Transcript 13. Oxygenation and FE and AB balances

OXYGEN THERAPY
Fluid, Electrolyte & Acid-Base Balance
Oxygen
• is a colorless, odorless, tasteless gas that
is essential for the body to function
properly and to survive.
WHAT IS MEANING OF O2
THERAPY
 Oxygen therapy is the administration of
oxygen at a concentration of pressure
greater than that found in the
environmental atmosphere
 The air that we breathe contain
approximately 21% oxygen
 the heart relies on oxygen to pump
blood.
OXYGEN THERAPY IS USED TO TREAT
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Documented hypoxemia
Severe respiratory distress (acute asthma or pneumonia)
Severe trauma
Chronic obstructive pulmonary disease (COPD, including
chronic bronchitis, emphysema, and chronic asthma)
Pulmonary hypertension
Acute myocardial infarction (heart attack)
Short-term therapy, such as post-anesthesia recovery
Oxygen may also be used to treat chronic lung disease patients
during exercise .
SOURCES OF OXYGEN:
• Wall outlets
• Cylinder
Oxygen is moistened by passing it through a humidification
system to prevent the mucous membranes of the respiratory
tree from becoming dry.
Wall outlets
• The oxygen is supplied from a central source through a
pipeline.
• Only a flow meter and a humidifier are required
USING OXYGEN CYLINDERS:
 The oxygen cylinder is delivered with a protective cap to
prevent accidental force against the cylinder outlet.
 To release oxygen safety and at a desirable rate, a regulator is
used. It consists of two parts.
A reduction gauge that reduces the pressure to a working level
and shows the amount of oxygen in the tank.
A flow meter that regulates the control of oxygen in liters per
minutes.
PREPARATION
• A physician's order is required for oxygen therapy, except in emergency
use.
• Clinical observations.
• Oxygen supplemental is determined by inadequate oxygen saturation
indicated in Artial Blood Gas measurements,(ABGs ) .
• Pulse Oximetry.
CAUTIONS FOR OXYGEN THERAPY
• Oxygen toxicity – can occur with FIO2 > 50% longer than 48 hrs
• Suppression of ventilation – will lead to increased CO2 and carbon dioxide
narcosis
• Danger of fire
• Infection
CLASSIFICATION OF OXYGEN DELIVERY SYSTEMS
• Low flow systems
– contribute partially to inspired
gas client breathes
– do not provide constant FIO2
Ex: nasal cannula, simple mask ,
non-re breather mask , Partial
rebreather mask
• High flow systems
– deliver specific and constant
percent of oxygen
independent of client’s
breathing
Ex: Venturi mask,, trach collar,
T-piece
NASAL CANNULA (PRONGS):
 It is a disposable.
 plastic devise with two protruding prongs for insertion into the
nostrils, connected to an oxygen source.
 Used for low-medium concentrations of Oxygen (24-44%).
Method
Nasal
Cannula
Amount
Delivered
F1o2
(Fraction
Inspired
Oxygen)
Low flow
24-44 %
1 L\min=24%
2 L\min=28%
3 L\min=32%
4 L\min=36%
5 L\min=40%
6 L\min=44%
Priority
Nursing
Interventions
Advantages
Disadvantages
ØCheck
frequently that
both prongs are
in clients nares
Ø Client able
to talk and eat
with oxygen in
place
Ømay cause
irritation to the
nasal and
pharyngeal
mucosa
ØNever deliver
more than 2-3
L\min to client
with chronic
lung disease
ØEasily used
in home setting Øif oxygen flow
rates are above
6 liters/minute
Variable FIO2
FACE MASK
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The simple Oxygen mask
The partial rebreather mask:
The non rebreather mask:
The venturi mask:
THE SIMPLE OXYGEN MASK
 Simple mask is made of clear, flexible , plastic or rubber that can be
molded to fit the face.
 It is held to the head with elastic bands.
 Some have a metal clip that can be bent over the bridge of the nose for a
comfortable fit.
It delivers 35% to 60% oxygen .
 A flow rate of 6 to 10 liters per minute.
 It has vents on its sides which allow room air to leak in at many places,
thereby diluting the source oxygen.
