This paper examines numerous published articles that speak about the benefits of oxygen therapy, its medical uses, and its palliative values. This paper discusses two differing possibilities in oxygen application, and various conditions that can be managed with oxygen (Sharifipour, 2011). This study will also explain tracheostomy use, when it is indicated, and how it is a benefit to the world of medicine today ( Nikitopoulou,2015). This paper will show two related nursing diagnoses.
It will elaborate on some nursing interventions during the administration of oxygen, or while performing the care of a tracheostomy(Kou, et al. 2012). Chronic obstructive pulmonary disease will be written as COPD, when referenced. Keywords: Oxygen, tracheostomy, benefits Benefits of Oxygen Therapy and Tracheostomy Placement In this paper, an attempt is made to acknowledge the various benefits of oxygen therapy used in medicine today. Oxygen can be used as a supplement, or it can be given in an unmixed form- in a closed, pressurized, specialized compartment, prepared especially for administration (Nikitopoulou, (2015).
First, we will discuss oxygen given as supplement to labored breathing. It is clear that Dyspnea can be induced from different causative factors. Kou,et al (2012) explains in Journal of Pain Management, that “muscle weakness, anemia, restrictive and obstructive lung changes, bronchospasm, anxiety, and hypoxia” can be etiologies of dyspnea. (2012, p. 119-130). Another causative factor, as pointed out by Edeiros (2012), is lack of oxygen, as in sleep apnea, especially in COPD patients.
Oxygen therapy will begin to displace the carbon dioxide that was formerly attached to the hemoglobin molecules, and, therefore alleviate shortness of breath. It an also help to maintain 3% oxygen that is normal in the plasma of the blood. (Koo, et al, 2012) Oxygen can be administered by means of nasal cannula, or a mask, in palliative care treatment. Small oxygen concentrators can be purchased that will deliver oxygen which has been separated out of room air. (Inogen, Inc. ,2013). These compressor machines are very portable, and can even be taken on an airplane.
The percentage of oxygen taken in at each inspiration is greatly increased, because the concentration in the air inspired by the individual is greater than just breathing the room air-which is 21% oxygen. This extra air bolus can help reduce hypoxic drive, decrease accessory muscle use in breathing, and increase nasal receptor activity (Kou, et al,2012).
In a study performed by Jatenrapatporn, et al, (2012), in Journal of Pain Management, 5 out of 8 patients treated with oxygen supplementation said that it was a “life-saver. They verified that it was definitely important in their management of dyspnea. Quality of life can be improved as perfusion of body tissues is effected. Hyperbaric oxygen, another form of oxygen therapy, has been gaining some popularity in he last 100 years. The administration of therapy is given at greater than sea level pressure, in 100% purity. It can be used to oxygenate tissues that are ischemic, and has the ability to stimulate cell activity of fibroblasts or macrophages.
In the American Journal of Ophthalmology, Sharifipour (2011) says, “It is known that oxygen is capable of favorably influencing a number of cytokines and growth factors that play an important role in wound healing. The effects of transforming growth factor-B1 and platelet-derived growth factor-B are synergistically enhanced by oxygen. When administered after wounding, oxygen may upregulate collagen synthesis. ”(Sharifipour, 2011) Hyperbaric oxygen can be administered by mask, or in a pressurized compartment. This treatment has been tested in many fields (Nikitopoulou,2015).
A case study was made in The Journal of Laryngology and Otology on a 12 year old boy who was diagnosed with large vestibular aqueduct syndrome. Treatment was given by hyperbaric oxygen mask for several weeks. After pre-treatment and post-treatment tests were compared, there was a 40 decibel rise in the right ear, and a return to pre-injury levels n his left ear (Nikitopoulou,2015). Hyperbaric oxygen has also been utilized in treating decompression sickness, carbon monoxide poisoning, extensive burns, inter-cranial abscesses, and cardiac complications.
Be aware that hyperbaric therapy is contraindicated in some medical situations, such as COPD. (Shilton, 2015) The second section of this paper will focus on the intervention of Tracheostomy placement. Long (2016), in the American Journal of Emergency Medicine writes it well: “Tracheostomies are placed for several reasons including chronic mechanical ventilation, failed irway protection, chronic inefficient swallow or cough mechanism, or upper airway obstruction such as from a mass. It is important to carefully ascertain if the tracheostomy is truly needed, so that a surgical procedure is not performed unnecessarily.
Intensive Care Medicine declared that “There are relatively few absolute indications for a tracheostomy tube…” says Wakeham (2014). If an endotracheal tube is sufficient, why perform a tracheostomy placement? On, the opposite side, some clinicians feel that early intervention with tracheostomy is beneficial for safer removal of the endotracheal tube. Berney,2011) This situation is difficult to answer, and many factors need to be included.
If a person is already in surgery for severe facial trauma, for example, it could seem appropriate to utilize a tracheostomy, even though it also poses some complications. One reason for this, is it allows continued intubation without more sedative drugs, which gives the patient a clearer thought process for continued plan of care. (Battle,2013) A patient can talk more quickly after trauma if a tracheostomy is placed early. Being able to talk aids his self-esteem. (Freeman, 2016)Included, oo, is the patient who is likely to be on mechanical ventilation until death.
If a tracheostomy is placed, it can enable that individual to die at home. These are some of the benefits, in short, of the tracheostomy placement. Discussion The subject of oxygen therapy is of a very broad nature, and therefore it is possible that conflicts will be found in application of the principles of oxygen therapy and tracheostomy placement. Oxygen therapy requires knowledge of a person’s medical history, familiarity with baseline oxygen levels, and vigilance for any changes in patient condition. Patency of the airway s paramount, and if not maintained, will ultimately lead to death.
Conclusion In conclusion, each situation and patient is unique, and it requires the skill of the interdisciplinary team to aid a patient in making oxygen therapy choices, or considering tracheostomy placement. It is important that patient teaching be clear, informative, and in the best interest of the patient. Nursing Diagnoses -Anxiety r/t shortness of breath AEB patient yelling, “Help me,” and clutching the throat with hands. -Interventions: per MD order, nasal canula, check O2 stats every 20 minutes for first hour.
Raise head of bed to Fowler’s position, if tolerated. Notify doctor of anxiety. -Rationale: Freedom from fear and anxiety can be experienced after physiologic need for oxygenation is met. -Risk for Suffocation r/t obstructive sleep apnea, AEB severe drop in oxygen saturation to 82%, and startled gasps for breath. -Interventions: Notify doctor and request a sleep study, suction airway per MD order, notify airway interdisciplinary team of risk in lieu of tracheostomy placement. -Rationale: Oxygenation is one of the physiologic needs on Maslow’s hierarchy.