Oxygenation

• Respiratory rate


  The number of breaths a person takes per minute
• Tachypnea (Too fast)


  1. Respiratory rate is faster than normal, can occur in response to: Strenuous exercise

  2. Fever

  3. Pain

  4. Anxiety

  5. Medications
• Bradypnea (Too slow)


  1. Respiratory rate is too slow, can be due to: Respiratory problems

  2. Medications

  
• Hypoventilation


  1. Breathing that is too shallow or too slow to meet the needs of the body, can be caused by: Prolonged bed rest

  2. Reluctant to breathe normally if breathing causes pain

  3. Overdose of drugs
• Hyperventilation


  1. Breathing that is too fast or deep, carbon dioxide is removed faster than the body produces it, can be caused by: Extreme fear or anxiety

  2. When a diabetic client's blood glucose gets too high
• Dyspnea


  Shortness of breath, where breathing gets difficult, uncomfortable, or even painful
• Measuring a client's respiration


  1. Count the number of respirations by looking at the client's chest rising as they take a breath in and falling as they breathe out

  2. For clients whose respiratory movements are subtle, position your hand over their chest or abdomen so that you can feel it rise and fall

  
• Coughing exercises


  1. Breathe in slowly and deeply through your nose

  2. Breathe out fully through your mouth

  3. Cough 2 or 3 times in a row
• Patients who are at risk for developing excess secretions should practice coughing exercises
• Patients who have recently had ear or eye surgery or repair of a hiatal or large abdominal hernia shouldn't do coughing exercises
• Patients undergoing neurosurgery shouldn't practice coughing exercise postoperatively because intracranial pressure will rise
• Deep-breathing exercises


  1. Exhale normally

  2. Inhale deeply through the nose, concentrating on feeling the abdomen rise

  3. Hold breath and count to five

  
• Incentive spirometry


  Using a breathing device to help patient achieve maximal ventilation
• Incentive spirometry devices


  • Measure patient's inspiratory effort (flow rate) in cubic cm per second (cc/second)
  • Encourage patient to take a deep breath and hold it for several seconds
  • Provide a visual incentive to breathe deeply and encourage slow, sustained maximal inspiration

  
• Flow incentive spirometer


  Used for patients at low risk for developing atelectasis
• Volume incentive spirometer


  Used for patients at high risk for developing atelectasis
• Using incentive spirometry


  1. Inhale as slowly and as deeply as possible

  2. Retain the entire volume of air they inhaled for 3 seconds or until the light turns off

  3. Exhale normally, relax and take several normal breaths before attempting another breath

  
• Chest physiotherapy


  1. Administer pain medication before the treatment as ordered

  2. Auscultate the lungs to determine baseline status

  3. Position the patient as ordered

  4. Ask the patient to inhale deeply and then exhale slowly through pursed lips

  5. Firmly press fingers and palms of hands against the chest wall during exhalation to send fine vibrations through the chest wall

  6. Percuss each segment for a minimum of 3 minutes

  
• Chest physiotherapy


  • Improves secretion clearance, ventilation & efficiency of respiratory muscles
  • Crucial for the bedridden patients
• Oxygen therapy


  The delivery of extra oxygen to those with conditions that cause hypoxia, which is when there is not enough oxygen to meet the needs of the body
• Conditions that require oxygen therapy

  • Pneumonia
  • Chronic bronchitis
  • Emphysema
  • Sleep apnea
  • Anemia
  • Heart failure
• Oxygen sources


  • Wall outlet
  • Oxygen tank
  • Liquid oxygen system
  • Oxygen concentrator

  
• Nasal cannula


  The most common oxygen delivery device, consists of two prongs that are placed into the nostrils and a band of tubing, which wraps around the cheeks and behind the ears to keep it in place
• Nasal catheter


  Can deliver low-flow oxygen

  
• Flow meter


  Indicates the flow rate, or the liters of oxygen administered per minute, usually between 1 and 15 liters per minute
• Delivery devices


  Various devices that can be applied to administer supplemental oxygen

  
• Nasal cannula


  • The most common choice
  • Consists of two prongs placed into the nostrils and a band of tubing
  • Simple to apply and less intrusive, allowing the client to eat, drink, and talk freely
  • High flow rates can cause nasal passages to dry out and sometimes bleed
  • If the bands are too tight, they might irritate the skin around the nose, cheekbones, and ears and potentially lead to open sores
  • Not preferred for clients who breathe through their mouths or those in serious conditions who require high oxygen concentrations
• Nasal catheter


  • Can deliver low-flow oxygen at somewhat higher concentrations
  • Not commonly used because of discomfort and drying of mucous membranes
• Face masks


  • Cover the client's nose and mouth
  • More complicated and might be more uncomfortable for the client
  • Make it harder to eat, drink, and talk
  • Variety of face masks including partial-rebreather masks, non-rebreather masks, and Venturi masks
• Encourage coughing and deep breathing


  To help prevent atelectasis
• Monitor ABG levels, pulse oximetry values

  Reduce oxygen concentrations as soon as results indicate it's feasible
• Low flow rate


  If patient has chronic pulmonary disease, but do not use a simple face mask because low flow rates won't flush carbon dioxide from the mask and the patient will rebreathe carbon dioxide
• Home oxygen therapy


  • Doctor orders flow rate, number of hours per day to be used, and conditions of use
  • Several delivery systems available including tank, concentrator, and liquid oxygen system
  • Chosen system depends on patient's needs and availability/cost

  
• Instruct patient, roommates, and visitors

  1. Not to use improperly grounded radios, televisions, electric razors, or other equipment

  2. Place an OXYGEN PRECAUTIONS sign on the outside of the patient's door

  
• Perform cardiopulmonary assessment


  Check that a baseline arterial blood gas (ABG) or oximetry value has been obtained
• Check patency of patient's nostrils


  Patient may need a mask if nostrils are blocked
• Assemble equipment, check connections, turn on oxygen source

  Make sure humidifier bubbles and oxygen flows through prongs, catheter, or mask

  
• Set flow rate as ordered

  Have respiratory care practitioner check flow meter for accuracy if necessary

  
• Periodically perform cardiopulmonary assessment

  On patient receiving any form of oxygen therapy

  
• Change patient's position frequently


  If on bed rest, to ensure adequate ventilation and circulation