Test 2 Objectives (3).docx

Chapter 38 Factors Affecting Micturition Developmental considerations Toilet training Effects of aging Food and fluid intake Psychological variables Activity and muscle tone Pathologic conditions Medications Diseases Associated with Renal Problems Congenital urinary tract abnormalities- when you wer...

Chapter 38 Factors Affecting Micturition Developmental considerations Toilet training Effects of aging Food and fluid intake Psychological variables Activity and muscle tone Pathologic conditions Medications Diseases Associated with Renal Problems Congenital urinary tract abnormalities- when you were in utero, something did not form the way it was supposed to. Like if you had one kidney, instead of two. Polycystic kidney disease (inherited disorder in which clusters of cysts develop primarily within your kidneys, causing your kidneys to enlarge and lose function over time.) Urinary tract infection-UTI, infections start off in the bladder but if you don’t take care of it, it becomes pyelonephritis, meaning the infection has become complicated by traveling to the kidney. Urinary calculi (masses/stones that form in the urinary tract and may cause pain, bleeding, or an infection or block of the flow of urine) In hospital setting, sometimes order will ask to strain the urine- assessing to see if the drug therapy has been therapeutic. Hypertension- Diabetes mellitus Gout Connective tissue disorders Effects of Medications on Urine Production and Elimination Diuretics: prevent reabsorption of water and certain electrolytes in tubules. With diuretics, you will see a patient pee a lot, possible dehydration, as a nurse, monitor input/output Cholinergic medications: stimulate contraction of detrusor muscle, producing urination With cholinergic medications you will see a patient pee a lot, possible dehydration, as a nurse, monitor input/output. Analgesics and tranquilizers: suppress CNS, diminish effectiveness of neural reflex, think about surgery, before they let you go home, they make you pee. Keep that in mind. Nursing History Usual patterns of urinary elimination- if we can establish a baseline for each client then we will know anything unusual that is presenting. If Zaddy normally goes pee 8 eight times. And hes going 8 times, there is no reason to be concerned. We want to know your baseline. Recent changes in urinary elimination-if Zaddy normally goes pee 8 times and hes only going pee 2 times, then there is something gong on. What is going on? Is there maybe a blockage somewhere? Is Zaddy taking a medication we don’t know about? Aids to elimination- some people like the faucet running, noise in the background, a stool to rest the legs. Present or past occurrence of voiding difficulties-include dysuria (painful urination) Presence of urinary diversion *100mL or less urinary residual volume is what is considered normal. Additional Assessment Techniques Measuring urinary output Continent patients- put a hat over toilet Incontinent patients, you can use an indwelling catheter and measure from there. Indwelling catheter- are sterile/aseptic technique. Routine urinalysis Clean-catch or midstream specimen Sterile specimen Urinary diversion specimen 24-hour specimens Measuring Urine Output Ask the patient to void into a bedpan, urinal, or specimen container in bed or bathroom Put on gloves. Pour urine into the appropriate measuring device Place the calibrated container on a flat surface and read at eye level Note amount of urine voided and record on the appropriate form Discard urine in the toilet unless specimen is needed. If a specimen is required, pour the urine into an appropriate specimen container Promoting Urinary Elimination Maintaining regular voiding habits- following the schedule someone normally uses. Promoting fluid intake- giving water to encourage urination. Strengthening muscle tone- with the use of Kegels to strengthen your pelvic floor muscles, you should do 30-80 per day. Assisting with toileting Planned Patient Goals Produce urine output about equal to fluid intake- ensure patient input and output is equal, if its not , the patient could have been dehydrated. Maintain fluid and electrolyte balance Empty bladder completely at regular intervals. Empty bladder to 100mL or less. Report ease of voiding- we want to know patient was able to urinate easily. Maintain skin integrity- change patient brief to maintain skin integrity and prevent skin breakdown. Demonstrate appropriate self-care behaviors- before you discharge them, make sure client is aware how to take care of themselves, bathing properly, how to change their brief, make sure they are aware of what medications they need to apply if they have a rash or something Promoting Normal Urination Maintaining normal voiding habits Promoting fluid intake Strengthening muscle