concepts of care for pt. requiring oxygen therapy or tracheostomy

Question 1

oxygen therapy purpose

Answer 1

relieves hypoxemia and hypoxia

Question 2

hypoxemia

Answer 2

low levels of oxygen in blood

Question 3

hypoxia

Answer 3

decreased tissue oxygenation

Question 4

goal of oxygen therapy

Answer 4

use the lowest fraction of inspired oxygen for acceptable blood oxygen level without causing harmful side effects

Question 5

ABG snslysis

Answer 5

an abg sample reports the status of oxygenation and acid-base balance in the blood

Question 6

ABG measures

Answer 6

ph 
pa02
paco2
hco3
sa02

Question 7

ph

Answer 7

amount of free hydrogen ions in the arterial blood

range 7.35-7.45

Question 8

pa02

Answer 8

partial pressure of oxygen

normalL 80-100

Question 9

paco2

Answer 9

partial pressure of carbon dioxide

range: 35-45

Question 10

hco3

Answer 10

the concentration of bicarbonate in arterial blood

range: 21-28

Question 11

sao2

Answer 11

% of oxygen bound to hgb as compared with total amount that can be possibly carried
range: 95-100

Question 12

how is an abg be obtained

Answer 12

arterial puncture of through an aterial line

Question 13

arterial puncture

Answer 13

• perform using surgical aseptic technique and collect into a heperinized syringe
• place in basin of ice and water to preserve ph and oxygen pressure
• hold pressure for 5 min over puncture site& make sure bleeding has stopped
• monitor abg sampling site for bleeding, loss of pulse and change in temp color

Question 14

arterial line

Answer 14

• verify line can be used
• obtain heparinized syringe
• collect and waste specimen
  transport on ice
• flush arterial line with preconnected flushing system
• assess for complications such as hematoma or air embolism

Question 15

pulse oximetry

Answer 15

noninvasive and painless test that measures your oxygen saturation level, or the oxygen levels in blood, rapidly detects small changes

Question 16

capnography

Answer 16

measurement of carbon dioxide in a patients exhaled breath over time

Question 17

oxygen therapy interventions

Answer 17

• recognize oxygen hazards
• check prescription
• use humidification if delivered at 4l/min or more
• check skin for pressure points around mouth and ears
• provide mouthcare; lubricate nostrils, face, lips
• clean cannula, mask
• collaborate respiratory therapist

Question 18

oxygen therapy complications

Answer 18

• combustion- no smooking/ candles
• oxygen toxicity: consider concentration, how much lungs can handle
• absorption atelectasis: collapsed alveoli, crackles, pt dry
• drying of mucous membranes
• infection: cause bacteria and fungus to grow

Question 19

type and use of oxygen depends on

Answer 19

• required oxygen concentration
• oxygen concentration that can achieved by a delivery system
• importance of accuracy and control of the oxygen concentration

Question 20

low flow oxygen delivery system

Answer 20

• easy to use
• comfortable
• amount of oxygen delivered varies
• nasal cannula (1-6l)

Question 21

low flow oxygen delivery system devices

Answer 21

• simple
• partial rebreather
• non-rebreather

Question 22

nasal cannula

Answer 22

Flow rate: 1-6L

• O2 concentration of 24%-44%
• flow rate >6l does not increase gas exchange because anatomical dead space is full

Question 23

nasal cannula used for

Answer 23

chronic lung disease or long term therapy

Question 24

sample facemask

Answer 24

• delivers o2 up to 40% to 60% for short term therapy
• minimum of 5L
• ensure appropriate fit

Question 25

partial rebreather mask

Answer 25

- provides 60% to 75% with flow rate of 6-11l | - patient rebreathes one third exhaled tidal

Question 26

non-rebreather mask

Answer 26

- delivers highest o2 level - can deliver fio2 greater than 90% - ensure valves are patent and functional

Question 27

non-rebreather mask used for

Answer 27

- used for unstable clients who may require intubation

Question 28

high flow nasal cannula

Answer 28

- 30l-60l - combination of heat and humidity minimizes damage to mucous membranes - tube connect to a machine - less risk of skin breakdown

Question 29

venturi mask

Answer 29

- adaptor located between bottom mask and o2 sources | - pull in a proportional amount of room air for each liter flow of oxygen

Question 30

t-piece

Answer 30

delivers desired fio2 to clients with trachestomy, laryngectomy, et tube - aerosol should appear on exhalation side

Question 31

noninvasive positive pressure ventilation (NPPV)

Answer 31

uses positive pressure to keep alveoli open, improves gas exchange

Question 32

noninvasive positive pressure ventilation (NPPV) used for

Answer 32

manage: - dyspnea - hypercarbia - acute exacerbations of chronic obstructive pulmonary disease - pulmonary edema - acute asthma attacks

