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The rate of flow may be as high as 12 L/min. Methods of administration are divided into high-flow and low-flow systems Moderate concentrationsof oxygen are prescribed when increased metabolic rate raises the consumption of oxygen or when there is poor distribution of oxygen because of heart failure. The concentrations of O2given in a moderate dosage are about 28% to 30% at a rate of flow of 4 to 7 L/min.Low concentrations of O2of about 24% to 28% delivered at a rate of 1 to 3 L/min are indicated when the patient needs oxygen over an extended period. These percentages and rates of flow are approximate amounts. The exact dosage delivered depends on the method of
administration and the patient's individual breathing pattern. Although oxygen is essential to life, excessive amounts are toxic. High concentrations of inhaled oxygen can cause lung injury much like that in ARDS. Short-term O2therapy, which is the administration of O2to treat hypoxemia, is indicated when:There is an inadequate intake of oxygen because of obstruction or restriction of airflow through the air passages.Oxygen is not distributed throughout the body because ofcirculatory failure.There is an inadequate supply of hemoglobin to transport the oxygen.Carbon dioxide or other gases displace the oxygen in the blood.Objective criteria for oxygen needs include maintaining the SaO2greater than 92% and the PaO2greater than 60 mm Hg (for disorders such as COPD).Outward signs of hypoxia vary among patients, but dyspnea, restlessness, and confusion are the most common signs. Blood gas analysis is the most reliable indicator.
For bedside assessment pulse oximetry is quick and noninvasive and gives a snapshot of oxygen saturation.Long-term O2therapy for patients with asthma or COPD is used to:Relieve hypoxemiaReverse tissue hypoxia and its signs and symptomsAllow the patient to function better mentally and physically, thereby increasing self-relianceOxygen orders for long-term management are prescribed in liters per minute or a specific FiO2. For acute situations orders are given to maintain an oxygen saturation at or above a certain level. You or respiratory therapist titrates the oxygen delivery toachieve the intended outcome.SLIDE 14Care of patients with chest tubes and closed drainage.Regular and frequent monitoring of patients with chest tubes with an understanding of why the tube has been placed will help with early identification of problems requiring intervention. It will also allow for assessment of effectiveness of the therapy.
There are three major areas of assessment:1. The respiratory status of the patient2. The site at which the tube is inserted into the chest and the length of the tube (for kinks or clots)3. The amount and character of the drainage in the collection chamberThe patient is assessed for ease of breathing, pain or discomfort, level of consciousness and orientation, andanxiety and restlessness.