Oxygen Therapy Flashcards
Oxygen Therapy Purpose
relieves hypoxemia and hypoxia
Hypoxemia
low levels of oxygen in the blood
Hypoxia
decreased tissue oxygenation
Oxygen Therapy Goal
use lowest fraction of inspired oxygen for acceptable blood oxygen level without causing harmful side effects
ABG analysis
an ABG sample reports the status of oxygenation and acid-base balance in the blood
-need to go on ice and brought to the lab immediately
Capnography
the measurement of carbon dioxide in a pts exhaled breath over time. Monitors the Waves
-looks like a thick nasal cannula
Capnography
the measurement of carbon dioxide in a pts exhaled breath over time. Monitors the Waves
-looks like a thick nasal cannula
Oxygen Therapy: Interventions-Take Action
-Recognize: oxygen hazard
-Check: perscription
-Use: humidification if delivered at 4L/min or > (too make sure pt doesn’t get to dry)
-Check: skin for pressure points
-Provide: mouth care; lubricate nostrils, face, lips
-Clean: cannula, mask (soap & water, make sure its dry)
-Collaborate: collaborate with repository therapist
Hazards and Complications of Oxygen Therapy
-Combustion
-Oxygen toxicity: concentration of O2 is too much for the pt
-Absorption atelectasis: crackles
-Drying of mucous membranes
-Infection: skin breakdown, dirty mask, humidification can create bacteria
Oxygen Delivery Systems
Types used depends on:
-required oxygen concentration
-oxygen concentration that can be achieved by a delivery system
-importance of accuracy and control of the oxygen concentration
-pt comfort
-use of humidity
-pt mobility
Low-Flow Oxygen Delivery Systems
-Nasal cannula (1-6L/min)
-Face-mask (simple, partial rebreather, non-rebreather)
-easy to use
-comfortable
-amount of oxygen delivered varies
Nasal Cannula
-flow rates of 1-6L/min
-O2 concentration of 24-44%
-flow rate >6L/min does not increase gas exchange because anatomical dead space is full
-often used for chronic lung disease or long-term therapy
Simple Facemask
-minimum of 5-8L/min
-deliver O2 up to 40-60% for short-term therapy
-ensure appropriate fit
Partial Rebreather Mask
-flow rate 6-11L/min
-60-75% O2
-pt rebreathes one third exhaled tidal
-bag should be slightly inflated with inspiration
Non-Rebreather Mask
-maintaining reservoir bag 2/3 full
-delivers highest O2 level (of the low-flow systems)
-can deliver FIO2 greater than 80-95%
-used for unstable pts who may require intubation
-ensure valves are patent and functional
-pt is very unstable, O2 is very low
High-Flow Nasal Cannula
-30-60 L/min
-combination of heat and humidity minimizes damage to mucous membranes
-gives the best flow, with adapters
Venturi Mask
-4-10L/min
-adaptor located between bottom of mask and O2 sources
-24-50%
-pulls in a proportional amount of room air for each liter flow of oxygen
-most accurate concentration without intubating pt
T-Piece
-delivers desired FIO2 to clients with tracheostomy, laryngectomy, ET tube
-aerosol should appear on exhalation side
noninvasive Positive-Pressure Ventilation (NPPV)
-uses positive pressure to keep alveoli open, improve gas exchange
-used to manage: dyspnea, hyperbarbia, and acute exacerbations of chronic ovstructive pulmonary disease, pulmonary edema, and acute asthma attacks
CPAP (NPPV)
delivers a set of positive airway pressure throughout each cycle of inhalation and exhalation
Volume-limited or flow-limited (NPPV)
delivers a set tidal volume with the pts inspiratory effort
BiPAP (NPPV)
cycles different pressures at inspiration and expiration
Transtracheal Oxygen Delivery (TTO)
-long-term delivery of O2 directly into lungs
-small flexible cath is passed into trachea through small incision
-flow rates prescribed for rest, activity
Tracheotomy
surgical incision into trachea to create an airway to maintain gas exchange
Tracheostomy
stoma (opening) that results from tracheotomy
Tracheostomy Complications
-tube obstruction
-tube dislodgment and accidental decannulation
-pneumothorax
-subq emphysema
-bleeding
-infection
Preventing Tissue injury: Tracheostomy
-tissue injury can occur where the inflated cuff presses against the tracheal mucose
-inflate the cuff to form a seal between the trachea and the cuff using the least amount of pressure
-*check the cuff pressure once a shift
Ensuring Air Warming and Humidification: Tracheostomy
-if humidification and warming are not adequate, tracheal damage can occur
-inadequate humidity causes thick, dry secretions to occlude the airway and increase the risk of infection
Suctioning: Tracheostomy
-suctioning maintains a patent airway and promotes gas exchange
-consider best practices for airway suctioning
-preoxygenation pt 3-5 minutes before suctioning
-never suction more than 10-15 seconds
-after, oxygenate pt
-continue as needed for 3 passes
Providing Tracheostomy Care: Assess
-assess for cyanosis
-check O2 sat
-assess the trach site
-assess skin around the tracheostomy and neck
-auscultate lung sounds
Providing Tracheostomy Care: Secure
-secure using twill tape ties or commercial tube holders
-change devices when soiled or at least daily to keep clean, prevent infection, and assess tissue integrity under ties
Providing Bronchial and Oral Hygiene
-turn/ reposition q1-2 hrs, support out-of-bed activities, encourage early ambulation
-coughing and deep breathing, chest percussion, vibration, and postural drainage promote pulmonary hygiene
-avoid glycerin swabs or mouthwash containing alcohol for oral care, use sponge tooth cleaner or soft-bristle toothbrush moistened in water
Ensuring Nutrition
-swallowing can be difficult
-teach pt to keep head of bed elevated for at least 30 min after eating
-small frequent meals
-while eating cuff can be partially deflated, small/ slow bites
-position upright while eating
Maintaining Communication
-writing tablets
-board w/ pictures and letters
-flashcards
-hand signals
-smartphone
-phrase questions with yes/no answers
-mark central call light to indicate pt cannot speak
-SLP
Supporting Psychosocial Needs and Self-Esteem: Trach
-acknowledge frustration
-use a normal tone of voice
-provide social contact
-allow sufficient time for communication
-address changes in self-image
Weaning Trach
-gradual decrease in tube size; ultimate removal of tube
-cuff is deflated when the pt can mange secretions; does not need assisted ventilation
-change from cuffed to uncuffed tube
-capping
-tracheostomy button
Tracheostomy: Care Coordination and Transition Management
-pt should be able to provide self-care
–Teach
-trach tube care
-shower shield
-cover loosely with small cotton cloth during the day
-increase home humidity
-wear a medical alert bracelet
-follow-up w/ ptovider
