Oxygen Therapy

Question 0

Oxygen therapy improves:

Answer 0

Survival, exercise capacity, cognitive function, sleep

Question 1

Goals of oxygen use:

Answer 1

Decrease work of breathing (RR <25), decrease workload of heart (decrease HR), keep SaO2 over 90%

Question 2

Indications for use of supplemental oxygen:

Answer 2

O2 administered for documented hypoxemia (PaO2 <90%), oxygen and SpO2, oxygen therapy, SaO2 measures saturation of HgB with O2

Question 3

Room air is :

Answer 3

21% oxygen, 78% nitrogen, 1% other gases

Question 4

What % of oxygen is bound to hemoglobin?

Answer 4

97%

Question 5

SaO2 measures saturation of HgB with oxygen:

Answer 5

Normal is > 94%, for patients with chronic lung disease: 88-92%, if falls < 60 mmhg and patient is not adequately oxygenated

Question 6

Oxygen therapy MD order requires:

Answer 6

Concentration, method of delivery, and liter flow per minute

Question 7

Oxygen therapy safety precautions:

Answer 7

O2 is combustible, and tanks pressurized

Question 8

O2 supports combustion:

Answer 8

Smoke outside and away from O2 equipment, place signs outside pt room, instruct patient/visitors about O2 safety, make sure electric devices are in good working order, avoid static, avoid flammable material, electrically ground equipment, and be aware of fire extinguishers

Question 9

General guidelines for administering O2:

Answer 9

Verify order, resp assessment, explain reason for need, humidify O2 for flow >4L/min, provide tubing for OOB, clean cannula/mask q2h and q8h, assess skin for irritation/necrosis around devices, and check SPO2 q shift, before, during, and after activity & prn

Question 10

Oxygen complications:

Answer 10

Oxygen toxicity, high O2 concentration damages alveolar-capillary membranes, absorption atelectasis, CO2 narcosis, and infection

Question 11

Oxygen toxicity:

Answer 11

Prolonged exposure to high O2 level (O2 > 50% for > 24 hrs)

Question 12

High oxygen concentration damages alveolar-capillary membranes:

Answer 12

Pulmonary edema, decreases compliance-stiff lung, increased trouble breathing, and ultimately acute respiratory distress syndrome (ARDS)

Question 13

Absorption atelectasis:

Answer 13

High oxygen washes out nitrogen and causes alveoli to collapse

Question 14

CO2 narcosis:

Answer 14

Normally CO2 stimulates breathing, COPD patients are different (tolerance to high CO2 levels, O2 adm=reduced drive to breath, O2 levels stimulate patient to breathe), easier to reverse high CO2 levels than low O2, monitor ABGs

Question 15

Infection:

Answer 15

Humidity, heated nebs, hospital equipment

Question 16

Types of oxygen delivery devices:

Answer 16

Nasal cannula, oxymizer, face mask, simple face mask, partial rebreather mask, non rebreather mask, Venturi mask, face tent, tracheostomy, trach collar

Question 17

Non rebreather mask:

Answer 17

Delivers O2 highest concentrations other than intubation,95-100% @ 10-15L, inspiration draws O2 through bag, one way valve prevents RA and expired air from flowing back into bag**, only O2 inspired, short term use, may be uncomfortable, mask should fit snugly, and bag must not collapse with inspiration

Question 18

Venturi mask:

Answer 18

Delivers precise high flow O2 @ 3-15L/min, air is pulled through openings in cone as O2 flows through small jets, exhaled air escapes through vents, narrowness of jet determines amount of dilution of O2 with RA, uncomfortable, remove to eat/muffled voice, insure correct adapters and O2 flow, no blockage of ports**

Question 19

Face tents:

Answer 19

Used when masks are not tolerated, fits over lower half of face, provides varying concentrations of O2 (30-50% with 4-8L/min), assess patient regularly, inspect skin for dampness or chafing, and facial skin must be kept dry

Question 20

Tracheostomy devices:

Answer 20

For patients needing long term airway support, inspired air bypasses upper respiratory tract, air is no longer filtered or humidified

Question 21

Tracheostomy collar:

Answer 21

Delivers high humidity and oxygen, can be attached to flow meter for exact amounts of O2 delivered, secretions collect in tubing, remove and clean under neck strap and O2 delivery device q4h, and drain condensed fluid from tubing.

