PNSG 216 Unit 7 Oxygen Therapy PDF

PNSG 216 Unit 7: Oxygen Therapy Revised Nov 2023 Learning Outcomes  Identify indications for administration of oxygen therapy.  Describe potential complications of oxygen therapy.  Explain the impact of client diversity on tissue oxygenation.  Perform focused assessments re...

PNSG 216 Unit 7: Oxygen Therapy Revised Nov 2023 Learning Outcomes  Identify indications for administration of oxygen therapy.  Describe potential complications of oxygen therapy.  Explain the impact of client diversity on tissue oxygenation.  Perform focused assessments related to the respiratory system, oxygen therapy and oral or nasal suctioning.  Demonstrate principles of medical asepsis, musculoskeletal injury prevention and accuracy of skills when administering oxygen and performing oral or nasal suctioning.  Identify nursing interventions that promote oxygenation and drainage of excessive secretions.  Demonstrate the use of oral and nasal suctioning and oxygen therapy equipment to promote oxygenation.  Describe the safety precautions that should be followed when oxygen is in use.  Demonstrate client teaching related to oxygen therapy and oral or nasal suctioning.  Document client care related to oxygen therapy and oral or nasal suctioning using appropriate medical terminology and selected systems and record keeping forms. Outline  Oxygen Therapy: Indications/Precautions  Oxygen Titration Guidelines  Oxygen Delivery Devices  Medical Air Valves  Pulse Oximetry  Respiratory medication delivery Promotion/Management of Lung Expansion  Noninvasive techniques such as: o Positioning – most effective is 45-degree semi- Fowler’s position. o Incentive Spirometry- method of encouraging voluntary deep breathing by providing a visual feedback.  Invasive techniques such as management of a chest tube. Indications for Oxygen Therapy  Goal: to prevent or relieve hypoxia and keep a healthy level of tissue oxygenation  Any client with impaired tissue oxygenation can benefit from O2 hypoxemia or impending respiratory or cardiac failure are suspected based on clinical indicators such as bronchospasm, dyspnea, cyanosis, hypotension, angina, etc...  Should be used only when indicated  Cardiac or respiratory arrest, Severe trauma, Post- anesthetic recovery, Pneumothorax Precautions with Oxygen Therapy  O2 should be treated as a drug. It can have dangerous side effects such as atelectasis or O2 toxicity. o When the delivered O2 is >60% for extended periods of time oxygen toxicity may occur.  Dosage or concentration of O2 needs to be constantly monitored.  The 10 rights of med. administration also pertain to oxygen therapy. Precautions with Oxygen Therapy  In patients with chronically elevated PaCO2 (CO2 Retainers), ventilatory depression may occur if the patients PaO2 is increased to > 60 mmHg.  The occurrence of this phenomenon is extremely rare and must be documented by the physician (more on this later) Safety Precautions  Highly combustible gas, can’t spontaneously burn or cause an explosion but it can easily cause a fire if exposed to a spark from an open flame or electrical equipment. Safety Precautions  No smoking permitted: Signs should be posted– esp. in home  Ensure that all electrical equipment is functioning properly and is grounded  Know the fire procedures, route for evacuation and the closest extinguisher.  Nurse must continuously monitor O2 equipment to ensure the right amount & concentration is being delivered  Check that enough O2 is left in the portable tank esp. on transport and during your shift in LTC Oxygen Delivery 1. Permanent wall-piped system 2. O2 tanks (refillable on unit or exchange with company) 3. Oxygen Concentrators Regulators & Flowmeters Oxygen Concentrators Respiratory Terminology  FiO2: Fraction of inspired Oxygen is the inspired oxygen level expressed as a decimal instead of as a percentage. FiO2 = 0.40 is equivalent to O2 = 40%.  SpO2:Oxygen saturation in arterial blood, as measured indirectly by a pulse oximeter (saturation of peripheral oxygen) Oxygen Concentrations ROOM AIR: MEDICAL AIR OXYGEN FLOWMETERS Types of Oxygen Delivery Devices Low Flow: High Flow: the flow rate the flow rate coming from the coming from the device is lower than device exceeds the the patient’s patient’s inspiratory inspiratory flow flow rate/demand. rate/demand Oxygen delivery Low Flow Systems  A normal healthy adult’s “peak inspiratory flow rate” is approximately 35 - 40 LPM during resting respirations.  The flow rate from “low flow” systems is less than the patient’s peak inspiratory flow rate during normal breathing, so the oxygen is diluted with room air.  