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Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Chapter 30 Care of Patients Requiring Oxygen Therapy or Tracheostomy.

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Presentation on theme: "Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Chapter 30 Care of Patients Requiring Oxygen Therapy or Tracheostomy."— Presentation transcript:

1 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Chapter 30 Care of Patients Requiring Oxygen Therapy or Tracheostomy

2 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 2 Oxygen Therapy  Hypoxemia—low levels of oxygen in the blood  Hypoxia—decreased tissue oxygenation  Goal of oxygen therapy—to use the lowest fraction of inspired oxygen for an acceptable blood oxygen level without causing harmful side effects

3 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 3 Oxygen Intake and Oxygen Delivery

4 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 4 Hazards and Complications of Oxygen Therapy  Combustion  Oxygen-induced hypoventilation  Oxygen toxicity  Absorption atelectasis  Drying of mucous membranes  Infection

5 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 5 Low-Flow Oxygen Delivery Systems  Nasal cannula  Simple facemask

6 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 6 Low-Flow Oxygen Delivery Systems (Cont’d)  Partial rebreather mask  Non-rebreather mask

7 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 7 High-Flow Oxygen Delivery Systems  Venturi mask  Face tent  Aerosol mask  Tracheostomy collar  T-Piece

8 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 8 Venturi Mask

9 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 9 T-Piece

10 10 Noninvasive Positive-Pressure Ventilation  Technique uses positive pressure to keep alveoli open and improve gas exchange without airway intubation  BiPAP—mechanical delivery of set positive inspiratory pressure each time the patient begins to inspire; as the patient begins to exhale, the machine delivers a lower set end-expiratory pressure, together improving tidal volume.  CPAP—continuous positive airway pressure

11 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 11 Continuous Positive Airway Pressure (CPAP)

12 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 12 Continuous Nasal Positive Airway Pressure  Technique delivers a set positive airway pressure throughout each cycle of inhalation and exhalation.  Effect is to open collapsed alveoli.  Patients who may benefit include those with atelectasis after surgery or cardiac- induced pulmonary edema; it may be used for sleep apnea.

13 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 13 Transtracheal Oxygen Delivery  Used for long-term delivery of oxygen directly into the lungs  Avoids the irritation that nasal prongs cause and is more comfortable  Flow rate prescribed for rest and for activity

14 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 14 Home Oxygen Therapy  Criteria for home oxygen therapy equipment  Patient education for use:  Compressed gas in a tank or cylinder  Liquid oxygen in a reservoir  Oxygen concentrator

15 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 15 Oxygen Therapy

16 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 16 Tracheostomy  Tracheotomy is the surgical incision into the trachea for the purpose of establishing an airway.  Tracheostomy is the stoma, or opening, that results from the procedure of a tracheotomy.  Procedure may be temporary or permanent.

17 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 17 Tracheostomy

18 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 18 Interventions  Preoperative care  Operative procedures  Postoperative care—ensure patent airway  Possible complications assessment:  Tube obstruction  Tube dislodgment—accidental decannulation

19 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 19 Other Possible Complications Assess for:  Pneumothorax  Subcutaneous emphysema  Bleeding  Infection

20 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 20 Tracheostomy Tubes  Disposable or reusable  Cuffed tube or tube without a cuff for airway maintenance  Inner cannula disposable or reusable  Fenestrated tube

21 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 21 Tracheostomy Tubes

22 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 22 Care Issues for the Tracheostomy Patient  Prevention of tissue damage:  Cuff pressure can cause mucosal ischemia.  Use minimal leak technique and occlusive technique.  Check cuff pressure often.  Prevent tube friction and movement.  Prevent and treat malnutrition, hemodynamic instability, or hypoxia.

23 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 23 Cuff Pressures

24 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 24 Air Warming and Humidification  The tracheostomy tube bypasses the nose and mouth, which normally humidify, warm, and filter the air.  Air must be humidified.  Maintain proper temperature.  Ensure adequate hydration.

25 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 25 Suctioning  Suctioning maintains a patent airway and promotes gas exchange.  Assess need for suctioning from the patient who cannot cough adequately.  Suctioning is done through the nose or the mouth.

26 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 26 Suctioning (Cont’d)  Suctioning can cause:  Hypoxia (see causes to follow)  Tissue (mucosal) trauma  Infection  Vagal stimulation and bronchospasm  Cardiac dysrhythmias from hypoxia caused by suctioning

27 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 27 Causes of Hypoxia in the Tracheostomy  Ineffective oxygenation before, during, and after suctioning  Use of a catheter that is too large for the artificial airway  Prolonged suctioning time  Excessive suction pressure  Too frequent suctioning

28 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 28 Possible Complications of Suctioning  Tissue trauma  Infection of lungs by bacteria from the mouth  Vagal stimulation—stop suctioning immediately and oxygenate patient manually with 100% oxygen  Bronchospasm—may require a bronchodilator

29 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 29 Tracheostomy Care  Assessment of the patient.  Secure tracheostomy tubes in place.  Prevent accidental decannulation.

30 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 30 Bronchial and Oral Hygiene  Turn and reposition every 1 to 2 hr, support out-of-bed activities, encourage early ambulation.  Coughing and deep breathing, chest percussion, vibration, and postural drainage promote pulmonary cure.  Oral hygiene—avoid glycerin swabs or mouthwash that contains alcohol; assess mouth for ulcers, bacterial or fungal growth, or infections.

31 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 31 Nutrition  Swallowing can be a major problem for the patient with a tracheostomy tube in place.  If the balloon is inflated, it can interfere with the passage of food through the esophagus.  Elevate the head of bed for at least 30 minutes after the patient eats to prevent aspiration during swallowing.

32 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 32 Speech and Communication  Patient can speak with a cuffless tube, fenestrated tube, or cuffed fenestrated tube that is capped or covered.  Patient can write.  Phrase questions to patient for “yes” or “no” answers.  A one-way valve that fits over the tube and replaces the need for finger occlusion can be used to assist with speech.

33 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 33 Fenestrated Tracheostomy Tube

34 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 34 Weaning from a Tracheostomy Tube  Weaning is a gradual decrease in the tube size and ultimate removal of the tube.  Cuff is deflated as soon as the patient can manage secretions and does not need assisted ventilation.

35 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 35 Weaning from a Tracheostomy Tube (Cont’d)  Change from a cuffed to an uncuffed tube.  Size of tube is decreased by capping; use a smaller fenestrated tube.  Tracheostomy button has a potential danger of getting dislodged.


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