 Often it is used when an increased delivery of oxygen is needed for short
periods
 (i.e., less than 12 hours).
Method
Amount
Delivered
F1o2
(Fraction
Inspired
Oxygen)
Simple mask
Low Flow
6-10 L\min
35%-60%
Priority Nursing
Interventions
Monitor client
frequently to
check
placement of
the mask.
Support client
if
claustrophobia
is concern
Secure
physician's
order to replace
mask with nasal
cannula during
meal time
Advantages
Can
provide
increased
delivery of
oxygen for
short
period of
time
Disadvantages
Tight seal required
to deliver higher
concentration
Difficult to keep
mask in position
over nose and mouth
Potential for skin
breakdown (pressure,
moisture)
Wasting
Uncomfortable for pt
while eating or talking
Expensive with nasal
tube
THE PARTIAL REBREATHER MASK:
• The mask is have with a reservoir bag must romaine inflated during both
inspiration & expiration
• It collection of the first parts of the patients' exhaled air.\
•
It is used to deliver oxygen concentrations up to 80%.
• The oxygen flow rate must be maintained at a minimum of 6 L/min to
ensure that the patient does not rebreathe large amounts of exhaled air.
• The remaining exhaled air exits through vents.
THE NON REBREATHER MASK
 This mask provides the highest concentration of oxygen (95-100%) at a flow
rate6-15 L/min.
 It is similar to the partial rebreather mask except two one-way valves prevent
conservation of exhaled air.
 The bag is an oxygen reservoir
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When the patient exhales air.
the one-way valve closes and all of the expired air is deposited into the
atmosphere, not the reservoir bag.
In this way, the patient is not rebreathing any of the expired gas.
Method
Amount
Delivered
F1o2 (Fraction
Inspired
Oxygen)
Priority
Nursing
Interventions
Partial Rebreather Mask
Low Flow Set flow
rate so
6 L\min
mask
remains
75%-80% tow-thirds
oxygen
full during
inspiration
Keep
reservoir
bag free of
twists or
kinks
Advantages
Disadvantages
Clinet
can inhale
room air
through
openings
in mask if
oxygens
supply is
briefly
interrupted
Requires
tight seal
(eating and
talking
difficult,
uncomfort
able
Not as
drying to
mucous
membrane
s
Method
Amount
Delivere
d
F1o2
Non
rebreather MASK
Low
Flow
6-15 L
\min
80%100%
Priority Nursing
Interventions
Maintain flow
rate so reservoir
bag collapses only
slightly during
inspiration
Check that valves
and rubber flaps
are function
properly (open
during expiration )
Monitor SaO2
with pulse oximeter
Advantages
Delivers the
highest possible
oxygen
concentration
Suitable for pt
breathing
spontaneous
with sever
hypoxemia
Disadvantages
Impractical for
long term Therapy
Malfunction can
cause CO2 buildup
suffocation
Expensive
Feeling of
suffocation
Uncomfortable
Costly
VENTURI MASK
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It is high flow concentration of oxygen.
Oxygen from 40 - 50%
At liters flow of 4 to 15 L/min.
The mask is so constructed that there is a constant flow of room air blended with a
fixed concentration of oxygen
 Is designed with wide- bore tubing and various color - coded jet adapters.
 Each color code corresponds to a precise
 oxygen concentration and a specific liter flow.
The narrower the jet adapter,
 the greater the air dilution, and the lower the concentration of oxygen.
 It is used primarily for patients with chronic obstructive pulmonary disease
,
Method
Amount
Delivered
F1o2
Venturi Mask
Oxygen
from 40-50%
of 4 to 15
L/min.
Priority
Nursing
Interventio
ns
Advantage
s
Disadvantages
Requires
careful
mointoring
to verify
F1O2 at
flow rate
ordered
Check
that air
intake
valves are
not
blocked
Delivers
most
precise
oxygen
concentrati
on
Doesn’t
dry
mucous
membrane
s (humidity
uncomfortable
Risk for skin
irritation
produce
respiratory
depression in
COPD patient with
high oxygen
concentration 50%
SIDE EFFECT & COMPLICATION OF OXYGEN
THERAPY
 Oxygen toxicity
 Retrolental fibroplasia
 Absorption atelectasis
OXYGEN TOXICITY
It is a condition in which ventilator failure
-occurs due to inspiration of a high concentration of oxygen for aprolonged
period of time.
