Mini Med School: Respiratory Care


OBJECTIVES:

At the end of this class, you will be able to:

  1. Discuss the role of oxygen in the body.
  2. Detail some common respiratory disorders, such as COPD and pneumonia.
  3. Describe some forms of oxygen and oxygen supplies.
  4. Use oxygen in a safe way.

INTRODUCTION

Our world is made up of 3 kinds of matter. These kinds of matter are:

  • solids,
  • liquids and
  • gases

Examples of solids are wood and skin. Examples of liquids are water and blood.

Oxygen is a gas. It is a clear gas that does NOT have an odor. You can NOT see it and you can NOT smell it. We inhale, or take in, oxygen from the air when we breathe.

Oxygen makes up about 21%, or about one 1/5 of the air that we breathe. The oxygen that we breathe goes into our lungs. It then goes into the blood and then it moves into the body's cells, organs and muscles.

We need oxygen to live. The body will die when it does not get oxygen. When a person stops breathing, or they have what is called "respiratory arrest", they will die unless they get rescue breathing or they begin to breathe on their own. Although we can sometimes control our breathing, breathing is an automatic function of the body.

A person can be short of breath, irritable, confused, or have a headache when their oxygen level is low. Extra oxygen is sometimes needed when a person's body needs more oxygen that it is getting from the air. Extra oxygen is given in a hospital, nursing home, and even in the patient's home when a doctor orders it for a patient. Some people need oxygen only at night while they are sleeping. Others need oxygen all of the time or just when they are doing exercise.

A doctor's order will tell you when the person needs the oxygen and what the rate of the oxygen flow should be. Blood tests, like arterial blood gases, help the doctor to find out how much a person needs. For example, a doctor may order 2 liters of oxygen per minute while the person is sleeping. It is very important that the amount given is what the doctor ordered. Too much can kill a person because it can stop them from breathing on their own.

There are several different ways that oxygen is given and a couple of different treatments, such as IPPB, that are used when a person has a respiratory or cardiac problem. Oxygen is most often used for lung and heart problems, however, it is also now used to treat wounds, such as those found on the feet of patients or residents with diabetes.

Oxygen saves lives. It also helps people to have an active life in their home when they have a lung or heart problem. Nursing assistants and other health care providers take care of patients and residents who use oxygen and take respiratory treatments for these health problems.

PNEUMONIA

What is Pneumonia?

Pneumonia is a very serious infection of the lungs. The lungs give the body oxygen. The lungs take in air from outside of the body and then they fill our blood with oxygen so that it can then be carried to every part of our body. This oxygen is needed to keep all our body parts and us alive.

Pneumonia takes the needed oxygen from our body. The amount of oxygen that our body needs to live cannot be carried when the lungs fill with a liquid, pus and an infection like pneumonia. The human body and all of the body's cells do not work in the correct way when oxygen is not being sent to all the body parts. When this disease is serious enough, it may greatly lower the amount of oxygen in the body, thus leading to death.

Pneumonia can affect only a section of one lung or it can affect areas of both lungs. It is caused by over 30 different causes. Most cases, however, result from a bacteria, a virus, chemicals and other things like a fungus.

How Serious is It?

In the past, pneumonia was the number one cause of death in the United States. This changed when antibiotics came into use. These new medicines very quickly began to control the disease. They still help to control it and save many lives but it still has not gone away completely. Some people are now getting pneumonia that cannot be attacked by medicines. Some pneumonias are not killed with medicine.

Pneumonia and the flu are still very serious. They are the 7th leading cause of death in the United States, according to the American Lung Association.

Who is At Greatest Risk for Pneumonia?

A person of any age can get pneumonia, but it is seen most often in older adults. It is a very serious problem for this age group. The elderly are the most seriously harmed age group when pneumonia strikes. It is the number one leading infection among the elderly and it is the 4th leading cause of death in this age group.

It is very often the cause of death for older adults and people who are younger after they have had a serious illness or something like a broken hip that keeps them in bed for a long period of time. This disease often happens when a person is not mobile and out of bed. Nursing assistants can help prevent pneumonia by encouraging a person to get out of bed and to stay as mobile as possible. Other things that help are:

  • having the person take deep breaths and cough,
  • providing fluids,
  • giving the person a good diet and
  • using proper infection control procedures.

How is Pneumonia Treated?

Most young people will get better in their own home without going to the hospital. A healthy, young person may be able to lead a normal life and go back to work or school in about a week after they begin to get treatment.

For older people and for some kinds of pneumonia, however, it may take weeks until the person feels strong and well enough to lead a normal life. Some of these people, especially if they are older, may need some home care services from a nurse and nursing assistant. Other people, like those that have been sick for a long time and older people, may have to go to the hospital. Still others may die from it.

Young, healthy people get better very quickly when they:

  • see their doctor and get treatment right away,
  • have good natural defenses against infection,
  • are well nourished,
  • healthy, and
  • have NO other diseases.

The treatment of pneumonia includes:

  • medications to kill the germs that are causing the disease when it is caused by a bacteria or some viruses,
  • rest,
  • fluids,
  • a good diet,
  • lung care (pulmonary hygiene) to clear the lungs and mucus, and
  • oxygen for some people.

When a person takes medicine for this disease, they must take it according to the doctor's order. They should not stop taking it even when they are feeling better or when their temperature is normal unless their doctor has told them that it is time to stop taking it. The patient may get a second, worse case of pneumonia if the person stops the medication before the doctor tells them to.

To learn more about pneumonia, take our class entitled "Mini Med School: Pneumonia"

COPD

What is COPD?

COPD stands for chronic obstructive pulmonary disease. This disease affects the air flow into and out of the lungs. It gets worse as time goes on. About 14 to 16 million people in the United States have COPD.