Question 22

Nasal cannula:

Answer 22

Most commonly used**, low concentration low flow (1-6L/min, 24-44%, well tolerated, easily dislodged, high flow rates irritate nasal membranes, drying to mm, and assess mates and around ears

Question 23

Oxygen conserving cannula: oxymizer:

Answer 23

Long term O2 home therapy, built in reservoir increases O2 concentration, allows pt to use lower flow rates, increases comfort/lowers cost, 1-8L/min, cannula cannot be cleaned, changed weekly, cannula heavy on ears, and more expensive than cannula

Question 24

Face masks:

Answer 24

Covers nose and mouth, exhalation ports on sides, release of exhaled CO2, ex: simple, partial rebreather, non rebreather, and Venturi mask

Question 25

Simple face mask:

Answer 25

Used only for short periods, 5-8L/min for 40-60% oxygen, minimum of at least 5L/min, fit mask to patients face, hot smothering feeling, must remove to eat or drink, wash and dry under mask q2h, watch of pressure necrosis at ears, and provide cannula for when eating

Question 26

Partial rebreather mask:

Answer 26

Reservoir bag allows pt to rebreathe first 1/3 exhaled air with O2, recycles expired O2, 6-10L/min for 60-90% O2, lightweight, easy to use, short term use of higher concentrations, may be too uncomfortable, not for COPD patient, bag must remain inflated**

Question 27

Noninvasive ventilation:

Answer 27

Prevention of hypoventilation during sleep or sleep apnea, improves respiratory status of pts with (COPD, neuromuscular weakness, restrictive chest wall disorders, support patient short term in respiratory failure), delivers air/oxygen through snugly fitting mask into respiratory tract using positive pressure, and assists patients own respiratory effort* pts must be able to breathe on their own

Question 28

CPAP:

Answer 28

Continuous positive airway pressure; during inspiration and expiration, for severe symptoms, nasal mask attached to high-flow blower, and compliance poor due to difficulty adjusting

Question 29

BIPAP:

Answer 29

Bilevel positive airway pressure, higher inspiration pressure, lower expiration pressure, tolerated better

Question 30

Chronic oxygen therapy:

Answer 30

Improves: disease progression and prognosis, exercise tolerance, cognitive performance, sleep in hypoxemic patients, and goal: SaO2 >90% rest, sleep, exertion.

Question 31

Short term oxygen therapy:

Answer 31

1-30 days, prolonged recovery from acute illness, re-evaluate in 30-90 days, exercise or sleep induced hypoemia, and resp therapy teaches pt/family about O2 therapy

Question 32

Long term oxygen therapy:

Answer 32

Required for >15 hrs/day, chronic O2 therapy at home, re-eval needed to determine if still necessary, teaching: O2 not addictive & considered a drug.

Question 33

O2 delivery systems:

Answer 33

Liquid oxygen: used with concentrator, compressed O2 cylinder: “tanks” can be carried, various sizes, concentrator/extractor: makes O2 from RA; electricity needed; noisy.

Question 34

Assessing patients on O2 therapy:

Answer 34

“Eyeball” assessment: anxiety, color, WOB, RR, SaO2, lung sounds, patient complaints, S/S of hypoxia, O2 equipment, liter flow, document!!

Question 35

Promoting oxygenation:

Answer 35

Positioning, hydration, humidification, breathing retraining, airway clearance techniques, and airway clearance devices.

