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NURS353 - Practice of Nursing 2 > MedSurg Mod 6: Oxygen Therapy Modalities and Pulmonary Embolism > Flashcards

MedSurg Mod 6: Oxygen Therapy Modalities and Pulmonary Embolism Flashcards

1
Q

What is oxygen therapy

A

administration of O2 at a concentration greater than Room air

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2
Q

What is Room air at sea level

A

21%

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3
Q

RA (room air) decreases with ___

A

elevation

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4
Q

Goal of Oxygen therapy

A

increase O2 availability to the lungs and tissues in order to reduce effort of breathing and cardiac stress

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5
Q

Low Flow Oxygen Therapy

A

Room Air AND Supplemental oxygen - oxygen is not meeting complete need as RA is involved to help

Inconsistent or unknown O2 concentration

Delivery options: Nasal cannula, simple mask, partial rebreather, non rebreather

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6
Q

High Flow oxygen therapy

A

TOTAL inspired air

precise O2 concentration

delivery options - Venturi mask, mechanical ventilation

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7
Q

Why can we know exact high flow concentrations but not low flow

A

We do not have total control over low flow since something like a nasal cannula may give air but some of it is given via RA - so we cannot find exactly what is breathed in and it changes due to lack of control

with high flow we are meeting or exceeding needs and we know exactly what they are getting

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8
Q

Nurses can apply __ flow systems without an order like…

A

low flow systems like nasal cannula, simple mask, partial rebreather, non rebreather

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9
Q

O2 is considered a ___

A

medication

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10
Q

In order for emergency use of O2 by the nurse, the nurse should know…

A
  1. the clinical indicators for applying each type of low flow system
  2. how to correctly apply each of the systems
  3. the appropriate oxygen regulation for each system
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11
Q

With a venti/venturi mask what controls flow

A

A Rate Valve

they come in different colors and give precise oxygen percentages

they take into account room air and give precise amounts so we know exactly what someone gets

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12
Q

What is the difference between Partial Rebreather and Nonrebreather masks

A

partial has a bag capturing exhalation which some is rebreathed back in but a nonrebreather always has fresh air coming in due to a valve

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13
Q

What treatment is given to someone with O2 sat of 95-100%

A

no treatment

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14
Q

What treatment is given to someone with O2 sat 91-94 % (Mild hypoxemia)

A

Nasal cannula or simple mask

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15
Q

What treatment is given to someone with O2 sat of 86% to 91% (moderate hypoxemia)

A

partial rebreather or non rebreather or venturi mask

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16
Q

What treatment is given to someone with O2 sat < or equal to 85% (severe hypoxemia)

A

partial rebreather or a nonrebreather mask as a temporary measure until they are intubated

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17
Q

Oxygen Toxicity

A

case where someone is getting too much O2

there are very vague responses that can be similar looking to hypoxia

not common but must be assessed for

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18
Q

What are s/s of Oxygen toxicity

A

HA

substernal discomfort

dyspnea

alveolar atelectasis

paresthesia

restlessness, anxiety

fatigue, malaise, confusion

progressive respiratory difficulties

refractory hypoxemia

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19
Q

Assessments for O2 toxicity

A

chest tightness

respiratory rate

breath sounds

O2 saturation

numbness and tingling of extremities

activity level

general attitude

change in mentation

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20
Q

Interventions for O2 toxicity

A

monitor O2 flow setting

monitor total therapy time

assess before therapy

assess with changes in therapy

ensure therapy is initiated/maintained at correct “dose”

recommend therapy changes based on assessments

treat other symptoms

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21
Q

What to educate the patient about regarding O2 use at home

A

maintaining therapy at prescribed settings as ordered

when to notify the provider

safety precautions like discouragement of smoking and danger of o2 to facilitate combustion

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22
Q

When should someone on O2 at home notify a physician

A

frequent HA

increased anxiety

blue tinge to lips and nail beds

drowsiness

confusion

restlessness

slow, shallow, difficult, irregular or significant change in established breathing pattern

