1. Promoting Oxygenation
Chapter 14
Promoting Oxygenation

2. Patient-Centered Care
The respiratory system may be interrupted by lung tissue damage or disease.
Patients with airway obstruction, inflammation, excess mucus, or impaired mechanics of ventilation may require artificial airways for respiratory support.
Provide positive verbal and nonverbal communication.
Use questions that only require yes or no responses.
Use alternative communication tools.
Encourage family members to be present to decrease loneliness and isolation.

3. Safety
Patients require supplementary oxygen when oxygen levels are low.
Assess for risk of confusion and falls.
Follow safety guidelines in the home and hospital.
Assess for hypoxemia when suctioning.
Identify the type and frequency of suctioning required:
Oropharyngeal or tracheal

4. Skill 14.1 Oxygen Administration
Oxygen therapy prevents or relieves hypoxia.
Indications for supplemental oxygen:
PaO2 less than 60 mm Hg
SpO2 less than 90%
Therapy may be temporary or long term.
The type and amount of oxygen delivered are based on the FIO2 required to maintain adequate oxygenation.

5. Skill 14.1 Oxygen Administration (cont’d)
Perform respiratory assessment.
When available check arterial blood gases (ABGs) or pulse oximetry results.
Observe for patent airway; suction if necessary.
Select appropriate delivery device and tubing.
Attach to appropriate flowmeter or humidified source.
Observe for proper fit and function.
Maintain safety guidelines when oxygen is in use.
Reassess patient.

6. Skill 14.2 Airway Management: Noninvasive Interventions
Position patient to enhance airway patency.
High- or semi-Fowler’s position promotes chest expansion.
Maintain turning schedule to drain affected lung areas.
Teach deep-breathing and coughing exercises.
Controlled coughing or “huffing” techniques
Administer pharmacological agents as ordered.
Deliver pressurized oxygen by mask for obstructive sleep apnea if ordered.
Continuous positive airway pressure (CPAP)
Bi-level positive airway pressure (BiPAP)

7. Procedural Guideline 14.1 Peak Expiratory Flow Rate
Peak expiratory flow rates (PEFRs) measure:
Maximum flow during quick forced expiration.
Current status or effectiveness of treatment.
Position patient in high-Fowler’s position.
Instruct to take deep breath and close lips around mouthpiece.
Blow out as hard and fast as possible.
Monitor PEFR results and compare with previous results or personal best.

8. Skill 14.3 Chest Physiotherapy
Chest physiotherapy mobilizes pulmonary secretions.
Chest percussion:
Cupped hands strike chest to change consistency and location of sputum.
Contraindicated: Bleeding disorders, osteoporosis, and fractured ribs
Vibration:
Fine shaking pressure during exhalation loosens mucus and induces cough.

9. Skill 14.3 Chest Physiotherapy (cont’d)
Postural drainage:
Positioning techniques drain secretions from specific lung and bronchi areas.
Coordinate chest physiotherapy around meal times, tube feedings, or bronchodilator therapy.

10. Skill 14.4 Airway Management: Suctioning
Suctioning is required when noninvasive techniques and medications do not maintain a patent airway.
Determine the method of suctioning based on:
Patient assessment.
Presence of artificial airway.
Thickness and volume of secretions.
Use clean technique to suction the oral cavity.
Use sterile technique to suction the lower airway.

11. Skill 14.4 Airway Management: Suctioning (cont’d)
Assess respiratory status.
Position in semi- or high-Fowler’s position.
Open suction kit/catheter using sterile technique.
Attach to suction device.
Check function and regulate correct amount of suction.
Provide supplemental oxygen if needed.
Lubricate with water-soluble lubricant on distal 2 to 3 inches of tube (nasotracheal only).

12. Skill 14.4 Airway Management: Suctioning (cont’d)
Insert appropriate depth during inspiration.
Do not apply suction during insertion.
Apply suction:
No longer than 15 seconds.
While withdrawing catheter.
While rotating back and forth between thumb and forefinger

13. Skill 14.5 Endotracheal Tube and Tracheostomy Care
Artificial airways increase risk for infection.
Provide regular oral and lip care.
Change securing device on a regular basis.
Monitor and document ET tube depth.
Change or clean tracheostomy tube inner cannula on a regular schedule.
Follow ventilator-associated pneumonia (VAP) prevention guidelines if on a mechanical ventilator.

14. Skill 14.6 Managing Closed Chest Drainage Systems
Chest tubes are inserted and attached to a closed drainage system.
Drain air and/or fluid from the pleural space.
Closed drainage systems have two or three chambers.
The first chamber collects fluid drainage.
The second chamber contains a water seal or valve.
Allows escape of air and prevents air from returning to the pleural space
If needed, a third chamber controls suction by fluid height or dial.

15. Skill 14.6 Managing Closed Chest Drainage Systems (cont’d)
Prepare drainage unit per manufacturer directions.
Assist physician with chest tube insertion.
Monitor chambers.
Monitor:
Dressing and skin around tube site.
Tubing connections.
Signs of lung expansion.