Wilk: Sorrentino's Canadian Textbook for the Support Worker, 5th Edition

Chapter 39: Promoting Oxygenation

Chapter 39

Promoting Oxygenation

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Oxygen Needs
 Oxygen (O2) is:
 A gas with no taste, odour, or colour
 The most important basic need for life
 Death occurs within minutes if breathing
stops.
 Brain damage and serious illnesses can
occur without enough oxygen.
 You assist in the care of persons who have
oxygen needs.

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Supporting Oxygen Needs

 As with any task, before assisting with or
giving care related to oxygen needs, you
must know the following:
 Does your province or territory allow you to
perform the task?
 Is the task in your job description?
 Do you have the necessary training?
 Do you know how to use the equipment?
 Have your reviewed the task with a nurse?
 Have you been supervised by a nurse or
respiratory technician for the task?
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 Oxygen Therapy
 Definition:
 The administration of oxygen to a client in
concentrations greater than those found in room
air
 A physician or nurse practitioner can
prescribe oxygen therapy.
 A respiratory therapist is a regulated
professional who evaluates, treats, and
maintains heart and lung function.
 The client should only receive the amount of
oxygen ordered.
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Slide 4

Factors Affecting Oxygen Needs

(1 of 4)
 The altered function of any system affects
oxygen needs.
 Oxygen needs are affected by:
• Respiratory system function
Airway must be open; must be adequate number of
alveoli to absorb oxygen and excrete carbon dioxide
• Cardiovascular system function
 Body systems depend on each other.
 See textbook Box 39.1: Factors Affecting Oxygen
Needs

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Factors Affecting Oxygen Needs

(2 of 4)
 Red blood cell (RBC) count
 Health challenges that reduce RBCs include:
• Chemotherapy
• Iron-deficiency anemia
• Nervous system function (disease or injury affect
respiratory muscles)
• Aging (muscles weaken, lungs become less elastic or
create difficulty coughing)
• Exercise (requires more oxygen)
• Fever (oxygen needs increase; body is working harder to
fight infection)
• Pain (oxygen needs increase; chest or abdominal
surgery make this difficult)
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Factors Affecting Oxygen Needs
(3 of 4)
 Drugs
 Depress the respiratory centre or cause
respiratory arrest.
 People with substance abuse problems at risk for
respiratory depression or arrest.
 Smoking
 Can damage lung tissue.
 Can cause lung cancer and COPD.

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Factors Affecting Oxygen Needs

(4 of 4)
 Allergies
 Swelling of upper airway can result in chronic
bronchitis, asthma, and death
 Pollutant exposure
 Damages lungs
 Nutrition
 Good nutrition is necessary for RBC production
 Alcohol
 Depresses the brain, reduces cough reflex
 Increases risk of aspiration
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Altered Respiratory Function

(1 of 7)
 Respiratory function involves three
processes:
 Air moves into and out of the lungs.
 O2 and CO2 are exchanged at the alveoli.
 The blood carries O2 to the cells and removes CO2
from them.

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 Altered Respiratory Function
(2 of 7)
 Signs and symptoms
 Shortness of breath (SOB)—may be acute or
chronic.
• When unable to breathe, the client may feel very
anxious, may panic
 Short of breath on exertion (SOBOE)
 Client often wants to sit up in bed or chair as it’s
difficult to breathe when lying flat (orthopnea)
• Struggling to breathe is exhausting
 Never turn up the oxygen level beyond what is
stated in client’s care plan.
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Altered Respiratory Function

(3 of 7)
 Signs and symptoms:
 Support worker needs to observe client for:
• Any abnormal breathing pattern, SOB
• Cough
 Frequency
 Productive or non-productive
• Sputum
 Colour, odour, consistency, bloody (hemoptysis)
• Noisy respirations
• Chest pain

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Altered Respiratory Function

(4 of 7)
 Signs and symptoms:
• Cyanosis
 Lips, nail beds, skin, mucous membrane
• Changes in vital signs
• Body position

 See textbook Box 39.2: Signs and Symptoms of

Altered Respiratory Function

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 Altered Respiratory Function
(5 of 7)
 Abnormal Respiratory Patterns
 Adults normally have 12 to 20 respirations per
minute.
 Infants and children have faster rates.
 Normal respirations are quiet, effortless, and
regular.
 Both sides of the chest rise and fall equally.
 The medical term for normal respirations is
eupnea.

