Chapter 36 Oxygen Needs Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Chapter 36Chapter 36

Oxygen NeedsOxygen Needs

Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

• Aging—respiratory muscles weaken, lung tissue is less Aging—respiratory muscles weaken, lung tissue is less elastic, and coughing strength decreaseselastic, and coughing strength decreases..

• Exercise—OExercise—O22 needs increase needs increase..

• Fever—OFever—O22 needs and respiratory rate and depth increase needs and respiratory rate and depth increase..

• Pain—respirations increase to meet increased needs for OPain—respirations increase to meet increased needs for O22.

• Drugs (narcotics) —some depress the respiratory center in Drugs (narcotics) —some depress the respiratory center in the brain.the brain.

• Smoking—causes lung cancer and COPD.Smoking—causes lung cancer and COPD.

• Allergies—severe swelling can close the airway.Allergies—severe swelling can close the airway.

• Pollutants—damage the lungs.Pollutants—damage the lungs.

• Nutrition—iron and vitamins are needed to produce RBCs.Nutrition—iron and vitamins are needed to produce RBCs.

• Alcohol-in excess reduces cough reflex, which increases risk Alcohol-in excess reduces cough reflex, which increases risk of aspiration-this is why drunk people drown on their own of aspiration-this is why drunk people drown on their own vomitvomit

Slide 2Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Factors Affecting Oxygen Needs Factors Affecting Oxygen Needs

Altered Respiratory FunctionAltered Respiratory Function Respiratory function involves three Respiratory function involves three

processes.processes. Air moves into and out of the lungs.Air moves into and out of the lungs. OO22 and CO and CO22 are exchanged at the alveoli. are exchanged at the alveoli. The blood carries OThe blood carries O22 to the cells and removes to the cells and removes

COCO22 from them. from them. Hypoxia means that cells do not have Hypoxia means that cells do not have

enough oxygen.enough oxygen. Early signs of hypoxia are restlessness, Early signs of hypoxia are restlessness,

dizziness, and disorientation.dizziness, and disorientation. Cyanosis-bluish color in the skin, lips, mucous Cyanosis-bluish color in the skin, lips, mucous

membranes and nailsmembranes and nails


CyanosisCyanosis

Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 4

Altered Respiratory Function (cont’d)Altered Respiratory Function (cont’d)

Normal adult respirations are 12 to 20 per Normal adult respirations are 12 to 20 per minute.minute.

Infants and children have faster rates.Infants and children have faster rates. Normal respirations are quiet, effortless, and Normal respirations are quiet, effortless, and

regular.regular. Both sides of the chest rise and fall equallyBoth sides of the chest rise and fall equally Abnormal sounds should be reported to the nurseAbnormal sounds should be reported to the nurse https://www.youtube.com/watch?v=gOB0nM0PR

Tc


https://www.youtube.com/watch?v=gOB0nM0PRTc

https://www.youtube.com/watch?v=gOB0nM0PRTc

These breathing patterns are abnormal.These breathing patterns are abnormal. Tachypnea—rapid breathingTachypnea—rapid breathing

• Respirations are more than 20 per minute.Respirations are more than 20 per minute. Bradypnea—slow breathingBradypnea—slow breathing

• Respirations are fewer than 12 per minute.Respirations are fewer than 12 per minute. Apnea—lack or absence of breathingApnea—lack or absence of breathing

• Occurs in sudden cardiac arrest and respiratory arrestOccurs in sudden cardiac arrest and respiratory arrest Hypoventilation—respirations are slow, shallow, Hypoventilation—respirations are slow, shallow,

and sometimes irregular.and sometimes irregular. Hyperventilation—respirations are rapid and Hyperventilation—respirations are rapid and

deeper than normal.deeper than normal.



*Dyspnea*Dyspnea —difficult, labored, or painful breathing —difficult, labored, or painful breathing Cheyne-Stokes respirations Cheyne-Stokes respirations —respirations gradually —respirations gradually

increase in rate and depth, and then they become increase in rate and depth, and then they become shallow and slow.shallow and slow.• Breathing may stop for 10 to 20 seconds.Breathing may stop for 10 to 20 seconds.

