Oxygen Flashcards
- to be able to decide when it is appropriate to adminsiter oxygen - to understand what hypoxia is and how it may present - to know the recommended traget saturations for different patient populations - to understand what type 2 respiratory failure is and who is at risk - to know how to use an oxygen cylinder - to be able to select the correct mask and flow rate to adminster oxygen safely
when delivering oxygen, what 4 factors must you consider
indication
route
dose
contraindications
what is oxygen a treatment for
hypoxia (low levels of oxygen)
5 signs and symptoms of hypoxia
- breathlessness
- increased RR (over 20 breaths per minute)
- HR (over 100 bpm)
- cyanosis (fingertips or lips turn blue)
- confusion/agitation
best way to test whether your pt is hypoxic
pulse oximetry test (observes oxygen saturation level in body)
what is the target oxygen saturation rate for most patient
what is the oxygen saturation for a pt that is hypoxic
94-98%
less than 94%
what is the target oxygen saturation rate for pt’s at riks of type 2 respiratory failure
what is the oxygen saturation for a pt that is hypoxic in this case
88-92%
less than 88%
what would be the effect of providing oxygen to a pt with acute coronary syndrome
causes coronary ateries to constrict
-> reduces perfusion of ischaemic tissues, making it worse
what is hypercapnia
increased levels of carbon dioxide
what is type 2 respiratory failure
hypercapnia with hypoxia (high co2, low o2)
list 6 patients at risk of hypercapnic respiratory failure
- COPD
- cystic fibrosis /bronchiectasis /TB
- neuromuscular disorders
- spinal/chest wall deformities
- morbid obesity (BMI over 40)
- some overdoses e.g. opioids, benzodiazepines
what is the effect of giving a pt with hypercapnia too much oxygen
- reduced ventilatory drive (reduced respiratory rate so not breathing out as much CO2)
- increased CO2 in the blood (CO2 that isn’t being exhaled absorbed back in the bloodstream)
- CO2 makes blood acidic (higher than normal levels of O2 in blood displace CO2 from haemoglobin, so CO2 is more loose in blood)
- This causes drowsiness, headache, flushed face and flapping tremor (pink puffer, pursed lips)
what is the first thing you must do when you know a pt is hypoxic
call an ambulance
what 4 things must you check with an oxygen cylinder before using one
where is it?
check if in date
is it over half full
kept clean (not with alcohol wipes-flammable)
how do you use an oxyegn cylinder
- remove covers
- attach tubing
- turn on
- set the flow rate
- put mask on patient
one person should complete all this
what are the 3 types of oxygen mask
nasal cannula
simple face mask
non-rebreather mask
- who is nasal cannula indicated for
- what is the rate of oxygen flow
- advantage of it just involving nose
- does it matter if pt is breathing through the mouth when in use
- what should you be aware of
- if more is needed, what would you do next
- patients at risk at T2RF with sats less than 88% (therefore also hypoxic)
- allows low flow of oxygen at 1-2L/min
- doesn’t trap any exhaled CO2, reduced risk of rebreathing CO2 and causing hypercapnia
max 4L/min - more causes nasal dryness - no
- dont strangle your patients (wrap round ears and then infront of chin)
- if more needed, move to 5/L on simple face mask
- who is a simple face mask indicated for
- what is the rate of oxygen flow
- why should you never use it below 5L/min
- why shouldnt you use it above 10L/min
- if more is needed, what would you do next
- hypoxic patient not at risk of hypercapnia with sats less than 94% but more than 85% OR pt at risk of T2RF but nasal cannula has been insufficient to get them to their normal range
- 5-10L/min depending on how hypoxic they are
- not enough to blow out exhaled CO2 increasing risk of hypercapnia
- not designed to deliver that much oxygen
- if more needed, move to non-rebreather mask
- who is a non-rebreather maks indicated for
- what is the rate of oxygen flow
- what is the pt breathing from
- what do you need to make sure before putting mask on pt
- why cant you use it at less than 10L/min
- very hypoxic pt with sats less than 85%, around 70% if at risk of T2RF OR simple face mask has been insufficient OR anaphylaxis/tonic-clonic seizure
- 15L/min
- reservoir bag
- inflate the bag before putting it on pt (cover valve with finger and let bag inflate)
- bag won’t stay inflated
why would you use a non-rebreather mask for an anaphylatic pt
what must you do for an anaphylatic pt
- pt critically ill (airway swelling, constriction of airways in lungs, poor perfusion of their lungs as they go into circulatory collapse)
- rapid deterioration
- impact of A or C on B
call ambulance
why would you use a non-rebreather mask for a tonic-clonic seizure
what do you do once pt starts to come around
what can you do for a pt with a tonic-clonic seizure
- apnoea followed by erratic breathing
- unreliable pulse oximetry (due to shaking)
wean off and move down to simple face mask and then nasal cannula
call ambulance but if short normal seizure for them, may not be needed
what do you do after administering oxygen
re-assess ABCDE and pulse oximetry