tone Assisting with toileting Patients at Risk for UTIs Sexually active people with female genitalia- teach these patients about hygiene like peeing after sex, showering after intercourse. People who use diaphragms for contraception- diaphragms may obstruct the urethra, a short tube that leads from the urinary opening to the bladder. This would leave a small amount of urine in the bladder, allowing bacteria to accumulate and multiply. Postmenopausal people- women normally make estrogen, postmenopausal have changes in the urogenital microbiome due to decreased levels of estrogen and this reduces the body’s natural defense mechanism against UTI’s. People with indwelling urinary catheter in place- patients who have an indwelling catheter inserted risk bacteria growth due to the catheter urine forming a biofilm, bacteria can then enter after the catheter insertion or about 3 days after. Biofilm development occurs when cells (planktonic) contact with the surface of the catheter with the thin film. This is also known as CAUTI (Catheter Associated Urinary Tract Infection) catheters become colonized with bacteria at a rate of 3-10% per day. People with diabetes mellitus- the people are at an increased risk of UTI’s because the blood in the sugar. Bacteria loves sugar so if there is an uncontrolled diabetic, they basically accumulate glucose in the urine (glycosuria), which causes bacteria growth, leading to a UTI. Older adults Types of Urinary Incontinence Transient: appears suddenly and lasts 6 months or less Mixed: urine loss with features of two or more types of incontinence Overflow: overdistention and overflow of bladder Functional: caused by factors outside the urinary tract Reflex: emptying of the bladder without sensation of need to void Total: continuous, unpredictable loss of urine Stress: involuntary loss of urine related to an increase in intra-abdominal pressure Reasons for Catheterization Relieving acute urinary retention Obtaining a sterile urine specimen when patient is unable to void voluntarily Accurate measurement of urinary output in critically ill patients Assisting in healing open sacral or perineal wounds in incontinent patients- to keep the urine from going into the ulcer and it burns so its an irritant, could make the pressure ulcer worse or create another one. Emptying the bladder before, during, or after select surgical procedures and before certain diagnostic examinations Providing improved comfort for end-of-life care Prolonged patient immobilization Types of Catheters Intermittent urethral catheters Indwelling urethral catheter Suprapubic catheter: (A suprapubic catheter is a medical device that helps drain urine from your bladder. It enters your body through a small incision in your abdomen. ) this is NOT a go to. This is for like if there is an obstruction present and we need to bypass the obstruction to relieve the bladder. Nursing Interventions Urethral catheter insertion and care for patients with an indwelling catheter. Big thing with a catheter is peri care! Caring for a patient with a urologic stent Caring for a patient with a urinary diversion Caring for a patient receiving dialysis The main thing on nursing interventions with urinary catheters is keep the area of insertion CLEAN, main thing is infection control, using aseptic technique, measuring input/output to ensure they are outputting what u out in them and to check for no signs of infections. Chapter 40 Factors Influencing Diffusion of Gases in the Lungs Change in surface area available- meaning you lose the surface available in the lung Thickening of alveolar–capillary membrane Partial pressure Solubility and molecular weight of the gas FOCUS ON ABG VIDEO POSTED Alterations in Respiratory Function Hypoxia: inadequate amount of oxygen available to the cells- as a nurse, you look for tachycardia, cyanosis, anxiety. Dyspnea: difficulty breathing Hypoventilation: decreased rate or depth of air movement into the lungs Hyperventilation: you would look for HYPERVENTILIATION in COPD patients, because they have increased carbon dioxide. YOU NEED TO BE ABLE TO EXPLAIN WHAT HYPOXIA IS. YOU NEED TO BE ABLE TO EXPLAIN WHAT DYSPNEA IS, YOU NEED TO BE ABLE TO IDENTIFY WHAT THESE PATIENTS WOULD LOOK LIKE WITH THEIR SYMPTOMS. Cardiovascular System Vital for exchange of gases The heart is the main organ of circulation, composed of two upper atria and two lower ventricles Oxygen is carried predominantly via red blood cells due to binding between the hemoglobin in RBCs and oxygen Hemoglobin also carries carbon dioxide Electrical impulses control contraction of the heart muscles—sinoatrial (SA) node, atrioventricular (AV) node, atrioventricular bundle Factors Affecting Cardiopulmonary Functioning and Oxygenation Level of health Developmental considerations Medication considerations