Oxygen therapy / high school (nurse)

Oxygen is an elemental gas essential for life.
Oxygen therapy means administering oxygen at a higher concentration than in atmospheric air (contains 21% O2, 78% nitrogen, 1% other gases)
Oxygen therapy is a treatment method that increases the oxygen supply to the tissues and organs of a patient who has preserved spontaneous breathing.
Tissue oxygen supply depends on ventilation, blood gas exchange, and circulatory distribution.

Methods of humidification of the airways[edit | edit source]

Under normal (physiological) conditions, the upper respiratory tract humidifies and heats the inhaled air. With the use of mechanical ventilation, this is completely eliminated and therefore it is necessary to fully replace this function: the aim is to heat the inhaled mixture to a temperature of 30 ° C and humidify it to 70–100% humidity.

Active humidification - the mixture flows through a chamber system, where it is heated and moistened with sterile water.

the advantage is high-quality heating and humidification of the inhaled mixture without increasing the dead space.
the disadvantage is the increased risk of multiplication of microorganisms in the water chamber and in the condensation vessels

Passive humidification - a humidity and heat exchanger (HME filter) is included in the circuit, it acts as an antibacterial screen. The efficiency of humidification depends on the type of filter.

advantages: easy handling, lower costs, lower risk of infection.
Disadvantages: larger dead space, higher resistance, risk of mucus obstruction, risk of insufficient heating and humidification.

Another type of humidifier is the so-called artificial nose - used for ventilating for a short time (transport), or for outpatients who have a TS cannula.

Drugs affecting the respiratory tract[edit | edit source]

Bronchodilators - reduce obstruction in chronic diseases (asthma , chronic bronchitis), highly effective drugs (Aminophylline, Theophylline).
Beta-agonists- their effect is bronchodilation (bronchodilation) in bronchial asthma (where isoprenaline, adrenaline, ephedrine). Preferred use is the use of beta-agonists with a selective (exclusive) effect on the bronchial system without affecting the heart muscle (Berotec, Ventolin, Brycanyl, Astmopent).

Parasympatholytic drugs, anticholinergics - these are used to widen the bronchi and have a similar effect to beta-agonists, but they have a slower onset and a smaller bronchodilator effect. They are indicated in cases of resistance to beta-agonists and corticoids, and for chronic therapy with beta-blockers (Atrovent, Berodual (aerosols)).

Glucocorticoids - anti-inflammatory, anti-allergic, relaxing effect on bronchial smooth muscle. Indicated for allergic conditions (asthma, anaphylactic shock, allergic skin diseases) and rheumatic diseases (Hydrocortisone, Solu-Medrol, Aldecin aerosol, Pulmicort).
Antitussives - suppresses the cough reflex (Codeine, Silomat, Sinecod, Intussin).
Expectorants, Mucolytics - facilitate coughing up mucus, reduce sputum viscosity (Ipecarin, Pleumolysin, Bromhexine, Mucosolvan, Mistabron, Ambrobene).
Respiratory stimulants - increase sensitivity to hypoxemia (Caffeine).
Surfactants - affect the surface tension of the alveoli

Preparing a patient / client in a hyperbaric chamber[edit | edit source]

They must not carry lighters, matches, cigarettes, flammable materials.
Only pure cotton clothing.
They must not use oils, creams, ointments.
Learn to use maneuvers to balance pressures.

Valsalva´s maneuver (forced exhalation with a closed nose)
Toynbee´s maneuver (swallow)

Air-filled chamber:

Patients can keep their watches and jewelry.
They can take books, magazines, crossword puzzles with a pencil.
Wounds can be treated with a damp or greasy dressing, and they should be covered with a cotton bandage only.
No restrictions on splints or plaster fixations.
A foam blanket can be used.

Oxygen-filled chamber:

Metals, jewelry, books, magazines, prostheses, and contact lenses must not be on the patient.
Do not use damp or greasy coatings, ointments.
All splints, orthoses, and prostheses must be removed.
Foams, disposable mats, and pulps must not be used.
Redon drain must not be introduced.

Unconscious patient:

Paracentesis before using HBO
Collection bags connected via anti-reflux valve.
Obturation balloons OTI, TS filled with fluid - AQ.
Infusion bottles must not be glass.
HD - we do not prevent air penetration.

Nursing diagnosis[edit | edit source]

Restlessness of a patient is due to the need to use O2 treatment and limited mobility, manifested by motor restlessness and non-cooperation.

Goal: calm, oriented patient.
Intervention:
- Listen to concerns, wishes and problems…
- Ensure patient safety, avoid the possibility of falling out of bed.
- Provide a comfortable position that improves patient ventilation.
- Choose an alternative aid for the application of O2 - according to the condition and in agreement with the doctor, inform the doctor and apply sedatives.
- Avoid pulling out invasive inputs and the risk of self-harm.

Risk of airway (AW) damage and infection due to invasive AW ET cannulation.

Objective: no damage and development of AW infection.
Intervention:
- Perform a regular and gentle AW cleaning under aseptic conditions, use disposable aids and a closed exhaust system.
- Check heating and humidification of the inhaled mixture.
- Give mucolytics, expectorants (by inhalation) according to the surgery.
- Perform regular changes of breathing circuits, filters, closed suction system, remove precipitated water from condensation vessels…

Lack of knowledge in patients in regards to the administration of oxygen treatment due to it being their first hospitalization, manifested by fear and anxiety.

Goal: informed and calm patient.
Intervention:
- Find out to what extent is the patient informed about the need for O2 treatment.
- Talk with and help relax and inform the patient on the importance of O2 treatment.
- Be empathetic.

References[edit | edit source]

ERTLOVÁ, Františka and Josef MUCHA, et al. Pre-hospital emergency care. 2nd edition. Brno: National Center for Nursing and Non-Medical Health Sciences, 2003. ISBN 80-7013-379-1 .

DOENGES, Marilynn E and Mary Frances MOORHOUSE. Pocket guide to a nurse. 2nd edition. Prague: Grada, 2001. ISBN 80-247-0242-8 .

Beranová Martina collaborated on the elaboration of the question