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RT210 > Lesson 7: Medical Gas Therapy CH 42 > Flashcards

Lesson 7: Medical Gas Therapy CH 42 Flashcards

1
Q

What is the overall goal of oxygen therapy?

A

To maintain adequate tissue oxygenation while maintaining cardiopulmonary work.

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2
Q

Clinical objectives for oxygen 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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3
Q

What are the indications for oxygen therapy?

A

Treat hypoxemia, decrease WOB, and decrease myocardial work

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4
Q

What are the hazards of Oxygen Therapy?

A

Oxygen toxicity, absorption atelectasis, oxygen induced hypoventilation, and Retrolental fibroplasia(ROP-retinopathy of prematurity).

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5
Q

What are the guidelines for Oxygen Administration?

A

O2 concentration < 40%, 100% O2 has NOT been shown to cause O2 toxicity when used less than 24h, 100% O2 is NOT contraindicated for brief periods in an emergency, use minimal O2 concentrations to achieve a state of no hypoxia, and monitor the patients closely.

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6
Q

What are the indications for Low Flow Devices?

A

Patients VT 300-700 ml, RR < 25 BPM, and consistent, regular, ventilatory patterns

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7
Q

What factors influence FIO2?

A

Patient’s ventilatory patterns, flow of gas, and reservoir.

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8
Q

As VT ___, FIO2 decreases due to more entrainment of room air.

A

increases

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9
Q

As VT decreases, FIO2 ___ due to less entrainment of room air.

A

increases

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10
Q

T or F

Respiratory rate will effect system if there is NOT adequate time for reservoir refill.

A

True

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11
Q

What are the characteristics of FiO2?

A

Unpredictable, immeasurable, and may vary from minute to minute.

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12
Q

List the low flow devices?

A

Nasal Cannula, nasal catheter, simple O2 mask, partial rebreather mask, and non-rebreather mask.
Nasal catheter, transtracheal catheter.

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13
Q

List the High Flow Systems:

A

AEM(Venturi Mask), face tent, aerosol mask, t-tube, trach collar, air-entrainment nebulizer, blender system

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14
Q

Characteristics of High flow systems:

A

Are consistent, predictable, and measurable(FiO2), must meet all the patient’s demands for gas delivered.

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15
Q

In high flow systems, the total system output must be at least ___ times the patient’s ____.

A

3, Minute ventilation

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16
Q

List the enclosed high flow systems:

A

Mist tent or croupette, isolette, headbox, oxyhood.

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17
Q

Formula for determining FiO2 w/ combined flow system:

A

(1st fio2)x(1st flow)+(2nd flow)x(2nd flow) / (1st flow + 2nd flow) = FiO2

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18
Q

What is the purpose of analyzers?

A

To analyze high flow systems, patients may not receive FiO2 analyzed if the flow is not adequate, used in measuring mechanical ventilation.

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19
Q

List the types of Analyzers:

A

Physical(paramagnetic), Electrical(thermal conduction), Electrochemical(polarographic), and Electrochemical(galvanic cell).

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20
Q

What does the clark electrode, sanz, and severing-house electrode measure?

A

Clark electrode: O2
Sanz: pH
Severing-house: CO2

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21
Q

What two analyzers have batteries?

A

The clark electrode(polarographic) and the electromechanical(galvanic cell).

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22
Q

The three basic ways to determine whether a pt needs O2 therapy?

A

lab measures, pt condition/problem, and assessment

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23
Q

Commonly used threshold for hypoxemia?

A

Pao2 < 55 TO 60 mmHg or SaO2 < 87%-90% in subjects breathing room air.

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24
Q

O2 therapy is needed for pts w/ disorders associated w/ hypoxemia. What are some examples?

A

Post-op pts, pts w/ cyanide poisoning, CO poisoning, shock, pulmonary embolism, trauma, and acute myocardial infarction or during cardiopulmonary resuscitation.

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25
Q

What are some clinical signs of mild to moderate respiratory hypoxia?

A

Tachypnea, dyspnea, paleness, tachycardia

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26
Q

What are some clinical signs of severe respiratory hypoxia?

A

Tachypnea, dyspnea, cyanosis

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27
Q

What are some clinical signs of mild to moderate cardiovascular hypoxia?

A

Mild hypertension, peripheral vasoconstriction, tachycardia

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28
Q

What are some clinical signs of severe cardiovascular hypoxia?

A

Tachycardia, (eventual bradycardia, arrhythmia), hypertension(eventual hypotension).

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29
Q

What are some clinical signs of mild to moderate neurologic hypoxia?

A

Restlessness, disorientation, headaches, lassitude(weakness, exhaustion, a sense of weariness).

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30
Q

What are some clinical signs of severe neurological hypoxia?

