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It is prescribed by the physician, who specifies the concentration, method of delivery, and liter flow per minute.
Additional Benefits of Oxygen Therapy: Increased clarity Relieves nausea Can prevent heart failure in people with severe lung disease Allows the bodies organs to carry out normal functions
Long-Term Benefits of Oxygen Therapy: Prolongs life by reducing heart strain Decreases shortness of breath Makes exercise more tolerable Results in fewer days of hospitalization Oxygen Delivery Systems 1. Nasal Cannula Also called nasal prongs. Is the most common inexpensive device used to administer oxygen. It is easy to apply and does not interfere with the client’s ability to eat or talk. It delivers a relatively low concentration of oxygen which is 24% to 45% at flow rates of 2 to 6 liters per minute.
2. Face Mask It covers the client’s nose and mouth may be used for oxygen inhalation. Exhalation ports on the sides of the mask allow exhaled carbon dioxide to escape
Types of Face Masks: 1. Simple Face Mask - Delivers oxygen concentrations from 40% to 60% at liter flows of 5 to 8 litters per minute, respectively. 2. Partial Rebreather Mask – Delivers oxygen concentration of 60% to 90% at liter flows of 6 to 10 litters per minute, respectively. 3. Non Rebreather Mask – Delivers the highest oxygen concentration possible 95% to 100% – by means other than intubation or mechanical ventilation, at litter flows of 10 to 15 litters per minute. 4. Venturi Mask – Delivers oxygen concentrations varying from 24% to 40% or 50% at litter flows of 4 to 10 litters per minute.
3. Face Tent It can replace oxygen masks when masks are poorly tolerated by clients. It provide varying concentrations of oxygen such as 30% to 50% concentration of oxygen at 4 to 8 liters per minute.
4. Transtracheal Oxygen Delivery It may be used for oxygen-dependent clients. The client requires less oxygen (0.5 to 2 liters per minute) because all of the low delivered enters the lungs.
Oxygen Therapy Safety Precautions: 1. For home oxygen use or when the facility permits smoking, teach family members and roommates to smoke only outside or in provided smoking rooms away from the client. 2. Place cautionary signs reading “No Smoking: Oxygen in use” on the clients door, at the foot or head of the bed, and on the oxygen equipment. 3. Instruct the client and visitors about the hazard of smoking with oxygen use.
4. Make sure that electric devices (such as razors, hearing aids, radios, televisions, and hearing pads) are in good working order to prevent the occurrence of short-circuit sparks. 5. Avoids materials that generate static electricity, such as woolen blankets and synthetic fabrics. Cotton blankets should be used , and client and caregivers should be advised to wear cotton fabrics. 6. Avoid the use of volatile, flammable materials such as oils, greases, alcohol, ether, and acetone(e.g. nail polish remover), near clients receiving oxygen. 7. Ground electric monitoring equipment, suction machines and portable diagnostic machines. 8. Make known the location of the fire extinguishers, and make sure personnel are trained in their use. ADMINISTERING OXYGEN BY MASK 1. Explain procedure to patient and review safety precautions necessary when oxygen is in use. Place No Smoking signs in appropriate areas. 2. Perform hand hygiene. 3. Attach face mask to oxygen setup with humidification. Start flow of oxygen to fill bag before placing mask over patient’s nose and mouth. 4. Position face mask over patient’s nose and mouth. Adjust it with the elastic strap so mask fits snugly but comfortable on face. 5. Use gauze pads to reduce irrigation on patient’s ears and scalp. 6. Perform hand hygiene. 7. Remove mask and dry skin every 2 to 3 hours if oxygen is running continuously. Do not powder around mask. 8. Assess and chart patient’s response to therapy. ADMINISTERING OXYGEN BY NASAL CANNULA 1. Explain procedure to patient and review safety precautions necessary when oxygen is in use. Place No Smoking sign in appropriate areas. 2. Perform hand hygiene. 3. Connect nasal cannula to oxygen setup with humidification, if one is in use. Adjust flow rate as ordered by physician. Check the oxygen is flowing out of prongs. 4. Place the prongs in patient’s nostrils. Adjust according to type of equipment: a. Over and behind each ear with adjuster comfortably under chin or b. Around patient’s head. 5. Use gauze pads at ear beneath tubing as necessary. 6. Encourage patient to breathe through nose with mouth closed. 7. Perform hand hygiene. 8. Assess and chart patient’s response to therapy. 9. Remove and clean cannula and assess nares at least every 8 hours or according to agency recommendations. Check nares for evidence of irrigation or bleeding.
Nebulization Therapy Nebulization is the process of medication administration via inhalation. It utilizes a nebulizer which transports medications to the lungs by means of mist inhalation.