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Altered Respiratory Function

(6 of 7)
 Abnormal Respiratory Patterns:
 The following breathing patterns are abnormal:
• Tachypnea is rapid breathing.
 Respirations are more than 20 per minute.
• Bradypnea is slow breathing.
 Respirations are fewer than 12 per minute.
• Apnea is lack or absence of breathing.
Sleep apnea and periodic apnea of newborns are
other types of apnea.
• Kussmaul respirations.
 These are deep and rapid respirations characteristic
of diabetic acidosis.

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Altered Respiratory Function

(7 of 7)
 Abnormal Respiratory Patterns:
• Hypoventilation
Respirations are slow, shallow, and sometimes
irregular.
• Hyperventilation
 Respirations are rapid and deeper than normal.
• Dyspnea
 Difficult, laboured, or painful breathing

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 Abnormal Respiratory Patterns
(1 of 3)
 Abnormal Respiratory Patterns:
 Cheyne-Stokes
• Respirations gradually increase in rate and depth and then
become shallow and slow.
• Breathing may stop for 10 to 20 seconds.
• Cheyne-Stokes respirations are common when death is near.
 Orthopnea
• Breathing deeply and comfortably only when sitting.

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Abnormal Respiratory Patterns

(2 of 3)
 Hypoxia is a deficiency of oxygen in the cells.
 Cells that do not have enough oxygen cannot
function properly.
 Anything that affects respiratory function can
cause hypoxia.
 The brain is very sensitive to inadequate supply of
oxygen.

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Abnormal Respiratory Patterns

(3 of 3)
 Hypoxia:
 Early signs of hypoxia are restlessness, dizziness,
and disorientation.
• See textbook Box 39.3: Signs and Symptoms of Hypoxia

 Hypoxia is life threatening.

• Report signs and symptoms immediately.

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 Promoting Oxygenation (1 of 7)
 To get enough oxygen, air must reach the
alveoli, where O2 and CO2 are exchanged.
 Disease and injury can prevent air from reaching
the alveoli.
 Pain and immobility interfere with deep breathing
and coughing.
 Narcotics can interfere with deep breathing and
coughing.

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Promoting Oxygenation (2 of 7)
 Measures to meet oxygen needs are
common in care plans, and may include:
 Administration of O2
 Activities that involve movement (e.g., a short
walk) to help expand the client’s lungs
 Positioning and rest periods
 Coughing and deep breathing
 Incentive spirometry

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Promoting Oxygenation (3 of 7)
 Positioning
 Breathing is usually easier in semi-Fowler’s and
Fowler’s positions.
 Clients with difficulty breathing often prefer the
orthopneic position.
 Frequent position changes are needed—at least
every 2 hours.
 Unless the physician has placed restrictions on
positioning the client, the client should never lie on
one side for long periods.

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 Promoting Oxygenation (4 of 7)
 Coughing and deep breathing
 Deep breathing moves air into most parts of the
lungs.
 Coughing removes mucus.
 Deep breathing and coughing help prevent
pneumonia and atelectasis (lung collapses).
 Clients may be reluctant to do exercises because
of pain after injury or surgery, or fear of breaking
open an incision.

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Promoting Oxygenation (5 of 7)
 Coughing and deep breathing
 Postsurgical period, bed rest, lung disease, and
paralysis are factors for atelectasis.
 Deep breathing and coughing may be done every
1–2 hours or four times a day, as ordered.
 See textbook procedure: Assisting With Coughing
and Deep-Breathing Exercises

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Promoting Oxygenation (6 of 7)
 Incentive spirometry
 Incentive spirometry is also called sustained
maximal inspiration [SMI]
 Spirometer is a machine that measures the
amount (volume) of air inhaled.
• Made up of breathing bug, air chamber, and indicator
that rises with each inhalation (client sees plastic balls or
bars move to different levels with degree of inhalation)
 The goal is to improve lung function:
• By taking long, slow, deep breaths, the client moves air
deep into the lungs.
• Secretions become loose.
• O2–CO2 exchange occurs between the alveoli and
capillaries.
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 Promoting Oxygenation (7 of 7)
 Incentive spirometry
 The client takes slow, deep breath until the balls
rise to desired height, holds breath for at least 3
seconds, and then exhales slowly.
 Care plan or supervisor gives instructions:
 How often client should use it
 The desired height that the floating balls should
reach
 Number of breaths needed

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The Support Worker’s Role in

Oxygen Therapy
 Oxygen is treated as a drug.
 Some clients need oxygen constantly; others need
it for symptom relief.
 Support workers do not give oxygen.
• They assist the nurse in providing safe care.
• May be trained to transfer oxygen, provide oral
suction.

