Respiratory Signs: Tachypnea (RR>30/min), Desaturation, Shallow breathing, Use of accessory muscles Breathing sound: Wheezing, Rhonchi, Crepitation.

Transcription

1 Respiratory Signs: Tachypnea (RR>30/min), Desaturation, Shallow breathing, Use of accessory muscles Breathing sound: Wheezing, Rhonchi, Crepitation. Paradoxical breathing Hyper-resonance on percussion: pneumothorax Pursed lip breathing Cardiovascular Signs: Tachycardia (HR>100/min), Arrhythmias Abnormal high/low BP Decrease conscious level, confusion. Right heart failure: JVP, ankle/sacral oedema

2 1. Aimed at maintaining effective airway clearance, gas exchange, tissue perfusion, and comfort. 2. Treat any life-threatening immediately. Anticipate the need for bag-valve mask ventilation (initiate if indicated), intubation or use of CPAP/BiPAP. 3. Obtain vital signs e.g. BP, ECG, RR, GCS, SpO2, re-assess as indicated. 4. Administer oxygen as order to maintain satisfactory SpO2. 5. Elevate HOB unless contraindicated.

3 6. Chest x-ray and ECG as order. 7. Obtain IV access and lab work such as ABG as order. 8. Administer medications as order i.e., diuretic, bronchodilator, steroids, antibiotics). 9. Assess the need for an oral or nasal airway 10. Assess function of the airway in terms of patency and effectiveness of ventilation. 11. Airway suction as needed. 12. Auscultate the chest and assess patient response to treatments and care.

4 Tsang Wai Yan APN /CND/ NLERT

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6 Oxygen therapy is the administration of oxygen at concentrations greater than that in room air: To treat or prevent hypoxemia (not enough oxygen in the blood). Decrease work of breathing Reduce stress in the myocardium

7 Significant hypoxemia Increased myocardial workload e.g. heart failure, hypertensive crisis, MI Decrease cardiac output e.g. Shock Increased oxygen demand e.g. sepsis, post-op stats Decreased oxygen carrying capacity e.g. carbon monoxide poisoning, anemia

8 Definitions Decrease in arterial blood oxygen tension Diagnosis by arterial blood gases (ABG) Low inspired oxygen concentration e.g. high altitudes Hypoventilation e.g. asthma, CNS depression V/Q mismatching e.g. pulmonary embolism

9 V/Q ratio: comparison the amount of air reaching the alveoli to the amount of blood reaching the alveoli. V/Q mismatch: a problem with either the Ventilation (air going in and out of the lungs) or the Perfusion (Oxygen and CO2 diffusion at the alvioli and the pulmonary arteries).

10 Respiratory a) Increased respiratory rate (Tachypnea), b) Dyspnea, cyanosis acc muscle use Cardiac a) Increased heart rate (Tachycardia), b) Hypertension Neurological a) Confusion b) Cyanosis c) Sweating d) Somnolence, blurred vision, loss of Coordination, impaired judgment

11 CO2 narcosis-a condition of confusion, tremors, convulsions, and possible coma result from increased PaCO2 level. When giving too much O2, the oxygen driven drive is slow down RR and build up CO2 level especially in COPD patient. Oxygen toxicity-prolonged exposure to high oxygen concentration, can cause cell membranes damage, collapse of alveoli in the lungs, retinal detachment and seizures. Absorption atelectasis-high concentrations of O2 wash out the nitrogen that normally holds the alveoli open at the end of expiration

12 Oxygen concentration depends on: a) Oxygen flow b) Capacity of reservoir c) Breathing volume d) Breathing Rate

13 Unpredictable delivery amount of oxygen, ranging from 24-44% at 1-6L/min Depending on patient inhalation effort and performance Uncomfortable especially high flow rate Drying and irritating effect

14 Delivers 24-44% FIO2 at 1-6L/min flow Flow 0L per minute:21% ( Room Air) Flow 1L per minute :24% Flow 2L per minute :28% Flow 3L per minute:32% Flow 4L per minute:36% Flow 5L per minute:40% Flow 6L per minute:44% For every liter per minute of flow delivered, the oxygen concentration the patient inhales increase by 4%

15 NO reservoir Can deliver FiO2 of 30-50% at an oxygen flow rate of 4-10L/min

16 Advantages: Higher oxygen concentration delivered than by nasal cannula Disadvantages: Not tolerated well by severely dyspneic patients Must be removed at meals Required a tight face seal to prevent the leakage of oxygen

17 A one way valve is between the mask and the bag that prevents air from entering the bag during exhalation Can deliver 90%-100% oxygen when a tight seal over the face is maintained Bag should be filled before placing on patient Flow rate should be adjusted to 10-15L/min

18 Advantages: Higher oxygen concentration delivered than by nasal cannula, simple face mask Inspired oxygen is not mixed with room air Disadvantages: Not tolerated well by severely dyspneic patients Must be removed at meals Mask must fit snugly on the patient s face to prevent room air form mixing with oxygen inhaled form the reservoir

19 Provides precise concentrations of oxygen Mostly used in the hospital settings for COPD patients Offers FIO2 of 24-60%

20 Assess the patient conditions ABG or PO2 and the functioning of the equipment's at regular intervals Determine patient comfort with oxygen use Remove mucus or saliva form the O2 device Monitor closely to ensure an accurate flow rate for specific FiO2

21 Determined the current vital, level of consciousness Assess risk forco2 retention with O2 administration Set the flow rate at prescribed liter per minute.

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