-oxygen concentration greater than 50% over 24 to 48 hours can cause
pathological changes in the lungs
OXYGEN TOXICITY
It is a condition in which ventilator
failure:
-occurs due to inspiration of a high
concentration of oxygen for
aprolonged period of time.
-oxygen concentration greater than
50% over 24 to 48 hours can
cause pathological changes in the
lungs
Signs and symptoms:
• Non-productive cough.
• Nausea and vomiting.
• Substernal chest pain.
• Fatigue.
• Nasal stuffiness.
• Headache.
• Sore throat.
• Hypoventilation.
• Nasal congestion.
• Dyspnea.
• Inspiration pain.
Retrolental fibroplasia
Absorption atelectasis
-blindness due to vasoconstriction &
100 % FLO2 breathing associated
with decrease ventilation (
obstruction )
Hypoventilation (increase 30 /M )
Effect ( lung collapse )
ischemia ( premature infants )
EVALUATION:
DOCUMENTATION:
 Breathing pattern regular
and at normal rate.
 pink color in nail beds, lips,
conjunctiva of eyes.
 No confusion,
disorientation, difficulty
with cognition.
 Arterial oxygen
concentration or
hemoglobin
 Oxygen saturation within
normal limits.
 Date and time oxygen
started.
 Method of delivery.
 Oxygen concentration and
flow rate.
 Patient observation.
 Add oronasal care to the
nursing care
plan
Fluid, Electrolyte & Acid-Base
Balance
Body Fluids
• Your body is 66% water
• Not evenly distributed – separated into compartments
• Able to move back and forth thru the cell membranes to
maintain an equilibrium
Fluid Compartments
• Intracellular fluid – fluid inside cells [ICF]
• Extracellular fluid – fluid outside cells and all other body fluids --- ¼ is
plasma [intravascular fluid], remaining ¾ is interstitial fluid. Small amount
is localized as CSF, serous fluid, synovial fluid, humors of eye &
endo/perilymph of ears
EDEMA
• Condition in which fluid accumulates in the interstitial
compartment. Sometimes due to blockage of lymphatic
vessels or by a lack of plasma proteins or sodium retention
FLUID BALANCE
• Amount in = amount out
• Average daily intake is 2500 ml [ fluids, food and metabolic
water]
• Average daily output is 2500 ml [ urine, feces, perspiration,
insensible perspiration]
• What can throw off these numbers?
ELECTROLYTE BALANCE
Def: - concentration of individual electrolytes in the body fluid
compartments is normal and remains relatively constant.
• Electrolytes are dissolved in body fluids
• Sodium predominant extracellular cation, and chloride is
predominant extracellular anion. Bicarbonate also in
extracellular spaces
• Potassium is the predominant intracellular cation and
phosphates are the predominant intracellular anion
• Cations are actively reabsorbed, anions passively follow by
electrochemical attraction
• Aldosterone works at kidney tubules to regulate sodium &
potassium levels
ACID - BASE BALANCE
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1.
2.
3.
Blood - normal pH of 7.2 – 7.45
< 7.2 = acidosis
> 7.45 = alkalosis
3 buffer systems to maintain normal blood pH
Buffers
Removal of CO2 by lungs
Removal of H+ ions by kidneys
Buffers
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Protein Buffer Systems
Amino Acid buffers
Hemoglobin buffers
Plasma Protein buffers
Phosphate Buffer Systems
Carbonic Acid – Bicarbonate Buffer System
Maintenance of Acid-Base
Balance
• Respiratory System:
removal of CO2 by lungs –
stabilizes the ECF, has
direct effect on Carbonic
Acid – Bicarbonate Buffer
System
• Urinary System: removal of
H+ ions by kidneys
Disturbances to Acid-Base
Balance
• Respiratory Acidosis
• Respiratory Alkalosis
• Metabolic Acidosis [ lactic
acidosis, ketoacidosis]
• Metabolic Alkalosis