FiO2 is unpredictable and variable and is affected by breathing pattern. Low Flow Systems  Nasal Prongs or Cannula ( NC)  Bi-flow Nasal Mask  Simple Mask (SM)  Non-Rebreathing Mask (NRB) Nasal Prongs or Nasal Cannula  1 – 6 L flow, 24-44 %  Comfortable and generally well tolerated.  Flows of up to 6 LPM oxygen.  Humidity is required for >4L NP Simple Mask  6- 12 L flow, 40-60 %  For Short-term (several hours) use only.  A simple face mask offers no additional humidification, and can quickly cause drying of the upper airway’s mucous membranes…  Never set below 6 LPM. (6 LPM is considered the minimum flowrate needed to flush the patient’s exhaled gases from the mask, therefore decreasing the chances of CO2 rebreathing) Non-Rebreathing Mask  10-15 L flow, 60- 80%  This mask is similar to a simple mask, except that it uses a reservoir bag and a series of one-way valves to increase the FiO2.  There is a one-way valve between the reservoir bag and the mask to prevent exhaled gases from entering the reservoir bag. Non-Rebreathing Mask  Theoretically delivers 100% O2, but realistically delivers 60-80% O2 due to leaks around the mask.  Quick and easy for high O2 requirements, but will rapidly cause drying of airway mucosa so should only be used for short periods (ie. Less than an hour) High Flow Systems  High flow: oxygen delivery system is that the flowrate from the device exceeds the peak inspiratory flow rate of the patient  The FiO2 delivered to the patient’s lungs is exactly what we have set by the device High Flow Benefits of High Flow  Consistent & predictable FiO2  Apparatus flow exceeds the peak inspiratory flow of the patient  Changing ventilatory pattern does not affect the FiO2  Easy to meet the humidity requirements of the patient’s airways. Aerosol Mask  7 – 15 L flow, precise medium FiO2  Nebulizer is then adjusted to desired FiO2.  Patients should NOT be transported using high flow oxygen devices Face Tent  7 – 15 L flow, imprecise FiO2  Should not be used on patients requiring high oxygen levels  Designed for use with patients that have facial burns/trauma that would limit use of an aerosol mask.  Less claustrophobic than an aerosol mask. This Photo by Unknown Author is licensed under CC BY OptiFlow BVM (Bag-Valve-Mask) CPAP Precautions with High Flow Devices  Patients should NOT be transported using high flow oxygen devices.  Non-Rebreathing Masks may be an appropriate choice for patient transport. Precautions with High Flow Devices Eating:  Some patients who are on high flow O2 may not be alert enough to eat food safely; however, for those that are, it is important to monitor the patient’s oxygenation carefully while they are eating.  Place the patient on 6LPM nasal prongs and have the oxygen mask near-by so the patient may replace the mask in between bites. Important Considerations in COPD Patients  Most modern authors agree to apply the oxygen required to keep the SpO2 88-90% in COPD patients. If you cannot achieve an SpO2 in this range with continuous low flow oxygen, call an RT for assistance to apply and assess high flow oxygen therapy.  Use the lowest flow or FiO2 of oxygen to keep the SpO2 in 88-90%. Oxygen therapy always requires a physician order. Nursing Responsibilities  Dr.’s order (usually)  Emergency?  Explain to pt. to calm fear  Monitor pt’s condition frequently  Note client’s colour, resp. rate, depth & ease or difficulty.  Note activity tolerance.  VS/chest assessment & pulse oximetry. (Sp02) Early VS. Late Signs of Hypoxia  Early: o restlessness, increased pulse and respiratory rate, dizziness, declining level of consciousness  Late:  cyanosis (but not reliable sign)  Central cyanosis-tongue, palate, lips, conjunctiva of the eye,(blood flow is high in these areas) Pulse Oximetry Non-invasive method of determining oxygen saturation of hemoglobin Provides an ESTIMATE of arterial oxyhemoglobin saturation (SpO2). An arterial blood gas is the only truly reliable way to measure SaO2 directly. Pulse Oximetry: Ensuring accurate results The measured heart rate on the machine must correlate with the patient’s actual heart rate. The signal strength on the machine must be strong and regular. An appropriately sized probe must also be used Pulse Oximetry Limitations Low perfusion Carbon monoxide poisoning Nail polish Intravascular dyes Motion artifact  Ambient light Abnormal Hemoglobin  Flickering lights and Ultraviolet lights Too tight/loose Respiratory Medication Delivery Methods  Metered Dose Inhalers (MDI)  Metered Dose Inhaler with Spacer – Preferred method  Small Volume Nebulizer (SVN)  Dry powder inhalers (Turbuhaler) Nursing Responsibilities: Documentation  Device used  Flow rate  Assessments (eg. Resp. Status & response to treatment) References  Potter, P. & Perry, A. (2019). Canadian fundamentals of nursing. (Revised 6th ed.). Toronto, ON: Elsevier Canada.