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c  Patients who require ×   Flow rates in excess of 6to 8 L/min may lead to swallowing of
low to medium   air or may cause irritation and drying of the nasal and
R    concentration of pharyngeal mucosa.Humidity must be provided while oxygen is
oxygen 1-2 used (except with portable devices) to counteract the dry,
3-5 irritating effects of compressed oxygen on the air-way. Nurses
have to assess frequently vital sins, especially SatO2, RR,
6 pulmonary auscultation.


 ×! Pt who need low to ×   1.Mask must be adjusted for proper ¿t. They should not press
moderate   too tightly againstthe skin because this can cause a sense of
R    concentrations of claustrophobia or skin breakdown
oxygen. 6-8
2.Adjustable elastic bands are provided to ensure comfort and
security.3. Nurses have to assess frequently vital sins,
   especially SatO2, RR, pulmonary auscultation.

 " #    Pt with physical ×   4.The mask should ¿t snugly enough to prevent oxygen from
trauma, chronic   Àowing into the patient¶s eyes
R    airway
limitation/chronic 12 5. The nurse checks the patient¶s skin for irritation
obstructive  6. It is necessary to remove the mask so that the patient can
pulmonary diseases, eat, drink, and take medications, at which time supplemental
smoke inhalation,  oxygen is provided through a nasal cannula.
and carbon monoxide
poisoning, or any
other patients who
require high-flow
oxygen, but do not 80-100 It is important to adjust theoxygen Àow so that the reservoir
require breathing bag does not completely collapse on inspiration.

 $  Pt. who cannot c   1. Check symmetry of chest expansion
maintain an adequate
     airway on their own 15-20 mm Hg 2. Auscultate breath sounds of anterior and lateral chest
(e.g., comatose bilaterally

patients, patients 3. Obtain order for chest x-ray to verify proper tube
with upper airway  placement.
obstruction), for
 4. Check cuff pressure every 6±8 hours.
patients needing
mechanical  5. Monitor for signs and symptoms of aspiration.
ventilation, and for
suctioning secretions  6. Ensure high humidity; a visible mist should appear in the T-
from the pulmonary piece or ventilator tubing.
7. Administer oxygen concentration as prescribed by physician.

8. Secure the tube to the patient¶s face with tape, and mark
the proximal end for position maintenance. a. Cut proximal
end of tube if it is longer than 7.5 cm (3inches) to prevent
kinking. b. Insert an oral airway or mouth device to prevent
the patient from biting and obstructing the tube.
9. Use sterile suction technique and airway care to prevent
iatrogenic contamination and infection.
10. Continue to reposition patient every 2 hours and as
needed to prevent atelectasis and to optimize lung expansion.
11. Provide oral hygiene and suction the oropharynx when-
ever necessary

c$ Pt who need CPAP machines Nurses should carefully assess for tachypnea, tachycardia,
continuous positive can generate a reduced tidal volumes, decreasing oxygen saturations, and

 airway pressure to range of increasing carbon dioxide levels.
reverse or prevent pressures above
micro-atelectasis, atmospheric
thusallowing a lower pressure, typically
percentage of oxygen # %   Explain to patient and relatives regarding the
to be used. &'. The compliance to the mask as well as:
Perioperative period, average patient V It may be uncomfortable
sleep apnea, after however requires V Xifficulty in breathing out
mechanical between (  V Tightness of the mask
ventilation, )%' V Feeling of ³locked in´
congestive heart pressure. V Possible eye swelling
failure, chronic ‡ Second hourly mouth and pressure relief care (whenever
obstructive × *A flow
rate of 30- possible)
pulmonary disease
40L/min is the ‡ Padding may be required as the mask are not
usual rate individualized
required. This
roughly ‡ Regular check of equipment, as there is no integrated
corresponds to monitoring facilities
about 1.5 times
‡ Hourly observations and recordings (monitor water level)
the usual minute
volume. This flow ‡ Monitor airway and respiratory function (If patient is in
rate should difficulty inform Xr.)
ensure an ample
reservoir of gas ‡ Monitor ABG¶s
from which to ‡ Consult with medical officer for the need of a nasogastric
breathe, however tube to prevent gastric distention and vomiting
higher gas flows
may be required
in patients with
tachypnea and
those able to
generate a large
negative pressure
through the
Pt who need positive
  pressure maintained +)+' Nursing interventions to identify the adverse effects of positive
by the ventilator at pressure ventilation include monitoring of breath sounds, fluid
positive end-expiratory pressure  balance, and cardiac output. Breath sounds which become
the end of exhalation
(instead of a normal distant, more diminished, or absent could indicate
zero pressure) to pneumothorax. A drop in cardiac output, evidenced by
increase functional decreased blood pressure, increased heart rate, decreased
residual capacity urine output, or change in level of consciousness, can indicate
andopen collapsed decreased venous return from positive pressure. Careful
alveoli. ARXS, assessment of fluid balance and conservative fluid adjustments
Pneumonia, are warranted.
Pulmonary edema,