2 Simple face mask: - Allows room ar to be inspired with the O2 delivered - Doesn't have a reservoir bag - Every increase of 1 L/min of O2 relates to approximately a 5% increase in O2 concentration delivered - 5 L/min=40% - 6 L/min=45% - 7 L/min=50% - 8 L/min=55% - Higher than 8 L/min=60% - Partial rebreather mask - Allows some of the exhaled air to enter the reservoir - Because this exhaled air is from the respiratory dead space, it contains little carbon dioxide - Flow rates and percentage oxygenation values are - 5-15 L/min=70% to 90% (10L/min needed to maintain reservoir inflation) - Nonbreather mask - One way valve does not allow exhaled air to enter the reservoir bag - Additional one way valves allow air to be exhaled through the mask, however no room air can be inhaled through the valves - Flow rates should be higher than 10L/min to maintain bag inflation - Flow rates and percent O2 values range from - 10 L/min to 15 L/min= 60% to 100% - Venturi mask - Ensure accuracy of the O2 concentration delivered - Often used with patients that retain CO2 such as COPD patients - Color coded adaptors or a dial with a liters per minute setting can be attacked to the mask - Flow rates and percentage oxygenation values rage from - 4-12 L/min=24%-60% Face mask nursing checklist - Evaluate the patients tolerance and make any necessary adjustments to the fit - Ensure that there are no large gaps or opening between the mask and skin - Ensure that the bag is filled before placing it on the patient - Conduct a focused respiratory assessment 15-30 minutes after initiation of therapy and at regular intervals thereafter - Evaluate the patients response to O2 - Contact the health care provider to adjust the plan of care if the patients deteriorates Positive pressure devices - Patients who are unable to maintain an open airway require forced air and O2 which can be administered through mask over the nose or through nasal pillows at the nares - CPAP: continuous positive airway pressure provides the same pressure during both inhalation and exhalation - BiPAP: bilevel positive airway pressure provides continuous bilevel positive airway pressure using a higher pressure during inhalation and a lower pressure during exhalation +-----------------------------------+-----------------------------------+ | Device | Nursing evaluation | +===================================+===================================+ | Nasal cannula | **Subjective**: patient reports | | | less dyspnea | | | | | | **Objective**: patient more alert | | | decreased respiratory rate and | | | less accessory muscle use. | | | Improved SpO2 on pule ox and PaO2 | | | on arterial blood gases | +-----------------------------------+-----------------------------------+ | Face mask | **Subjective**: patient reports | | | less dyspnea | | | | | | **Objective**: patient more | | | alert. Decreased respiratory rate | | | and less accessory muscle use. | | | Improved SpO~2~ on pulse oximetry | | | and PaO~2~ on arterial blood | | | gases. | +-----------------------------------+-----------------------------------+ | BVM device | **Subjective:** Patient reports | | | less dyspnea.\ | | | **Objective:** Patient more | | | alert. Decreased respiratory rate | | | and less accessory muscle use. | | | Improved SpO~2~ on pulse oximetry | | | and PaO~2~ on arterial blood | | | gases. | +-----------------------------------+-----------------------------------+ | CPAP/BiPAP | **Subjective:** Patient reports | | | compliance and less daytime | | | somnolence.\ | | | **Objective:** Echocardiogram and | | | cardiac catheterization findings | +-----------------------------------+-----------------------------------+ Types of airways Pharyngeal airways: - Decreased levels of consciousness - Loss of muscle tine - Frequent suctioning needs Tracheal airways - Inability to breathe effectively - Need for positive pressure mechanical ventilation - Long term airway patency problems - Need for general anesthesia - Blocked upper airway Types of tubes Pharyngeal airways - Nasopharyngeal tube - Inserted through the nose - Protects nares and provides a guide for catheter insertion when frequent suctioning is required - Oropharyngeal tube - Inserted through the mouth with the airway going over the tongue - Should be removed from the airway every 4 to 8 hours - Secured in place with a holder or tape Tracheal airways - Endotracheal tube - Semirigid, curved tube with a cuff at the distal end - Inflated cuff prevents aspiration of gastric contents into the lungs - Placed through the mouth - Sealed with a balloon at the end of the tube - Tracheostomy tube - Plastic polymer or metal tube that fits through a stoma in the neck - Most have an outer cannula with an attached flange and cuff and a removable inner cannula - Based on facility policy, specific items are kept at the bedside in case of tracheostomy dislodgement (e.g., BVM device, O~2~ and suction equipment, extra inner and outer cannulas with obturators, extra tracheostomy care kit)