• See textbook Box 39.4: Caring for a Client Who

Has Altered Respiratory Function

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Oxygen Sources (1 of 8)
 Oxygen is considered a Class A compressed
gas. WHMIS regulations must be followed.
 Three main delivery systems:
 Oxygen concentrator
 Oxygen cylinder
 Liquid oxygen system

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 Oxygen Sources (2 of 8)
 Oxygen concentrator
 The machine filters oxygen from the air in the
room.
 It is plugged into a grounded electrical outlet.
 Used in facilities and community settings.

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Slide 28

Oxygen Sources (3 of 8)

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Oxygen Sources (4 of 8)
 Oxygen cylinder
 Contains compressed oxygen
 The oxygen tank is placed at the bedside
 Used when clients are on outings
 In hospitals and some continuing care facilities,
oxygen is piped directly into a person’s unit
through a wall oxygen outlet.

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 Oxygen Sources (5 of 8)

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Oxygen Sources (6 of 8)

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Oxygen Sources (7 of 8)
 Liquid oxygen system
 A portable unity is filled from a stationary container
called a reservoir
 The portable unit can be worn over the shoulder

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Slide 33

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 Oxygen Sources (8 of 8)

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Oxygen Therapy and Safety

(1 of 2)
 Remember:
 You ASSIST with oxygen therapy.
 You do not administer oxygen.
 You are responsible for giving safe care to clients
receiving oxygen—always follow safety guidelines.

 See textbook box: Think About Safety: Safety

Guidelines for Oxygen Therapy

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Oxygen Therapy and Safety

(2 of 2)
 Oxygen and Fire Safety
 Oxygen is flammable
• Keep oxygen source away from heat and open flame.
 The physician, nurse, or respiratory therapist is
responsible for teaching the client and family
members about oxygen safety.
• Warn client of dangers and the safety hazard
• Report concerns to supervisor
 See textbook Box 39.5: Oxygen and Fire Safety
Guidelines

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 Oxygen Administration Devices
(1 of 2)
 The physician orders the device to give
oxygen.
 These devices are common:
 Nasal cannula
 Simple face mask
 Partial-rebreather mask
 Non-rebreather mask
 Venturi mask

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Oxygen Administration Devices

(2 of 2)
 Moisture can build up under the mask.
 Keep the client’s face clean and dry.
 Masks are removed for eating.
 Usually oxygen is given by cannula during meals.

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Oxygen Flow Rates (1 of 2)

 The flow rate is the amount of oxygen given.
 It is measured in litres per minute (L/min).
 The doctor orders 2 to 15 litres of O2 per
minute.
 The nurse or respiratory therapist sets the flow
rate.
 The nurse and care plan tell you the person’s flow
rate.

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 Oxygen Flow Rates (2 of 2)
 When giving care and checking the person:
 Always check the flow rate.
 Tell the supervisor at once if the flow rate is too
high or too low.
• A nurse or respiratory therapist will adjust the flow rate.

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Preparing for Oxygen

Administration (1 of 2)
 Oxygen administration set-up
 Humidified oxygen
• If not humidified, oxygen dries the airway’s mucous
membranes.
• Therefore, distilled water is added to the humidifier.
• The humidifier is then attached to the oxygen
administration system (wall outlet, oxygen tank, or
oxygen concentrator) to produce humidified oxygen
(oxygen that contains water vapour).

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Preparing for Oxygen

Administration (2 of 2)
 Oxygen safety
 You assist the nurse with oxygen therapy.
 You do not give oxygen, but your supervisor may
ask you to set up the oxygen administration
system.
• See textbook procedure: Setting Up for Oxygen
Administration
 You do not adjust the flow rate unless allowed by
your province/territory and agency.
 You must give safe care.