A

Somnolence(sleepy, hard to arouse), confusion, distressed appearance, blurred vision, tunnel vision, loss of coordination, impaired judgement, slow reaction time, manic- depressive activity, coma

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31
Q

Oxygen toxicity is currently termed:

A

hyperoxic acute lung injury

32
Q

Hyperoxia is a PaO2 greater than ____.

A

300 mmHg

33
Q

What two factors determine the extent of harmful effects of O2?

A

PaO2 and exposure time.

Explanation: The higher the PaO2 and the longer the exposure, the greater the likelihood of damage.

34
Q

O2 toxicity primarily affects what?

A

The lungs and the central nervous system(CNS effects such as tremors, twitching, and convulsions occur mainly in patients breathing 100% O2 at pressures greater than 1 atm (pbar).

35
Q

The toxicity of O2 is caused by?

A

By the overproduction of O2 free radicals(byproduct of cellular metabolism).

36
Q

RULE OF THUMB: OXYGEN TOXICITY

A

Limit patient exposure to 100% O2 to less than 24h whenever possible. High FiO2 is acceptable if the concentration can be decreased to 70% within 2 days and 50% or less in 5 days.

37
Q

T or F?

Regardless of approach, supplemental O2 never should be withheld from hypoxemic patients.

A

True

38
Q

T or F?
A small percentage of COPD patients and chronic hypercapnia may NOT hypo-ventilate when breathing moderate to high FiO2 concentrations.

A

False
Explanation: They may hypo-ventilate. Decreases in ventilation of nearly 20% have been observed in these patients with accompanying elevations in PaCO2 of 20-23mmHg.

REMEMBER!: THIS HYPOVENTILATION IS NOT TYPICAL OF PTS W/ COPD, AND APPROPIATE USE OF OXYGEN TO AVOID HYPOXEMIA SHOULD ALWAYS BE THE PRIORITY IN CLINICAL MANAGEMENT!

39
Q

What is the theory on why the small group of COPD pts hypoventilate during moderate to high O2 administration?

A

O2 administration and the resulting increase in arterial oxygen levels cause suppression of the hypoxic drive. The increase in the blood O2 lvl in these patients suppresses peripheral chemoreceptors , depresses ventilatory drive, and elevates PaCO2.

40
Q

What is Retinopathy of prematurity (ROP) also known as retrolental firboplasia?

A

An abnormal eye-condition that occurs in some premature or low birth weight infants who receive supplemental oxygen.

REMEMBER: An excessive O2 lvl causes retinal vasoconstriction, which leads to necrosis(death) of the blood vessels.

41
Q

ROP often affects neonates up to _____.

A

One month of age(by which the time retinal arteries have sufficiently matured).

42
Q

What is the best way to minimize ROP?

A

The American Academy of Pediatrics recommends keeping arterial PO2 in an infant < 80 mmHg.

43
Q

What range of FiO2 poses a significant risk of absorption atelectasis?

A

FiO2> 0.50.

44
Q

The likelihood of absorption atelectasis is greatest when?

A

When present with other risk factors associated with low Vt such as sedation, CNS dysfunction , and surgical pain.

45
Q

In what situations are fire hazards present while administering O2 (I.e. home care, healthcare facilities)?

A

Fires seem to pose the greatest risk in operating rooms and in association with selected respiratory procedures. Electronic devices are used while supplemental O2 is being supplemented. In the home setting, increased fire risk involve home care patients smoking while receiving low- flow O2 and the use of aluminum O2 regulators.

46
Q

If a fire does occur in a healthcare facility, what protocols should you take?

A 
R.A.C.E
Rescue at-risk pts and personnel
Alarm, initiate it
Contain to fire by closing doors 
Extinguish flames in a safe manner through the use of fire extinguishers
47
Q

What are the three basic designs of O2 devices?

A

Low flow systems, high flow systems, and reservoir systems.

SIDENOTE: Enclosures are commonly identified as a fourth category.

48
Q

Typical Low flow systems provide supplemental O2 directly to the airway at a flow of ____L/min. Because the inspiratory flow of a healthy adult exceeds that, the O2 provided by a low flow device is always ________.

A

8L/min, diluted with air

49
Q

A humidifier is used only when the input flow is what on a nasal cannula?

A

> 4L/min

50
Q

How do we estimate the FiO2 provided by low flow systems?

A

For pts with a normal rate and depth of breathing:
Each 1L/min of nasal O2 increases FiO2 4%.

Example: A patient is using a nasal cannula at 4L/min has an estimated FiO2 of 37%
4x4=16+21(room air) = 37%

51
Q

What are some common problems associated with low flow systems?

A

Inaccurate flow, system leaks and obstructions, device displacement, and skin irritation.

52
Q

List the three types of reservoir masks

A

Simple mask, partial rebreather mask, and nonrebreather mask

53
Q

Why does partial and nonrebreathing mask provide a higher FiO2 than a simple mask?

A

Each has a 1L flexible reservoir bag attached to the O2 inlet. The bag increases reservoir volume which provides a higher FiO2 than a simple mask.

