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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