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
Wide range FiO2
24-100% FiO2 (8-15 liters)
Typ High humidity
Aerosol mask - breathing treatments through; lot humidity
Face tent - plastic mask that comes below pat’s chin and held on by elastic and top open - not seal around nose; for ENT surgerys where want lot humidification and not lot pressure on nasal area
Aerosol mask and Face Tent
Adv airway
Over trach; careful when attaching to trachs because moving it around
Dial below flow meter; apparatus set up under there for humidification and dial in O2
24-100% FiO2 (8-15 liters)
High humidity - always lot of this; not protectiveness of nasal passages for moisture and trap bacteria
See mist
Tracheostomy mask
Adv airway
Adj same amount for O2
24-100% FiO2 (8-15 liters)
Delivered through trach or endotracheal tube; careful when attaching to trachs because moving it around
High humidity (should see mist - out tube piece)
One side open (reservoir tube) and always stay open because if not nowhere for pat to exhale and see mist out there; otherside where O2 coming from
Keep exhalation port open
Often for lot suctioning because can do in-line suctioning
T-tube/T-piece
Ensure humidification -
Assess for skin breakdown
Assess mucous membranes for dryness and can cause bleeding
Assess for patency of tubing
Educate patients regarding oxygen safety
Nursing considerations when on O2
O2 drying; need bubblers/saline nasal spray
Ensure humidification -
Use padding if needed
Dependent on type using
Nasal cannula - ears
Facial masks - bridge noses bad
Elastic from masks
Assess for skin breakdown
If tubing occluded cannot provide O2; high pitched sound and make sure not kinked and not folded; extension tubing - attached; connection devices are imp because need ensure connected to wall
Assess for patency of tubing
Esp if going home on O2
Educate patients regarding oxygen safety
Oxygen is delivered through a small flexible catheter that is placed in the trachea through a small incision
Used for patients with LONG term O2 needs
Avoids irritation that nasal prongs cause
Typically require less L O2 when delivered in this method
Lot comps: break in skin (pats have to be able to take care of it because catheters have to be changed it and must know good infection control); not like nasal prongs or needing so much O2 that could not tolerate it anymore so do this
Where high cut shirt and hide this
Not used often
Transtracheal O2
Seen more and more
Nursing very involved in process
Nursing and RT collab and nurses see how much O2 needs - resting, ambulating and how far walk and monitor that to determine how much needed to go home with
88% or less will quality for home O2; L for walking vs resting if diff
Collab with social services to ensure med equipment set up; equipment need brought to hospital need make sure happens; if already have O2, make sure have O2 when discharged
Verify need for home oxygen
Ensure set up with medical equipment company
Home oxygen supply - 3 diff ways to have O2
Educate
Provide support
Home oxygen
Compressed Air/Tank - big tank; get O2 filled into; little ones that walk around with
Liquid oxygen - mobile pat and lot lighter and easier to carry; more expensive
Oxygen concentrator - fill tanks from home; takes air and concentrates it so 90%; not refilled as much
Home oxygen supply - 3 diff ways to have O2
use of equipment and safety
Make sure know how use equipment, turn it on, know all safety precautions; get ahold of med equipment company if probs
Educate