• Cheyne-Stokes respirations are common when death is near.Cheyne-Stokes respirations are common when death is near.

*Orthopnea*Orthopnea —breathing deeply and comfortably only —breathing deeply and comfortably only when sitting- sitting over the table to breathe is the when sitting- sitting over the table to breathe is the orthopneic positionorthopneic position

Respiratory arrest-breathing has stoppedRespiratory arrest-breathing has stopped Biot’s respirations Biot’s respirations —rapid and deep respirations followed —rapid and deep respirations followed

by 10 to 30 seconds of apneaby 10 to 30 seconds of apnea Kussmaul respirations Kussmaul respirations —very deep and rapid respirations—very deep and rapid respirations

• They signal diabetic coma.They signal diabetic coma.



Pulse oximetry measures the oxygen Pulse oximetry measures the oxygen concentration in arterial blood.concentration in arterial blood. The normal range is 95% to 100%.The normal range is 95% to 100%. A sensor attaches to a finger, toe, earlobe, nose, or A sensor attaches to a finger, toe, earlobe, nose, or

forehead.forehead. A good sensor site is needed- no fingernail polish or A good sensor site is needed- no fingernail polish or

fake nails, patient should be stillfake nails, patient should be still Oxygen concentration (called pulse ox or O2 sat) is Oxygen concentration (called pulse ox or O2 sat) is

often measured with vital signs-it will also record the often measured with vital signs-it will also record the pulse as well. pulse as well.

Reduced oxygen in the blood is called Reduced oxygen in the blood is called hypoxemiahypoxemia Hypoxia Hypoxia is when cells do not get enough oxygenis when cells do not get enough oxygen


Assisting with Assessment Assisting with Assessment and Diagnostic Tests (cont’d)and Diagnostic Tests (cont’d)

pulse oxpulse ox


Pain, immobility, and narcotics interfere with Pain, immobility, and narcotics interfere with deep breathing and coughing.deep breathing and coughing.• Secretions collect in the airway and lungs and interfere Secretions collect in the airway and lungs and interfere

with air movement and lung function.with air movement and lung function.

• Secretions provide a place for microbes to grow and Secretions provide a place for microbes to grow and multiply.multiply.

Respiratory disorders cause the lungs, Respiratory disorders cause the lungs, bronchi, and trachea to secrete mucus.bronchi, and trachea to secrete mucus. MucusMucus from the respiratory system is called from the respiratory system is called

sputumsputum when expectorated (expelled) through when expectorated (expelled) through the mouth.the mouth.

Sputum that contains blood is Sputum that contains blood is hemoptysishemoptysis-tell the -tell the nurse at oncenurse at once


Assisting with Assessment Assisting with Assessment and Diagnostic Tests (cont’d)and Diagnostic Tests (cont’d)

Meeting Oxygen Needs (cont’d)Meeting Oxygen Needs (cont’d) The following measures are common in care plans.The following measures are common in care plans.

• PositioningPositioning Breathing is usually easier in the semi-Fowler’s Breathing is usually easier in the semi-Fowler’s

and Fowler’s positions.and Fowler’s positions. Frequent position changes are needed-turn q 2.Frequent position changes are needed-turn q 2.

• Deep breathing and coughing-use pillow for support Deep breathing and coughing-use pillow for support Deep breathing moves air into most parts of the Deep breathing moves air into most parts of the

lungs.lungs. Coughing removes mucus.Coughing removes mucus. Exercises promote oxygenation.Exercises promote oxygenation. Remind pt to cover mouth and nose when Remind pt to cover mouth and nose when

sneezing, use tissues and throw tissues into sneezing, use tissues and throw tissues into waste bucket, and wash hands frequentlywaste bucket, and wash hands frequently


Incentive spirometryIncentive spirometry..

• IS means inhaling as deeply as possible and IS means inhaling as deeply as possible and holding the breath for at least 3 seconds.holding the breath for at least 3 seconds.

