CARE OF CLIENTS WITH PROBLEM NCM 112

1 S T
IN OXYGENATION: ACUTE/CHRONIC
RLE / with LECTURE DEMO TERM

OXYGEN THERAPY NON-REBREATHER MASK: 12–15 L/min

What Is Oxygen Therapy?

-
Oxygen therapy refers to the administration of
supplemental oxygen to patients with acute or
chronic conditions that prevent them from
obtaining sufficient oxygen from the ambient air.
It's a critical therapeutic modality, especially in
critical care settings.
WHY OXYGEN THERAPY?
- Fundamental Physiology: Every cell in our body
requires oxygen for metabolism. Oxygen is
inhaled into the lungs and then transported via
the bloodstream to all cells. When there is a 3. High-flow Nasal Cannula (HFNC): Delivers warmed
deficit, cells might function less effectively or die. and humidified oxygen at higher flows, improving
METHODS OF DELIVERING OXYGEN comfort and oxygenation. - 60 L/min
1. Nasal Cannula: A simple and common method
where two small prongs fit into the nostrils, it’s
suitable for those who need a lower, more
constant level of supplemental oxygen.
2. Face Masks: Including simple face masks, venturi
masks, and non-rebreather masks. These provide
higher oxygen concentrations.
SIMPLE FACEMASK: 6 to 10 L/minute

4. Non-Invasive Ventilation (NIV): Uses devices like

PAP (continuous positive airway pressure) and
BiPAP (bilevel positive airway pressure) machines
to help maintain open airways and augment
oxygenation without intubation.

VENTURI: flow rate depending on its color

- BLUE = 2-4L/min
- WHITE = 4-6L/min
- YELLOW = 8-10L/min
- RED = 10-12L/min
- GREEN = 12-15L/min

5. Mechanical Ventilation: For patients unable to

breathe on their own. Oxygen is delivered
through an endotracheal tube directly into the
trachea.

FIRST SEM / FIRST TERM 1

by Bea Rikka B. Ihong
CARE OF CLIENTS WITH PROBLEM NCM 112
1 S T
IN OXYGENATION: ACUTE/CHRONIC
RLE / with LECTURE DEMO TERM

MONITORING AND RISKS

- Pulse Oximetry: This is a non-invasive method to
monitor oxygen saturation in the blood. SUCTIONING
- Arterial Blood Gas (ABG): A diagnostic test that
measures the oxygen and carbon dioxide levels in DEFINITION:
the bloodstream. Suction - Is the use of a rigid plastic suction catheter,
RISKS OF OXYGEN THERAPY known as a yankuer, to remove pharyngeal secretions
- Oxygen toxicity can occur if high concentrations through the mouth.
of oxygen are administered for extended periods. - The oral suctioning catheter is not used for
- Dry or bloody nose from the nasal cannula. tracheostomies due to its large size.
- Increased carbon dioxide levels in COPD patients. - Oral suctioning is useful to clear secretions from
- Fire hazards, as oxygen supports combustion. the mouth in the event that is unable to remove
CHRONIC OXYGEN THERAPY secretions or foreign matter by effective
- For patients with chronic respiratory or cardiac coughing.
diseases, long-term oxygen therapy (LTOT) can PURPOSE:
enhance quality of life and improve survival. This - to maintain a patent airway and improve
often involves portable oxygen systems allowing oxygenation by removing mucous secretions and
for increased mobility. foreign material (vomit or gastric secretions from
HYPERBARIC OXYGEN THERAPY (HBOT) the mouth and throat (oropharynx).
- This involves breathing pure oxygen in a SAFETY CONSIDERATIONS:
pressurized room or chamber. HBOT is a - Avoid oral suctioning on patients with recent
specialized treatment for conditions like head and neck injuries.
decompression sickness, carbon monoxide - Avoid mouth sutures, sensitive tissues, and any
poisoning. and some wound infections. tubes located in the mouth
- Avoid stimulating gag reflex
- Use clean techniques for oral suctioning
- Know which patients are at risk for suctioning
- Keep supplies readily available at the bedside and
ensure that suction is functioning in the event of
oral suctioning is required immediately
- Always perform a pre and post respiratory
assessment

FIRST SEM / FIRST TERM 2

by Bea Rikka B. Ihong
CARE OF CLIENTS WITH PROBLEM NCM 112
1 S T
IN OXYGENATION: ACUTE/CHRONIC
RLE / with LECTURE DEMO TERM

TRACHEOSTOMY CARE ✓ As preparation for extensive head and neck

procedure
TRACHEOSTOMY ✓ To bypass obstruction: CANCER OF LARYNX
✓ To remove secretions more easily : Inability to
- It is a surgical opening in the anterior wall of the swallow or cough: STROKE PATIENT
trachea just below the larynx. (Below cricoid ✓ To improve patient comfort.
cartilage) ✓ To decrease the work of breathing and increase
volume of air entering the lungs.
Types of Tracheostomy Tubes
1. METAL OR PLASTIC

2. CUFFED or UNCUFFED

Important Terms to Remember:

