Care of pats requiring O2 therapy Flashcards
Oxygenation - how take care of everything else
Inhalation of O2 and exhalatoin of CO2 through airways
Alterations in RR and pattern to regulate O2 needs and acid/base balance
Pulm circ circulates O2 rich blood to heart
Exchange of O2 and CO2 at the alveoli
oxygenation/tissue/perfusion/acid base balance - main funcs/concepts of resp sys
Oxygen (O2) is a gas essential for all cells and tissue; essential for everything our body does
Room air is about 21%oxygen; FiO2 what giving pats above 21% because giving more/supplementing them
Indications for use:
Oxygen
Hypoxemia-low O2 levels in blood (SpO2 or PaO2); not enough O2 in blood
Hypoxia-low O2 levels in tissue; not enough O2 in tissues
Indications for use:
The purpose of oxygen therapy is to use the lowest fraction of inspired oxygen (Fio2) to have acceptable blood oxygen level without causing harmful side effects - want to give lowest amount O2 to meet our goal; want pat have SpO2 of 95 but if achieve with 2L not 10
O2 not benign and does have issues and comps with it; smallest amount of supplemental O2 needed
Oxygen therapy measured in liters per minute (L/min - face mask, nasal cannula)or fraction of inspired oxygen (FiO2) - % O2 of air breathing in; more specific delivery sys where specific for amount O2 given need flow meter with L flow set on it but looking at measurement based on FiO2
Oxygen therapy
Know getting enough O2
Arterial blood gases (ABG)
Oxygen saturation (SpO2)
Capnography
Monitoring oxygen
Most accurate - draw blood out arterial blood sys; measure partial pressure of O2 in blood
Invasive - needle in someone to get that; not routinely; ICU have arterial lines in place and draw ABG but not routine check but check them but not daily
Obtain by arterial blood draw
Arterial blood gases (ABG)
Non invasive
Look at frequently
Easy to obtain
Use pulse oximetry to measure - on finger; look at with special probes
Get above depending on pat above 90s
Oxygen saturation (SpO2)
Non invasive
Measures exhaled CO2 - not measuring oxygenation but O2 and CO2 work hand in hand so gives idea how pat oxygenating
Capnography
Not benign
Combustion
Oxygen induced hypoventilation
Oxygen toxicity
Absorption Atelectasis
Dry mucous membranes
Infection
Hazards/comps of O2 therapy
Oxygen doesn’t burn but supports fire
Does not burn itself but supports flames; rules no smoking, no open flame around O2 so inform pats about this
Combustion
Chronic lung patients at risk for hypercapnea with high levels of O2
Hypoventilation if too high levels O2 with high CO2 and high levels O2 admin that need be aware of with chronic lung pats
Oxygen induced hypoventilation
High levels of O2 can damage lungs
Looks sim to acute resp distress syndrome so can be pretty severe when have it
Oxygen toxicity
Less nitrogen in inhaled air can cause alveoli to collapse
Certain % N in room air and when put more O2 in air pats breathing and less N and N one things helps keep alveoli open and when less % N harder for alveoli stay open
Absorption Atelectasis
Oxygen very drying
Dry mucous membranes
Anytime using equipment so making sure clean
Bacteria love moist environment so when using humidification much higher risk for infection
Humidification or equipment can be a source
Infection
Low flow delivery - nasal cannula, simple face mask, partial nonrebreather, nonrebreather
High flow delivery - venturi, aerosol, trach mask, T tube
Non invasive positive pressure ventilation
Invasive ventilation - when being ventilated by endotracheal tube, tracheostomy, adv airway
**Type of delivery system used is determined by O2 need, patient comfort, expense and mobility - how delivering O2 based on pat needs and pat comfort (can pat tolerate mask), how need get around (mobility very imp so if delivery device restrictive not best option), expense - if need something at home what qualify for and afford
O2 delivery sys
Nasal cannula
Simple face mask
Partial non rebreather mask
Non rebreather mask
Low flow O2
Seen most often
1-6 liters O2 (24-44% FiO2)
Simple and comfortable
Nasal cannula
About 4% increase in FiO2 for each liter
Simple, comfy, easy to use, still cautious skin, most common
High flow - green tubing but more and more pop so higher flow but still cannulas
1=24%; 2=28%; 3=32%; 4=36%; 5=40%; 6=44%
1-6 liters O2 (24-44% FiO2)
Minimal flow of 5 liters (40-60% FiO2)
Mask fits simply over nose and mouth (most often L&D)
Simple face mask
Higher O2
6-11 liters (60-75% FiO2)
Pat will “Re Breath” about 1/3 of exhaled air - CO2; not always best mask to use and typ not utilized much
Enough liter flow so bag inflated because that is what makes it work
Partial non rebreather mask
Higher O2
Highest level of O2; 10-15 liters (about 90% FiO2); sometimes flush up flow meter
Ensures no rebreathing of CO2
Liter flow high enough to keep bag 2/3 inflated
Designed to eliminate re breathing of CO2
Enough liter flow so bag inflated because that is what makes it work
Ensure that valves are patent and functional - one way valves allowing air not be rebreathed and want make sure working and clear
Determining if need intubate pat and not doing well
Non rebreather mask
Venturi/Venti mask
Aerosol mask and Face Tent
Tracheostomy mask
T-tube/T-piece
High flow O2
24-50% FiO2 (4-10 liters) - L flow dependent on how much given
Dial to set FiO2 rate located between bottom of mask and O2 sources - precise levels O2
Delivers precise O2 concentration
Best device for chronic lung disease - not give too much O2 - just enough
Venturi/Venti mask
