2 Oxygen TherapyAdministration 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.Oxygen administration systems
5 Complications of Oxygen Therapy Oxygen toxicityReduction of respiratory drive in patients with chronic low oxygen tensionFire
6 Oxygen ToxicityOxygen 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.Prevention:Use lowest effective concentrations of oxygen.PEEP or CPAP prevent or reverse atelectasis and allow lower oxygen percentages to be used.
7 Incentive Spirometer Types: volume and flow Device insures that a volume of air is inhaled and the patient takes deep breathes.Used to prevent or treat atelectasis.Nursing carePositioning of patient, teach and encourage use, set realistic goals for the patient, and record the results.
8 Intermittent Positive-Pressure Breathing Indicated for patients who need to increase lung expansion.Rarely used.Monitor for side effects, which may include pneumothorax, increased intracranial pressure, hemoptysis, gastric distention, psychological dependency, hyperventilation, excessive oxygen administration, and cardiovascular problems.
9 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 breathes through mouth and hold a few seconds at the end of inspiration.Coughing exercises may be encouraged to mobilize secretions after a treatment.Assess patent before treatment and evaluate patient response after treatment.
10 Chest PhysiotherapyIncludes 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
18 Patient Teaching: Home Oxygen- Safety considerationsFlow rate and flow adjustmentMaintenance of equipmentIdentification of malfunctionHumidificationOrdering of supplies and oxygenSigns and symptoms to reportDiet and activity, travelElectrical outlets
19 Endotracheal Intubation: Placement of a tube to provide a patent airway for mechanical ventilation and for removal of secretionsPurpose and complications related to the tube cuffAssessment of cuff pressurePatient assessmentRisk for injury/airway compromise related to tube removalPatient and family teaching
21 TracheostomyBypasses the upper airway to bypass an obstruction, allow removal of secretions, permit long-term mechanical ventilation, prevent aspirations of secretions, or to replace an endotracheal tube.Complications include bleeding, pneumothorax, aspiration, subcutaneous or mediastinal emphysema, laryngeal nerve damage, posterior tracheal wall penetration.Long-term complications include airway obstruction, infection, rupture of the innominate artery, dysphagia, fistula formation, tracheal dilatation, and tracheal ischemia and necrosis.
23 Nursing Diagnoses: Patients with Endotracheal Intubation or Tracheostomy CommunicationAnxietyKnowledge deficitIneffective airway clearancePotential for infection
24 Mechanical Ventilation Positive or negative pressure breathing device to maintain ventilation or oxygenation.IndicationsNegative-pressure“Iron lung”, chest cuirassPositive-pressurePressure-cycledTimed-cycledVolume-cycled
25 Noninvasive Positive–Pressure Ventilation Use of mask or other device to maintain a seal and permit ventilation.IndicationsContinuous Positive Airway Pressure (CPAP)Bi-level Positive Airway Pressure (bi-PAP)
26 Positive Pressure Ventilator Figure 39–9 A, Positive-pressure ventilator and B, the control panel used to set the mode, rate, limits, and percentage of oxygen delivered.
27 Figure 39–9 A, Positive-pressure ventilator and B, the control panel used to set the mode, rate, limits, and percentage of oxygen delivered.
28 Nursing Process: The Care of Patients who are Mechanically Ventilated Infections- Assessment Assessment of the patientSystematic assessment include all body systemsIn-depth respiratory assessment including all indicators of oxygenation statusComfortCoping, emotional needsCommunicationAssessment of the equipment
29 Nursing Process- The Care of Patients who are Mechanically Ventilated Infections- Diagnoses Impaired gas exchangeIneffective airway clearanceRisk for traumaImpaired physical mobilityImpaired verbal communicationDefensive copingPowerlessness
30 Collaborative Problems Alterations in cardiac functionBarotraumaPulmonary infectionSepsis
31 Nursing Process: The Care of Patients who are Mechanically Ventilated Infections- Planning Goals include achievement of optimal gas exchange, maintenance of patent airway, attainment of optimal mobility, absence of trauma or infection, adjustment to nonverbal methods communication, acquisition of successful coping measures, and the absence of complications.
32 Enhancing Gas Exchange Monitor ABGs and other indicators of hypoxia. Note trends.Auscultate lung sounds frequentlyJudicious use of analgesicsMonitor fluid balanceA complex diagnosis that requires a collaborative approach.
33 Promoting Effective Airway Clearance Assess lung sounds at least every 2-4 hours.Measures to clear airway: suctioning, CPT, position changes, promote mobilityHumidificationMedications
34 Preventing Trauma and Infection Infection control measuresTube careCuff managementOral careElevation of HOB
35 Other Interventions ROM and mobility; get out of bed Communication methodsStress reduction techniquesInterventions to promote copingInclude in care: family teaching, and the emotional and coping support of the family.Home ventilator care
36 Weaning Process of withdrawal of dependence upon the ventilator Successful weaning is a collaborative processCriteria for weaningPatient preparationMethods of weaning
37 Patients Undergoing Thoracic Surgery Preoperative assessmentPreoperative preparationPatient teachingReduction of anxietyPostoperative expectationsStrategies to reduce postoperative complications: atelectasis and infection
38 Chest Drainage Used to treat spontaneous and traumatic pneumothorax Used postoperatively to reexpand the lung and remove excess air, fluid, and blood.Types of drainage systemsTraditional water sealDry suction water sealDry suctionManagementPrevention of cardiopulmonary complications
39 Patient Teaching and Home Care Considerations Breathing and coughing techniquesPositioningAddressing pain and discomfortPromoting mobility and arm and shoulder exercisesDietPrevention of infectionSigns and symptoms to report
40 Technique for Supporting Incision While a Patient Coughs