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CHAPTER 6
OXYGENATION NEEDS
LANCASTER HIGH SCHOOL
MRS. CARPENTER
OBJECTIVES
 FACTORS AFFECTING OXYGEN
STATUS
 IDENTIFY SIGNS OF HYPOXIA
 PERFORM
 SETTING UP FOR OXYGEN
ADMINISTRATION
 COUGH AND DEEP BREATHE
EXERCISES
 COLLECTING A SPUTUM SPECIMEN
 PERFORMING PULSE OXIMETRY
Oxygen status
 factors affecting oxygen needs
 Respiratory system status
 all structures must be intact and
functioning
 open airway
 exchange of o2 and co2 in alveoli
FACTORS AFFECTING
OXYGEN STATUS
 Cardiovascular system
function


good blood flow to and from the heart.
narrowed vessels decrease O2 to cells
and cause excess CO2 in capillaries
FACTORS AFFECTING
OXYGEN STATUS
 Red blood cell count



RBC’s carry oxygen, insufficient amount
causes decrease in the cells.
blood loss reduces #
production by the bone marrow affected
by:


poor diet
chemotherapy
FACTORS AFFECTING
OXYGEN STATUS
 Intact Nervous system


disease of nervous system affect
respiration and respiratory muscle
function
breathing is difficult
FACTORS AFFECTING
OXYGEN STATUS
 affects of disease in nervous system:
brain damage=decreased rate, depth,
and rhythm
 narcotics=slowing of respirations
 lack of O2 and CO2 in the blood=increased
respirations to get more
FACTORS AFFECTING
OXYGEN STATUS
 Aging


muscles weaken and lung tissue less
elastic
less strength for coughing to remove
secretions leading to pneumonia
FACTORS AFFECTING
OXYGEN STATUS
 Exercise


demand for O2 increases
those with diseases have enough at
rest but unable to get with increase
FACTORS AFFECTING
OXYGEN STATUS
 Fever


increases need for O2
rate and depth of respirations must
increase to meet need.
FACTORS AFFECTING
OXYGEN STATUS
 Pain


increases need for O2, rate and depth o
may not be able to do this is chest or
abdominal injury or surgery
FACTORS AFFECTING
OXYGEN STATUS
 Medication

may depress respiratory center in the
brain two ways:


respiratory depression=slow, weak respirations,
>12/minute
too shallow to get enough air into lungs
FACTORS AFFECTING
OXYGEN STATUS
 respiratory arrest


=breathing stops
medications that can cause respiratory
depression and respiratory arrest
FACTORS AFFECTING
OXYGEN STATUS


narcotics
 morphine
 Demerol
 Opium
 Heroin
 Methadone
depressants
 barbiturates
FACTORS AFFECTING
OXYGEN STATUS
 Smoking


causes lung cancer and COPD
at risk for CAD
 Allergies
 respiratory system response to allergen
 symptoms cause swelling
FACTORS AFFECTING
OXYGEN STATUS
 Pollutant exposure

pollutants in the air or water cause
damage to the lungs.
 Nutrition


iron and vitamin B, c, and folic acid to
produce new RBC
live only 3-4months then are replaced
FACTORS AFFECTING
OXYGEN STATUS
 Substance abuse
 alcohol can depress brain function,
decrease cough reflex which increases
risk of aspiration
Altered respiratory
function
 Three processes involved with respiration
 if one process is affected the respiratory
process is altered.
-types of respiratory
alteration
 hypoxia
 deficiency of oxygen in the cells
 cause cells to function abnormally, and brain
function to decrease
 caused by :

illness

disease

injury

surgery affecting respiratory function
signs and symptoms
 signs and
symptoms





restlessness
dizziness
disorientation
confusion
behavior and personality
changes
 apprehension
 anxiety




fatigue
agitation
increased pulse rate
increased rate and depth
R
 leaning forward,
constantly sitting
 cyanosis
 dyspnea





abnormal respirations
12 to 20 times per minute
increased in infants and children
should be quiet, effortless, and regular
both sides of chest rise and fall equally.
 types of abnormal respirations
 tachypnea-above 24/minute
 caused by: pregnancy, pain, exercise,
airway obstruction, hypoxemia
 bradypnea-less than 10 /minute
 caused by:drug overdoses, CNS
disorders
types of abnormal
respirations







apnea
hypoventilation
hyperventilation
dyspnea
Orthopnea
Biot’s
Kussmauls
tests ordered to determine
cause




chest x-ray
lung scan
Bronchoscopy
Thoracentesis
 pulmonary function
test
 arterial blood gases
 pulse oximetry*
 normal =95%-100%
Sputum culture
choosing a site for pulse
oximetry.
 Based on
 condition of the person
 breaks in the skin
 poor circulation
 don’t use fingers or toes
 Dark nail polish will distort the reading
 Movements can alter the reading
 ( tremors, shivering, seizures)
 Children attach to sole of foot, palm of hand , finger,
toe or earlobe
 Older person use ear, nose and forehead d/t poor
circulation
reporting pulse oximetry
results
 *Write as SpO2
 S=saturation, p=pulse, O2=oxygen





