-
respiratory treatment
- supplemental oxygen
- pharmacology agent
- positioning
- suction
-
Oxygen
- fraction of Inspired Oxygen (FiO2) this is the percent of O2 a pt is inhaling. RA FiCo2 is 21%. by applying supplment oxygen, the FiO2 can go as high as 100%. Cannula, masks, trachs, tents- ventilator
- supplemental O2 devices should be used for the following until treatment resolves the following symptoms:
- - hypoxemia- low pp of O2 in arterial blood
- - hypoxia- insufficient tissue oxygenation
-
other indication for O2 therapy
- circulatory problems-
- - heart failure, MI, dsyrhythimias, hemorrhage
- Oxygen transport problems-
- - anemia, sickle cell crisis, CO poisoning
- Pulmonary problems
- - obstructive disease, restrictive disease, PE, pulmonary edema, resp failure
- ** cant throw oxygen at everyone you can cause O2 toxicity
-
Goals of Oxygen Therapy
- treat hypoxemia
- dec work of breathing, lower RR- dec tachyapnea
- dec myocardial workload
-
Methods of Oxygen administration
- low flow systems
- - NC
- - simple face mask
- - NRB mask - non rebreather
- High flow systems:
- - venturi mask
- - ventilators
- vents
-
Nursing care
- correct o2 rate
- consider nasal cannula for pts on mask during meal time
- freq mouth care, proper humidification
- freq breath sounds, lung sounds
- monitor I&O
- prevent hazard- fire/safety
- watch for co2 narcosis
- skin care
-
CO2 narcosis
- condition of confusion
- tremors, convulsions and possible coma- if blood level CO2 > 70
- COPD pt- maybe asymptomatic w/co2 narcosis, bc of developement of tolerance inc co2
- RR is usually low
-
Oxygen toxicity
- this can develop when O2 concentration is > 50% administered longer 48 to 72 hours
- prolonged use of high o2 concentration reduces surfactant production, which leads to alveolar collapse and reduce lung elasticity
- symptoms- dry cough, nasal congestion, sore throat, dyspnea, bronchial irritation, HA that progresses to confusion
-
Transtracheal O2
- for chronic disease pts
- more confortable effective
- outpatient insertion
- no interference with talking, eating drinking
- PaO2 is </= 55 on RA
- ineligible if bleeding disorder, severe bronchospasm, resp acidosis, high dose steriods
- worry about pt- social, psychosocial
-
home O2 therapy
- shown to extend lives, improve mental function and motor ability and shorten hospital stay
- consider safety and pyschological support **
- safety- fall, smoking
- psychological- worry about how other will view them
-
respiratory pharmacologic agents
- goals
- relieve bronchoconstriction and promote bronchodilation
- improve mucociliary transport and removal of secretion
- imorove alveolar ventilation and oxygenation
- promote normal breathing pattern
-
respiratory pharm agents
- adrenergic sympathomimetics- albuterol- used to often go to md, too much can mess with K. heart affects
- anticholi- atrovent
- corticosteriords- s/e inc infection, htn, inc bs, bone loss,
- Methylzanthines- theophylline0 look for this lab- cause toxicity
- leukotriene receptor antagonist- singular
- Anitussive
- mucolytics
- expectorants
- - be careful for sugar, not too much, dm pt
-
Other nursing management
- always listen to your patient first. assessment first
- postural drainage
- suctioning
- CPT- chest physiotherapy
- incentives spirometer- use in normal and abn situation
- pursed lip breathing- inhale slowly through nose/exhale slowly through pursed lip
- effective coughing
- before you position pt listent to your pt
-
suctioning
- indications
- - increased RR & HR
- - noisy respiration
- - restlessness
- - anxiety
-
Suctioning
- procedure
- hyperoxygenated pre and post
- set suction- sterile procedure
- prelubrication catheter- H2o or surgilube
- insert cathter carefully
- apply suction only on withdrawing , 10 seconds or less
- allow rest periods between attempts
-
suctioning
- complications
- hypoxemia
- dysrhythmias
- trauma to mucosal
- infection
- atelectasis
- sudden death (usually when > 15 sec)
-
general nursing care for respiratory disorders
- positioning and posture- high/semi fowler's
- - orthopneic position
- - tripod position
- - good body alignment
- Environment - free of irritants **
- - avoid aerosolized sprays
- - humidification
- - cool environment
- separate abd cavity and thoracic cavity
-
general nursing care for respiratory disorders
- activity and rest etc
- activity and rest- over exert
- oral hygiene- antispetic mouth wash
- appetite- small, frequent meals
- - avoid gas forming foods
- - dec CHO- carbs inc CO2
- - adequate hydration- 3000-4000L/d
- -- especially with no cardiac issue
- -- pne
- -- moisture
- HF contraindicated
-
general nursing care for respiratory disorders
- Infection control
- avoid repeated respiratory infections- ie if pt is still smoking
- opportunistic infections
- T,C,DB
- change resp equipment daily
- separate infected pts from non
- flu/pne shorts for pt and staff
-
general nursing care for respiratory disorders
- psychosocial support
- avoid blaming the victim- esp if smoking
- reduce anxiety
- fear of dying
- financial concerns
- include pt and family
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