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Med Surg 1 > concepts of care for pt. requiring oxygen therapy or tracheostomy > Flashcards

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

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
Q

partial rebreather mask

A
  • provides 60% to 75% with flow rate of 6-11l

- patient rebreathes one third exhaled tidal

26
Q

non-rebreather mask

A
  • delivers highest o2 level
  • can deliver fio2 greater than 90%
  • ensure valves are patent and functional
27
Q

non-rebreather mask used for

A
  • used for unstable clients who may require intubation
28
Q

high flow nasal cannula

A
  • 30l-60l
  • combination of heat and humidity minimizes damage to mucous membranes
  • tube connect to a machine
  • less risk of skin breakdown
29
Q

venturi mask

A
  • adaptor located between bottom mask and o2 sources

- pull in a proportional amount of room air for each liter flow of oxygen

30
Q

t-piece

A

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

31
Q

noninvasive positive pressure ventilation (NPPV)

A

uses positive pressure to keep alveoli open, improves gas exchange

32
Q

noninvasive positive pressure ventilation (NPPV) used for

A

manage:

  • dyspnea
  • hypercarbia
  • acute exacerbations of chronic obstructive pulmonary disease
  • pulmonary edema
  • acute asthma attacks
33
Q

noninvasive positive pressure ventilation (NPPV): CPAP

A
  • delivers a set of positive airway pressure throughout each cycle on inhalation and exhalation
34
Q

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

A

delivers a set of tidal volume with the patients inspiratory effort

35
Q

noninvasive positive pressure ventilation (NPPV): BIPAP

A

cycles different pressures at inspiration and expiration

36
Q

Transtracheal oxygen delivery (TTO)

A
  • 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
Q

homecare management

A
  • stabilize patient prior to sending home on oxygen

- medicare will cover the cost of home oxygen therapy for pt. with hypoxemia

38
Q

self-management for o2

A
  • 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
Q

home oxygen therapy is provided in one of three ways:

A
  • compressed gas in tank or cylinder
  • liquid oxygen in a reservoir
  • oxygen concentrator
40
Q

trachestomy

A

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

41
Q

tracheostomy

A

stoma that results from tracheotomy

- may be temporary or permanent

42
Q

preoperative care for tracheostomy

A

teach and discuss tracheotomy care, communication, and speech

43
Q

operative procedures for tracheostomy

A
  • 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
Q

post op care for tracheostomy: assessment

A
  • ensure pt. airway
  • assess for bilateral breath sounds, perform a respiratory assessment at least hourly
  • assess for complications from the procedure
45
Q

tracheostomy complications

A
  • tube obstruction
  • tube dislodgement and decannulation
  • pneumothorax
  • subc emphysema
  • bleeding
  • infection
46
Q

trach tubes

A
  • plastic or metal
  • most are disposable
  • cuffed tube
  • inner cannula
  • fenestrated tube
47
Q

preventing tissue injury with trachs

A
  • 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
Q

ensuring air warming and humidification

A
  • 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
Q

suctioning

A
  • maintains a patent airway and promotes gas exchange
50
Q

providing trach care: assess

A
  • assess for cyanosis
  • check o2 stat
  • asses the trach site
  • asses the skin around the tracheostomy and neck
  • auscultate lung sounds
51
Q

providing trach care: sure tubes in place

A
  • 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
Q

providing trach care: prevent accidental decannulation

A

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

53
Q

bronchial and oral hygiene

A
  • 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
Q

ensuring nutrition

A

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
Q

maintaining communication

A
  • 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
Q

weaning off trach

A
  • gradual decrease in tube size
  • cuff is deflated when the pt. can manage secretions
  • change from cuffed to uncuffed
  • capping
  • tracheostomy
  • tracheostomy button
57
Q

pt. teaching trach everyday care activites

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

Med Surg 1 (25 decks)

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