Date and time
Activity of the person
O2 rate if in use
Reason for measurement
Other observation=difficulty breathing,
cyanosis, slow pulse
 APPLICATION #1
 PROCEDURE: PULSE OXIMETRY
sputum specimens*






sputum = secretion from trachea, lungs, and
bronchi, expectorated through the mouth
saliva is from salivary glands in the mouth
“spit”
studied for blood, microbes, and abnormal
cells.
painful and difficult for patient
rinse mouth to remove food particles and
decrease saliva
never use mouthwash, can destroy microbes
special needs-sputum
specimens
 children
 breathing treatments and suctioning to produce
sputum
 elderly
 lack strength to cough up sputum
 use of postural drainage (RN or RT)
Oxygenation
 Positioning
 usually easier in Semi-Fowler’s or
Fowlers position
 may prefer to sit up in bed or lean on
overbed table=Orthopneic position
 changes of position q2hr to prevent
pooling of fluids
Coughing and Deep
breathing

removal of mucous and expansion of
lungs from the respiratory tract



pneumonia
atelectasis
routine after surgery and pts on bed rest
problems to look for

pain


if post op or injured
fear


breaking open an incision
increased pain
Incentive Spirometry

measure the amount of air a person
inhales and increase intake in the lungs.
uses







post operatively
pneumonia
respiratory disease
bedridden patient
elderly that have been hospitalized
how often and amount of breaths is
determined by RN and facility policy
 APPLICATION #2
PROCEDURE: COUGH AND DEEP
BREATHING
PROCEDURE: COLLECT A SPUTUM
SPECIMEN
Oxygen Therapy


used for hypoxemia
treated as a drug needs MD order with
device and amount
OXYGEN THERAPY
 types.
 Continuous
 never stopped or interrupted for any reason
 intermittent
 used for symptom relief of chest pain and SOB
 PCT is responsible for safe care to pt
receiving O2
oxygen sources
 wall outlet
 O2 piped into each room from central oxygen
supply
 may only use in the room
 extension is often needed to reach restroom,
etc.
 oxygen tank
 portable
 filled by a company and brought to the facility
for storage
 gauge to determine how much O2 in the tank
oxygen sources
Oxygen concentrator
no source of oxygen is needed




takes oxygen from the air
limits movement of the patient
useless in a power failure
flammability
devices to administer oxygen
nasal cannula
 two prongs from tubing inserted into
nostrils
 pressure from ears, nasal irritation
face mask
 covers nose and mouth with small holes
in the sides
devices to administer oxygen
partial rebreathing face mask



reservoir bag added to the face mask for
exhaled air
inhales room air, exhaled air and oxygen
bag should never totally deflate
nonrebreathing face mask



prevents exhaled air from entering the
reservoir bag
inhales air and oxygen from the reservoir bag
bag should never totally deflate
devices to administer oxygen

Venturi mask

precise amount delivered indicated by
color code
administering oxygen
 special care of
patient with mask
 communication
 skin integrity
 food intake
administering oxygen
 O2 delivered in Liters/minute set by RT
or RN, should be checked frequently
 AP’s may adjust in some states check
facility policy
 patient name/room number/bed
number/device ordered
 may assist not responsible for
administering O2
 APPLICATION #3 PROCEDURE:
SETTING UP FOR OXYGEN
ADMINISTRATION
Artificial Airways





