Oxigenation

Oxygenation refers to the process of supplying oxygen to the body’s tissues, which is essential for the proper functioning of organs and bodily processes. Oxygenation is crucial for cellular respiration, the process by which cells produce energy to carry out their functions.

The NCLEXRN exam may cover various aspects of oxygenation, including the physiological processes involved in oxygen delivery and consumption, common conditions that affect oxygenation, and nursing interventions for patients with impaired oxygenation. Some of the key concepts related to oxygenation that may be tested on the NCLEXRN include:

• The structure and function of the respiratory system, including the lungs, airways, and alveoli
• The mechanisms of breathing, including inhalation and exhalation
• The role of oxygen in cellular metabolism and energy production
• Common respiratory conditions, such as asthma, chronic obstructive pulmonary disease (COPD), and pneumonia
• Interventions to improve oxygenation, such as supplemental oxygen therapy, airway management, and breathing exercises
• Assessment and monitoring of oxygenation, including the use of pulse oximetry, arterial blood gas analysis, and respiratory rate measurement

Oxygen Delivery Methods

Oxygen delivery methods are ways of delivering oxygen to patients who have difficulty breathing or low oxygen levels. There are various oxygen delivery methods that nurses should be familiar with, including:

1. Nasal cannula: A nasal cannula is a device that delivers oxygen through two small tubes that are placed in the nostrils. It is the most common oxygen delivery method and is used for patients who need low to moderate oxygen levels.
2. Oxygen mask: An oxygen mask is a device that covers the nose and mouth and delivers oxygen through a tube that is connected to an oxygen source. It is used for patients who need higher concentrations of oxygen.
3. Venturi mask: A venturi mask is a type of oxygen mask that delivers precise concentrations of oxygen by mixing oxygen with room air. It is often used for patients with COPD or other conditions that require precise oxygen delivery.
4. Non-rebreather mask: A non-rebreather mask is similar to an oxygen mask, but it has a one-way valve that prevents exhaled air from being breathed in again. It delivers high concentrations of oxygen and is often used in emergency situations.
5. BiPAP and CPAP: BiPAP (bilevel positive airway pressure) and CPAP (continuous positive airway pressure) are non-invasive methods of providing oxygen and pressure support to patients who have difficulty breathing. These devices deliver a steady stream of air or oxygen to keep the airway open and improve breathing.
6. Mechanical ventilation: Mechanical ventilation is a method of delivering oxygen to patients who are unable to breathe on their own. It involves the use of a machine that delivers air or oxygen to the lungs through a tube that is inserted into the airway.

Safety Precautions

Oxygen In Use Sign

Ensure that proper signage is in place in your facility to warn visitors about the danger of open flames around oxygen. Educate people to refrain from smoking near areas where oxygen is in use.

No Electrical Sparks

Oxygen is highly combustible, and it can cause an explosion in certain situations. Always remove the bag valve mask from the patient’s bedside before administering an electrical shock during resuscitation attempts.

Six Feet Away from Open Flames

Teach patients to avoid smoking while using oxygen and to stay away from open flames. Oxygen can easily ignite when it comes into contact with an open flame.

Nursing Considerations

Dry Nasal and Upper Airway Mucosa

Oxygen can cause dryness of the mucosal membranes. Use a humidifier when administering high concentrations or when patients will be on oxygen for an extended period of time to reduce airway irritation.

Skin Irritation

Nasal cannula use can cause skin breakdown around the ears and nostrils. Conduct a daily assessment for skin breakdown and wrap gauze around the tube or strap to minimize pressure and irritation.

Home Education

Educate patients on how to monitor their oxygen tank level at home and when to notify the agency for a refill. Advise them to avoid using an excessively long oxygen tube, which can be a tripping hazard. Additionally, instruct patients on how to secure the oxygen cylinder properly and always keep it in an appropriate holder

Hypoxia

Hypoxia refers to a lack of oxygen in the body tissues, which can result in tissue damage or death. The early symptoms of hypoxia include restlessness, confusion, and headaches, while the late symptoms include cyanosis, bradycardia, and decreased level of consciousness. Hypoxia can be caused by a variety of factors, including respiratory failure, carbon monoxide poisoning, altitude sickness, and drowning. Nurses should closely monitor patients for signs of hypoxia, administer oxygen therapy as needed, and take steps to prevent hypoxia from occurring in the first place, such as monitoring oxygen saturation levels and providing adequate ventilation.

Early signs of hypoxia include diaphoresis, restlessness, tachypnea, dyspnea on exertion, tachycardia, hypertension, arrhythmias, decreased urine output, and unexplained fatigue. Diaphoresis is caused by compensatory release of catecholamines and results in moist, cool skin. Restlessness and irritability may occur due to the release of epinephrine and norepinephrine. Tachypnea and increased respiratory rate are triggered when cells are deprived of oxygen. Dyspnea on exertion occurs as the demand for oxygen exceeds supply. Tachycardia and hypertension are early compensatory responses to hypoxia. Decreased urine output can occur as a compensatory change in the kidneys. Late symptoms of hypoxia include cyanosis, cool clammy skin, use of accessory muscles, retractions, hypotension, and arrhythmias. Cyanosis is caused by a decrease in oxygenated hemoglobin and can be accompanied by cool, clammy skin. The use of accessory muscles and retractions occur when patients try to increase the volume and rate of respiration. Hypotension can occur when the body can no longer meet the demands for oxygen and tissues are unable to compensate. Arrhythmias can occur in early and late stages of hypoxia and can be lethal.

Tracheostomy Care

• A tracheostomy is an airway created surgically to bypass airway obstructions or to aid in long-term ventilation.
• The inner cannula should be removed and cleaned every 8 hours to prevent airway obstruction and accumulation of mucous inside the tube.
• The area around the stoma should be cleaned every 8 hours to prevent skin breakdown and subsequent infection. Avoid cutting the dressing or any 4 x 4s that can be aspirated through the tracheostomy tube.
• The tracheostomy ties should be changed as needed. A pinkie finger should fit snugly under the ties, ensuring they are not too tight or too loose.
• If the patient is able to breathe spontaneously, deflating the cuff of the tracheostomy tube allows for speech. Speaking valves and specialized tracheostomy tubes are encouraged to help with speech.
• The patient can eat while the tracheostomy tube is in place, but they may experience difficulty swallowing. They should eat slowly, in an upright position, with the cuff partially deflated, and with the chin tucked down and forehead moved forward while swallowing.
• A replacement tube of equal or smaller size should be kept at the bedside in case of emergency reinsertion. If the tube is dislodged, immediately try to replace it with a new tube.
• The physician should perform the first tube change at least one week after tracheostomy insertion to assess the stoma. After the first tube change, the tracheostomy tube should be changed one month later.

Note:

• The inner cannula should be cleaned every 8 hours.
• The area around the stoma should be cleaned every 8 hours.
• The tracheostomy ties should be changed as needed.
• A replacement tube should be kept at the bedside in case of emergency reinsertion.
• The physician should perform the first tube change at least one week after tracheostomy insertion

Nurses play a critical role in monitoring and promoting oxygenation in patients, particularly those with respiratory conditions or other factors that may impair oxygen delivery or consumption. Nurses may use various interventions to promote oxygenation, including administering medications, positioning patients for optimal breathing, and providing education and support for patients and their families.