Published: Вс, Марта 05, 2017
World | By Tasha Manning

Nursing of the Adult and Elderly: Nursing Care in Oxygen Therapy (I part)

Nursing of the Adult and Elderly: Nursing Care in Oxygen Therapy (I part)

Oxygen therapy is a therapeutic procedure aimed at preventing and treating hypoxia increasing the oxygen content (O2) in arterial blood which results in PaO2 (normal> 60 mmHg). The beneficial effects of this therapy were established based on clinical experience and scientific publications which showed that the mortality of patients with advanced COPD declines when receiving oxygen therapy continuously. In addition, the quality of life of these patients has been shown to be significantly higher. The factors that influence tissue oxygenation are mainly the transfer of O2 through the alveolar-capillary membrane, the concentration of hemoglobin in blood and the cardiac minute volume. The existence of an alteration in some of these factors can produce hypoxia. Many respiratory diseases are characterized because the gaseous exchange of the lung is not performed correctly. The lung is unable to properly take oxygen from the breathed air and pass it into the blood, appearing what is called respiratory failure. This can be demonstrated if we measure the amount (concentration) of oxygen that the patient has in arterial blood, through a gasometry (acid-base state).

Oxygen therapy indications: · Arterial hypoxemia . It is the most frequent indication. It occurs in cases of chronic obstructive pulmonary disease, asthma, atelectasis, pneumonia, altitude sickness, interstitial pneumonitis, arteriovenous fistulas, pulmonary thromboembolism, etc. · · Tissue hypoxia without hypoxemia . It happens in cases of anemia, cyanide poisoning, hypermetabolic states, hemoglobinopathies, marked hypotension, etc. · · Special situations (where O2 is recommended): acute myocardial infarction, Heart failure, hypovolemic shock, carbon monoxide poisoning, and chest trauma of any kind.

The goal of oxygen therapy is to maintain adequate levels of oxygenation to prevent tissue hypoxia. This is achieved when the partial pressure of O2 in arterial blood reaches values ​​higher than 60 mmHg, corresponding to hemoglobin saturation of approximately 90-95% (evaluable by pulse oximetry)

Pulsioximetry: It is performed by means of a light sensor of the circulating hemoglobin in the blood of the capillaries of the finger pulp or the auricular pavilion, which can be disposable or fixed connected by a cable to a digital receiver that registers the heart rate and the Percentage of saturation (% of oxygen molecules adhered to the hemoglobin detected in the capillary area). It has a system of alarms and sound of beat that can be modified. This system can be found individually and portable or in multi-parameter monitors.
For an accurate recording of the pulse oximeter, it is necessary to take into account:
1. The patient should not have limbs that are cold or moist. Do not use nail polish. (Another place where you can feel it is in the toes or lobe of the auricular). Delimit alarms between 85% (minimum) and 100% (maximum).

Oxygen therapy:
To be able to administer oxygen properly, we must have the following elements:

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> Flowmeter (flumeter)
Humidifier.

- - It is distributed. The O2 is stored compressed in order to fit as much as possible into the containers. This great pressure to which the gas is subjected must be reduced before administering it, since it would not damage the respiratory system. The sources of O2 can be:
A) Oxygen Central: It is used in hospitals, where the gas is in a central tank (tank) that is located outside the hospital building. From the tank part a system of pipes that distributes the oxygen to the different hospital units (central O2 intake). B) Tube or pressure cylinder: It is the source used in primary care, although it is also present in hospitals (In areas where there is no central O2 outlet or if it fails). They are elongated metal containers of greater or less capacity.

Once the elements that are used to administer oxygen are known, we can make a description of the route that follows the gas: oxygen is at the source (pressure cylinder) under high pressure. When leaving the source we measure this pressure (manometer) and regulate the pressure that we want (knob - manorreductor). Then, the oxygen passes through the flowmeter and regulates the quantity of liters per minute to be supplied. Finally, the gas passes through the humidifier, which is now ready for the patient to inhale.

In the next, we will return with: Oxygen Management Devices ... >

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