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Oxygenation Skills
By Mary Knutson, RN
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The Nursing Process: Start with Assessment:
Subjective/objective data Nursing Diagnosis
Identify problems Planning
Goals/interventions Implementation Evaluation
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Focused Respiratory Assessment: Look for signs of dyspnea/hypoxia Ask about cough/sputum/breathing Monitor vital signs, O2 saturation Observe and auscultate chest Utilize respiratory and pain interventions
ordered by physician Evaluate effectiveness of interventions
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Interventions to Improve Oxygenation:
Comfort and reassure patient Promote relaxation and cooperation Non-pharmacological interventions Pharmacological interventions
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General Comfort and Positioning:
Elevate Head of Bed or use sitting position Maintain adequate fluids and nutrition Position patient as comfortably as possible Provide effective pain management
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Non-pharmacologic Interventions: Incentive Spirometer Coughing and deep breathing Hydration of secretions Postural drainage Chest physiotherapy Involve family, considering
culture and beliefs
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Patient Teaching:
Coughing and Deep Breathing Incentive Spirometry Prepare surgical patients for pain
assessments Anticipatory Guidance
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Pharmacologic Interventions:
Expectorants, Mucolytics Antitussives/Cough suppressants Bronchodilators (inhalers or
nebulizers) Pain medication (especially surgical
patients) Medications for chronic respiratory
conditions
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Oxygen Therapy: Use nasal cannulas, catheters, masks Wall oxygen, tanks, or concentrators Control liters per minute with
flowmeter and O2 concentration FiO2
Hyper-oxygenate patients prior to suctioning
Use lower flow rates if patient is a CO2 retainer
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Artificial Airways:
Nasal Airway Oral Airway Endotracheal tube Tracheostomy
Be sure to keep the openings
clear- potential
for obstruction
exists
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Suctioning Skills:
Oral Suctioning Tracheostomy Suctioning
Use of Ambu bagCare of tracheostomy
Suctioning of ET (Endotracheal) tubeInline suctioning of ventilator patient
Suction only as needed, not on a routine basis.
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Catheter Selection:
Choose catheter size based on airway size and sputum thickness
Adult size is usually 12-16 Fr.Pediatric size is usually 8-10 Fr.Newborn size is usually 6-8 Fr.
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Vacuum Pressure Selection:Wall Unit suction:
Adult: 100 to 120 mm HgChild: 95 to 110 mm HgInfant: 50 mm Hg
Portable Suction Unit:Adult: 10 to 15 mm HgChild: 5 to 10 mm HgInfant: 2 to 5 mm Hg
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Additional Assessments and Interventions: Arterial Blood Gases Postural Drainage Chest P.T. (Physiotherapy) Thoracentesis Chest Tube CPAP or BiPAP Mechanical Ventilation
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Chest Tubes:
Assist with insertion and removal Monitor respiratory status/drainage Check for secure, occlusive dressing Maintain functioning gravity drainage
system with no loops or kinks Keep 2 clamps at bedside in case the
unit needs changing
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Thoracentesis: Explain procedure/obtain signed permit Position patient/observe for reactions
Patient sitting on edge of bed with elbows propped
If unable, lie on unaffected side, raising hand of affected side
Prepare lab specimen, evaluate and document patient’s response
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Pre-skill Organization:
Wash hands Introduce yourself Observe the patient and the situation Listen to patient and answer questions Explain what you will be doing Assemble equipment
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Skill Completion:
Keep patient comfortable as possible Check oxygenation and administer
oxygen as prescribed/needed Evaluate results of intervention and
how the patient tolerated the procedure Wash hands Finish documentation
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Assessment Variables:
Concurrent illness or chronic illnesses Type of airway Dementia, sensory impairment, or
inability to express needs Age
Pediatric patients
Frail, elderly patients
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Pediatric Oxygenation Blood oxygen drops quickly Different sizes and types of
oxygen equipment Use developmentally
appropriate language Teach parents about
equipment, CPR, support services and safety factors
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Respiratory Care of Elderly Patients Physiological changes in lungs and
chest Less productive coughing Drier mucus membranes Respiratory problems limit
independence Increased risk for pneumonia and
other respiratory diseases
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Critical Thinking: 3 year old boy with a tracheostomy
had O2 saturation of 85%. Oxygen was started and then 89% sats. He was anxious, with resp. rate of 38. There were no abnormal lung sounds. The tubing was not kinked or blocked with water, and the oxygen was flowing. What would you do next if you suspected a mucus plug in trach?
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Critical Thinking:
You began a focused respiratory assessment on your elderly patient. You have completed the Vital Signs, but have not listened to the lungs yet. She became dyspneic, cyanotic, and had loud, audible crackles from excess secretions. Do you complete your assessment, or begin suctioning?
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Respiratory Blended Skill: Your patient is a 77 year old woman with
asthma exacerbation, pneumonia, HTN, Diabetes Mellitus II, and GERDDo focused respiratory assessmentEffective Communication Interventions to promote oxygenationEvaluation and Documentation
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Reflection: There is a lot more to the
ABC’s than you thought!AirwayBreathingCirculation
Understanding oxygenation skills gives you more of the foundation you need for excellent patient care
This presentation was created in 2004.