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N353: Practice of Nursing II > MedSurg Mod 6: Oxygen Therapy Modalities and Pulmonary Embolism > Flashcards

MedSurg Mod 6: Oxygen Therapy Modalities and Pulmonary Embolism Flashcards

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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
Q

BiPAP is more commonly used when?

A

for sleep apnea to prevent times of no gas exchange

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26
Q

PEEP is more commonly used when?

A

for those with spontaneous or mostly mechanical ventilation

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27
Q

PEEP

A

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
Q

CPAP

A

continuous positive airway pressure

maintains a positive airway pressure throughout THE WHOLE RESPIRATORY CYCLE

used with spontaneous ventilation NO MECHANICAL

29
Q

BiPAP

A

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
Q

What are some safety precautions to educate patients using O2 about

A

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
Q

Always remember what for nursing interventions regarding O2 therapty

A

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
Q

What may cause a false low O2 sat reading

A

cold extremities or finger

hypothermia or hypovolemia

33
Q

What may cause a false high O2 sat reading

A

anemia (may have enough O2 but not enough O2 anyway due to relativity)

carbon monoxide poisoning

34
Q

The benefit of Incentive spirometry is ?

A

it maintains alveoli open for efficient gas exchange

35
Q

How to use IS?

A
  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
Q

IS is all about…

A

breathing in

37
Q

Pulmonary embolism (PE)

A

an embolus that clogs an artery (or arteries) in the PULMONARY VASULCAR SYSTEM

38
Q

PE does not…

A

block airways! it blocks the blood flow

39
Q

What is the vascular problem in PE and the respiratory response

A

blood flow obstructed –> poor perfusion of lung tissue

air gets into lungs but enough O2 cannot get into the obstructed blood stream –> SOB

40
Q

Where do PE usually originate from?

A

Most originate in the venous system from the inferior vena cava –> right atrium –> right ventricle –> lung vasculature

41
Q

Generally is a clot originates in the left hear it will impact …

A

the brain

42
Q

Basic Diagnostics for PE

A

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
Q

What is the gold standard diagnostic for PE

A

Pulmonary Angiogram (Arteriogram)

44
Q

d-DIMER test can indicate…

A

breakdown products of clots - if there are none then it rules out a clot

45
Q

Pulmonary Angiogram (Arteriogram)

A

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
Q

Risk Factors for PE

A

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
Q

How fast can death occur with a PE

A

within 1 hour of onset

48
Q

Priorities regarding PE

A
  1. early recognition of clinical picture
  2. Early treatment
49
Q

the Clinical picture of PE depends on what 3 things

A
  1. size of the clot and amount of obstruction
  2. location of clot
  3. the amount of lung tissue affected
50
Q

What is the human response to PE like?

A

non specific and non diagnostic

51
Q

S/S of PE

A

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
Q

PE is often referred to as what

A

the great imitator of other conditions

since its s/s are so general

53
Q

PE Severity Index

A

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
Q

With PE, more complexity =…

A

higher mortality

55
Q

What is nursing care

A

the diagnosis and treatment of human responses to actual or potential health problems

56
Q

Nursing Interventions to Prevent PE

A

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
Q

Emergency INDEPENDENT Nursing Interventions for PE

A

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
Q

Emergency WITH ORDER Nursing Interventions for PE

A

establish IV access

labs: H&H, electrolytes, d-DIMER

Medications: morphine, sedation, anti anxiety

59
Q

What is the goal of nursing interventions for PE

A

to stabilize pulmonary and cardiovascular systems

60
Q

Do lung sounds sound different with PE?

A

no because it is a blood problem not an airway problem

61
Q

Emergency Medical Management of PE

A

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
Q

IVC Filter (Intravenous Catheter/Umbrella Filter)

A

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
Q

Post PE Nursing Interventions after a Post embolectomy or Umbrella catheter

A

routine post op care:

assessment, activity, ROM, AE/SCD, C/T/DB, skin and incision care, hydration, O2 prn

64
Q

Post PE Nursing Interventions for all post PEs

A

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
Q

What should the Patient be educated on regarding anti coagulation medication post-PE

A

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
Q

Patient education for post op PE

A

activity

incision care

notify MD if/when

67
Q

Patient education for Post-PE

A

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

N353: Practice of Nursing II (14 decks)

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