Deep Breathing & Coughing Exercises

Oxygen Therapy

Pre-Lab Questions:
1. Define:
• Ventilation: the movement of gases in and out of the lungs
• Perfusion: the movement of oxygen and carbon dioxide between the alveoli and the red blood cells
• Diffusion: the distribution of red blood cells to and from the pulmonary capillaries
2. Define the following alterations of breathing:
• Hyperventilation: is a state of ventilation in excess of that required to eliminate the normal venous
carbon dioxide produced by cellular metabolism.

• Hypoventilation: occurs when alveolar ventilation is inadequate to meet the body's oxygen demand
or to eliminate sufficient carbon dioxide

3. What are the causes and signs and symptoms of hypoxia?

As alveolar ventilation decreases, PaCO2 is elevated. Severe atelectasis can produce hypoventilation.
Atelectasis is a collapse of the alveoli that prevents normal respiratory exchange of oxygen and carbon
dioxide. As alveoli collapse, less of the lung can be ventilated and hypoventilation occurs.

Signs and symptoms of hypoventilation include mental status changes, dysrhythmias, and potential
cardiac arrest. Treatment requires improving tissue oxygenation, restoring ventilatory function, treating
the underlying cause of the hypoventilation, and achieving acid–base balance. If untreated, the patient's
status can rapidly decline, leading to convulsions, unconsciousness, and death.

4. How does the presence of secretions affect oxygenation?

Secretions can plug the airway, thereby decreasing the amount of oxygen available for gas exchange in
the lung

5. Why can high concentrations of oxygen be lethal for clients with chronic
obstructive pulmonary disease (COPD)?......(Keep it simple.... can be confusing)
These patients have adapted to a high carbon dioxide level, and their carbon dioxide–sensitive
chemoreceptors are essentially not functioning. Their stimulus to breathe is a decreased PaO2 . If
excessive oxygen is administered, the oxygen requirement is satisfied and the stimulus to breathe is
negated. High concentrations of oxygen (e.g., >24%– 28% [1–3 L/min]) prevent the PaO2 from falling
and obliterate the stimulus to breathe, resulting in hypoventilation. The excessive retention of carbon
dioxide may lead to respiratory arrest
6. Describe the following two basic breathing techniques:
• Pursed-lip breathing: is a breathing technique designed to make your breaths more
effective by making them slower and more intentional. You do this after inhaling by
puckering your lips and exhaling through them slowly and deliberately, often to a count.
• Diaphragmatic or abdominal breathing: Abdominal (or diaphragmatic) breathing The
diaphragm is a dome-shaped muscle, which separates our chest and abdomen. When we
breathein the diaphragm tightens, flattens and moves down, sucking air into the lungs. As the
diaphragm moves down, it pushes the abdominal contents down, which forces the abdominal
wallout.

7. What are the important considerations to remember for someone receiving

 oxygen? Ensure pulse oximetry is available to monitor response to oxygen
therapy
 Document baseline observations including saturations, respiratory rate, blood
pressure and pulse
 Note respiratory effort, colour, level of consciousness
 Check that there is a prescription for oxygen with a stated target saturation
range (except in peri-arrest situation)
 Where there is no known risk of carbon dioxide retention (target 94-98%), start
oxygen therapy using a reservoir mask at 10-15L/min. Where there is a risk of
carbon dioxide retention (target 88-92%), start oxygen therapy using a 28%
Venturi device and mask
 Ensure delivery device is connected via tubing to oxygen supply and turned on
to the appropriate flow rate (if cylinder, check fill level of cylinder and be aware
of duration time)
 Explain procedure to the patient and gain consent where possible. In patients
who are acutely sick, this may not be possible and clinicians should act in the
patient’s best interests
 Place the oxygen mask on the patient’s face, adjusting the nose clip and
elastic straps to ensure a close fit
 Reassure the patient – if the patient is very breathless, oxygen masks can feel
very claustrophobic
 Monitor response to oxygen therapy – recheck oxygen saturations, vital signs,
colour and level of consciousness
 Titrate oxygen according to oxygen saturations (Fig 4) to maintain saturations
within prescribed target range. Allow five minutes at each dose before further
adjustment. Sudden withdrawal of oxygen in a patient with hypercapnia leads
to rebound hypoxaemia
  Document all adjustments to inspired oxygen (FiO2), with saturations recorded

8. What are some important points for someone receiving oxygen by:
Nasal prongs: Select the appropriate size nasal prong for the patient's age and size. 
For nasal prong oxygen without humidification a maximum flow of:

 2 LPM in infants/children under 2 years of age

 4 LPM for children over 2 years of age.
 1 LPM for neonates
With the above flow rates humidification is not usually required. However, if humidification is clinically
indicated - set up as per the recommended guidelines for the specific equipment used. As with the other
delivery systems the inspired FiO2 depends on the flow rate of oxygen and varies according to the
patient's minute ventilation. 
Care and considerations of child with simple nasal prongs: 

 Position the nasal prongs along the patient’s cheek and secure the nasal prongs on the patient’s
face with adhesive tape.
 Position the tubing over the ears and secure behind the patient’s head. Ensure straps and tubing
are away from the patient's neck to prevent risk of airway obstruction.
 Check nasal prong and tubing for patency, kinks or twists at any point in the tubing and clear or
change prongs if necessary. 
 Check nares for patency - clear with suction as required. 
 Change the adhesive tape weekly or more frequently as required 

Oxygen mask:
1. Inspect patient for signs and symptoms associated with hypoxia and presence of airway
secretions.
2. Obtain patient's most recent SpO2 or arterial blood gas (ABG) values. Review patient's medical
record for the medical order for oxygen, noting delivery method, flow rate, and duration of
oxygen therapy
3. Explain to the patient and family what the procedure entails and the purpose of oxygen therapy.
4. Perform hand hygiene.
5. Attach oxygen delivery device (e.g., mask) to oxygen tubing and attach to humidified oxygen
source adjusted to prescribed flow rate
6. . Place tips of cannula into patient's nares, and adjust elastic headband or plastic slide until
cannula or face mask fits snugly and comfortably