Question 33

noninvasive positive pressure ventilation (NPPV): CPAP

Answer 33

- delivers a set of positive airway pressure throughout each cycle on inhalation and exhalation

Question 34

noninvasive positive pressure ventilation (NPPV): volume- limited or flow limited

Answer 34

delivers a set of tidal volume with the patients inspiratory effort

Question 35

noninvasive positive pressure ventilation (NPPV): BIPAP

Answer 35

cycles different pressures at inspiration and expiration

Question 36

Transtracheal oxygen delivery (TTO)

Answer 36

- long term delivery of 02 directly into lungs - small flexible catheter is passed into trachea through small incision - flow rates prescribed for rest activity - if needs to be clean pt. would be switched to nasal cannula

Question 37

homecare management

Answer 37

- stabilize patient prior to sending home on oxygen | - medicare will cover the cost of home oxygen therapy for pt. with hypoxemia

Question 38

self-management for o2

Answer 38

- pt. family education needed on equipment for oxygen therapy and safety considerations for maintaining and using oxygen therapy - oxygen will be delivered to pt. home - follow up care is needed and reevaluation of the need of oxygen therapy

Question 39

home oxygen therapy is provided in one of three ways:

Answer 39

- compressed gas in tank or cylinder - liquid oxygen in a reservoir - oxygen concentrator

Question 40

trachestomy

Answer 40

surgical incision into trachea to create an airway to maintain gas exchange

Question 41

tracheostomy

Answer 41

stoma that results from tracheotomy | - may be temporary or permanent

Question 42

preoperative care for tracheostomy

Answer 42

teach and discuss tracheotomy care, communication, and speech

Question 43

operative procedures for tracheostomy

Answer 43

- neck is extended and an endotracheal (ET) tube is placed by anesthesia to maintain an airway - incision are made through neck and tracheal rings to enter trachea - once trachea in entered, et tube is removed while the tracheostomy tube is inserted, tube is secured with sutures and tracheostomy ties or velcro tube holders - chest x-ray to determine placement

Question 44

post op care for tracheostomy: assessment

Answer 44

- ensure pt. airway - assess for bilateral breath sounds, perform a respiratory assessment at least hourly - assess for complications from the procedure

Question 45

tracheostomy complications

Answer 45

- tube obstruction - tube dislodgement and decannulation - pneumothorax - subc emphysema - bleeding - infection

Question 46

trach tubes

Answer 46

- plastic or metal - most are disposable - cuffed tube - inner cannula - fenestrated tube

Question 47

preventing tissue injury with trachs

Answer 47

- injury can occur where the inflated cuff presses against the tracheal mucosa - inflate the cuff to form a seal between the trachea and the cuff using the least amount of pressure - check the cuff pressure at least once a shift

Question 48

ensuring air warming and humidification

Answer 48

- if not adequate, trach damage can occur - inadequate humidity causes thick dry secretions to occlude the airway and increase the risk of infection - humidity air based on order

Question 49

suctioning

Answer 49

- maintains a patent airway and promotes gas exchange

Question 50

providing trach care: assess

Answer 50

- assess for cyanosis - check o2 stat - asses the trach site - asses the skin around the tracheostomy and neck - auscultate lung sounds

Question 51

providing trach care: sure tubes in place

Answer 51

- secure using twill tape ties or commercial tube holders | - change devices when soiled or at least daily to keep clean, prevent infection, and assess tissue integrity uder ties

Question 52

providing trach care: prevent accidental decannulation

Answer 52

use a coworker to stabilize the tube and prevent decannulation when changing the ties of tube holders

Question 53

bronchial and oral hygiene

Answer 53

- turn pt ever 1-2 hours, early ambulation - coughing and deep breathing, chest percussion, vibration, and postural drainage promote pulmonary hygiene - avoid glycerin swabs or mouthwash containing alc for oral care; use sponge tooth cleaenr or soft bristile toothbrush

Question 54

ensuring nutrition

Answer 54

swallowing can be difficult - teach pt. to keep head of bed elevated for at least 30 min after eating - avoid thin liquids - no straw - eat slow - smaller frequent meals

Question 55

maintaining communication

Answer 55

- writing tablet - board with pictures and letters - flash cards - hand signals - smartphones - phrase questions with yes/ no answers - mark central call light to indicate pt. cannot speak - SLP

Question 56

weaning off trach

Answer 56

- gradual decrease in tube size - cuff is deflated when the pt. can manage secretions - change from cuffed to uncuffed - capping - tracheostomy - tracheostomy button

Question 57

pt. teaching trach everyday care activites

Answer 57

- tube care - shower shield - cover loosely with small cotton cloth during day - increase home humidity - wear a medical alert bracelet -