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Foundations of Nursing > Oxygen Therapy > Flashcards

Oxygen Therapy Flashcards

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1
Q

Why should oxygen always be prescribed?

A

Because it is a drug. There are relevant places on drug charts to do this, usually defined with two options: 88-92% or >94%

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2
Q

What is the aim for oxygen saturations in non-COPD patients?

A
  • 94-98%. There is no point in aiming for sats of 100%
  • In fact saturations of 100% are less helpful than 98-99% as they can reflect a normal PaO2 (10-13 kPa) but may also reflect an inappropriately high kPa of e.g. 30 (in an over-oxygenated patient).
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3
Q

What would you do if your patient has sats of 100% on 35% Venturi?

A
  • Decrease it to 28% and see if saturations stay in the target range. If they do, use the lowest oxygen delivery percentage available to reliably maintain sats in the required range
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4
Q

What is the aim for oxygen saturations in patients with COPD?

A

88-92%

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5
Q

What percentage and maximum flow rate of oxygen do nasal cannulae use?

A

24-30% O2

Flow rate maximum 4L/min

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6
Q

When are nasal cannulae used?

A
  • Use for non-acute ward use, or if mildly hypoxic
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7
Q

What are the advantages and disadvantages to using nasal cannulae?

A
  • Comfortable and well-tolerated but can dry the nose. If patient complain of this use a humidified circuit (oxygen passed through water prior to getting to patient)
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8
Q

What percentage and maximum flow rate of oxygen does the hudson mask use? (rarely used)

A
  • Delivers 30-40%
  • Flow rate 5-10L/min
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9
Q

What percentage and maximum flow rate of oxygen does a venturi mask use?

A
  • Delivers 24-60% oxygen depending on colour of fitting.
  • Flow rate (oxygen flow rate is set on the O2 wall tap) is shown on mask along with the % O2 delivery. Each colour must be used with a given flow rate (written on the mask) to give the correct oxygen percentage.
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10
Q

What are the different types of venturi mask and their oxygen percentages/flow rates?

A
  • BLUE = 2-4L/min = 24% O2
  • WHITE = 4-6L/min = 28% O2
  • YELLOW = 8-10L/min = 35% O2
  • RED = 10-12L/min = 40% O2
  • GREEN = 12-15L/min = 60% O2
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11
Q

Why are venturi masks often used in COPD?

A

It the most accurate way of giving variable percentage inspired oxygen.

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12
Q

What percentage oxygen and flow rate does a non-rebreather mask use?

A
  • Delivers 85-90% with 15L flow rate.
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13
Q

When is a non-rebreathe mask used and how does it work?

A
  • Bag on mask with valves stopping almost all rebreathing of expired air
  • Used for acutely unwell patients BUT note that uncontrolled high flow oxygen is damaging (see notes opposite). As such, a non-rebreather is rarely indicated for long-term treatment.
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14
Q

What are the two non-invasive means of ventilation?

A

CPAP and BiPAP

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15
Q

What is CPAP and how does it work?

A

CPAP= continuous positive airway pressure = high pressure air/oxygen with a tight fitting mask. Positive pressure all the time.

  • Keeps airways open in sleep apnoea or heart failure.
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16
Q

What is BiPAP and how does it work?

A

BiPAP= bilevel positive airway pressure = high positive pressure on inspiration and lower positive pressure on expiration. Used in COPD and atelectasis.

17
Q

What is invasive ventilation and when is it used?

A
  • A ventilation bag or machine is attached to an artificial airway to ventilate lungs.
  • Gives total control over flow or volume, percentage inspired oxygen (FiO2) and respiration rate – and therefore total control over minute ventilation.
  • Used in intensive care and theatre.
18
Q

At what score of the GCS would you intubate someone?

A

If GCS is less than or equal to 8

19
Q

Why is oxygen saturation below 90% problematic?

A

The oxygen-haemoglobin saturation curve drops significantly at this point, meaning haemoglobin will rapidly become significantly less saturated with small changes in oxygen partial pressure.

20
Q

What would you do if O2 therapy is being used maximally (15L high flow) and oxygen levels continue to drop?

