module 1 (oxygen) Flashcards
selection of oxygen delivery devices is made by?
-made on the level of oxygen support the patient needs, severity of hypoxia, disease process
oxygen therapy is inexpensive or expensive?
inexpensive! widely available & used in a variety of settings
high flow oxygen delivery devices?
- a venture mask, large volume nebulizer, blender mask, or nasal cannula
- high flow discourages entraining room air which dilutes the inspired oxygen concentration (fiO2)
low flow oxygen delivery devices?
-nasal cannula, face mask, nonrebreather, partial rebreather masks
you can estimate the Fi02 by?
the flow rate
nasal cannula? (flow rate, summary)
simple, effective, comfortable
- less than 4L/min
- high flow nasal cannula is used in patients prone to severe O2 desaturation: can deliver up to 6L/min of heated humidified oxygen
when is a oxygen conserving cannula used?
for patients who require higher O2 concentrations than what can be provided via regular cannula
simple oxygen mask?
short term, fits loose and delivers 35-50-60%
assessment before applying a nasal cannula or oxygen mask?
- resp assessment, symmetry of chest wall, hypoxia
- assess airway patency (remove airway secretions by having pt cough)
- inspect skin around nose and ears
- inspect pt most recent arterial blood gas results or SpO2
curved tips of cannula should point which way into nares?
curved tips should point downward inside
partial or nonrebreather mask should fit?
tightly around mouth, reservoir fills on exhalation and almost collapses in inspiration
how often do you check cannula/masks?
every 8 hours- make sure to put signs up at entrance of room
patient teaching of cannulas/masks?
teach about the signs of carbon dioxide retention (confusion, headache, decreased LOC, somnolence, C02 narcosis, resp arrest)
pediatrics and cannulas?
- some infants and small children are able to tolerate a nasal cannula
- secure prongs with tape over childs cheek
- some infants get oxygen hood
gerontological considerations with cannulas?
-fragile mucous membrane, water-based gels are useful
what are incentive spirometers for?
- helps patient deep breathe
- provide visual feedback as encouragement! long, slow deep breathes
two types of incentive spirometers?
- flow oriented: one or more plastic chamber with freely moveable balls, advantage is slow steady expansion of the lungs.. pt tries to keep the ball elevated as long as possible
- volume oriented: uses a bellow that a pt must raise to a predetermined volume by inhaling slowly, advantage is that pt can achieve a known inspiratory volume and measure each breath
assessment for using a incentive spirometer?
- assess if it is the appropriate route of treatment for them
- assess for confusion, cognitive impairment, ability to follow directions
- assess resp and lung symmetry, sputum production, lung sounds
- assess level of pain at rest/active
evaluation of incentive spirometer use?
- observe pt ability to use IS by demonstrating to you
- auscultate chest during resp cycle
- obtain pulse oximeter reading
- use teach back
patient teaching for incentive spirometer?
-teach patient to examine sputum for consistency, amount and colour changes, should be clearer over time and decrease in volume
what is a oropharyngeal airway?
- semicircular, minimally flexible, curved piece of hard plastic
- when inserted, it extends from just outside the lips, over the tongue, and to the pharynx
oral airways allow you to?
suction through a central core or along the side of the airway and maintain airway patency iin an unconscious patient
assessment for oral airways?
- identify a need to insert an oral airway (upper airway gurgling with breathing, absent cough or gag reflex, oral secretions, grinding teeth and more)
- assess for presence of gag reflex (place tongue blade on back of pts tongue)
- ensure pt does not have dentures in place before attempting an oral airway insertion
never insert an oral airway in:
a conscious patient or patient with recent oral trauma, oral surgery, or loose teeth.
-never force an airway into place!
expected outcomes after insertion of oral airway?
pt resp status improves (normal resp rate, easier removal of secretions, lack of gurgling)
- pt not able to grind teeth or bite ice cubes
- pts tongue does not obstruct airway
implementation of oral airway?
- position unconscious pt in semi-fowlers if possible (30-45 degrees)
- when possible, use padded tongue blade to open patients mouth
- hold airway with curved end up and insert distal end until airway reaches back of throat (touches soft palate), then turn airway over 180 degrees and follow natural curve of tongue (you can also insert sideways halfway and rotate 90)
- make sure outer flange is just outside patients lips
- suction secretions
- reassess pts resp status: auscultate
- clean pts face
- administer mouth care freq
evaluation of oral airway?
- resp status, compare resp assessments before and after insertion
- evaluate that airway is patent and patients tongue does not obstruct airway
- observe for patient pushing airway out with tongue or coughing
unexpected outcomes of oral airway?