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 Assisting With Assessment And
Diagnostic Testing (1 of 6)
 Physicians order tests to find the cause of a
breathing problem and to prevent it from
becoming worse.
 Test are performed by the following:
physician, specially trained nurse, respiratory
therapist, or laboratory technician
 You will assist client before and after the test,
as directed by care plan and supervisor.

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Assisting With Assessment And

Diagnostic Testing (2 of 6)
 Pulse Oximetry
 Measures the oxygen concentration in arterial
blood
• The normal range is 95% to 100%
 A sensor attaches to a finger, toe, earlobe, nose,
or forehead; may need to remove nail polish.
 A good sensor site is on the client is important.

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Assisting With Assessment And

Diagnostic Testing (3 of 6)
 Pulse Oximetry
 Use SpO2 when recording the oxygen
concentration value:
• S = saturation
• P = pulse
• O2 = oxygen
 Report and record measurements accurately.

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 Assisting With Assessment And
Diagnostic Testing (4 of 6)
 Collecting Sputum Specimens
 Sputum is mucus from the respiratory system; it is
not saliva (spit).
 Sputum is studied for blood microbes and
abnormal cells.
 The client must cough up sputum from the bronchi
and trachea.
• This can be painful or hard to do.

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Assisting With Assessment And

Diagnostic Testing (5 of 6)
 Collecting Sputum Specimens
 Specimen should be collected in morning.
 Instruct the client not to use mouthwash prior to
procedure.
 Provide privacy—the procedure can be
embarrassing.
 Follow Standard Practices

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Assisting With Assessment And

Diagnostic Testing (6 of 6)
 Collecting Sputum Specimens
 Postural Drainage
• Some clients do not have the strength to cough up
sputum, so postural drainage is required.
• Involves positioning the client to allow secretions to drain
by gravity
 Makes coughing easier
 Allows client to raise sputum
• Chest percussion (chest clapping) is a technique that
loosens thick, sticky mucus trapped in the lungs.
• If it is within your scope of practice for your province or
agency, you may have to assist with postural drainage.

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 Artificial Airways (1 of 7)
 Artificial airways keep the airway patent
(open).
 They are needed in the following circumstances:
• When disease, injury, secretions, or aspiration
obstruct the airway
• When the client needs mechanical ventilation
• When the client is semi-conscious or
unconscious
• When the client is recovering from anaesthesia
 Intubation means inserting an artificial
airway.
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Artificial Airways (2 of 7)
 These types of airways are common:
 Oro-pharyngeal airway: inserted through the
mouth and into the pharynx
 Naso-pharyngeal airway: inserted through a nostril
Endo-tracheal (ET) tube: inserted through the
mouth or nose and into the trachea
• A cuff is inflated to keep the airway in place.
 Tracheostomy tube: inserted through a surgically
created opening into the trachea
• Cuffed tubes are common.

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Artificial Airways (3 of 7)
 Care of a Client with an Artificial Airway
 Check vital signs often:
• Observe for hypoxia and other respiratory signs and
symptoms.
• If an airway comes out or is dislodged, tell the nurse at
once.
 Frequent oral hygiene is needed
• Follow the care plan.
 Provide comfort and reassure the client.
 Follow the care plan for communication methods.
 Always keep the call bell within reach.
 Use touch to show you care, if appropriate for your
client’s culture and ethnicity.
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 Artificial Airways (4 of 7)
 Tracheostomies
 A tracheostomy is a surgically created opening
into the trachea.
 Tracheostomies are temporary or permanent.
 A tracheostomy tube has three parts:
• The obturator is used to guide the insertion of the outer cannula
• The inner cannula is inserted and locked in place
• The outer cannula is not removed
 The tube must not come out (extubation).
• A loose tube can damage the trachea.
 The tube must remain patent.
• If the client is unable to cough up secretions, suctioning is
needed.

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Artificial Airways (5 of 7)
 Safety Measures for Clients with
Tracheostomies
 Call for the nurse or supervisor if:
• You note signs and symptoms of hypoxia or respiratory
distress.
• The outer cannula comes out.
 Nothing must enter the stoma.