A
  • Involve intensive care with a view to non-invasive ventilation or intubation and ventilation
  • The same applies if oxygen levels are suboptimal but a rising carbon dioxide prevents increasing the percentage of inspired oxygen
21
Q

What procedure should be carried out if oxygen saturations are <94%?

A

Arterial Blood Gas (ABG).

22
Q

What are CO2 retainers?

A
  • CO2 retainers are those who tend have higher CO2 concentrations and, if given oxygen, will retain more CO2 potentially leading to hypercarbic respiratory failure.
    • Possible CO2 retainers include, obstructive lung disease (10 % of COPD, bronichiectasis, CF) and severe restrictive lung diseases (neuromuscular, severe kyphoscoliosis, severe obesity).
    • The most common are those with COPD
23
Q

Why do people retain CO2

A

V/Q mismatch (main reason)

  • In COPD, patients optimise their gas exchange by hypoxic vasoconstriction leading to altered alveolar ventilation-perfusion (V/Q) ratios
  • Excessive oxygen administration overcomes this, leading to increased blood flow to poorly ventilated alveoli
    • This increases the V/Q mismatch and increases dead space, increasing CO2 levels

The Haldane effect (minor reason)

  • Deoxygenated haemoglobin (Hb) binds CO2 with greater affinity than oxygenated haemoglobin (HbO2)
  • Oxygen therefore induces a rightward shift of the CO2 dissociation curve, which is called the Haldane effect
  • In patients with severe COPD who cannot increase minute ventilation, the Haldane effect accounts for about 25% of the total PaCO2 increase due to O2 administration
24
Q

How should you give oxygen in patients who are CO2 retainers?

A
  • If patients are in respiratory distress, give 100% oxygen at 15L via a non-rebreather mask initially
  • Never withhold oxygen from a seriously ill hypoxic patient due to fear of cause hypercapnic respiratory failure!
  • If patients are not in distress but are hypoxic, perform baseline ABG
  • If not able to ABG immediately, start on 24-28% (via Venturi mask)
  • LOOK FOR PREVIOUS ABGS IF POSSIBLE.
    • This is very helpful in determining baseline respiratory function.
  • If significant hypoxia continues try increasing the oxygen level in small increments and repeating ABG after 30 minutes of next stage up
  • In other words, if you cannot get enough oxygen into patients to maintain sats 88-92% without causing a hypercapnic acidosis, then they need likely need non-invasive ventilation (BiPAP)
25
Q

What is the aim of giving oxygen to COPD patients?

A
  • The aim of giving oxygen in COPD is to prevent hypoxia while not leading to an increased CO2
  • If you cannot get enough oxygen into the patient to maintain sats 88-92% without causing a hypercapnic acidosis, then they need non-invasive ventilation (BiPAP)
26
Q

When should you carry out an ABG in COPD patients?

A
  • In those with COPD or other known lung disease, always get a baseline ABG if the admission problem involves low GCS, chest pain or shortness of breath
  • It is particularly important to check ABGs promptly if a patient with COPD has been brought in as emergency by an ambulance: ambulance crews have to give high-flow oxygen if a patient is hypoxic, regardless of previous history
27
Q

How do you titrate oxygen in patients with COPD?

A
  • Once on 24-28%, perform baseline ABG and then titrate oxygen as follows:
  • Hypoxia without hypercapnia (PaCO2 < 5.3kPa)
    • = hypoxic drive unlikely
    • Can use higher flow oxygen
  • Hypoxia with hypercapnia but IMPROVING acidosis
    • = no hypoxic drive
    • Room to increase oxygen: if significant hypoxia continues increase the oxygen level in increments and repeat ABG after 30 minutes of next stage up
  • Hypoxia with hypercapnia and STABLE acidosis (PaCO2 > 5.3kPa)
    • = hypoxic drive possible
    • Continue 24-28% initially but consider you may need to switch tonon-invasive ventilation if no improvement
  • Hypoxia with hypercapnia and WORSENING acidosis
    • = hypoxic drive
    • Reduce oxygen and discuss with ITU/HDU regarding non-invasive ventilation if oxygen levels stay dangerously low

Foundations of Nursing (1 decks)

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