Interference with Ventilation Oxygen Therapy Indications: Indications: Treat: Respiratory; CV; CNS disturbances Treat: Respiratory; CV; CNS disturbances Oxygen Administration: High or low flow systems Oxygen Administration: High or low flow systems High Flow — delivers fixed concentrations independent of the patient’s respiratory pattern High Flow — delivers fixed concentrations independent of the patient’s respiratory pattern Venturi Mask – up to 50% Venturi Mask – up to 50% Low Flow — amount delivered varies with patient’s respiratory pattern Low Flow — amount delivered varies with patient’s respiratory pattern Nasal cannula 2L/min = 28% oxygen Nasal cannula 2L/min = 28% oxygen Face tent or trach collar – Increased humidity Face tent or trach collar – Increased humidity Non-re-breathing mask – delivers 80-90% Non-re-breathing mask – delivers 80-90% Humidity: Humidity: 1-4L low flow – use of “bubble-through” controversial 1-4L low flow – use of “bubble-through” controversial Nebulizer Nebulizer

Interferences with Ventilation Oxygen Therapy- Complications CO2 Narcosis – CO2 Narcosis – two chemoreceptors – O2 CO2 two chemoreceptors – O2 CO2 CO2 accumulation – major stimulus CO2 accumulation – major stimulus COPD patient – COPD patient – Develops tolerance to high CO2 Develops tolerance to high CO2 Respiratory Center loses sensitivity to elevated CO2 Respiratory Center loses sensitivity to elevated CO2 O2 Drive “Hypoxemia” O2 Drive “Hypoxemia” Concern about administering O2 to COPD patients ?? Concern about administering O2 to COPD patients ?? Bigger Concern: not providing adequate O2 Bigger Concern: not providing adequate O2 Goal: Titrate O2 to the lowest effective dose based on arterial blood gas monitoring Goal: Titrate O2 to the lowest effective dose based on arterial blood gas monitoring

Interferences with Ventilation Oxygen Therapy- Complications O2 Toxicity O2 Toxicity Prolonged exposure to high level O2 Prolonged exposure to high level O2 Determined by patient tolerance, exposure time, and effective dose Determined by patient tolerance, exposure time, and effective dose High level Manifestations – High level Manifestations – Initial -- Inactivate surfactant and lead to ARDS : reduced vital capacity, cough, substernal chest pain, N&V, paresthesia, nasal stuffiness, sore throat, malaise Initial -- Inactivate surfactant and lead to ARDS : reduced vital capacity, cough, substernal chest pain, N&V, paresthesia, nasal stuffiness, sore throat, malaise Later – affects alveolar-capillary gas exchange: pulmonary edema with copious sputum Later – affects alveolar-capillary gas exchange: pulmonary edema with copious sputum End Stage – lung fibrosis End Stage – lung fibrosis O2 Administration Goal: enough O2 to maintain PaO2 within normal or acceptable limit O2 Administration Goal: enough O2 to maintain PaO2 within normal or acceptable limit O2 administration > 50% for > 24 hours potentially toxic O2 administration > 50% for > 24 hours potentially toxic

Chronic Obstructive Lung Disease Complications

Nursing Care Management Ineffective airway clearance Assess: breath sounds; ability to effectively coughing Assess: breath sounds; ability to effectively coughing Nsg Action: Elevate head of bed; sitting up; hydration 2-3L/d; chest physiotherapy; Meds: inhaled bronchodilators & steroids. Nsg Action: Elevate head of bed; sitting up; hydration 2-3L/d; chest physiotherapy; Meds: inhaled bronchodilators & steroids. Pt Education: Effective breathing & coughing techniques; Medications & administration Pt Education: Effective breathing & coughing techniques; Medications & administration

Nursing Care Management Impaired Gas Exchange Assess: Mental status; VS with Pulse oximetry; ABGs Assess: Mental status; VS with Pulse oximetry; ABGs Nsg Action: Position – Tripod-supported extremities; Administer O2 to effective level; Nsg Action: Position – Tripod-supported extremities; Administer O2 to effective level; Pt Education: Pursed-lip breathing; signs, symptoms & consequences of hypercapnia; avoidance of CNS depressants; Medication action; smoking cessation Pt Education: Pursed-lip breathing; signs, symptoms & consequences of hypercapnia; avoidance of CNS depressants; Medication action; smoking cessation

Breathing Exercises

Orthopnea Positions to Decrease the Work of Breathing

Nursing Care Management Imbalanced Nutrition Assess: Assess: Weight within normal range for height and age; appetite; caloric intact; energy level; gastric distention; sputum production; affect; lack of interest in foods; serum albumin level Weight within normal range for height and age; appetite; caloric intact; energy level; gastric distention; sputum production; affect; lack of interest in foods; serum albumin level Nsg Action: Nsg Action: Hi PRO, HI Calorie foods & liquid supplements; small frequent feedings; periods of rest after food intake; Referral—financial & nutritional support (Meals-on-wheels; food stamps) Hi PRO, HI Calorie foods & liquid supplements; small frequent feedings; periods of rest after food intake; Referral—financial & nutritional support (Meals-on-wheels; food stamps) Pt Education: Pt Education: Referrals / Importance of rest / digestion / high protein & calorie foods – menu planning Referrals / Importance of rest / digestion / high protein & calorie foods – menu planning

Nursing Care Management Disturbed Sleep Pattern Assess: Assess: Identify usual patterns; explore reasons for discomfort, wakefulness, or difficulty sleeping; sleep apnea Identify usual patterns; explore reasons for discomfort, wakefulness, or difficulty sleeping; sleep apnea Nsg Action: Nsg Action: Identify pt-specific relaxation methods; environment conducive to rest Identify pt-specific relaxation methods; environment conducive to rest Pt Education: Pt Education: Balance activity (ADL’s) / rest; avoidance of alcoholic beverages, caffeine products, & other stimulants before bedtime; include family; sexual activity— positions of comfort; psychosocial issues Balance activity (ADL’s) / rest; avoidance of alcoholic beverages, caffeine products, & other stimulants before bedtime; include family; sexual activity— positions of comfort; psychosocial issues