Exam 2 Flashcards
Supplemental Oxygen Goals
correct hypoxemia
what is hypoxemia
decreased oxygen levels in the arterial blood available for profusion of tissues
heart works harder when hypoxemia is present in order to get oxygen to the tissue
Oxygen is ____________
drug! need an order to use it and requires frequent assessment required
What is the issue with respiration…
ventilation or oxygenation
if there is an issue with oxygenation
then need to increse FiO2 –> make FiO2 higher then room air (21%)
if there is an issue with ventilation
they need more floow –> like BiPAP and CPAP that provide continuous positive pressure in the airways
what if there is oxygenation and ventilation
they need both FiO2 and flow
factors that affect the success of supplemental oxygen
LOC, airway patency,
when considering LOC what are airway options
OPA
NPA
hypoventilation
O2 pools in the conducting airways because the lungs are not pullung it into the alveoli
hyperventilation
increased mixing of O2 that we are supplemnting with and room ai which dilues down the actual FiO2 numbers
depth of breathing
aka tidal volume
which is how much of the O2 the patient is actually pulling in
hemoglobin level
low hemoglobin = less ability to carry and bring oxygen to the tissues
electrolytes level
low phosphorus levels are associated with muscle weakness including the diaphragm
what would you want to consider for medical history of a patient with respiratory issues
pulmonary fibrosis
pleural effusion
secondary complications of respiratory issues
- skin breakdown
drying of mucuos membranes - epistaxis
- infection of the sinuses
- oxygen toxicity
oxygen toxicity
we want to use the least amount of oxygen needed to keep the SaO2 up
greater the 60% FiO2 for more then 24 hours has been shown to cause damage to the alveoli
effective oxygen therapy is all about finding the balance
we want to use the least mount of oxygen (FiO2) in order to achieve normal PaO2 on ABG or noraml oxygen sat on pulse oximetry reading
room air has what precent oxygen
room air has 21% oxygen
nasal canula O2 parameters in adults
1-6 liter flow
who uses the nasal canula
patients who need just little supplement
simple mask O2 parameters in adults
5 to 10 liters per minute
when would use the simple mask
need the higher flow oxygen to push out carbon dioxide through the holes on the sides
venturi/ venti mask O2 parameters in adults
ranges from 4L giving 25% FiO2 to 15L giving 60% depending on which device you use
venturi and venti mask information
Through the openings on the colored part, mixes a combination of room air and delivered oxygen which gets you your desired FiO2 depending on the piece and the flow rate
non-rebreather face mask
consider a high flow O2 device
Non-rebreather face mask O2 parameters
O2 parameters in adults: greater than 10 (give around 80% to 95% FiO2)
- Remember to move meter flow all the way up to 15 (100% O2)
- Helps to increase the flow of oxygen
- Anything less than 10, you interfere with patient’s oxygenation
High Flow O2 (Vapotherm)
**Can give up to 100% FiO2
Patients have their own set inspiratory volume that is decided by how much work the lungs are able to do
With Low Flow O2 you’re adding a higher concentration of oxygen but the patient is doing the work of bringing the extra oxygen in
What are the o2 parameters with the vapotherm mask
O2 parameters in adults: can give 1 to 40 L/min
trach collar
this is regulated delivery
needs to be humidified
list the three types of low flow masks
non acute situations:
nasal canula
simple mask
acutly ill patients:
non-rebreather mask
list the three types of high flow devices
high flow ocygen therapy
venturi mask
face tent
Chest PT is also called
pulmonary toilet
what does chest pt help the patient accomplish
helps the patients remove secretions and open up the aveoli
what is considered forms of chest pt
posteral drainage
chest percussion and vibration
coughing and deep breathing
positoning
mobilizing patient
incentive spirometry
non invasive mechanical ventilation includes
CPAP and BiPAP
CPAP
continuous positive airway pressure
CPAP accomplishes what ?
Maintains a constant minimum airway pressure throughout the respiratory cycle
Keeps airway/alveoli open at the end of expiration
Improves oxygenation
Set PEEP level
Increases functional residual capacity
what type of patient can CPAP be used on
Can only be used on patients who are spontaneously breathing
when is CPAP most commonly used
obstructive sleep apnea
what is a little more difficult for the patient when they are on CPAP
expiration
what is CPAP called in neonates or pediatrics
SIPAP
CPAP decreases the ________________
work of breathing
BiPAP
bilateral positive pressure ventilation
what does BiPAP do
a. Works by facilitating an increase in tidal volume, preventing alveoli collapse (because of expiratory pressure support), and decreasing work of breathing
b. Allows for provider to order both inspiratory pressure-support (IPAP) and expiratory pressure support (EPAP)
c. Increases ventilation
primary function of the respiratory system
to deliver oxygen to the lungs (ventilation) where through diffusion, oxygen is released into the blood at the alveolar-capillary membrane (perfusion); the oxygen is then transported to the tissues, and the CO2 is transported by the blood to the lungs and released at the alveolar-capillary membrane through diffusion and then released as a gas
respiration is
process of the transport of oxygen from the inhaled air to the cells and the transport of CO2 in the opposite direction
ventilation is
- The movement of air between the atmosphere and the alveoli by inhalation/exhalation (higher to lower pressure)
lung compliance
Increased compliance means easier to expand lung tissue
Decreased compliance means difficult to expand the lung tissue
what causes the lungs to have increased resistance
secretions
bronchospasm
work of breathing
this becomes important with certain disease processes. Remember expiration is a passive process caused by elastic recoil of the lung. SO it is in inspiration that WOB takes place: it can be divided into compliance work (expand lungs against lung/chest wall elastic forces), tissue resistance work (required to overcome viscosity of lung/chest wall structures) and airway resistance work (required to overcome airway resistance during movement of air into lungs
what is diffusion
Exchange of O2 ad CO2 between pulmonary capillaries and alveoli (movement of solutes between area of high concentration to an area of low concentration)
what is perfusion
Flow of blood through the pulmonary capillary bed
Perfusion is required for diffusion to take place
in what position are the lungs best perfused at
sitting upright the bases of the lungs are best perfused
what is the upper respiratory tract
Air enters the body through the upper airway (nose, mouth, pharynx, nasopharynx, oropharynx, laryngopharynx, and larynx), the air is humidified, and filtered as it passes though these structures into the lower respiratory tract
what is the lower respiratory tract
i. As the air enters the lower respiratory tract (the trachea, bronchi, bronchioles, and into the alveoli), the air continues to be filtered by hairlike cilia that line the respiratory tract
conducting airways
the gas highway that shuttles oxygen and CO to where it needs to go
does gas exhange happen in the conducting airways
no
what is conducting airways considered
anatomic dead space
what is primary function of the conducting airways alongside shuttling air
humidifying and filtering the air
what is included in the conducting airways
nasopharynx, oropharynx, trachea, bronchi, bronchioles, and terminal bronchioles
what is part of the respiratory airways
respiratory bronchioles, aveolar ducts, and aveolar sacs
Type 1 aveolar cells
responsible for rapid gas exchange
type 2 aveolar cells
secrete surfactant which decreases surface tension and keeps the aveoli from collapsing
Lobule
where gas exchnge taks place = smallest component where the pulmonary capillaries, arterioles, and venules
why is it important to differentiate the conducting and respiratory airways
mechanical ventilation – need to provide warming, humidification and filtering of the air being mechanically provided
ventilation-perfusion relationship (V/Q)
V=ventilation (air going in and out of lungs)
Q=perfusion (gas exchange of oxygen and CO2 in the alveoli)
why is V/Q not 1:1
dead space and shunting of air