Lifestyle considerations Environmental considerations Psychological health considerations Respiratory Functioning in the Older Adult Bony landmarks are more prominent due to loss of subcutaneous fat. Kyphosis contributes to the appearance of leaning forward. Kyphosis is hunchback. Barrel chest deformity may result in increased anteroposterior diameter. Tissues and airways become more rigid; diaphragm moves less efficiently. Older adults have an increased risk for disease, especially pneumonia. Nursing History Usual patterns of respiration Medications- we want to know if patient is on any SABA’s or LABA’s any respiratory medications. Health history- We want to know if you have a history of Pneumonia, COPD.. etc Recent changes- like recent changes in weight, that would change respiratory pattern. Lifestyle and environment- we want to know if someone worked in the burn pits and now they cant breathe right and now they have come to see us. Cough or sputum – sputum tells you if there is an infection Pain or dyspnea- dyspnea is shortness of breath Fever or fatigue Physical Assessment of the Respiratory System Inspect for general appearance, color (cyanosis, pallor), structural abnormalities of the chest, like if the patient is laying down and you are looking at the chest and only half the chest rises, the patient could have a collapsed lung. Check respiratory rate, rhythm and depth Palpate for temperature, if the patient is ICE cold, this indicates the client has perfusion issues. If the client is hot, this indicates the client more than likely has an infection. chest expansion, tenderness, masses, pulsations. Percuss to assess the position of the lungs, density of lung tissue Auscultate breath sounds Normal Breath Sounds Vesicular: low-pitched, soft sound during expiration heard over most of the lungs Bronchial: high-pitched and longer, heard primarily over the trachea Bronchovesicular: medium pitch and sound during expiration, heard over the upper anterior chest and intercostal area. https://www.youtube.com/watch?v=JFWMJGtmG5E **Abnormal (Adventitious) Breath Sounds SLIDE 50 Whenever your auscultating lung sounds and your trying to identify what it is that your hearing. Always ask yourself the following questions. -Ask yourself about timing. Is this happening on inspiration, on expiration or both? -Ask yourself what the pitch sounds like. Are these high pitched or low pitched sounds? -Ask yourself if the sounds are discontinuous (sounds are distinguishable individually, occur in succession such as pops in fine crackles and last less than 250ms) or continuous, (when sounds are more constant in nature and generally last more than 250ms)? Crackles: crackles are also called Rales. intermittent sounds occurring when air moves through airways that contain fluid. Occur towards the start of inspiration but can extend into expiration Classified as fine, medium, or coarse. Fine crackles sounds like pop/cracks of a fire; coughing doesn’t clear it. To me, it sounds like a little Debbie snack wrapper being crumbled. Lol Coarse crackles: (course crackles are longer than fine crackles). Coarse crackles are discontinuous distinguishable individual sounds (gurgling). Coarse crackles have a low pitch and are usually located in the larger airways (bronchi). Characteristics of coarse crackles are gurgling/bubbling sounds that coughing does not clear. Medium crackles https://www.youtube.com/watch?v=AbfsN1YgeSw Wheezes: continuous sounds heard on expiration and sometimes on inspiration as air passes through airways constricted by swelling, secretions, or tumors. sound like musical notes, whistling noise. Classified as sibilant or sonorous https://www.youtube.com/watch?v=aMMlclpBNpg Values Measured from Pulmonary Function Tests Tidal volume (VT). This is the amount of air inhaled or exhaled during normal breathing. Vital capacity (VC). This is the total volume of air that can be exhaled after inhaling as much as you can. Forced vital capacity (FVC). This is the amount of air exhaled forcefully and quickly after inhaling as much as you can. Forced expiratory volume (FEV). This is the amount of air expired during the first, second, and third seconds of the FVC test. Total lung capacity. This is the total volume of the lungs when filled with as much air as possible. Residual volume. This is the amount of air left in the lungs after exhaling as much as you can. Peak expiratory flow rate (PEFR). This is the fastest rate that you can force air out of your lungs. Promoting Optimal Function #1 & #2 Healthy lifestyle choices and behaviors Vaccinations Influenza Pneumococcal disease COVID-19 Teaching about a pollution-free environment Reducing anxiety Maintaining good nutrition Promoting comfort Promoting proper breathing Promoting and controlling coughing Performing chest physiotherapy