The curve of the airway should follow the angle of the patient’s jawline. Have the patient in the sitting or semi-Fowler’s position with arms crossed below the rib cage (hugging a pillow may be more comfortable). Fixed-performance devices should be used in acute illness in patients who are at risk of carbon dioxide retention. Use gloves to remove and discard the old tracheostomy dressing. Hyperextend the patient’s neck, if allowable, and gently insert the airway in the nares. 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. Low concentrations. There has been trauma to the upper airways. Check that dentures are removed and that there are no loose teeth before inserting the airway. If paroxysmal coughing starts, instruct the patient to use slow deep breaths or. Nasal cannulae are useful: They are commonly used to deliver oxygen in the home setting. Place the patient in the supine position and open the mouth using the “cross-finger technique,” using the thumb and forefinger on the upper and lower teeth to open the mouth. Because the tube is a direct opening into the lower respiratory tract, all the protective mechanisms of the upper airways have been bypassed. Nursing Care Plan. Monitor saturations for five minutes after stopping oxygen and recheck after one hour, Be aware of, and understand, local oxygen policy/guidelines, Demonstrate a basic understanding of oxygen physiology, normal and abnormal values, Be able to discuss the indications for oxygen and the potential risks, Demonstrate an ability to use oxygen equipment safely, including an awareness of fire risks and cylinder use, Demonstrate an ability to use a pulse oximeter to determine oxygen saturations, Demonstrate accurate monitoring and recording of oxygen therapy, Be able to recognise changes in a patient’s respiratory status, Understand how to use oxygen in emergency situations, for example, cardiac arrest, Demonstrate an understanding of target range prescriptions and applications to different patient groups, Demonstrate an ability to assess suitability of delivery devices for individual patients and recognise when a change of device is needed, Be able to correctly identify and set up a range of oxygen-delivery devices, Understand how to select appropriate oxygen/driving gas for nebulised therapy, Demonstrate accurate recording of adjustments to the oxygen dose and the patient’s response, Recognise the need for escalation of treatment/medical review and further assessment, Hypoxia is an indication that oxygen therapy should be started, If blood oxygen levels are not low, oxygen will not treat breathlessness, A target oxygen saturation range should be prescribed to guide therapy, A lower target saturation range should be prescribed for patients at risk of hypercapnia, The amount of oxygen received by the patient is dependent on the delivery device used; ensure appropriate device is selected. Patients using oxygen therapy require electric power. Effective suctioning cannot be performed with other airways. Do not use oil-based preparations such as Vaseline or petroleum jelly, Consider discontinuing oxygen therapy once the patient has stable saturations (at least two consecutive recordings) within their target range on low-dose oxygen (for example, 1-2L/min via nasal cannula). When used as a medical treatment, oxygen is regarded as a drug and must be prescribed. Pain, surgical incision, medications, and age may make it difficult for the patient to move and breath. Nursing interventions should be anchored on the goals in the nursing care plan. Nursing Responsibilities• Medications• Incentive spirometry• Chest PT• Postural drainage• Oxygen therapy• Artificial airways• Airway suctioning• Chest tubes 38. Using a water-soluble gel, lubricate the distal end of the airway. Ongoing care of patients requiring oxygen therapy in the acute setting, Box 3. Maintain airway patency with coughing to clear secretions and, if necessary, suctioning. Loud, noisy respiration, an increased respiratory rate, crackles, wheezes, or rhonchi on auscultation may indicate the need for suctioning or the patient himself may request it. This is a non-invasive test and is the ideal tool to determine episodes of failing respiratory function requiring immediate intubation. Those at risk include patients with: Pulse oximetry must be available in all settings where emergency oxygen is used. Have the patient in an upright position such as sitting or semi-Fowler’s position. Rest and repeat for a total of three cycles. Oxygen is delivered through plastic cannulas via nares (24-44%). To provide supplemental oxygen therapy during meals; To provide air-driven nebulised therapy for those requiring controlled oxygen therapy. Otherwise, scroll down to view this completed care plan. Oral or nasal airways cannot maintain a patent airway. Assess the drainage on the dressing and the site. Fill the container with saline or sterile water. The tube should be slightly wider than the patient’s nares. Repeat for three breaths and rest for 1 minute. (Suction for no more than 10 seconds.). Reduce exposure to noxious fumes at home and at work. If the patient requires more suctioning, wait at least 2 minutes before performing it again. Sign in or Register a new account to join the discussion. Author: Sandra Olive, respiratory nurse specialist, Norfolk and Norwich University Hospitals Foundation Trust. Assist the patient into a sitting or high semi-Fowler’s position. Give minimal amount they need Citation: Olive S (2016) Practical procedures: oxygen therapy. Plastic prongs face down. They need to have a backup generator or alternate power source in case of electrical power outage. Assess the patient’s breath sounds and breathing patterns. Have theophylline blood levels measured periodically according to physician’s protocol. Hold the tracheostomy tube with one hand to keep it from moving (which could stimulate coughing) and use the other hand to gently clean around the tube with sterile saline (or half-strength saline and peroxide depending on the institution’s guidelines). Chest physical therapy is composed of three techniques that may be used individually or in combination. Flow rates above 4L/min can cause considerable drying of nasal mucosa and are more difficult to tolerate. Clearing respiratory secretions promotes patent airways and easier, Patients with chronic respiratory disorders such as COPD and cystic fibrosis may require more aggressive interventions to remove mucous, Coughing is the most effective and natural way to clear the airways. Nursing Interventions For Diabetic Gangrene. Always record saturations at rest and document FiO2 in situ at the time, Patients requiring >28% oxygen for more than 24 hours can have oxygen delivered via a humidification system for comfort and to avoid the drying of secretions, Stable patients may be more comfortable with nasal cannulae but care must be taken to ensure saturations remain in the target range, Patients requiring increasing doses of oxygen to maintain saturations within range, or with signs of respiratory deterioration (increasing respiratory rate, drowsiness, headache, tremor, increasing early warning score) require prompt medical review and further assessment including monitoring of arterial blood gas, Help the patient to stay in an upright position to maximise ventilation unless contraindicated by underlying clinical problems, for example, spinal or skeletal trauma, Give other prescribed therapies, such as nebulised bronchodilation, diuretics, ventilatory support, Refer for respiratory physiotherapy if patients have difficulty clearing thick secretions, Observe potential pressure areas, particularly behind the ears, from nasal cannula tubing or mask elastic and ensure skin is protected and pressure is relieved by altering the position of the tubing or using padding, Be aware of the drying effect of oxygen on oral and nasal mucosa; encourage patients to maintain adequate oral fluid intake where appropriate, and provide water-based lubricant gel to relieve nasal drying.
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