Indication Nebulization therapy is used to deliver medications along the respiratory tract and is indicated to various respiratory problems and diseases such as: Bronchospasms Chest tightness Excessive and thick mucus secretions Respiratory congestions Pneumonia Atelectasis Asthma Contraindications In some cases, nebulization is restricted or avoided due to possible untoward results or rather decreased effectiveness such as: Patients with unstable and increased blood pressure Individuals with cardiac irritability (may result to dysrhythmias) Persons with increased pulses Unconscious patients (inhalation may be done via mask but the therapeutic effect may be significantly low)
Equipments Nebulizer and nebulizer connecting tubes Compressor oxygen tank Mouthpiece/mask Respiratory medication to be administered Normal saline solution
Procedure 1. Position the patient appropriately, allowing optimal ventilation. 2. Assess and record breath sounds, respiratory status, pulse rate and other significant respiratory functions. 3. Teach patient the proper way of inhalation: Slow inhalation through the mouth via the mouthpiece Short pause after the inspiration Slow and complete exhalation Some resting breaths before another deep inhalation 4. Prepare equipments at hand 5. Check doctor’s orders for the medication, prepare thereafter 6. Place the medication in the nebulizer while adding the amount of saline solution ordered. 7. Attach the nebulizer to the compressed gas source
8. Attach the connecting tubes and mouthpiece to the nebulizer 9. Turn the machine on (notice the mist produced by the nebulizer) 10. Offer the nebulizer to the patient, offer assistance until he is able to perform proper inhalation (if unable to hold the nebulizer [pediatric/geriatric/special cases], replace the mouthpiece with mask 11. Continue until medication is consumed 12. Reassess patient status from breath sounds, respiratory status, pulse rate and other significant respiratory functions needed. Compare and record significant changes and improvement. Refer if necessary 13. Attend to possible side effects and inhalation reactions Complications Possible effects and reactions after nebulisation therapy are as follows: Palpitations Tremors Tachycardia Headache Nausea Bronchospasms (too much ventilation may result or exacerbate bronchospasms) Teachings As nurses, it is important that we teach the patients the proper way of doing the therapy to facilitate effective results and prevent complications (demonstration is very useful). Emphasize compliance to therapy and to report untoward symptoms immediately for apposite intervention.
Thoracentesis Also known as pleural fluid aspiration, the thoracic wall is punctured to obtain a specimen of pleural fluid for analysis or to relieve pulmonary compression and resultant respiratory distress. Locating the fluid before thoracentesis reduces the risk of puncturing the lung, liver, or spleen. The pleural cavity should contain less than 20 ml of serous fluid. Pleural effusion results from the abnormal formation or reabsorption of pleural fluid. Certain characteristics classify pleural fluid as either a transudate or exudates.
Pupose To provide pleural fluid specimens to determine the cause and nature of pleural effusion. To provide symptomatic relief with large pleural effusion.
Procedure Preparation 1. Check the patient’s history for bleeding disorders or anticoagulant therapy. 2. Explain that a chest X-ray or ultrasound study may precede the test. 3. Explain the procedure to the patient. 4. Instruct the patient no to cough, breathe deeply, or move during the test to minimize the risk of lung injury. 5. Record the patient’s baseline vital signs. 6. Shave the area around the needle insertion site, if necessary, and position the patient properly. Implementation 1. Position the patient to widen the intercostals spaces and allow easier access to the pleural cavity. 2. If the patient can’t sit up, position him on his unaffected side with the arm on the affected side elevated. 3. After the patient is in proper position, prepare and drape the site. 4. Inject a local anesthetic into the subcutaneous tissue; the thoracenthesis needle is then inserted. 5. When the needle reaches the pocket of fluid, it’s attached to a 50-ml syringe or a vacuum bottle and the fluid is removed. 6. During aspiration, the patient is monitors for signs of respiratory distress and hypotension. 7. Pleural fluid characteristics and total volume are noted. 8. After the needle is withdrawn, apply pressure until hemostasis is obtained and a small dressing is applied. 9. Place specimens in proper containers, labeled appropriately, and send to the laboratory immediately.
10. Pleural fluid for pH determination must be collected anaerobically, heparinized, kept on ice, and analyzed promptly. Nursing Interventions 1. Elevate the head of the bed to facilitate breathing. 2. Obtain a chest X-ray. 3. Tell the patient to immediately report difficulty of breathing. 4. Immediately report signs and symptoms of pneumothorax, tension pneumothorax, and pleural fluid reaccumulation. 5. Monitor the patient for reexpansion pulmonary edema (RPE), a rare but serious complication of thoracentesis. Thoracentesis hould be halted If the patient has sudden chest tightness or coughing. 6. Monitor vital signs, pulse oximetry, and breathe sounds. 7. Observe the puncture site and dressings. 8. Watch for subcutaneous emphysema. 9. Monitor pleural pressure. Interpretation Normal Results Negative pressure in the pleural cavity with less than 50 ml serous fluid. Abnormal Results Bloody fluid suggests possible hemothorax, malignancy, and traumatic tap. Milky fluid suggests chylothorax. Fluid with pus suggests empyema. Transudative effusion suggests heart failure, hepatic cirrhosis, or renal disease. Exudative effusion, suggests lymphatic drainage abstraction, infections, pulmonary infarctions, and neoplasma. Positive cultures suggest infection. Predominating lymphocytes suggest tuberculosis or fungal or viral effusions. Pleural fluid glucose levels that are 30 to 40 mg/dl lower than blood glucose levels may indicate cancer, bacterial infection, or metastasis. Increased amylase suggests pleural effusions associated with pancreatitis. Interfering Factors Failure to use sterile technique. Antimicrobial therapy before fluid aspiration for culture (possible decrease in numbers of bacteria, making it difficult to isolate the infecting organism). Precautions Thoracentesis is contraindicated in the patient who has a history of bleeding disorders or anticoagulant therapy. The strict sterile technique. Complications Laceration of intercostals vessels Pneumothorax Mediastinal shift Reexpansion pulmonary edema (RPE) Bleeding and infection