Meeting oxygen needs with medications Medications Cough Suppressants Expectorants Lozenges Bronchodilators- given before steroids because they open the airway by decreasing inflammation Mucolytic agents Corticosteroids Antihistamines Leukotriene receptor antagonists Administering Inhaled Medications Bronchodilators: open narrowed airways Nebulizers: disperse fine particles of liquid medication into the deeper passages of the respiratory tract Meter-dose inhalers: deliver a controlled dose of medication with each compression of the canister Dry powder inhalers: breath-activated delivery of medications Providing Supplemental Oxygen Source of oxygen Flow rate Humidification Delivery systems Nasal cannula—low or high flow Simple mask Nonrebreather Venturi mask Precautions for Oxygen Administration Avoid open flames in the patient’s room. Place “no smoking” signs in conspicuous places. Check to see that the electrical equipment in the room is in good working order. Avoid wearing and using synthetic fabrics (builds up static electricity). Avoid using oils in the area (oils ignite spontaneously in oxygen). Nursing Skills to Support Respiration Tracheal suctioning – is a sterile/aseptic procedure KEEP THAT IN MIND! Assisting ventilation with mechanical ventilator Clearing an obstructed airway Administering cardiopulmonary resuscitation This also includes collecting a SPUTUM SAMPLE How to collect a sputum sample: Sputum is mucus or phlegm coughed up from your lungs (not spit, saliva, or nasopharyngeal discharge). Sputum samples are used to diagnose active tuberculosis (TB) and to monitor the effectiveness of TB treatment. Step 1 Drink plenty of water the night before collection. Best time of day to collect sputum is when you first wake. Do not eat, drink or smoke before coughing up sputum from the lungs. Rinse (do not swallow) the mouth with water before sputum is collected to minimize residual food particles, mouthwash, or oral drugs that might contaminate the specimen. Step 2 Go away from other people either outside or beside an open window before collecting the specimen. This helps protect other people from TB germs when you cough. Take the plastic tube with you. The collection tube is very clean. Do not open it until you are ready to use it. Carefully open the plastic tube. Step 3 Take several deep breaths. Cough hard from deep inside the chest three times to bring sputum up from your lungs. Spit the sputum into the tube carefully. Try not to touch the rim of the container. Repeat until you have 1 - 2 tablespoons of sputum in the tube. Replace the cap tightly on the plastic tube. Wash and dry the outside of the tube. Write date of collection in the proper box on the lab slip. Step 4 Place the primary specimen container (usually a conical centrifuge tube) in the clear plastic baggie that has the biohazard symbol imprint. Place the white absorbent sheet in the plastic baggie. Expel or "push" excess air from the plastic baggie and then seal it. Refer to the printed instructions on the baggie for detailed guidance on sealing the baggie properly. Place the plastic baggie inside the white Tyvek envelope. Expel or "push" excess air from the Tyvek envelope and then seal the Tyvek envelope securely. Place the Tyvek envelope inside the fiberboard canister. Place the specimen submission form inside the fiberboard canister. Screw the canister lid onto the canister. Secure the lid closed with sealing/mailing tape Chapter 41 Fluid Balance- the main thing the body wants to do is maintain homeostasis, the body does this with solvents and solutes Solvents: liquids that hold a substance in solution (water) Solutes: substances dissolved in a solution (electrolytes and nonelectrolytes). Electrolytes are substances that conduct electricity in its aqueous molten state and decompose into its constituent ions. Examples of electrolytes are Sodium Chloride, Hydrochloric acid and sodium hydroxide. Non- Electrolytes are substances that do not conduct electricity in solids, they do not ionize. Examples of non-electrolytes are sugars, alcohols, organic solvents, and urea. Fluid Losses- fluid losses occur from the: Kidneys: urine Intestinal tract: from feces Skin: perspiration/sweating Insensible water loss/ respirations etc. Fluid Imbalances Involve either volume or distribution of water or electrolytes Hypovolemia: deficiency in amount of water and electrolytes in ECF with near-normal water/electrolyte proportions Dehydration: decreased volume of water and electrolyte change Third-space fluid shift: distributional shift of body fluids into potential body spaces, also known as edema. Major Electrolytes/Chief Function KNOW THESE LAB VALUES AS WELL Sodium: controls and regulates volume of body fluids. Lab value 135-145 mEq/L Potassium: chief regulator of cellular enzyme activity