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z_MEDSURGE: FINAL REVIEW > O2 Therapy and Tracheostomy Care > Flashcards

O2 Therapy and Tracheostomy Care Flashcards

1
Q

Oxygen via nasal canulla – when do we need an order and what is the max amount that can be delivered?

A
  • Need order over 2L
  • Max O2 via canulla is 6L
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2
Q

What are important things to keep in mind regarding Intubation?

A
  • 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
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3
Q

When using an AMBU bag, when should you compress the bag?

A

When the PT inhales

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4
Q

If O2 equipment goes down, what do we do?

A
  • We do not fix it
  • Disconnect, use ambu bag
  • Call for help for machine repair
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5
Q

S/S of Respiratory Distress?

A
  • 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
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6
Q

What is the purpose and goal of O2 therapy?

A
  • 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
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7
Q

What percentage of O2 do intubated PTs get and why is it problematic?

A
  • 100%
  • It is super high and cannot be sustained
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8
Q

How much O2 is there in typical room air?

A

21%

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9
Q

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 __%

A
  • Respiratory therapists
  • 30%
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10
Q

Oxygen administration reduces the amount of adjustment needed by ____ and _____ to maintain tissue oxygenation.

A
  • Heart
  • RBCs
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11
Q

Explain oxygen-induced hypoventilation and what it leads to.

A
  • 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)
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12
Q

Constant high levels of CO2 can lead to CO2 narcosis. What is this?

A

Loss of sensitivity to high levels of CO2

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13
Q

Pulmonary oxygen toxicity results in damage to the lungs, causing…

A

pain and difficulty in breathing

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14
Q

The type of oxygen delivery system to be used is determined by…

A
  • Oxygen concentration required/achieved
  • Importance of accuracy and control of oxygen concentration
  • Patient comfort
  • Importance of humidity
  • Patient mobility
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15
Q

What are the types of low-flow oxygen delivery systems?

A
  • Nasal cannula
  • Facemask
    • Simple
    • Partial rebreather
    • Non-rebreather
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16
Q

What are the specs of nasal cannula delivery?

A
  • Flow rates of 1-6 L/min
  • > 2 L/min requires order
  • O2 concentration of 24-44%
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17
Q

What are we respiratory assessments are we making with nasal cannula delivery?

A
  • Patency of nostrils/airway
  • Changes in RR and depth
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18
Q

Describe a simple facemask

A
  • 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)
19
Q

Specs for O2 delivery via simple facemask

A
  • 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
20
Q

Describe a Partial Rebreather Mask

A
  • 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
21
Q

Specs on the Partial Rebreather Mask?

A
  • Provides 60-75% O2
  • Flow rate of 6-11 L/min
  • Adjust flow rate to keep bag inflated
22
Q

Describe a non-rebreather mask

A
  • 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
23
Q

Key points for use of non-rebreather mask?

A
  • Can deliver >90% O2
  • Used for unstable PTs requiring intubation
  • Ensure valves are patent and functional
24
Q

What are the specs for high-flow oxygen delivery systems?

A

Can deliver 24-100% O2 at 8-15 L/min

25
Q

What are the types of high-flow delivery systems?

A
  • Venturi mask
  • Face tent
  • Aerosol Mask
  • Tracheostomy collar
  • T-piece
26
Q

Describe a Venturi Mask

A
  • 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
27
Q

When on a Venturi mask, when would you use nasal cannula?

A

During mealtimes

28
Q

Outside of apnea, what other uses are there for BiPAP and CPAP devices?

A
  • They can be used for atelectasis after surgery
  • Cardiac induced pulmonary edema
29
Q

What is a tracheotomy?

A

Surgical incision into trachea for purpose of establishing an airway

30
Q

What is a tracheoStomy?

A
  • stoma (opening) that results from tracheotomy
  • May be temporary or permanent
31
Q

What are the priority patient problems we need to provide education for to avoid/minimize adverse outcomes?

A
  • Reduced oxygenatin
  • Inadequate communication
  • Inadequate nutrition
  • NG tube and Peg tube
  • Potential for infection
32
Q

What is our most important nursing intervention post surgery for tracheostomy?

A
  • Ensure patent airway
  • Assess for possible complications/tube obstruction/dislodgement
33
Q

Purulent drainage, redness, and swelling at the tracheostomy site is indicative of…

A

Infection

34
Q

When caring for a PT with a Tracheostomy, how can we prevent tissue damage?

A
  • 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
35
Q

How is the air humidification addressed w/ a tracheostomy tube?

A

Air is humidified before delivery

36
Q

What is the purpose of Suctioning in Tracheostomy care?

A

To keep patent airway and promote gas exchange

37
Q

What patients do we need to evaluate frequently for suctioning?

A

Those who cannot cough adequately

38
Q

What are some complications that can arise from suctioning?

A
  • Hypoxia
  • Tissue (mucosal) trauma
  • Infection
  • Vagal stimulation, bronchospasm
  • Cardiac dysrhythmias from induced hypoxia
39
Q

What must you always do post suctioning?

A

Document how PT tolerated procedure

40
Q

How does a tracheostomy tube interfere w/ nutrition?

A
  • 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
41
Q

What aspiration prevention do we do after a PT with a tracheostomy has eaten?

A

Elevate HOB for @least 30mins

42
Q

What does a fenestrated tracheostomy tube allow for?

A
  • 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
43
Q

A fenestrated tube is not recommended for…

A
  • PTs at high risk for aspiration
  • On positive pressure ventilation
44
Q

Explain the process of weaning off a tracheostomy tube

A
  • 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

z_MEDSURGE: FINAL REVIEW (15 decks)

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