Download Oxygen Therapy Venturi Mask, Nonrebreathing Mask, Partial

Chapter 25
Respiratory Care Modalities
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Oxygen Therapy
• Administration of oxygen at greater than 21% (the
concentration of oxygen in room air) to provide adequate
transport of oxygen in the blood, to decrease the work of
breathing, and to reduce stress on the myocardium
• Assess for signs and symptoms of hypoxia
• arterial blood gas results, and pulse oximetry to determine O2
need.
• MD order only
• Os goal: Return patient to their baseline.
• Humidify with high flow Nasal Cannula
• Oxygen administration systems
See Table 25-1
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Venturi Mask, Nonrebreathing Mask,
Partial Rebreathing Mask
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T-Piece and Tracheostomy Collar
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Patient Teaching: Home Oxygen (See
Chart 25-2)
• Safety considerations
• Flow rate and flow adjustment
• Maintenance of equipment
• Identification of malfunction
• Humidification
• Ordering of supplies and oxygen
• Signs and symptoms to report
• Diet and activity, travel
• Electrical outlets
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Complications of Oxygen Therapy
• Oxygen toxicity
• Reduction of respiratory drive in patients with chronic low
oxygen tension
• Fire – no smoking signs
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Oxygen Toxicity
• Oxygen concentrations of greater than 50% for extended
periods of time (longer than 48 hours) can cause an
overproduction of free radicals, which can severely damage
cells.
• Symptoms include substernal discomfort, paresthesias,
dyspnea, restlessness, fatigue, malaise, progressive respiratory
difficulty, refractory hypoxemia, alveolar atelectasis, and
alveolar infiltrates on x-ray.
• Need high antioxidant diet
• Prevention:
– Use lowest effective concentrations of oxygen.
– PEEP or CPAP prevents or reverses atelectasis and allows
lower oxygen percentages to be used.
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Suppression of ventilation
• In COPD = resp drive is from increased blood O2 not
increased CO2
• Therefore, high flow O2 causes the respiratory drive to
be suppressed
• Solution
– Give lowest flow rate possible (1-2 L/min)
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Incentive Spirometer (See Chart 25-3)
• Types: volume and flow
• Device ensures that a volume of air is inhaled and the
patient takes deep breaths.
• Used to prevent or treat atelectasis
• Nursing care
– Positioning of patient, teach and encourage use, set
realistic goals for the patient, and record the results.
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Mini-Nebulizer Therapy
• A hand-held apparatus that disperses a moisturizing
agent or medication such as a bronchodilator into the
lungs. The device must make a visible mist.
• Nursing care: instruct patient in use.
– Patient is to breathe with slow, deep breaths through
mouth and hold a few seconds at the end of
inspiration.
– Coughing exercises may be encouraged to mobilize
secretions after a treatment.
• Assess patient before treatment and evaluate patient
response after treatment.
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Chest Physiotherapy
• Includes postural drainage, chest percussion and vibration, and
breathing retraining. Effective coughing is also an important
component.
• Goals are removal of bronchial secretions, improved
ventilation, and increased efficiency of respiratory muscles.
• Postural drainage uses specific positions to use gravity to assist
in the removal of secretions.
• Vibration loosens thick secretions by percussion or vibration.
• Breathing exercises and breathing retraining improve
ventilation and control of breathing and decrease the work of
breathing.
See Chart 25-4
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Postural Drainage Positions: lower lobes,
anterior basal segment
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Postural Drainage Positions: lower lobes,
superior segments
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Postural Drainage Positions: lower lobes,
lateral basal segment
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Postural Drainage Positions: upper lobes,
anterior segment
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Postural Drainage Positions: upper lobes,
posterior segments
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Postural Drainage Positions: upper lobes,
apical segment
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Percussion and Vibration
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High-Frequency Chest Wall Oscillation
Vest
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Technique for Supporting Incision While a
Patient Coughs
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Arm and Shoulder Exercises
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