- pt continues to gag and cough: do NOT insert, remove and position pt on side
- obstruction not relieved: obtain assistance
- pt pushes airway out of place: reassess need for oral airway
do paediatrics use oral airways?
-seldom used because airway is narrow and they are often more occlusive than beneficial
oxygen therapy is the admin of?
- oxygen at a concentration greater than in the air
- at sea level, air is 21% oxygen
- goal is to provide enough O2 to decrease work of breathing
indications for oxygen therapy?
-change in resp rate, hypoxemia, hypoxia
with long-standing hypoxia (like COPD, chronic HF), what things may occur?
fatigue, drowsiness, apathy, inattentiveness and delayed reaction time
oxygen is a med, except in emergency it is only used with:
doctors order!
baseline O2?
60-95mmHg
what is oxygen toxicity?
- too high conc (greater than 50% is administered for extended period- greater than 48 hours)
- can kill cells
- signs: discomfort, resp difficulty, hypoxemia, atelactasis
- PEEP or CPAP used with O2 therapy to allow a lower % O2 to be used
flow rate over _______ may cause irritation?
6-8L
in many pt with COPD, stimulant to breathe is a decrease in O2 rather than an increase in C02, when a high level of O2 is administered…
decreased resp drive
—> can lead to C02 acidosis and death
geriatric considerations for O2 therapy?
- resp muscles weaken with age
- larger bronchi and alveoli
- SA of lung decreases
- Cilia reduced
- osteoporosis can cause calcification on costal cartilage
- chest rigidity
- risk for aspiration and infection
- adequate diet important to help diminish build up of CO2
what is a mini nebulizer?
- handheld, dispenses moisturizing agent or medication
- for pt with difficult clearing secretions, reduced vital capacity, ineffective deep breathing and coughing
- pt must be able to generate a deep breath
- common in COPD
goal of chest physiotherapy?
-remove bronchial secretions, improve ventilation, increase efficiency of resp muscles
chest percussion is?
thick secretions loosed by tapping
- cup hands and lightly strike
- may use towel as barrier
- 3-5 min in each position
- do not percuss over sternum, spine, liver, kidneys, spleen, breasts, or eldery
- evaluate breath sounds before and after
endotracheal intubation?
- provides patent airway
- may be used no longer than 3 weeks
- tubes cause discomfort and gag reflex is depressed
- ulcers may occur
- dangers of removing tube can be life threatening
bag valve (child vs adult)
- 1 pump for every 3 seconds for child or infant
- 1 pump every 5-7 seconds for adult
- make sure good mask seal and check for rise and fall of the chest
important safety consideration for administering oxygen?
avoid using anything that may create a spark around oxygen because it is combustible
a client is receiving oxygen therapy via a nasal cannula, above which rate should the oxygen be humidified?
4L/min for prongs, all face masks must be humidified
should water-soluble lubricants be used in nares for clients using oxygen therapy to prevent or treat dryness or irritation of mucous membranes?
yes! only water-soluble
vaseline is petroleum based therefore combustible
candidates for receiving incentive spirometry?
- ppl overweight
- post op surgery patients
- ppl on bedrest
- ppl who smoke
- ppl who have pneumonia
correct method for measuring a client for an oral airway?
flange is parallel to the front of the teeth and the curved end at the angle of the jaw
“lip to ear”
before placing a partial or nonbreathing mask on patient, what do you do?
attach mask tubing to oxygen delivery device and fill up the reservoir bag fully (with oxygen) before placing on pt
-ensure mask is sealed tightly around mouth, that oxygen reservoir fills on exhalation and almost but not completely collapses with inspiration
why do you inspect the bag of a oxygen mask frequently?
-make sure it is fully inflated because if it is not, the pt breathes in large amounts of exhaled carbon dioxide
what is a face tent?
shield like device that fits under patients chin and sweeps around face, used primarily for humidification and oxygen only when a
when are oxygen tents or oxygen hoods particularly useful?
pediatrics
children with airway inflammation, epiglottis, other resp tract infections
-high concentrations of humidified oxygen!
partial nonrebreather?
10-12L/min, bag always remains partially inflated!! flow rate must be high enough to prevent collapse of bag
who is the simple oxygen mask contraindicated in?
ppl with carbon dioxide retention
difference between simple face mask and venturi mask?
venturi mask delivers higher concentrations of oxygen
why do you let the patient rest between incentive spirometry breaths?
to prevent hyperventilation and fatigue!!
in a pediatric patient with oral airway, do NOT:
rotate the oral airway bc the tip will damage the soft palate