and water content. LAB VALUE 3.5-5.0 mEq/L Calcium: nerve impulse, blood clotting, muscle contraction, B12 absorption. Lab Value for total 8.6-10.2mg/Dl and ionized 4.5-5.1mg/dL Magnesium: metabolism of carbohydrates and proteins, vital actions involving enzymes. Lab Value 1.3-2.3mEq/L Chloride: maintains osmotic pressure in blood, produces hydrochloric acid. Lab Value 97-107 mEq/L Bicarbonate: body’s primary buffer system. Lab Value 25-29 mEq/L Phosphate: involved in important chemical reactions in the body, cell division, and hereditary traits. Lab Value 2.5-4.5mg/dL Primary Organs of Homeostasis #1 & #2- these are the primary organs that will help to maintain homeostasis. Kidneys normally filter 170 L of plasma and excrete 15 L of urine. The cardiovascular system pumps and carries nutrients and water in body. Lungs regulate oxygen and carbon dioxide levels of the blood. Adrenal glands help the body conserve sodium, save chloride and water, and excrete potassium. The pituitary gland stores and releases ADH. The thyroid gland increases the blood flow in the body and increases renal circulation. The nervous system inhibits and stimulates mechanisms influencing fluid balance. Parathyroid glands regulate the level of calcium in ECF. The GI tract absorbs water and nutrients that enter the body through this route. Osmolarity of a Solution Isotonic: same concentration of particles as plasma Hypertonic: greater concentration of particles than plasma Hypotonic: lesser concentration of particles than plasma Hypertonic causes cells to shrink Hypotonic solutions cause cells to swell YOU NEED TO KNOW WHICH SOLUTIONS FALL INTO EACH CATEGORY AND THEIR USES Electrolyte Imbalances- if under the lab value then its hypo , if its above the normal value then its hyper. Hyponatremia and hypernatremia Hypokalemia and hyperkalemia Hypocalcemia and hypercalcemia Hypomagnesemia and hypermagnesemia Hypophosphatemia and hyperphosphatemia Hypochloremia and hyperchloremia Acid–Base Imbalances Occur when carbonic acid or bicarbonate levels become disproportionate Respiratory acidosis: primary excess of carbonic acid in ECF Respiratory alkalosis: primary deficit of carbonic acid in ECF Metabolic acidosis: proportionate deficit of bicarbonate in ECF Metabolic alkalosis: primary excess of bicarbonate in ECF https://www.youtube.com/watch?v=3fwCBFRLO4k <-respiratory acid review og Arterial Blood gases. Arterial Blood Gas Values FOR PH : ACIDOSIS 7.35-7.45 ALKALOSIS FOR CO2 RESPIRATORY ALKALOSIS 35-45 ACIDOSIS FOR HCO3 METABOLIC ACIDOSIS 23-27- ALKALOSIS UNCOMPENSATED VERSUS COMPENSATED: in compensated, you have a normal PH of 7.35-7.45. If it is abnormal then it becomes uncompensated, Anything between 7.35 and 7.40 is acidosis and anything between 7.40-7.45 is alkalosis. Example if you have a ph of 7.37 then it would be compensated acidosis. Where as if you have a ph of 7.42, it would be compensated alkalosis. Is it respiratory or metabolic ? you look at the result of the compensated or uncompensated acidosis or alkalosis. For example if I have a ph of 7.35 then its compensated acidosis and then when you get your CO2 which is respiratory and you look at your HCO3 which is metabolic.. you look at both of the CO2 AND HCO3 values and determine which one of their values is acidosis and matches the original compensated acidosis. Example. If your respiratory C02 comes back with a value of 28 then its alkalosis and if your HC03 comes back with a value of 11 then that’s acidosis. This means your original ph value of 7.35 if compensated acidosis and is metabolic. *WHEN both respiratory and metabolic values are both acidosis for example then that means it’s a mix of the both them. ** Nursing History Usual patterns of fluid intake Usual pattern of fluid elimination Patient’s evaluation of hydration status History of disease process Medication/nutrition history Fluid, electrolyte, and acid-base imbalances and contributing factors Assessment Nursing history and physical assessment Fluid intake and output Daily weights Laboratory studies Risk Factors for Imbalances Pathophysiology underlying acute and chronic illnesses Abnormal losses of body fluids Burns Trauma Surgery Therapies that disrupt fluid and electrolyte balance. When you see therapies, think about medications. Some medications cause frequent urination like Lasix. Physical Assessment Skin and tone turgor Moisture and oral cavity Tearing and salivation Appearance and temperature of skin Facial appearance Edema Body temperature, pulse, respirations, and blood pressure Lab Studies to Assess for Imbalances Complete blood count- CBC Serum electrolytes, blood urea nitrogen (BUN), and creatinine levels Urine pH and specific gravity Arterial blood gases Actual or Potential Health Problems- as you study these, try to come up with nursing diagnosis