O2 Therapy and Tracheostomy Care Flashcards
Oxygen via nasal canulla – when do we need an order and what is the max amount that can be delivered?
- Need order over 2L
- Max O2 via canulla is 6L
What are important things to keep in mind regarding Intubation?
- PT should not be awake/aware. MUST BE SEDATED!
- After intubation, you MUST assess lung sounds and document
- X-ray must be done to confirm placement
- PT will need to be on a cardiac monitor, Pulse ox, etc for all vital monitoring
When using an AMBU bag, when should you compress the bag?
When the PT inhales
If O2 equipment goes down, what do we do?
- We do not fix it
- Disconnect, use ambu bag
- Call for help for machine repair
S/S of Respiratory Distress?
- Dyspnea
- Nasal flaring
- Use of accessory muscles to breathe
- Pursed-lip or diaphragmatic breathing
- Decreased endurance
- Skin, mucous membrane changes (pallor, cyanosis)
- Cyanosis
- Late sign (occurs later) for adults
- Occurs quickly for babies
What is the purpose and goal of O2 therapy?
- Purpose—relieves
- Hypoxemia—low levels of oxygen in the blood
- Hypoxia—decreased tissue oxygenation
- Goal—use lowest fraction of inspired oxygen for acceptable blood oxygen level without causing harmful side effects
What percentage of O2 do intubated PTs get and why is it problematic?
- 100%
- It is super high and cannot be sustained
How much O2 is there in typical room air?
21%
ABGs are performed to monitor effects by _____ , then they reduce o2 delivery based on ABG outcomes w/ a goal of getting them back down to around __%
- Respiratory therapists
- 30%
Oxygen administration reduces the amount of adjustment needed by ____ and _____ to maintain tissue oxygenation.
- Heart
- RBCs
Explain oxygen-induced hypoventilation and what it leads to.
- People are triggered to breath by O2 levels in the blood
- If O2 levels are too high, the body will slow its rate of breathing
- This leads to retention of CO2 (hypercarbia)
Constant high levels of CO2 can lead to CO2 narcosis. What is this?
Loss of sensitivity to high levels of CO2
Pulmonary oxygen toxicity results in damage to the lungs, causing…
pain and difficulty in breathing
The type of oxygen delivery system to be used is determined by…
- Oxygen concentration required/achieved
- Importance of accuracy and control of oxygen concentration
- Patient comfort
- Importance of humidity
- Patient mobility
What are the types of low-flow oxygen delivery systems?
- Nasal cannula
- Facemask
- Simple
- Partial rebreather
- Non-rebreather
What are the specs of nasal cannula delivery?
- Flow rates of 1-6 L/min
- > 2 L/min requires order
- O2 concentration of 24-44%
What are we respiratory assessments are we making with nasal cannula delivery?
- Patency of nostrils/airway
- Changes in RR and depth
Describe a simple facemask
- Strapped around head
- Placed over nose and mouth
- Metal piece to conform mask to nose
- Exhalation ports present on the sides
- O2 tube connects to port on front of mask
- (no bags are attached to this)
Specs for O2 delivery via simple facemask
- Delivers O2 up to 40%-60%
- Minimum of 5 L/min
- Exhalation will vent out ports on side
- Inhalation will be a mix of O2 and exhaled air (mostly O2)
- Will require order
Describe a Partial Rebreather Mask
- Same as simple face mask with one change
- O2 tube AND an inflated reservoir bag are attached to the front of the mask
- Exhalation will go out ports and into bag
- Inhalation will be a mix of CO2 and O2 from the bag/O2 tube (O2 being the majority) – 1/3 of exhaled tidal volume
Specs on the Partial Rebreather Mask?
- Provides 60-75% O2
- Flow rate of 6-11 L/min
- Adjust flow rate to keep bag inflated
Describe a non-rebreather mask
- Same as the partial rebreather with the change to the vent ports
- Vent ports (side and to bag) are now one way valves that allow air out, but not back in.
- This allows for greater O2 delivery
Key points for use of non-rebreather mask?
- Can deliver >90% O2
- Used for unstable PTs requiring intubation
- Ensure valves are patent and functional
What are the specs for high-flow oxygen delivery systems?
Can deliver 24-100% O2 at 8-15 L/min
What are the types of high-flow delivery systems?
- Venturi mask
- Face tent
- Aerosol Mask
- Tracheostomy collar
- T-piece
Describe a Venturi Mask
- Same as simple mask w/ difference being what is attached
- Special tubing (no bag) is attached to facemask that allows for (the most) precise delivery of O2
When on a Venturi mask, when would you use nasal cannula?
During mealtimes
Outside of apnea, what other uses are there for BiPAP and CPAP devices?
- They can be used for atelectasis after surgery
- Cardiac induced pulmonary edema
What is a tracheotomy?
Surgical incision into trachea for purpose of establishing an airway
What is a tracheoStomy?
- stoma (opening) that results from tracheotomy
- May be temporary or permanent
What are the priority patient problems we need to provide education for to avoid/minimize adverse outcomes?
- Reduced oxygenatin
- Inadequate communication
- Inadequate nutrition
- NG tube and Peg tube
- Potential for infection
What is our most important nursing intervention post surgery for tracheostomy?
- Ensure patent airway
- Assess for possible complications/tube obstruction/dislodgement
Purulent drainage, redness, and swelling at the tracheostomy site is indicative of…
Infection
When caring for a PT with a Tracheostomy, how can we prevent tissue damage?
- Check cuff pressure often, it can cause mucosal ischemia
- Use minimal leak and occlusive techniques
- Prevent tube friction and movement
- Prevent/treat malnutrition, hemodynamic instability, hypoxia
How is the air humidification addressed w/ a tracheostomy tube?
Air is humidified before delivery
What is the purpose of Suctioning in Tracheostomy care?
To keep patent airway and promote gas exchange
What patients do we need to evaluate frequently for suctioning?
Those who cannot cough adequately
What are some complications that can arise from suctioning?
- Hypoxia
- Tissue (mucosal) trauma
- Infection
- Vagal stimulation, bronchospasm
- Cardiac dysrhythmias from induced hypoxia
What must you always do post suctioning?
Document how PT tolerated procedure
How does a tracheostomy tube interfere w/ nutrition?
- If balloon is inflated, it can interfere w/ passage of food through esophagus
- Can cause aspiration
- Effort can cause PT to not want to eat
What aspiration prevention do we do after a PT with a tracheostomy has eaten?
Elevate HOB for @least 30mins
What does a fenestrated tracheostomy tube allow for?
- Since it has openings, it allows air to pass both through the PTs oral/nasal passages as well as the tracheostomy site.
- Air movement allows PT to speak
- Produces more effective cough
A fenestrated tube is not recommended for…
- PTs at high risk for aspiration
- On positive pressure ventilation
Explain the process of weaning off a tracheostomy tube
- Gradual decrease in tube size
- Cuff is deflated when patient can manage secretions; does not need assisted ventilation
- Change from cuffed to uncuffed tube
- Size of tube decreased by capping; use smaller fenestrated tube