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23
Q

Positive End Expiratory Pressure / Continuous Positive Airway Pressure / Bilevel Positive Airway pressure (PEEP/CPAP/BiPAP)

A

Gives an extra boost in pressure to help prevent micro atelectasis / keep alveoli open

BiPAP and CPAP are more common

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24
Q

What are the benefits of PEEP/CPAP/BiPAP

A

it maintains a slight positive lung pressure and maintains slightly expanded lung tissue to prevent micro atelectasis

it also allows a lower percentage of O2 to be effective

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25
BiPAP is more commonly used when?
for sleep apnea to prevent times of no gas exchange
26
PEEP is more commonly used when?
for those with spontaneous or mostly mechanical ventilation
27
PEEP
positive end expiratory pressure maintains airway pressure above atmospheric airway pressure at the END OF EXPIRATION may be used with either spontaneous or mechanical ventilation
28
CPAP
continuous positive airway pressure maintains a positive airway pressure throughout THE WHOLE RESPIRATORY CYCLE used with spontaneous ventilation NO MECHANICAL
29
BiPAP
bilevel positive airway pressure similar to CPAP, still noninvasive delivers 2 levels of pressure with the higher one DURING INHALATION can be used for a variety of situations including COPD< sleep apnea, pneumonia, etc
30
What are some safety precautions to educate patients using O2 about
No open flames No combustible products exercise care with electrical devices use explosion proof plugs storage precautions like cart/collar cylinders, avoid bumping cylinders together/at all, keep in well ventilated area, post no smoking signs around
31
Always remember what for nursing interventions regarding O2 therapty
look at the WHOLE patient - do not rely on saturation numbers alone monitor VS and note color of nail beds, lips, and ears for signs of cyanosis look for respiratory retraction and nasal flaring false low/high O2 readings
32
What may cause a false low O2 sat reading
cold extremities or finger hypothermia or hypovolemia
33
What may cause a false high O2 sat reading
anemia (may have enough O2 but not enough O2 anyway due to relativity) carbon monoxide poisoning
34
The benefit of Incentive spirometry is ?
it maintains alveoli open for efficient gas exchange
35
How to use IS?
1. EXHALE (BREATHE OUT) NORMALLY 2. Put mouthpiece in mouth and close lips tight 3. INHALE SLOWLY AND DEEPLY through the mouthpiece to raise indicator 4. When you cannot inhale any longer, remove the mouthpiece and hold your breath for at least 5 seconds if possible 5. exhale normally * cough is not necessarily a part of this but can be for breaking up secretions to make it easier*
36
IS is all about...
breathing in
37
Pulmonary embolism (PE)
an embolus that clogs an artery (or arteries) in the PULMONARY VASULCAR SYSTEM
38
PE does not...
block airways! it blocks the blood flow
39
What is the vascular problem in PE and the respiratory response
blood flow obstructed --> poor perfusion of lung tissue air gets into lungs but enough O2 cannot get into the obstructed blood stream --> SOB
40
Where do PE usually originate from?
Most originate in the venous system from the inferior vena cava --> right atrium --> right ventricle --> lung vasculature
41
Generally is a clot originates in the left hear it will impact ...
the brain
42
Basic Diagnostics for PE
CXR - dilated pulmonary artery seen Spiral CT Scan EKG - sinus tachycardia and right heart strain d-Dimer test - rules out blood clot - negative <0.5 micrograms/mL VQ scan comparing the ventilation (air) and perfusion (blood) in each of several specific lung fields
43
What is the gold standard diagnostic for PE
Pulmonary Angiogram (Arteriogram)
44
d-DIMER test can indicate...
breakdown products of clots - if there are none then it rules out a clot
45
Pulmonary Angiogram (Arteriogram)
Pic of the lung vessels dye is injected through a catheter that is threaded through the vena cava into the right side of the heart allows for direct visualization of obstruction using fluoroscopy allows for accurate assessment of perfusion deficit requires specially trained teams to do
46
Risk Factors for PE
Age 50+ venous stasis prolonged immobility hypercoagulability previous history of thrombophlebitis damage to vessel walls orthopedic surgery - hip > knee for PE certain disease states like heart disease, trauma, postoperative, diabetes mellitus, and COPD other conditions like pregnancy, post partum, supplemental estrogen, birth control pill, obesity, and constrictive clothing