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Artificial Airways (6 of 7)
 Safety Measures for Clients with
Tracheostomies
 Follow Standard Practices when assisting with
tracheostomy care.
 Tracheostomy care involves:
• Cleaning the inner cannula to remove mucus and keep
the airway patent
• Cleaning the stoma to prevent infection and skin
breakdown
• Applying clean ties or a Velcro collar to prevent infection
 Care is usually provided every 8 to 12 hours.

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 Artificial Airways (7 of 7)
 Safety Measures for Clients with
Tracheostomies
 The trachea dressing should never have anything
that can be inhaled.
 The stoma or tube should always be covered
when the client goes outside.
 Never cover a stoma with plastic or leather.
 Client should take tub baths instead of showers.
 Water should never enter the stoma.
 Medical Alert jewellery should always be worn.

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Suctioning An Airway (1 of 3)
 Secretions can collect in the upper airway.
 Retained secretions:
• Obstruct air flow into and out of the airway
• Provide an environment for microbes
• Interfere with oxygen (O2) and carbon dioxide (CO2)
exchange
• Hypoxia can occur.
 Persons who cannot cough or have a cough that
is too weak to remove secretions need suctioning.
• Suction is the process of withdrawing or sucking up fluid
(secretions).

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Suctioning An Airway (2 of 3)
 Suctioning Sites
 These routes are used to suction the airway:
• Oro-pharyngeal
 The mouth and pharynx are suctioned.
• Naso-pharyngeal
 The nose and pharynx are suctioned.
• Lower airway
 The suction catheter is passed through an
endotracheal (ET) or tracheostomy tube.

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 Suctioning An Airway (3 of 3)
 Safety Measures for Suctioning
 If not done correctly, suctioning can cause serious
harm to a client.
• The client may be unable to breathe during suctioning.
• Hypoxia and life-threatening complications can arise.
 The client’s lungs are hyperventilated prior to
suctioning by use of an Ambu bag.
 You may be asked to assist a nurse with suctioning.
• It is your responsibility to ensure that suctioning is within your
scope of practice for your province or agency.

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Mechanical Ventilation (1 of 2)
 Mechanical ventilation is using a machine to
move air into and out of the lungs.
 Needed for a variety of health care problems,
including:
• Hypoxia caused by weak muscle effort, airway
obstruction, and damaged lung tissue
• Nervous system diseases and injuries that can affect the
respiratory centre, interfering with messages between the
lungs and the brain
• Drug overdoses that can depress the brain’s
hypothalamus or the breathing control centre

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Mechanical Ventilation (2 of 2)
 An ET or tracheostomy tube is needed for
mechanical ventilation.
 Alarms sound when something is wrong:
• One alarm means the client is disconnected from the
ventilator.
• When any alarm sounds, first check to see if the client’s
tube is attached to the ventilator.
 If it is not, attach it to the ventilator.
• Then tell the nurse or supervisor at once about the alarm.
• Do not reset alarms.
 Clients needing mechanical ventilation are
very ill.
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 Chest Tubes (1 of 3)
 Air, blood, or fluid can collect in the pleural
space (sac or cavity), when the chest has
been penetrated because of injury or surgery.
 Pneumothorax
• Air in the pleural space
 Hemothorax
• Blood in the pleural space
 Pleural effusion
• The escape and collection of fluid in the pleural space

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Chest Tubes (2 of 3)
 Pressure occurs when air, blood, or fluid collects
in the pleural space.
 The pressure collapses the lung.
 Air cannot reach affected alveoli.
 O2 and CO2 are not exchanged.
• Respiratory distress and hypoxia result.
 Pressure on the heart threatens life.

 The doctor inserts chest tubes to remove the air,

blood, or fluid.
 Chest tubes attach to a drainage system.
• The system must be airtight.
• Water-seal drainage keeps the system airtight.

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Chest Tubes (3 of 3)
 Caring for chest tubes:
 Keep drainage system below the level of the chest
 Keep tubing coiled on the bed
 Check vital signs as directed
 Prevent tubing kinks
 Observe chest drainage
 Turn and reposition the client carefully
 Assist with deep breathing, coughing, incentive
spirometry
 Keep sterile petrolatum gauze at bedside
• See textbook Box 39.9: Guidelines for Caring for Clients
With Chest Tubes
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