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1101- Basic Respiratory Care > Chapter 42- Medical Gas Therapy > Flashcards

Chapter 42- Medical Gas Therapy Flashcards

1
Q

How do RT’s know what to do?

A

Guidelines that are established by the American Association of Respiratory Care to help guide practitioners in delivering safe and effective patient care

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2
Q

What is the overall goal of O2 therapy?

A
  • Maintain adequate tissue oxygenation

- Minimizing cardiopulmonary work

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3
Q

What is the clinical objectives for O2 therapy?

A
  • Correct documented or suspected acute hypoxemia
  • Decrease symptoms associated with chronic hypoxemia
  • Decrease the workload hypoxemia imposes on the cardiopulmonary system
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4
Q

What are some indications for needing oxygen therapy?

A
  • Documented hypoxemia as evidenced by: –PaO2 less than 60 mm Hg/SpO2 less than 90% on R/A
  • Acute care situations in which hypoxemia is suspected
  • Severe trauma
  • Acute myocardial infarction
  • Short term therapy or surgical intervention
  • Tachycardia, tachypnea, confusion
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5
Q

What are some precautions and/or possible complications with oxygen therapy with a PaO2 greater than or equal to 60 mm HG?

A

Ventilator depression may occur rarely in spontaneously breathing patients with elevated PaCO2

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6
Q

What are some precautions and/or possible complications with oxygen therapy when a patient has a FiO2 greater than 0.5?

A

Absorption atelectasis, O2 toxicity, or depression of ciliary or leukocyte function may occur

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7
Q

What are some precautions and/or possible complications with oxygen therapy in premature infants?

A

PaO2 greater than 80 mm Hg may contribute to retinopathy of prematurity

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8
Q

What are some precautions and/or possible complications with oxygen therapy in infants with heart problems?

A

Infants with certain congenital heart lesions such as hypoplastic left heart syndrome, High PaO2 can compromise the balance between pulmonary and systemic blood flow

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9
Q

What are some precautions and/or possible complications with oxygen therapy in general to infants?

A

In infants, O2 flow directed at the face may stimulate an alteration in respiratory patter.

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10
Q

What are some precautions and/or possible complications with oxygen therapy in infants with current lung injury?

A

Increased FiO2 can worsen lung injury in patients with paraquat positioning or patients receiving bleomycin

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11
Q

What is paraquat?

A

Insecticide, used for commercial use only

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12
Q

What is bleomycin?

A

Drug to treat cancer patients

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13
Q

What are some precautions and/or possible complications with oxygen therapy for asthma patients?

A

During laser bronchoscopy or tracheostomy, minimal FiO2 should be used to intratracheal ignition

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14
Q

What are some precautions and/or possible complications with oxygen therapy and fire?

A

Fire hazard increased in the presence of high FiO2

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15
Q

What are some precautions and/or possible complications with oxygen therapy with typical ventilation?

A

Depression of ventilation on FiO2. This is not typical.

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16
Q

What is ABG’s?

A

Arterial blood gas-the cornerstone of dx of management of oxygenation and acid-base disturbances?

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17
Q

What is the WNL of pH during an ABG?

A

acid/base (H+) balance of blood (7.35-7.45)

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18
Q

What is the WNL of PaO2 in a ABG?

A

Partial pressure of oxygen dissolved in the arterial blood. Normal limits are (80-100 mm Hg)

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19
Q

What is the WNL of PCO2 in a ABG?

A

Partial pressure of carbon dioxide dissolved in arterial blood (35-45 mm Hg)

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20
Q

What is the WNL of HCO3 in a ABG?

A

The calculated value of the bicarbonate in blood (22-26 mEq/liter)

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21
Q

What are the 3 basic designs for O2 delivery?

A

Low-flow, high-flow and reservoir system?

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22
Q

Low-Flow systems: Nasal Cannula

What is the FiO2 range?

A

Delivers FiO2 of 0.24 to 0.40 %

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23
Q

Low-Flow systems: Nasal Cannula

Why is the flow rate?

A

Used with flow rates of 1/4 to 8 L/min

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24
Q

Low-Flow systems: Nasal Cannula

Does the flow depend?

A

Yes, its depends on how much room air a patient inhales in addition to O2

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25
Q

Low-Flow systems: Nasal Cannula

When do you use a humidifier?

A

A humidifier is used when the input flow is greater than 4 L/min

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26
Q

Low-Flow systems: Nasal catheter

When is this used?

A

Generally limited to short-term O2 administration during specialized procedures
Example: Bronchoscopy

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27
Q

Low-Flow systems: Nasal catheter

What is the flow rate?