How Serious is It?

COPD is very serious and a major cause of death. People with COPD may have:

  • a constant cough,
  • shortness of breath,
  • difficulty breathing which is sometimes very severe,
  • wheezing,
  • loss of weight,
  • blood in sputum,
  • cyanosis,
  • swelling of the feet and ankles, and
  • abnormal breath sounds.

Who is At Greatest Risk for COPD?

People that smoke are at great risk for COPD. Other risk factors include:

  • second hand smoke,
  • air pollution,
  • poor indoor ventilation, and
  • old age.

How is COPD Treated?

COPD is treated with a number of medicines, including those that dilate the lungs and keep the respiratory secretions thin so that they can be coughed up.

Other treatments include:

  • a good diet,
  • plenty of fluids,
  • oxygen, and
  • deep breathing exercises.

OXYGEN TREATMENTS

Oxygen can be given as:

  • compressed oxygen gas,
  • liquid oxygen and
  • concentrated oxygen

Compressed oxygen is stored under pressure in a large cylinder that has a regulator to control the flow rate. The gas comes out only when a person inhales. The flow is cut off when the person exhales.

The liquid form of oxygen is used mostly with people who are in their home and active. It is made by cooling the oxygen gas until it turns into a liquid. This form is held in smaller tanks than compressed oxygen. A large amount of oxygen in a small container allows the person to carry it around when they leave their home.

The concentrated form of oxygen is made from room air with an electrical device. This form of oxygen is NOT portable. It costs less than other forms. In the event of a power failure, the person must use another form since electricity is necessary to make this form of oxygen.

OXYGEN SUPPLIES

Some of the oxygen supplies that are used are:

  • a regulator or flow meter
  • oxygen tubing
  • masks
  • a nasal cannula and
  • a humidifier.

The regulator or flow meter is used to make sure that the person gets the right amount of oxygen. For example, the regulator may be set at 2 liters per minute.

Oxygen tubing is used to move the oxygen from the tank to the person's nose or trach.

Masks are used to move the oxygen from the tubing to the persons nose. They are most often used when the person needs a large amount of oxygen. Nasal cannulas have 2 small prongs that deliver the oxygen into the nose without the need for a mask to cover the person's entire face. Tuck some gauze under the nasal cannula tubing to prevent the cheeks or the skin behind the ears from becoming sore.

Oxygen is very dry. Humidity is often added to it with a humidifier to prevent the person from drying out. Use a water based lubricant on the patient's lips and/or nostrils if they become dry. Do NOT use an oil based product like petroleum jelly.

All supplies and equipment must be kept clean and in good working order. Filters should be cleaned every day. Take out the filters and knock any dust off them. Wash them with warm soapy water and let them air dry for a couple of hours. Do NOT put wet filters back into any electrical equipment.

Wipe down the outsides of equipment with a damp, soapy cloth on a regular basis. If the patient is using a humidifier, empty the water out from the jar and wash the jar in hot soapy water every day. Change the bottle every month. Nasal cannulas and masks should be changed at least every 2 to 4 weeks. The tubing should be changed at least every month. If the patient has a cold or flu, change the tubing and mask often.

OXYGEN SAFETY

Oxygen must be used safely. Some of the safety rules that you must follow are:

  1. Maintain electrical safety. All electrical appliances should be at least three to four feet from any sink, tub, shower, or stove. Do NOT use worn or frayed wires. Do NOT use an extension cord. Use a three prong grounded outlet.

  2. Never smoke when oxygen is being used.

  3. Tell visitors not to smoke.

  4. Put up a no-smoking signs in the home.

  5. Keep oxygen at least five feet away from candles, gas stoves, fireplaces, or other heat.

  6. Do NOT use things like cleaning fluids, paint thinners, or aerosol spray cans near the oxygen.

  7. Make sure that all oxygen cylinders are stored in a safe way so that they will NOT tip over or fall.

  8. Keep liquid oxygen upright so that it does not pour out and cause skin damage.

  9. Keep a fire extinguisher close by and let the local fire department know that oxygen is being used in a home.

SUMMARY

Nursing assistants and other healthcare providers take care of many people that have both acute and chronic respiratory problems. This course has given you some information that can help you to provide the best care possible to these patients and residents.

REFERENCES

American Lung Association. (2010) “Supplemental Oxygen” [online].  http://www.lungusa.org/lung-disease/copd/living-with-copd/supplemental-oxygen.html

American Lung Association. (2010) “Lung Cancer”. [online]. http://www.lungusa.org/lung-disease/lung-cancer/

American Lung Association. (2010) “Asthma”. [online]. http://www.lungusa.org/lung-disease/asthma/

American Lung Association. (2010) “COPD”. [online]. http://www.lungusa.org/lung-disease/copd/

American Lung Association. (2010) “Influenza”. [online]. http://www.lungusa.org/lung-disease/influenza/

Berman, Audrey, Shirlee Snyder, Barbara Kozier and Glenora Erb. (2010). Kozier & Erb's Fundamentals of Nursing: Concepts, Process, and Practice. 8th Edition. Pearson Prentice Hall.

 

Hockenberry, Marilyn J. and David Wilson. (2010).Wong's Essentials of Pediatric Nursing. 8th Edition. Elsevier Mosby.

 

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Monahan, Frances Donovan and Wilma J. Phipps (2007). Phipps’ Medical-Surgical Nursing: Health and Illness Perspectives. 8th Edition. Elsevier Mosby.

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Wold, Gloria Hoffmann. (2008). Basic Geriatric Nursing. Elsevier Mosby.

 

 

 

Copyright © 2010 Alene Burke



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