Question 36

Positioning of a respiratory patient:

Answer 36

Semi/high fowlers (HOB > 35*), orthopneic position, provides maximum chest expansion, decreased dyspnea, improved removal of secretions

Question 37

Positioning of a respiratory patient II:

Answer 37

Encourage frequent position changes, encourage ambulation as tolerated, and promote comfort measures

Question 38

Hydration and humidification:

Answer 38

Maintains moisture of resp mm, fluid intake 2-3L/day (unless contraindicated), nebs: deliver humidity and meds, humidifiers: add water to inspired air and cool mist to room temp, both nebs and humidifiers moisten mm and loosen secretions

Question 39

Breathing retraining exercises:

Answer 39

Purpose: decrease dyspnea, improve oxygenation, and slow RR, types: pursed lip breathing and diaphragmatic breathing

Question 40

Pursed lip breathing:

Answer 40

Prolong expiration, prevent air trapping, allows patient control over breathing, goals: to help keep airway open, prolong exhalation, slow RR, calm patient. Steps: inhale slow and deep through nose for 3 sec., exhale slowly with “whistle” lips for 7sec., relax facial muscles w/o puffing out checks, and breath out for twice as long as breathed in

Question 41

Diaphragmatic breathing:

Answer 41

Allow full deep breaths with ease, slow RR, goal: achieve max inhalation, slow RR, controversial, not for acute dyspnea, steps: lie flat or sit w/knees bent, upper body relaxed, one hand in upper chest, other below ribs (diaphragm), breathe in slowly through nose (abd moves hand), and tighten stomach muscles & allow to fall inward with exhalation through pursed lips. Keep hand on upper chest as still as possible.

Question 42

Airway clearance techniques:

Answer 42

Deep breathing and coughing, chest physiotherapy: postural drainage, percussion, and vibration.

Question 43

Deep breathing and coughing;

Answer 43

Facilitates easier passage of air in respiratory tract, breathing exercises: for patients with restricted chest expansion or after thoracic sx, cough: raises secretions for expectoration and discourage swallowing.

Question 44

Coughing:

Answer 44

Effective and controlled cough comes from deep in lungs, loosens and carries mucus out w/o collapse of airway, saves energy and O2 use, assist by drinking 6-8 glasses of H2O/day unless contraindicated

Question 45

Controlled and huff coughing:

Answer 45

Assume a sitting position, inhale deeply from diaphragm, him breath for a few seconds, lean forward and exhale sharply with a “huff” sound (moves secretions up/out of lungs to larger airways), repeat “huff” one or two times more but do not fully cough (prevents mucous from moving backward), cough, rest and repeat

Question 46

Evaluating a cough:

Answer 46

Quality (dry, loose, barky, congested), productivity (amount, color, consistency), acute or chronic, cough patten (report changes in cough/sputum)

Question 47

Chest physiotherapy (CPT):

Answer 47

For patients with excessive bronchial secretions (cystic fibrosis), CPT: percussion, vibration, postural drainage, percussion and vibration used to augment postural drainage; CPT assists in bringing secretions into larger, central airways

Question 48

Postural drainage:

Answer 48

Gravity drainage of secretions from lung segments (want bad lung up!), prevents: infection/obs/atelectasis. Purpose: drain smaller into larger airway, bronchodilator and hydration before. Maintain position about 5 min., usual order: BID/QID, 1 hr before meals or 3 hrs after (prevent vomiting)

Question 49

Percussion:

Answer 49

Forceful striking of skin with cupped hand, percuss over congested lung area (dislodges thick secretion from bronchial wall), cover area with towel or gown to promote comfort, have patient breathe slow and deep to asst relaxation, percuss 1-2 minutes in each affected lung segment (do not perform over kidneys, sternum, SC, tender areas)

Question 50

Vibration:

Answer 50

Used after percussion to increase turbulence of exhaled air and loosen thick secretion, hands over another or side by side and flat against chest wall, during exhalation, tense arm and vibrate/shake heel of hands, stop with inspiration, repeat x 5, encourage cough after

Question 51

Chest physiotherapy:

Answer 51

Requires MD order, proper training, contraindicated in: chest trauma, hemoptysis, heart disease, head injury, pulmonary embolus, and unstable patients. Eval frequently/ document!!

