concepts of care for pt. requiring oxygen therapy or tracheostomy Flashcards

(57 cards)

1
Q

oxygen therapy purpose

A

relieves hypoxemia and hypoxia

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2
Q

hypoxemia

A

low levels of oxygen in blood

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3
Q

hypoxia

A

decreased tissue oxygenation

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4
Q

goal of oxygen therapy

A

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

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5
Q

ABG snslysis

A

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

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6
Q

ABG measures

A
ph 
pa02
paco2
hco3
sa02
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7
Q

ph

A

amount of free hydrogen ions in the arterial blood

range 7.35-7.45

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8
Q

pa02

A

partial pressure of oxygen

normalL 80-100

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9
Q

paco2

A

partial pressure of carbon dioxide

range: 35-45

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10
Q

hco3

A

the concentration of bicarbonate in arterial blood

range: 21-28

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11
Q

sao2

A

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

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12
Q

how is an abg be obtained

A

arterial puncture of through an aterial line

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13
Q

arterial puncture

A
  • 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
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14
Q

arterial line

A
  • 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
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15
Q

pulse oximetry

A

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

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16
Q

capnography

A

measurement of carbon dioxide in a patients exhaled breath over time

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17
Q

oxygen therapy interventions

A
  • 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
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18
Q

oxygen therapy complications

A
  • 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
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19
Q

type and use of oxygen depends on

A
  • required oxygen concentration
  • oxygen concentration that can achieved by a delivery system
  • importance of accuracy and control of the oxygen concentration
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20
Q

low flow oxygen delivery system

A
  • easy to use
  • comfortable
  • amount of oxygen delivered varies
  • nasal cannula (1-6l)
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21
Q

low flow oxygen delivery system devices

A
  • simple
  • partial rebreather
  • non-rebreather
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22
Q

nasal cannula

A

Flow rate: 1-6L

  • O2 concentration of 24%-44%
  • flow rate >6l does not increase gas exchange because anatomical dead space is full
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23
Q

nasal cannula used for

A

chronic lung disease or long term therapy

24
Q

sample facemask

A
  • delivers o2 up to 40% to 60% for short term therapy
  • minimum of 5L
  • ensure appropriate fit
25
partial rebreather mask
- provides 60% to 75% with flow rate of 6-11l | - patient rebreathes one third exhaled tidal
26
non-rebreather mask
- delivers highest o2 level - can deliver fio2 greater than 90% - ensure valves are patent and functional
27
non-rebreather mask used for
- used for unstable clients who may require intubation
28
high flow nasal cannula
- 30l-60l - combination of heat and humidity minimizes damage to mucous membranes - tube connect to a machine - less risk of skin breakdown
29
venturi mask
- adaptor located between bottom mask and o2 sources | - pull in a proportional amount of room air for each liter flow of oxygen
30
t-piece
delivers desired fio2 to clients with trachestomy, laryngectomy, et tube - aerosol should appear on exhalation side
31
noninvasive positive pressure ventilation (NPPV)
uses positive pressure to keep alveoli open, improves gas exchange
32
noninvasive positive pressure ventilation (NPPV) used for
manage: - dyspnea - hypercarbia - acute exacerbations of chronic obstructive pulmonary disease - pulmonary edema - acute asthma attacks
33
noninvasive positive pressure ventilation (NPPV): CPAP
- delivers a set of positive airway pressure throughout each cycle on inhalation and exhalation
34
noninvasive positive pressure ventilation (NPPV): volume- limited or flow limited
delivers a set of tidal volume with the patients inspiratory effort
35
noninvasive positive pressure ventilation (NPPV): BIPAP
cycles different pressures at inspiration and expiration
36
Transtracheal oxygen delivery (TTO)
- 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
37
homecare management
- stabilize patient prior to sending home on oxygen | - medicare will cover the cost of home oxygen therapy for pt. with hypoxemia
38
self-management for o2
- 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
39
home oxygen therapy is provided in one of three ways:
- compressed gas in tank or cylinder - liquid oxygen in a reservoir - oxygen concentrator
40
trachestomy
surgical incision into trachea to create an airway to maintain gas exchange
41
tracheostomy
stoma that results from tracheotomy | - may be temporary or permanent
42
preoperative care for tracheostomy
teach and discuss tracheotomy care, communication, and speech
43
operative procedures for tracheostomy
- 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
44
post op care for tracheostomy: assessment
- ensure pt. airway - assess for bilateral breath sounds, perform a respiratory assessment at least hourly - assess for complications from the procedure
45
tracheostomy complications
- tube obstruction - tube dislodgement and decannulation - pneumothorax - subc emphysema - bleeding - infection
46
trach tubes
- plastic or metal - most are disposable - cuffed tube - inner cannula - fenestrated tube
47
preventing tissue injury with trachs
- 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
48
ensuring air warming and humidification
- 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
49
suctioning
- maintains a patent airway and promotes gas exchange
50
providing trach care: assess
- assess for cyanosis - check o2 stat - asses the trach site - asses the skin around the tracheostomy and neck - auscultate lung sounds
51
providing trach care: sure tubes in place
- 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
52
providing trach care: prevent accidental decannulation
use a coworker to stabilize the tube and prevent decannulation when changing the ties of tube holders
53
bronchial and oral hygiene
- 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
54
ensuring nutrition
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
55
maintaining communication
- 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
56
weaning off trach
- gradual decrease in tube size - cuff is deflated when the pt. can manage secretions - change from cuffed to uncuffed - capping - tracheostomy - tracheostomy button
57
pt. teaching trach everyday care activites
- tube care - shower shield - cover loosely with small cotton cloth during day - increase home humidity - wear a medical alert bracelet -