- Decannulation: The process whereby a
tracheostomy tube is removed once patient no
longer needs it.
- Humidification: The mechanical process of
increasing the water vapor content of an inspired
gas.
3. FENESTRATED or UNFENESTRATED
- Stoma: An opening, either natural or surgically
created, which connects a portion of the body
cavity to the outside environment (in this case,
between the trachea and the anterior surface of
the neck)
- Tracheostomy: A surgical procedure to create an
opening between 2-3 (3-4) tracheal rings into the
trachea below the larynx.
- Tracheal Suctioning: A means of clearing thick
mucus and secretions from the trachea and lower
- Cuffed FEN tube is particularly useful when a stable
airway through the application of negative
patient is weaning from tracheostomy.
pressure via a suction catheter.
- Uncuffed FEN tubes are used for patients Who are
- Tracheostomy tube: A curved hollow tube of
no longer dependent on a cuffed tube
rubber or plastic inserted into the tracheostomy
stoma (the hole made in the neck and windpipe
4. DOUBLE or SINGLE
(Trachea) to relieve airway obstruction, facilitate
mechanical ventilation or the removal of tracheal
secretions.
INDICATIONS:
✓ To provide and maintain patent airway.
✓ To enable the removal of trachea-bronchial
secretions.
✓ Provide mechanical ventilation on a long-term
basis as in cases of neuromuscular disease.

FIRST SEM / FIRST TERM 3

by Bea Rikka B. Ihong
CARE OF CLIENTS WITH PROBLEM NCM 112
1 S T
IN OXYGENATION: ACUTE/CHRONIC
RLE / with LECTURE DEMO TERM

IMMEDIATE COMPLICATIONS: Planning

- Hemorrhage
- Hурохіа - Tracheostomy care involves application of
- Trauma to recurrent laryngeal nerve scientific knowledge, sterile technique, and
- Damage to esophagus problem solving, and therefore needs to be
- Pneumothorax performed by a nurse or respiratory therapist.
- Infection Nursing Considerations
- Subcutaneous emphysema Cleaning the tracheostomy inner cannula tube (for
EARLY COMPLICATIONS reusable inner cannulas only)
- Tube obstruction or displacement 1. The tracheostomy inner cannula tube should be
- Pooling of secretions leading to aspiration and cleaned two to three times per day or more as
LRTI (Lower Respiratory Tract Infection) needed. Please note that this only applies to
- Bleeding from tracheostomy site reusable inner cannulas. Cleaning is needed more
- Infection immediately after surgery.
LATE COMPLICATIONS 2. Tracheostomy dressing should be done every 8
- Airway obstruction with aspiration hours or when the dressing is soiled.
- Damage to larynx. e.g. Stenosis o Tracheal 3. Tracheostomy tubes may come w/ disposable
stenosis o Tracheomalacia inner cannula or with the inner cannula.
- Aspiration and pneumonia o Fistula formation e.g. 4. If disposable cannula is present, replace the one
Tracheo-cutaneous or Tracheo-esophageal that is inside new one.
- Air escapes around stoma; generally of no clinical DECANNULATION
consequence - can be palpated around the stoma
Definition: The process whereby a tracheostomy tube is
site
removed once patient no longer needs it.
Dislodgement of the Tube Indication: When the initial indication for a tracheostomy
- Due to excessive manipulation of the no longer exists
tracheostomy tube during coughing suctioning. Requirements: A patient is considered a candidate for
- Thinning of the trachea (Trachemalacia) decannulation once the following conditions are met:
- Development of granulation of tissue (bump 1. Patient is alert and oriented and responsive to
formation in trachea commands.
- Narrowing of the airway above the site of 2. Patient is no longer dependent on a ventilator for
tracheostomy. assisted breathing.
3. The frequency requirement for tracheal
Stoma Care suctioning is less than once a (This is not always
- Meticulous care towards hygiene and asepsis is the case. Check with your physician]
necessary. Remember the skin surrounding the 4. Patient has met the criteria for decannulation
stoma is also prone to irritation. outlined below.
Tube Care - Once all of the above criteria are met, the patient is
informed that their trach tube is going to be removed.
- Tubes need to be cleaned.
- They are instructed that they may experience a sensation
- The area should be cleaned with normal saline
of shortness of breath for a few minutes once they are
(inner double cannula, the inner cannula need to
decannulated.
be remove and clean using with warm water.
- Arrangements should be made for back-up personnel (RT
Assessment: or RM) to be available in case of emergency.
1. Respiratory status (ease of breathing, rate, - Decannulation is usually not done at home.
rhythm, depth, lung sounds, and oxygen - The patient is placed supine (flat) on their bed, the tube
saturation level) is removed and the opening into the neck is covered with
2. Pulse rate sterile gauze and a tape is placed over the gauze.
3. Secretions from the tracheostomy site (character - The patient is instructed to occlude the gauze with their
and amount fingertip every time they cough or speak so that air does
4. Presence of drainage on tracheostomy dressing not leak.
or lies - They should change the gauze and the tape at least once
5. Appearance of incision (redness, swelling, a day (more often as needed) until the hole in the neck
purulent discharge, or odor) heals itself closed over the next few days to weeks.
- In a minority of patients («10 %), the opening into die neck
skin has to be surgically closed.

FIRST SEM / FIRST TERM 4

by Bea Rikka B. Ihong