Intubation=insertion of an artificial
airway to help it remain patent
airway is obstructed d/t disease, injury,
secretions, aspiration
semiconscious or unconscious state of
patient
recovering from anesthesia
needs mechanical ventilation
care of the patient with
artificial airway
 *vitals signs checked often
 *observe for hypoxia and respiratory distress
 *maintain the airway and notify the RN if
dislodged
 *oral hygiene
 *encourage communication
 *comfort and reassurance by use of touch and
compassion
common airways
 oropharyngeal
 inserted through the mouth into the pharynx
 can be done by RN
 nasopharyngeal
 inserted through a nostril and into the
pharynx
 can be done by RN
common airways
endotracheal



inserted through mouth or nose and into the trachea
by a MD or RN with special training using a lighted
scope.
kept in place by a balloon at the end of the tube
tracheostomy

inserted through a surgical incision into the
trachea

some types have cuffs that are inflated to keep in
place

done by MD
common airwaysTracheostomies
 vary depending on the need and the
condition of the pt.
 permanent
 when airway structures are removed d/t disease
or trauma
 children from congenital defects
 temporary
 conditions requiring mechanical ventilation
 usually removed when the condition returns to
normal and pt can breathe on their own.
Trach tubes
 made of plastic or metal and consists of three parts
 vary depending on their function and need of the pt
 outer cannula-secured in place by ties or a
Velcro collar around the neck
 never removed
 inner cannula-inserted through the outer and
locked into place
 removed for cleaning and mucus removal for
patency
 obturator-used to insert the outer cannula, then
removed
 taped to wall or bedside table incase outer
cannula comes out
Trach tubes
 patient education







no loose gauze or lint on dressings
keep the stoma or tube covered when outside
no showers
don’t get shampoo into the stoma
cover the stoma when shaving
do not swim
wear a medical alert bracelet
Trach tubes
Tracheostomy care


cleaning the inner cannula, stoma, and
application of clean ties or collar
Why?



removes mucus from the inner cannula
to keep airway patent
prevent infection at the tracheostomy
site
decrease incidence of skin breakdown
Trach tubes
 CALL THE RN IF SIGNS/SYMPTOMS
OF HYPOXIA OR RESPIRATORY
DISTRESS OCCUR OR THE OUTER
CANNULA COMES OUT DURING
Suctioning
 for pts who cannot cough or the cough is
too weak to remove secretions
 the process of withdrawing or sucking up
fluid (secretions)
 tube connected to a suction source and
to a suction catheter inserted into the
airway
Suctioning
 purpose
 removal of secretions that obstruct
airflow
 decrease incidence of microbes
 prevent hypoxia
Suctioning
 Suction routes
 oropharyngeal and nasopharyngeal
 used for person who cannot
expectorate after coughing
 tracheal
 for tracheal tube or tracheostomy
tube
Suctioning







oropharyngeal
-suction through the mouth and into the pharnyx
-a complete cycle involves inserting the catheter,
suctioning, and removing the catheter
-should be no longer than 10-15 seconds
-type of suction catheter will depend on the
secretions
*Yankauer
*Standard
Suctioning


Nasopharyngeal
- suction catheter is passed through the
nose and into the pharynx
Suctioning

Tracheostomy


usually hooked to mechanical
ventilation
may be performed by AP




if condition of the patient is stable and not
likely to change suddenly
tracheostomy is healed
hypoxia is a risk d/t no oxygen while the
suction catheter is inserted
must hyperventilate before suctioning
**for infants and children suction is no
longer than 5 seconds
 APPLICATION #5: PROCEDURE:
OROPHARYNGEAL SUCTION
Mechanical ventilation
 used if can’t breathe on their own or
cannot maintain enough oxygen in the
blood
 use of a machine to move air in and out
of the lungs
 always have artificial airways
 most common: endo tracheal and
tracheostomy
Mechanical ventilation
 reactions to ventilation
 most are seriously ill and may be dying
1.confusion and disorientation
2.fear of the machine
3.fear of dying
4.relief that they are getting oxygen
5.restricted in movements
 Care of the person on ventilation
 See text
Chest tubes
 air, blood, or fluid can collect in the
pleural space from surgery or injury
 pneumothorax
 collection of air in the pleural space
 hemothorax
 collection of blood in the pleural space
 pleural effusion
 collection of fluid in the pleural space
care of the person with a
chest tube
 keep the drainage system below the
level of the chest.
 measure vital signs and report any
changes
 note and report signs and symptoms of
hypoxia
 keep connecting tubing coiled on the
bed with slack
care of the person with a
chest tube
 prevent the tubing from becoming
kinked
 observe chest drainage and report
 increased amount
 bright red drainage
 bubbling activity increase, decrease or
stopping
care of the person with a
chest tube








record drainage
turn and position
assist with coughing and deep breathing
assist with incentive spirometery
note if the system is loose or disconnected
observe that chest tube is still in place
place gauze pad with petrolatum on insertion
site
stay with patient until the nurse arrives
QUESTIONS ????