A

Used at flows of 1/4 to 8 L/min

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28
Q

Low-Flow systems: Nasal catheter

What FiO2 is given to the patient?

A

Delivers FiO2 of 0.22 to 0.45 %

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29
Q

Low-Flow systems: Nasal catheter

When should they be replaced?

A

At least every 8 hours and placed in the opposite naris

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30
Q

Transtracheal Catheter

What is it?

A

Catheter surgically placed in the trachea through the neck by a physican

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31
Q

Transtracheal Catheter

flow rate?

A

Used with flow rates of 1/4 to 4 L/min

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32
Q

Transtracheal Catheter

What are some disadvantages?

A

Requires careful maintenance and clean. Also complications such as infection are possible

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33
Q

Name some characteristics of low-flow systems?

A
  • Provide O2 concentrations ranging from 22%at 1 L/min to 60% at 15 L/min
  • Concentration delivered by a low-flow system varies with the amount of air dilation
34
Q

How much FiO2 changes per liter?

A

Each 1 L/min nasal O2 increases FiO2 approximately 4%

35
Q

List the FiO2 at different liter flows for nasal cannulas

A 
1 lpm is 24%
2 lpm is 28%
3 lpm is 32%
4 lpm is 36%
5 lpm is 40%
6 lpm is 44%
36
Q

How do we increase FiO2 while using a low-flow device?

A 
Higher O2 output
Mouth-closed breathing 
Low inspiratory flow
Slow rate of breathing
Low tidal volume
37
Q

How do we decrease the FiO2 while using a low-flow device?

A 
Lower O2 input
Mouth-opening breathing
High inspiratory flow
Fast rate of breathing
High tidal volume
38
Q

How do we troubleshoot low-flow system?

A

Inaccurate flow
System leaks and obstructions
Skin irritation
Device displacement

39
Q

What are some solutions to trouble shooting low-flow device?

A

Check connections
Adjust flowmeter
Check connections
Fill for gas and adjust as needed

40
Q

Reservoir system: cannulas

What are they designed to do?

A

Designed to conserve oxygen for both nasal reservoir and pendant reservoir
-Can reduce O2 use by 50-70%

41
Q

Reservoir system: Mask

What are the 3 types of the masks?

A
  • Simple mask
  • Partial rebreathing mask
  • Nonrebreathing mask
42
Q

Simple Mask

What is the input flow range?

A

Adult simple mask is 5 to 10 L/min

-At a flow of less than 5 L/min, the mask volume acts as dead space and causes CO2 rebreathing

43
Q

Simple Mask

What would happen at a flow less than 5 L/min?

A

At a flow less than 5 L/min, the mask volume acts as dead space and causes carbon dioxide (CO2) rebreathing

44
Q

Simple Mask

What is the FIO2 range?

A

Range is 0.35 to 0.50

-Air dilution easily occurs during inspiration through it’s ports and around its body, provides a variable FiO2

45
Q

Simple Mask

Does the FiO2 vary?

A

YES, FiO2 varies depending on the O2 input flow, the mask volume, the extent of air leakage and the patients breathing pattern

46
Q

Partial Rebreathing Mask

Does this have higher FiO2 than a simple mask?

A

Yes, because the bag increases the reservoir volume, provides high FiO2 capabilities than a simple mask

47
Q

Partial Rebreathing Mask

3 key points of this mask?

A
  1. A partial rebreathing source O2 flows into the mask and passes directly to the patient
  2. A partial rebreathing mask has no valves
  3. During exhalation, source O2 enters the bag
48
Q

Partial Rebreathing Mask

What is the input flow range for an adult?

A

Minimum of 10 L/min to prevent bag collapse on inspiration

49
Q

Partial Rebreathing Mask

What is the FiO2 range?

A

0.40 t0 0.80

50
Q

Nonrebreathing mask

Describe it

A

Prevents rebreathing with one-way valves. An inspiratory valve sits on top of the bag, and expiratory valve covers the exhalations ports on the mask body preventing air dilution

51
Q

Nonrebreathing mask

What happens with the valve on top of the mask?

A

At the same time of the of the calve on the side of the mask, the inspiratory valve on the top of the bag opens, providing O2 to the patient

52
Q

Nonrebreathing mask

What happens during exhalation?

A

During exhalation, valve action reverse the direction of flow

53
Q

List some troubleshooting of reservoir system?

A
  • device displacement
  • system leaks and obstructions
  • improper flow adjustment
  • skin irritation
54
Q

What is a high flow system?

A

A system that gives O2 concentration at flow equaling or exceeding patients peak inspiratory flow

55
Q

What is considered a high flow system?

A
  • Air-entrainment system

- Blending system

56
Q

What patient would use a high-flow system?