that you would se in these specific patients. What would cause a patient to have fluid overload? What would cause a patient to have fluid imbalance? What would cause a patient to have impaired fluid intake? Fluid overload- also known as hypervolemia. The most common cause of hypervolemia is heart failure, specifically the right ventricle. Cirrhosis (cirrhosis of the liver is chronic liver damage from a variety of causes leading to scarring and liver failure) , often caused by excess alcohol consumption or hepatitis. Can also be caused by kidney failure, caused by diabetes or other metabolic disorders. This patient may present with hypertension, peripheral edema, pulmonary edema and JVD. Fluid imbalance- this is either when you lose more liquids than you take in or take in more liquids that are being output. Fluid imbalance can arise due to hypovolemia, normovolemia with maldistribution of fluid, and hypervolemia. Impaired fluid intake- this can occur from common causes of deficient fluid volume like diarrhea, vomiting, excessive sweating, fever, and poor oral fluid intake. Expected Outcomes Maintain approximate fluid intake and output balance (2,500-mL intake and output over 3 days). Maintain urine specific gravity within normal range (1,010–1,025). Practice self-care behaviors to promote balance. If an imbalance exists, the patient will: Report relief of symptoms after treatment Exhibit signs and symptoms of restored balance Identify signs and symptoms of recurrence. Implementing Preventing fluid and electrolyte imbalances Developing a dietary plan Modifying fluid intake Administering medications Mineral–electrolyte preparations Diuretics Administering intravenous fluid therapy Intravenous Therapy PICCs-Peripherally inserted Central Catheter a long thin tube that inserted in and passed through your veins in your arm to the larger veins near your heart. This gives doctors access to larger central veins near the heart. Usually given and placed for medications and sometimes liquid nutrition as well. This can help avoid the pain of frequent needle sticks. A picc line requires special care, like monitoring for any possible complications like infections or blood clots. Picc lines are inserted by specially trained nurses. Nontunneled percutaneous central venous catheters- used for temporary venous access and may be placed into a larger vein near the neck, chest and groin. Tunneled central venous catheters are also thin tube that is placed in a vein beneath the skin providing long term access to the vein. Used without the fear of being dislodged. Implanted ports-this is metal or plastic disc shaped port, about the size of a quarter. goes beneath the skin and normally put in the chest but can also be placed in arm and abdomen. It is barely visible and when you no longer need it, the physician takes it out. This can be used for IV treatments or for blood draws. These are all done, or implanted by specialist or providers. Vein Site Selection Accessibility of a vein Condition of vein Type of fluid to be infused Anticipated duration of infusion PLEASE REMEMBER If a patient is NPO, you still have to do oral hygiene and always assess for infiltration or phlebitis or infiltration. With phlebitis you will have redness and hot skin. With infiltration, you will have a cold and pale skin. RANDOM THINGS I THINK WOULD BE HELPFUL: A 14F to 16F catheter should be used when catheterizing an adult client. Size 18F can distend the urethra and cause more discomfort to the client during the procedure, as well as increase erosion of the bladder. If resistance is met, having the client take a deep breath helps relaxes the external sphincter.  The nurse should document the client's condition as functional incontinence when the client is unable to retain urine for some time after getting an urge to void. Stress incontinence can result in the loss of small amounts of urine when intra-abdominal pressure rises. Urge incontinence is the need to void, perceived frequently with a short-lived ability to sustain control of flow. Total incontinence is the loss of urine without any identifiable pattern. The nurse should use a flow meter to regulate the amount of oxygen delivered to the client. A flow meter is a gauge used to regulate the amount of oxygen delivered to the client and is attached to the source of oxygen. An oxygen analyzer is a device that measures the percentage of delivered oxygen to determine if the client is receiving the amount prescribed by the health care provider. An adhesive nasal strip increases the nasal diameter and promotes easier breathing. A nasal cannula is a hollow tube used for delivering a small concentration of oxygen. However, these devices are not used to regulate the amount of oxygen delivered to the client. Hemoglobin is responsible for carrying oxygen