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Acute - Respiratory (Exam 2) > O2 Therapy, ETTs & Chest Tubes > Flashcards

O2 Therapy, ETTs & Chest Tubes Flashcards

1
Q

S/S of O2 toxicity

A 
dyspnea
nonproductive cough
chest pain beneath sternum
GI upset
crackles on auscultation (due to lack of nitrogen to keep alveoli open)
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2
Q

FiO2 delivered: nasal cannula

A 
24% @ 1L / min (add 4% for each add'l L)
28% @ 2L / min
32% @ 3 L / min
36% @ 4 L / min [begin humidifying]
40% @ 5 L / min
44% @ 6 L / min
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3
Q

FiO2 delivered: simple face mask

A

Must be set at minimum of 5L / min to flush mask of CO2

  • 40% @ 5 L/min
  • 45-50% @ 6 L/min
  • 55-60% @ 8 L/min
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4
Q

FiO2 delivered: Partial Rebreather Mask

A

60-75% at 6-11 L/min

- reservoir bag must be 2/3 full during inspiration & expiration

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5
Q

FiO2 delivered: non-rebreather mask

A

80-95% @ a flow rate high enough to maintain reservoir bag 2/3 full

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6
Q

Venturi mask (Venti)

A
  • considered high-flow O2 delivery
    24-50% FiO2 @ 4-10 L/min
  • delivers most accurate O2 level w/o intubation
  • no humidity needed
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7
Q

High-flow O2 delivery systems

A
  1. face tent
  2. aerosol mask
  3. tracheostomy collar
  4. T-collar
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8
Q

Assist-control (AC)

A

who: weak and critically ill

provides most ventilator support

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9
Q

O2 toxicity - when

A

O2 level > 50% for 24-48 hours may damage lungs

Monitor ABGs - if PaO2 > 90 mmHg = notify provider

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10
Q

Oxygen induced Hypercarbia - s/s

A 
COPD patients at risk
ABGs = acidic (retaining CO2)
Patient will be hypoventilating (shallow breath)
Monitor K+ = increases w/acidosis
s/s = deceased RR, decreased LOC
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11
Q

nursing interventions for intubation

A

Document:

  1. tube size
  2. cuff pressure
  3. lung sounds & movement
  4. position @ lips/teeth
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12
Q

cuff pressure monitoring

A
  1. cuff inflation – inject air until no leak is heard at peak inspiration
    * disadvantage - generates higher cuff pressures (tracheal necrosis)
    * advantage - less risk for aspiration/better seal
  2. every shift
  3. pressure = 20-25 mmHg
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13
Q

ETT troubleshooting: DOPEY

A

Displaced: esophagus, R mainstem
Obstructed: secretions, blood, kink
Pneumothorax
Equipment: malfunction, O2, ETT, ventilator
You: your approach, technique: missing something?

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14
Q

Endotracheal suctioning - when?

A 
coughing
secretions in airway
respiratory distress
rhonchi on auscultation
increased PIP on ventilator
decreased SsO2 or PaO2
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15
Q

suctioning technique

A
  1. sterile procedure
  2. Suction no greater than 120-150
  3. duration of each pass: 5-10
  4. # of passes: 3 or less
  5. apply suction only during w/drawal
  6. hyperoxygenate before AND after
  7. suction prior to paralytics
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16
Q

signs of too much suctioning/complications

A
  • hypoxemia
  • atelectasis
  • bronchospasm
  • dysrhythmias (bradycardia, PVC)
  • decreased BP
  • airway trauma
  • pneumonia
17
Q

Extubation procedure

A
  1. thoroughly suction trachea, oropharynx, and nasopharynx
  2. elevate HOB, hyperoxygenate, auscultate
  3. tell pt to take deep breath - at peak inspiration, deflate cuff & remove tube rapidly
  4. tell pt to cough; suction as pt coughs
  5. give pt NC or facemask = usually 10% higher than was on ETT
  6. encourage voice rest - will be hoarse for awhile
  7. use spirometer
18
Q

after extubation - monitor for?

A
  • stay in pt’s room/don’t leave unattended!
  • respiratory distress or s/s of airway occlusion
  • monitor SaO2, BP, pulse and patient effort
  • Semi-Fowler’s position
19
Q

post-extubation complications

A
  • hoarseness/vocal cord paralysis
  • sore throat
  • dysphagia
  • tracheal stenosis
  • laryngeal incompetence
  • laryngospasm - MEDICAL EMERGENCY
20
Q

chest tube drainage systems

A

Three bottle system

  1. drainage chamber
  2. water-seal chamger
  3. suction control chamber
21
Q

CT drainage chamber

A

collection chamber

  • easy measurement
  • recording of time
  • date/amt of drainage
22
Q

CT water-seal chamber

A
  • maintain 2 cm sterile water (pressure)
  • if bubbling in water-seal chamber
    = air leak (air drainage from pt)
  • air leak monitor = approx degree of air leak from chest cavity (1-low, 7-high)
23
Q

CT air leak

A
  • continuous bubbling in water seal chamber
  • clamp CT close to dressing
    = if bubbling stops = air leak is at site of CT insertion or w/in chest (ASSESS INSERTION SITE AND CT POSITION)
    = if bubbling continues = air leak is between clamp and drainage system (REPLACE DRAINAGE SYSTEM AND TUBING)
24
Q

CT: tidaling

A

fluctuation in water-seal

  • during inspiration: fluid level goes UP
  • during expiration: fluid level goes DOWN

If absent: occluded CT or lungs fully expanded (good!)

  • *mechanical vent: reversed
  • during inspiration: fluid level goes DOWN
  • during expiration: fluid level goes UP

**mediastinal chest tube: NO TIDALING

25
Q

CT - suction control chamber

A

WET SUCTION CONTROL

  • fill sterile water to 20 cm (-20 cm H2O suction pressure)
  • NORMAL: gentle bubbling when connected

DRY SUCTION CONTROL

  • higher suction pressures
  • set suction control on dial (-20 cm H2O)
  • orange float will appear
  • NORMAL: no bubbling
26
Q

CT - clamp the tube?

A

NO - could cause tension pneumothorax

May clamp if:

  1. assessing for an air leak
  2. prior to removing CT
  3. pleurodesis
27
Q

NI for Chest Tubes

A
  • assess breath sounds Q4H
  • reposition pt. who reports a “buring” pain in the chest
  • avoid kinks in tubing
  • keep system lower than chest level
  • check and document drainage - amt, color, characteristics

NOTIFY MD IF:

  • O2 sats < 90%
  • drainage is >70 ml/hr OR STOP
  • tube falls out of chest (cover w/sterile dressing)
  • tube disconnects from drainage system (place end of tube in sterile water)

Acute - Respiratory (Exam 2) (5 decks)

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