UNIT FOUR
568
Clinical Skills and Care
Table 28.4 Oxygen Delivery Devices—cont'd
Delivery Device
Liter Flow Description
Tips for Use
Tracheostomy collar
4–10 L/min
Delivers highly humidi fi ed oxygen through large tubing; rests over the tracheostomy with an elastic band that goes around the neck and can be tightened at the sides.
Because of high humidity, conden- sation builds up in the large tubing. Be cautious when turning or mov- ing the patient so that pooled water does not migrate into the tracheos- tomy and cause choking.
4–10 L/min
Attaches to the fl ange of the tra- cheostomy; oxygen fl ows from one side of the T-piece to the tra- chea. During exhalation, air exits through the open end of the T-piece.
Keep the connection to the trache- ostomy intact, being careful not to allow tension on it to pull out the inner cannula.
T-piece
Source: Adapted from Wilkinson JM, Treas LS, Barnett, KL, et al. Fundamentals of Nursing: Thinking, Doing, and Caring. Vol. 2. 4th ed. Philadelphia, PA: FA Davis; 2020.
oxygen delivery devices, their liter fl ows, and the purposes of each. Skill 28.5 gives the steps in administering supple- mental oxygen. Conservation of Energy Patients with chronic lung disease often must use the acces- sory muscles in the neck and shoulders to move air in and out of their lungs. When this is the case, the patient cannot use the same muscles to perform tasks such as bathing and eating. The patient must then make a choice between bathing and breathing or eating and breathing. That is why you often see patients with chronic lung disease who are very thin and have poor nutritional status. You can help these patients conserve their energy so that they can use those accessory muscles to breathe but still are able to obtain nourishment and perform some activities of daily living (ADLs). Some tips for assisting them include the following: • For bathing assistance, encourage the patient to place a nonrusting chair or bench in the shower and to get a terrycloth robe. During the shower, the patient can sit while applying soap and rinsing the body. After the shower, the patient can slip on the robe and sit and rest outside the shower. The robe will absorb water, and the patient will not have to use the shoulder and neck
muscles to dry off with a towel. Often just the activ- ity of taking a shower is exhausting for the patient with chronic lung disease. • For nutritional assistance, encourage the patient to use Pulmocare or a similar meal supplement to increase pro- tein and calories without high carbohydrate intake. Metabolism of carbohydrates produces carbonic acid, which in turn can contribute to acidosis in the patient with chronic lung disease. • Encourage the patient to eat frequent, small meals sev- eral times per day rather than three larger meals. This will help them get in more calories before tiring. The patient may become weary after eating only a few bites of a meal because they are using the accessory muscles to eat instead of breathe. • For other ADLs, encourage the patient to take frequent rest periods during these activities. When you care for a patient with chronic lung disease in the hospital setting, plan to take a longer time than usual for bathing, dressing, grooming, and oral care. The patient will require frequent breaks to rest and breathe with those accessory muscles rather than using them for daily care. • Be patient and kind. Rushing the patient causes more stress for both of you. The patient cannot go any faster and needs your understanding and patience regarding the pace required to complete activities.
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