47
How fast can death occur with a PE
within 1 hour of onset
48
Priorities regarding PE
1. early recognition of clinical picture | 2. Early treatment
49
the Clinical picture of PE depends on what 3 things
1. size of the clot and amount of obstruction 2. location of clot 3. the amount of lung tissue affected
50
What is the human response to PE like?
non specific and non diagnostic
51
S/S of PE
anxiety and fear chest pain that is sudden, pleuritic, substernal and may become worse with deep breaths, coughing, eating, bending and stooping chest pain that worsens with exertion but wont recede with rest cough that may produce bloody sputum crackles and or a rub near the area of the embolus sudden dyspnea (when the clot lodges) syncope tachycardia tachypnea diaphoresis
52
PE is often referred to as what
the great imitator of other conditions since its s/s are so general
53
PE Severity Index
A scale that can provide indication of the outcome for a patient who suffers a PE, and although not its main purpose - it can also give early indication of impending PE if you check patient status against the predictors and notice early changes in those dimensions like climbing heart and respiratory rate or decreasing O2 sat before any complains of substernal chest pain It can even find mortality
54
With PE, more complexity =...
higher mortality
55
What is nursing care
the diagnosis and treatment of human responses to actual or potential health problems
56
Nursing Interventions to Prevent PE
identify presence of risk factors early ambulation reposition frequently active and passive leg exercises AE hose / SCDs (may not help but do not hurt) change in IV sites according to best practices patient and family education on avoiding prolonged sitting, legs and feet in dependent position, knees crossed, adequate hydration, wearing AE hoses and SCDs, etc recognition of PE clinical presentations
57
Emergency INDEPENDENT Nursing Interventions for PE
VS Assess lung sounds Assess RR/Effort Administer O2 via low flow systems high fowlers position EKG to check dysrhythmia and R sided failure
58
Emergency WITH ORDER Nursing Interventions for PE
establish IV access labs: H&H, electrolytes, d-DIMER Medications: morphine, sedation, anti anxiety
59
What is the goal of nursing interventions for PE
to stabilize pulmonary and cardiovascular systems
60
Do lung sounds sound different with PE?
no because it is a blood problem not an airway problem
61
Emergency Medical Management of PE
protect airway manage pain and anxiety confirm diagnosis pharmacology like thrombolytic drugs' like t-PA or anticoagulants like heparin and warfarin surgery like an intravenous catheter embolectomy for major and massive PE or implantation of an umbrellas filter into the inferior vena cava (greenfield)
62
IVC Filter (Intravenous Catheter/Umbrella Filter)
Grabs clots and traps them so the body can break them down over time the body will make its own t-PA over time to break the clots and the filter remains in place except for once it is needed to be removed (via the femoral artery)
63
Post PE Nursing Interventions after a Post embolectomy or Umbrella catheter
routine post op care: assessment, activity, ROM, AE/SCD, C/T/DB, skin and incision care, hydration, O2 prn
64
Post PE Nursing Interventions for all post PEs
monitor labs - PT/INR/PTT, platelets monitor pulmonary parameters monitor respiratory effort evaluate all assessment data against previous data - intervene as appropriate, alert PCP, document patient and family education
65
What should the Patient be educated on regarding anti coagulation medication post-PE
importance of labs as ordered and dosing as ordered safety such as s/s of bleeding in joints or brain, OTC interference or interactions, and alert of HCPs self care notify MD if/when...
66
Patient education for post op PE
activity incision care notify MD if/when
67
Patient education for Post-PE
alert all future HCP of PE history stay active and get out of bed ASAP after illness on long car or plane trips take breaks and walk at least every 2 hours change positions often do leg exercises if you are on bed rest dont cross your legs get immediate medical attention if an emergency occurs

NURS353 - Practice of Nursing 2 (14 decks)

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