Background
- Chronic Obstructive Pulmonary Disease (COPD) is an umbrella term used to describe progressive lung diseases including emphysema, chronic bronchitis, and refractory (non-reversible) asthma.
- Therapeutic air exchange cannot occur
- Breathing becomes more difficult
- Results in decreased ability to participate in ADLs, IADLs, etc.
- Can cause the heart to become enlarged
- Can cause hypertension
- Can cause cognitive impairment
- Possible psychosocial (anxiety & depression) involvement
Vital Signs
- Beware of the dangers of over-supplementing oxygen.
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In patients with COPD, “titrate their oxygen” and aim for an oxygen saturation target of 88-92%.
- Provides adequate tissue oxygenation while avoiding the complication of hyperoxic hypercapnia by giving the minimum amount of oxygen needed to stay above severe hypoxemia.
- Giving patients with COPD lots to oxygen tells their breathing mechanism that they have a lot of oxygen and they should slow their breathing. They retain CO2 and their body gets worse.
- Normal oxygen saturation does not rule out respiratory failure.
Do not rely on the oxygen saturation to warn you of impending respiratory failure.- Hemoglobin may remain saturated with oxygen despite hypoventilation causing rising levels of carbon dioxide.
- The oxygen saturation may not fall below 90% until the patient is already in serious trouble, especially if the patient is on supplemental oxygen.
- Respiratory rate, pCO2, and level of consciousness should all be assessed routinely.
- At a minimum, it is also necessary to record the respiratory rate, and if they are having supplemental oxygen.
Oxygen Delivery Methods for OTs
- Room Air
- Nasal Cannula (most common) – with or without a humidifier
- High Flow Nasal Cannula (HFNC)
- HFNC allows for high flow due to air being heated and humidified.
- Isn’t just a standard nasal cannula cranked up to very high flow rates.
- Takes gas and can heat it to 37oC with a 100% relative humidity.
- Can decrease airway inflammation, maintain mucociliary function, improve mucous clearance and reduce the caloric expenditure in acute respiratory failure.
- In patients with acute respiratory failure, the percentage of gas we rebreathe gets larger, and as a result, we can rebreathe larger amounts of carbon dioxide as we draw our breaths from a mixed reservoir from our upper airway.
- HFNC gives a continuous flow of fresh gas at high flow rates replacing or washing out the patient’s pharyngeal dead-space (the old gas low in oxygen and high in CO2). Each breath that the patient now re-breathes will be washed out of carbon dioxide and replaced with oxygen-rich gas improving breathing efficiency.
- Cons: cannot be hooked up to portable tank to mobilize patient due to high flow rate
- Oxygen Mask
- CPAP & BiPAP
Breathing Techniques
- Pursed lip breathing
- Diagram breathing
- Pacing (stop, rest, continue)
Interventions
- Stress management
- Therapeutic breathing
- Pacing/Planning/Prioritizing/Positioning
- Energy conservation
- Oxygen safety, contraindications, and use
- Body mechanics
Tips
- Carry a portable pocket-sized pulse oximeter to use in a tight squeeze.
- Use extension tubing if possible.
- Double-check oxygen tank level prior to mobilizing.
- Ensure nasal cannula is fitted incorrect orientation (prongs facing DOWNWARD and towards the patient), often patients may re-don them incorrectly.
- To facilitate breathing, position patient upright in bed in fowler’s instead of supine.
Sources:
https://www.copdfoundation.org
https://journals.lww.com/em-news/Fulltext/2011/02000/Titrated_Oxygen_Better_than_High_Flow_for_Patients.3.aspx
https://acphospitalist.org/archives/2009/12/tech.htm
rebelem.com/high-flow-nasal-cannula-hfnc-part-1-how-it-works/