54
Q

What is the difference between a partial and nonrebreather mask?

A

The use of the valves. A partial rebreather mask has no valves, whereas a nonrebreather does.

55
Q

T or F ?
A nonrebreathing mask, which is much more commonly used than a partial rebreathing mask, prevents rebreathing with a reservoir bag.

A

False

Explanation: It prevents rebreathing with one-way valves.

56
Q

T or F?

Nonrebreathing masks are often referred to as 100% oxygen devices because it actually delivers 100%

A

False
Explanation: Although it is referred to as “100% oxygen devices,” modern disposable nonrebreathing masks normally do not provide much more than 70% O2.

57
Q

To qualify as a high flow device a system should provide at least ___L/min total flow. This is based on the criteria that the average adult inspiratory flow during Vt is approximately ___ times the ___.

A

60, 3 times the minute ventilation

58
Q

What principle does the venturi mask use, and what does it state?

A

Bernoulli principle: as flow increases , the pressure in the fluid will decrease along w/ its potential energy.

59
Q

What tubing does Low and high flow systems use?

A

Low: small bore tubing
High: Large bore tubing

60
Q

T or F?

The magic box is ONLY used to estimate air-to-O2 ratio.

A

True

61
Q

List the air-to-oxygen ratio for the following(hint: (FiO2-100)/(FiO2-21) ).
60, 40, 35, 30, 28, and 24.

A

60- 1:1. 40- 3:1 35- 5:1. 30- 8:1

28- 10:1. 24- 25:1

62
Q

T or F?
High flow systems provide precise FiO2, and for COPD patients who need precise controlled low FiO2 would need a AEM venturi mask.

A

True

63
Q

What can be done if air-entrainment devices cannot provide a high enough O2 concentration or flow?

A

Use of a gas blending system could be used.
Explanation: With a blending system pressurized air and O2 sources are input, and the gases are mixed either manually or w/ a precision valve(blender).

64
Q

What are the three P’s and why are they used?

A

Purpose, performance, and patient: used in the initial selection or recommendation of a change in O2 delivery systems.

Explanation: the goal is to match the performance characteristics of the equipment to both the objectives of therapy and the pts special needs.

65
Q

For a LOW (<35%) desired FiO2 level, what FIXED and VARIABLE oxygen delivery systems can be used?

A

Fixed: AEM, air-entrainment nebulizer, blending system, isolette, incubator
Variable: nasal cannula, nasal catheter, and transtracheal catheter

66
Q

For a MODERATE(35%-60%) desired FiO2 level, what FIXED and VARIABLE oxygen delivery systems can be used?

A

Fixed: Air-entrainment nebulizer, blending system, oxyhood
Variable: simple mask, air-entrainment nebulizer TENT(child)

67
Q

For a HIGH (>60%) desired FiO2 level, what FIXED and VARIABLE oxygen delivery systems can be used?

A

Fixed: blending system, oxyhood (infant), high flow nasal cannula
Variable: Partial rebreather, nonrebreather

68
Q

What is the most common combination of Helium?

A

80/20 , but premixed could come both in 80/20 or 70/30.

69
Q

T or F?
When heliox is given alone or as part of nebulization, a typical hospital O2 flowmeter is inaccurate because helium has a lower density.

A

True
Explanation: Helium has less density than oxygen. For a mixture of 80/20 you must multiply LPM x 1.8. For a mixture of 70/20 you multiply by 1.6.

70
Q

What is the normal range for a nasal cannula?

What is the FiO2 range and stability?

A

Adult: 1/4-6L/min
Infant: less than or equal to 2L/min
Range: 22-44% , variable

71
Q

What is the normal range for a simple mask?

What is the FiO2 range and stability?

A

Flow: 5-10L/min

FiO2 range: 40-60% , variable

72
Q

What is the normal range for a Partial rebreathing mask?

What is the FiO2 range and stability?

A

Minimum of 10L/min to prevent bag collapse, 60-80% , and variable

73
Q

What is the normal range for a Nonrebreathing mask?

What is the FiO2 range and stability?

A

minimum of 10L/min to prevent bag collapse on inspiration, 80-100%, variable

74
Q

What is the normal range for a AEM?

What is the FiO2 range and stability?

A

Varies, should provide output flow >60L/min, 24-50%, fixed

75
Q

What is the normal range for a Air-entrainment nebulizer?

What is the FiO2 range and stability?

A

10-15L/min, should provide output flow of atleast >60L/min, 28-100%, fixed

76
Q

What is the normal range for a Blending system?

What is the FiO2 range and stability?

A

Should provide output flow of atleast >60L/min, 21-100%, fixed

77
Q

What is the normal range for a High flow nasal cannula?

What is the FiO2 range and stability?

A

up to 50L/min or more, 35-100%, Fixed

RT210 (4 decks)

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