Download 1-4L low flow – use of

Interference with Ventilation
Oxygen Therapy

Indications:
 Treat: Respiratory; CV; CNS disturbances
 Oxygen Administration: High or low flow systems
 High Flow — delivers fixed concentrations independent of
the patient’s respiratory pattern
 Venturi Mask – up to 50%
 Low Flow — amount delivered varies with patient’s
respiratory pattern
 Nasal cannula 2L/min = 28% oxygen
 Face tent or trach collar – Increased humidity
 Non-re-breathing mask – delivers 80-90%
 Humidity:
 1-4L low flow – use of “bubble-through”
controversial
 Nebulizer
Interferences with Ventilation
Oxygen Therapy- Complications

CO2 Narcosis –



two chemoreceptors – O2 CO2
CO2 accumulation – major stimulus
COPD patient –

Develops tolerance to high CO2





Respiratory Center loses sensitivity to elevated CO2
O2 Drive “Hypoxemia”
Concern about administering O2 to COPD patients ??
Bigger Concern: not providing adequate O2
Goal: Titrate O2 to the lowest effective dose
based on arterial blood gas monitoring
Interferences with Ventilation
Oxygen Therapy- Complications

O2 Toxicity



Prolonged exposure to high level O2
Determined by patient tolerance, exposure time,
and effective dose
High level Manifestations –




Initial -- Inactivate surfactant and lead to ARDS :
reduced vital capacity, cough, substernal chest pain, N&V,
paresthesia, nasal stuffiness, sore throat, malaise
Later – affects alveolar-capillary gas exchange:
pulmonary edema with copious sputum
End Stage – lung fibrosis
O2 Administration Goal: enough O2 to maintain
PaO2 within normal or acceptable limit

O2 administration > 50% for > 24 hours potentially toxic
Chronic Obstructive Lung
Disease Complications
Nursing Care Management
Ineffective airway clearance



Assess: breath sounds; ability to effectively
coughing
Nsg Action: Elevate head of bed; sitting up;
hydration 2-3L/d; chest physiotherapy; Meds:
inhaled bronchodilators & steroids.
Pt Education: Effective breathing & coughing
techniques; Medications & administration
Nursing Care Management
Impaired Gas Exchange



Assess: Mental status; VS with Pulse oximetry;
ABGs
Nsg Action: Position – Tripod-supported
extremities; Administer O2 to effective level;
Pt Education: Pursed-lip breathing; signs,
symptoms & consequences of hypercapnia;
avoidance of CNS depressants; Medication
action; smoking cessation
Breathing Exercises
Orthopnea Positions to
Decrease the Work of Breathing
Nursing Care Management
Imbalanced Nutrition

Assess:


Nsg Action:


Weight within normal range for height and age;
appetite; caloric intact; energy level; gastric
distention; sputum production; affect; lack of
interest in foods; serum albumin level
Hi PRO, HI Calorie foods & liquid supplements;
small frequent feedings; periods of rest after
food intake; Referral—financial & nutritional
support (Meals-on-wheels; food stamps)
Pt Education:

Referrals / Importance of rest / digestion / high
protein & calorie foods – menu planning
Nursing Care Management
Disturbed Sleep Pattern

Assess:


Nsg Action:


Identify usual patterns; explore reasons for
discomfort, wakefulness, or difficulty sleeping; sleep
apnea
Identify pt-specific relaxation methods; environment
conducive to rest
Pt Education:

Balance activity (ADL’s) / rest; avoidance of alcoholic
beverages, caffeine products, & other stimulants
before bedtime; include family; sexual activity—
positions of comfort; psychosocial issues