After completing the chapter, you will be able to accomplish the following:

1. Use a pulse oximeter.
2. Teach a patient to use a peak flow meter.
3. Teach a patient to use an incentive spirometer.
4. Administer oxygen by nasal cannula.
5. Administer oxygen by mask.
6. Care for a patient receiving noninvasive continuous positive pressure.
7. Suction the oropharynx and nasopharynx.
8. Perform nasotrachaeal suctioning.
9. Insert an oropharyngeal airway.
10. Insert a nasopharyngeal airway.
11. Suction the airway via an endotracheal tube using an open system.
12. Suction the airway via an endotracheal tube using a closed system.
13. Secure an endotracheal tube.
14. Suction the airway via a tracheostomy using an open system.
15. Provide care of a tracheostomy tube and site.
16. Provide care of a chest drainage system.
17. Assist with chest tube removal.
18. Use a manual resuscitation bag and mask to deliver oxygen.

• Assessment
• Cellular Regulation
• Clinical Decision Making/Clinical Judgment
• Oxygenation/Gas Exchange
• Perfusion
• Safety

• alveoli
• cardiopulmonary system
• cilia
• dyspnea
• endotracheal tube
• expiration
• extubation
• hemothorax
• hyperventilation
• hypoventilation
• hypoxia
• inspiration
• nasal cannula
• nasotracheal airway
• oropharyngeal and nasopharyngeal airways
• peak flow meter
• pneumothorax
• pulse oximetry
• respiration
• spirometer
• subcutaneous emphysema
• tachypnea
• tracheostomy tube
• ventilation

Life depends on a constant supply of oxygen. This demand for oxygen is met by the function of the respiratory and cardiovascular systems, together known as the cardiopulmonary system. Gas exchange, the intake of oxygen and the release of carbon dioxide, is made possible by the respiratory system (Fig. 14-1). The cardiovascular system (Fig. 14-2) delivers oxygen to the cells. Oxygenation and perfusion of body tissues depend on essentially three factors:

• Integrity of the airway system to transport air to and from the lungs.
• A properly functioning alveolar system in the lungs to oxygenate venous blood and to remove carbon dioxide from the blood.
• A properly functioning cardiovascular system and blood supply to carry nutrients and wastes to and from body cells.

Any condition that interferes with normal functioning must be minimized or eliminated to prevent cardiopulmonary distress, which could lead to death. This chapter covers the skills necessary for the nurse to promote oxygenation. While performing skills related to oxygenation, keep in mind factors that affect cardiopulmonary function which may result in impaired oxygenation, and how these factors might affect a particular patient (Fundamentals Review 14-1). Chapter 15 presents select skills necessary for the nurse to promote perfusion.

1. Notify the health care team immediately. This can indicate fresh bleeding. Assess the patient's vital signs and level of consciousness. Significant changes from baseline may indicate complications. Assess the patient's respiratory status, including oxygen saturation level. The patient may become tachypneic and hypoxic. Assess the patient's lung sounds. The lung sounds over the chest tube site may be diminished due to the presence of increased blood. Also assess the patient for pain. Sudden pressure or increased pain indicates potential complications. Reassure the patient, as necessary, to decrease anxiety. Maintain the patient on bed rest and monitor closely. Anticipate the need for additional IV fluids or blood transfusions, as well as the potential for surgery to control the bleeding.
2. Assess the patient's level of knowledge regarding the use of an incentive spirometer. Assess the patient's level of pain. Administer pain medication, as prescribed, if needed. Wait the appropriate amount of time for the medication to take effect. Explain the rationale for use of an incentive spirometer and the goal of the activity. If the patient has recently undergone abdominal or chest surgery, place a pillow or folded blanket over a chest or abdominal incision for splinting. Demonstrate how to steady the device with one hand and hold the mouthpiece with the other hand. If the patient cannot use hands, assist the patient with the incentive spirometer. Instruct the patient to exhale normally and then place lips securely around the mouthpiece. Instruct the patient to inhale slowly and as deeply as possible through the mouthpiece without using the nose (if necessary, a nose clip may be used). When the patient cannot inhale anymore, the patient should hold their breath and count to three. Check the position of gauge to determine progress and level attained. If the patient begins to cough, splint an abdominal or chest incision. Instruct the patient to remove lips from mouthpiece and exhale normally. If the patient becomes lightheaded during the process, tell their to stop and take a few normal breaths before resuming incentive spirometry. Encourage the patient to perform incentive spirometry 5 to 10 times every 1 to 2 hours, if possible. Clean the mouthpiece with water and shake to dry. Patient should verbalize an understanding of the rationale, procedure, and cleaning of equipment and be able to give a return demonstration of the use of the incentive spirometer.
3. Assess lung sounds. Patients who need to be suctioned may have crackles or gurgling present. Assess oxygen saturation level. Oxygen saturation usually decreases when a patient needs to be suctioned. Assess respiratory status, including respiratory rate and depth. Patients may become tachypneic when they need to be suctioned. Assess patient for signs of respiratory distress, such as nasal flaring, retractions, or grunting. Additional indications for suctioning via an endotracheal tube include secretions in the tube, acute respiratory distress, and frequent or sustained coughing. Also assess for pain and the potential to cause pain during the intervention. Individualized pain management must be performed in response to the patient's needs (Arroyo-Novoa et al., 2008; Chaseling et al., 2014; Wrona et al., 2021; Düzkaya & Kuğuoğlu, 2015). If the patient has had abdominal surgery or other procedures, administer pain medication before suctioning. Assess appropriate suction catheter depth (refer to Box 14-2 in Skill 14-9). Determine if suctioning the patient's airway was effective by reassessing the patient. The symptoms that indicated the need for airway suctioning should be absent or greatly diminished. The patient should not exhibit signs of respiratory distress and should have an oxygen saturation level within normal limits.