A

Patients who are requiring precise FiO2, with high or variable minute ventilation

57
Q

What amount of air entrained in the ports connect with?

A

The amount of air entrained at port varies directly with the size of the port and the velocity of O2 at the jet

58
Q

What would cause the FiO2 in a air-entrainment system varies?

A
  • The air-to-O2 ration

- The amount of flow resistance downstream from the mixing site

59
Q

Describe the Air-Entrainment Mask (Venturi)

A

Air is entrained by shear forces at the boundary of jet flow, not by low lateral pressures
-The smaller the orifice the greater the velocity of O2, and more air entrained

60
Q

Describe Air-Entrainment neubilzer

A

Power air-entrainment nebulizers have most of the features of AEMs but have added capabilities including additional humification and temperature control

61
Q

What would cause an issue with air-entrainment system?

A

Any increase in flow resistance downstream from (distal to) the point of air entrainment alters the performance of all-air entrainment system

62
Q

What are 3 main features of a high-flow nasal cannula?

A
  1. delivers a high FiO2
  2. meets or exceeds the patients minute ventilation and therefore acts as a fixed oxygen delivery device
  3. generates a distending positive airway pressure
63
Q

What are the names of high-flow nasal cannulas?

A
  • Vapotherm precision flow system

- Fisher and Paykel Optiflow

64
Q

What the features of oxygen blender system?

A

Air and O2 enter the blender and pass through dual pressure regulators that exactly match the two pressures

65
Q

What are two other oxygen delivery devices?

A
  • Bag-mask devices

- demand flow and pulse dose system

66
Q

How do you select a delivery approach?

A

The three P’s - purpose, patient and performance

67
Q

Selecting a delivery approach:

Purpose?

A

The general purpose of all O2 therapy is to increase FiO2 sufficiently to correct arterial hypoxemia

68
Q

Selecting a delivery approach:

Patient

A

Patient considerations

-Severity and cause of hypoxemia, patient age group, degree of consciousness and alertness.

69
Q

Selecting a delivery approach:

Performance

A

O2 systems vary according to actual FiO2 delivered and stability of FiO2 under changing patient demands

70
Q

What is an O2 therapy protocol?

A

An order for “O2 therapy via protocol” permits O2 therapy to be initiated, modified or discontinued by the RT

71
Q

What does a well designed O2 protocol ensures to the patient?

A
  • Undergoes initial assessment
  • Evaluated for protocol criteria
  • Receives a tx plan that is modified to the need
  • Stops receiving therapy as soon as it is no longer needed
72
Q

What is hyperbaric oxygen (HBO) therapy?

A

The therapeutic use of O2 at pressures greater than 1 atm
1 atm- 760 mmHG
Allows us to hyperoxygenation the blood and tissues

73
Q

When would you used hyperbaric oxygen therapy?

A

Chronic conditions:

  • diabetic wounds of the lower extremities and other nonhealing wounds
  • refractory osteomyelitis
  • chronic system abscesses
74
Q

What is some criteria for HBO in CO poisoning?

A
  • History of unconsciousness
  • -presence of neuropsychiatric abnormality
  • presence of cardiac instability
75
Q

Complications and Hazards of HBO?

A 
Barotrauma:
-Ear or sinus trauma
-gas embolism
-alveolar overdistention and pneumothorax
O2 toxicity:
-CNS toxic reaction
-pulmonary toxic reaction
Other:
-fire
-sudden decompression
-claustrophobia
76
Q

Nitric oxide therapy: advantages

A
  • improves blood flow to lungs
  • reduces shunting
  • improves oxygenation
  • decreases pulmonary vascular resistance
  • lower cost alternative to drug therapies
77
Q

What are some potential uses for inhaled nitric oxide?

A
  • ARDS
  • Persistent pulmonary hypertension of the newborn
  • COPD
  • Acute pulmonary embolism
78
Q

What are some concerns of nitric oxide therapy?

A
  • poor or paradoxical response
  • increased left ventricular filling pressure
  • complications of certain cardiac anomalies
79
Q

Helium-oxygen therapy:

What does it do and who would use it?

A
  • Value of helium as therapeutic gas is based solely on its low density.
  • Can decrease work of breathing for patients with airway obstruction
80
Q

What are some guidelines for helium-oxygen therapy?

A
  • Helium must always be mixed with O2
  • Heliox can be prepared at bedside or used from premixed cylinders
  • In general, heliox should be delivered to patients via tight fitting nonrebreathing mask with high flow
81
Q

What is some troubleshooting and hazards of helium-oxygen therapy?

A
  • poor vehicle for aerosol transport
  • reduces effectiveness of coughing
  • badly distorts patients voice

1101- Basic Respiratory Care (13 decks)

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