Chapter 30Oxygen Needs

• Oxygen (O2) is a gas. It has no taste, odor, or color. Oxygen is needed for life. Every cell needs oxygen.

The respiratory and cardiovascular systems

must function properly for cells to get enough oxygen.

The Respiratory System brings oxygen into the lungs and it rids the bodyof carbon dioxide. Oxygen and carbon dioxide are exchanged betweenthe alveoli and capillaries

A. Parts of the Respiratory System1. Nose2. Mouth3. Larynx4. Epiglottis5. Trachea6. Lungs7. Bronchi & Bronchioles8. Alveoli & capillaries9. Diaphram

B. Circulatory System:- Oxygen and carbon dioxide are exchanged between the alveoli and capillaries. Blood in the capillaries pick up oxygen from the alveoli. The blood returns to the L side of the heart (left atrium) and pumped to the body.

C. Terms:Inhalation: breathing inInspiration: breathing air into the

lungsExhalation: breathing outExpiration: exhaling air out of the

lungsDiaphragm: is a muscle structure

thatseparates the lungs from the abdcavity.

2. Factors that affect Oxygen Needs:

• Respiratory system status: Is it functioning normal?- Opened airway is needed- Must exchange O2 and CO2 in the alveoli

•Cardiovascular System: blood must flow to and from the heart in order to pick up oxygen.- Narrowing blood vessels (hardening of arteries) effect blood flow.

•Red blood cell count: red blood cells contain hemoglobin. -Hemoglobin pick up oxygen in the lungs and carry it to the cells.

•Nervous System: Diseases or injuries can affect breathing.-Brain damage affects respiratory rate, rhythm, and depth.

•Age: Respiratory muscles weaken, lung tissues are less elastic.-Older people are at risk for respiratory complications.

•Exercise – Fever – Pain: increase need for oxygen•Drugs & Alcohol: depress the respiratory system in the brain. (Narcotics – pain killers)•Smoking: Cause lung cancer and chronic obstructive pulmonary disease (COPD)•Allergies/pollutant exposure•Nutrition: body needs iron and vitamins

Vocabulary:Hypoxia – cells do not have enough oxygen (restless, disoriented, agitated, pulse rate, pallor cyanosis) hypoxia is life threatening restlessness is an early sign.Tachypnea/hyperpnea: rapid breathing, respirations are more than 20 per minuteBradypnea/hypopnea: Slow breathing, respirations are fewer than 12 per minuteApnea: lack of or absence of breathingDyspnea: Difficult, labored, or painful breathingCheyne-stokes: increase in rate and depth then shallow and slow breathing may stop for 10-20 seconds. Common when death is near.Orthopnea: Breathing deeply and comfortably only when sittingOrthopneic position: sitting up and leaning over a table to breath

Shortness of Breath (SOB): is difficulty breathing or pain on breathing.

It is a common symptom with emphysema and COPDAspiration: breathing fluid, food, vomitus or an object into the lungs.Bronchitis: inflammation of the bronchiolesPneumonia: inflammation of the lung tissue, caused by infection and results in impaired gas exchangeAsthma: condition that affects the bronchi & bronchioles of the lungs. Triggers (allergies, smoke) cause the bronchi to narrow and make it hard to breath.Chronic Obstructive Pulmonary disease: Lung disorders – emphysema, chronic bronchitis, leading cause is smoking.Emphysema: after prolonged COPD, destruction of the lungs occursTuberculosis: an airborne infection caused by a bacterium that usually infects the lungs

4. What to report to the nurse:

- hypoxia (see S&S in box 28-1)- SOB or complaints of being “winded” or “short-winded”- cough (note description)- sputum – mucus from respiratory tract; color, odor, consistency- noisy respirations- chest pain- cyanosis- changes in Vital Signs- pallor-apnea ( no breathing)

5. Ways to promote Oxygen:To get enough oxygen, air must move deep into the lungs.

A: Positioning: Persons who have difficulty breathing prefer sitting up (semi-fowlers) or leaning over a table (orthopneic position). Frequent position changes are needed.

B: Turn, Cough, Deep Breathing (TCDB): coughing removes mucus. Deep breathing moves air into the lungs.

- prevents pneumonia and atelectasis (collapse of a portionof the lung- They are done after surgery or injury and during bedrest.

C: Incentive Spirometry: device that measures the amount (volume) of air inhaled.

*Goal is to improve lung function

D: Pulse oximetry: measures oxygen concentration in arterialblood.*Normal Range is 95-100 SpO2*it can be attached to the finger, toe, earlobe *Tell nurse right away if alarm sounds – CNA’s do NOT turn alarms off!

6. Oxygen Therapy: Is considered a DRUGCNA’s are not responsible for administering oxygen. Doctor’s orderamount, device to use and when it is given.

A. Flow rate: amount of oxygen given is called the flow rate. Can be anywherefrom 2 to 15 liters per minute.

The nurse or respiratory therapist sets the rate.The CNA need to be aware of flow rate – if different from charts, notify the nurse at once.

B. Humidifier: Oxygen is dry gas. Oxygen dries the airways mucous membranes.Distilled water is added to the humidifier to create water vapors. Makesure water bottle does not get too low. If the water gets to low and notbubbling the humidifier is not working.

C. Oxygen Safety: Page 455 Box 28-3- Never remove oxygen device- Check for signs of irritation from the device- Make sure there are no kinks in tubing- Make sure person is not lie on any part of the tubing- Report any S&S of abnormal breathing- Give oral hygiene as needed.- Maintain adequate water level in the humidifier.

**CNA’s do not administer oxygen, do not adjust flow rate, and never shut off oxygen!**

D. Oxygen devices:- Nasal cannula: prongs are inserted into the nostrils.

Allows eating and drinking- Simple face mask: covers the nose and mouth. Co2 escape exhaling

E. **Do not remove the mask or NC unless you are specifically told to do so bythe nurse. Also, provide oral care Q2hrs or PRN**

F. Always check for:*skin breakdown around the nose, cheekbones and the ears.*no kinks or lying on tubing*lubricate area or use cotton balls between cannula tubing and ear

7. Artificial Airways: are used to keep the airway open.

Intubation: inserting an artificial airway into the trachea.

Tracheostomy: is temporary or permanent and should be covered by a gauze dressing

A. Measures are needed to prevent aspiration. Nothing can enter the stoma.- do not have loose gauze or lint- covered when you go outside- take tub baths instead of showers- be careful when shampooing- person with a tracheostomy may

have a hard time communicating.

B. Causes: smoking ,diseased, injury, secretions, or aspiration obstructs the airway. Unconscious or recovering from anesthesia.

8. Mechanical Ventilation:Alarms sound when something is wrong. First make sure tube is attached to the ventilator. If not…attach the tube and get the nurse.

**Never turn off alarms**

9.Hypoxia: the cells do not have enough oxygen (hypo-decreased, oxia-oxygen)Individuals who have a chest tube, artificial airway and or on a mechanical ventilator is at risk for HYPOXIA.

Signs and symptoms of hypoxia: BOX 28-1- restlessness - dizziness

- disorientation - confusion- apprehension - agitation