Question 52

High-frequency chest compression (ThAIRapy vest):

Answer 52

Inflatable vest connected to high freq pulse generator, air vibrates the chest, more effective than CPT in clearing mucous, unit is portable and quiet, and monitor/document!

Question 53

Airway clearance devices:

Answer 53

IS, flutter device, and acapella

Question 54

Incentive spirometer:

Answer 54

Improves pulmonary ventilation and inhalation, S/P anesthesia, hypoventilation, loosens secretions, improves gas exchange, expands collapsed alveoli, goal: prevent or correct atelectasis, and improve or promote coughing, performed hourly 10/hr, sustained elevation of cylinder or balls

Question 55

Flutter valve:

Answer 55

Vibrates airways and loosens mucous from airway walls, flutters with expiration, moves mucous up airway to be expectorated, can be used in place of CPT if pt cannot tolerate.

Question 56

Acapella:

Answer 56

Combines positive expiratory pressure and airway vibrations, mobilizes secretions, ease of use, and nebs can be attached

Question 57

Inhalation devices for drug delivery:

Answer 57

HHN, MDI, and DPI

Question 58

Nebulized medication:

Answer 58

Choice for acute exacerbation, aqueous solution into fine mist, inhaled with normal respirations, reaches lower airway more effectively, can be done at home (most need power source, noisy, must keep parts clean and maintained),

Question 59

Aerosol nebulization therapy/hand held neb:

Answer 59

Pt in upright position allows: efficient breathing and meds inhalation, breathe slow/deep diaphragmatic, through mouth, hold inspiration for 3 sec, reg RR in between, after tx: cough, postural drainage, CRT. Disadvantages: bacterial growth in machine, wash equipment daily

Question 60

Metered dose inhaler (MDI):

Answer 60

Suspension of medication in fine liquid, must push to activate propellant, coordination of push with inhalation, most common delivery of resp meds**, can use spacer if needed

Question 61

Steps for using (MDIs) inhalers:

Answer 61

Prepare: Shake inhaler/expire all the way/hold inhaler properly, breathe slowly: press down on inhaler on inspiration, hold your breathe: count to 10, for B2 agonists wait 1 min between puffs.

Question 62

Problems with MDI:

Answer 62

Coordinate with inspiration, breathing in through nose, inspiring too rapidly, not hold breath for 10 s (<5), holding MDI incorrectly, not shaking prior to use, not waiting enough time b/w puffs, not opening mouth wide enough to activate, and unable to understand and follow instructions.

Question 63

Caring for the MDI:

Answer 63

Clean inhalers as needed, and when to replace inhaler

Question 64

Dry powder inhaler (DPI):

Answer 64

Solid particles in air, powder delivered with inspiration, no propellant is used, must be able to inhale well, no need to coordinate device with inhalation breathes, and most have a counter for doses remaining.

Question 65

MDI:

Answer 65

Shake well, inspire slowly, coordination difficult, medication delivered by propellant, use spacer/especially with inhaled corticosteroids, no counting device, usually 2 inh/dose, clean plastic case with warm water prn

Question 66

DPIs:

Answer 66

No shaking before use, rapid inspiration to create own propellant, no coordination needed, no spacer used, preloaded medication container with counter, able to count doses left, doses often 1 inh., avoid moisture near medication

Question 67

Nursing considerations:

Answer 67

Prevent exacerbations & complications, teach pt/family, asst with and reinforce resp therapy teaching, be aware of S/S of resp distress and how to intervene, and be ready and able to administer resp medications to patient appropriately.