• The goal is to improve lung function.The goal is to improve lung function. Atelectasis (collapse of a portion of the Atelectasis (collapse of a portion of the

lung) is prevented or treated.lung) is prevented or treated.

• This exercise:This exercise: Moves air deep into the lungsMoves air deep into the lungs Loosens secretionsLoosens secretions Promotes the exchange of OPromotes the exchange of O22 and CO and CO22

between the alveoli and capillariesbetween the alveoli and capillaries


Meeting Oxygen Needs (cont’d)Meeting Oxygen Needs (cont’d)

Incentive SpirometerIncentive Spirometer


Oxygen is treated as a drug-ordered by MDOxygen is treated as a drug-ordered by MD.. The doctor orders:The doctor orders:

When to give OWhen to give O22

The amount of OThe amount of O2 2 to giveto give The device to useThe device to use

Some people need oxygen constantly.Some people need oxygen constantly. If not humidified, oxygen dries the airway’s mucous If not humidified, oxygen dries the airway’s mucous

membranes-remember mouth caremembranes-remember mouth care Bubbling in the humidifier means that water vapor is Bubbling in the humidifier means that water vapor is

being produced.being produced. Oxygen flow ratesOxygen flow rates

The flow rate is the amount of oxygen given.The flow rate is the amount of oxygen given.• It is measured in liters per minute (L/min).It is measured in liters per minute (L/min).

The doctor orders 2 to 15 liters of OThe doctor orders 2 to 15 liters of O22 per minute. per minute.


Assisting with Oxygen TherapyAssisting with Oxygen Therapy

Humidified O2Humidified O2


Assisting with Oxygen Therapy (cont’d)Assisting with Oxygen Therapy (cont’d)

Oxygen sourcesOxygen sources Wall outletWall outlet

• OO22 is piped into each person’s unit. is piped into each person’s unit.

Oxygen tankOxygen tank• The oxygen tank is placed at the bedside.The oxygen tank is placed at the bedside.

Oxygen concentratorOxygen concentrator• The machine removes oxygen from the air.The machine removes oxygen from the air.

Liquid oxygen systemLiquid oxygen system• A portable unit is filled from a stationary unit.A portable unit is filled from a stationary unit.

• The portable unit can be worn over the shoulder for The portable unit can be worn over the shoulder for ambulatory or mobile patients.ambulatory or mobile patients.


Types of Oxygen Delivery Types of Oxygen Delivery MethodsMethods


Oxygen devicesOxygen devices The doctor orders the device for giving OThe doctor orders the device for giving O22.. These devices are common:These devices are common:

• Nasal cannula-two prongs inserted into nostrilsNasal cannula-two prongs inserted into nostrils• Simple face maskSimple face mask• Partial-rebreather maskPartial-rebreather mask• Non-rebreather maskNon-rebreather mask• Venturi maskVenturi mask

Moisture can build up under the mask.Moisture can build up under the mask.• Keep the face clean and dry. Keep the face clean and dry.

Oxygen is given by cannula during meals.Oxygen is given by cannula during meals.• The nurse changes the oxygen mask to a cannula.The nurse changes the oxygen mask to a cannula.• Remember to check behind ears, under and on bridge Remember to check behind ears, under and on bridge

of nose for breakdownof nose for breakdown


Assisting with Oxygen Therapy (cont’d)Assisting with Oxygen Therapy (cont’d)

Overview of Mask Overview of Mask Delivery DevicesDelivery Devices


https://www.youtube.com/watch?v=4OUEPvcAyRM



BiPap-usually worn at night for BiPap-usually worn at night for sleep apneasleep apnea


Safety with OxygenSafety with Oxygen

Remember that O2 is highly flammable!Remember that O2 is highly flammable! No smoking sign should be postedNo smoking sign should be posted No smoking materials should be in roomNo smoking materials should be in room No candles are allowedNo candles are allowed Make sure electrical items are turned off prior to Make sure electrical items are turned off prior to

unplugging them to prevent sparksunplugging them to prevent sparks


Chapter 36 Oxygen Needs Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

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