oxygen therapy Flashcards
whats the goal of oxygen therapy
deliver the least amount necessary
name some low flow devices
Nasal Cannula
Face mask
Venturi mask
Nonrebreather
describe acute respiratory failure
Inadequate gas exchange
Usually occurs secondary to another disorder
Problem with oxygenation or CO2 elimination or both
ABGs reveal hypoxemia and/or hypercapnia
causes of respiratory failure
Intrapulmonary
Lower airways, alveoli, pulmonary circulation, alveolar-capillary membrane
Extrapulmonary
CNS injury, neuromuscular disorders, thorax, pleura, upper airway disorder
treatment of respiratory failure
Improve oxygenation &/or ventilation
Non-invasively if possible (CPAP/BiPAP/NIV mask)
Intubation if necessary
Treat cause
describe non-invasive ventilation and give examples
Uses a mask that fits tightly over the mouth and nose, or just the nose
BiPAP – Positive pressure on both inspiration AND expiration; inspiratory and expiratory pressures are different. IPAP & EPAP
CPAP – Continuous Positive Airway Pressure; inspiratory pressure and expiratory pressure is the same
nursing considerations for NIV
Airway protection
Nutrition & Hydration
Oral care
Skin care
Communication
describe intubation
Tube is placed in trachea - between vocal cords – can not speak
Tube is placed 2-3 cm above carina
ETCO2 monitor– color change (purple to yellow) assures correct placement ETCO2
Breath sounds heard equally bilaterally
Chest x-ray for placement
Coughing - indicates need for suctioning or inappropriate tube placement
intubation nursing interventions
Ensure equipment is ready (intubation tray, ambu bag, suction)
Ensure pulse oximeter is in place, BP cuff
Administer medications (sedative, paralytic) as directed
Monitor time during each attempt–Each attempt should be limited to 30 seconds
Monitor vital signs!
Secure and note placement
what are some goals of mechanical ventilation
Improve ventilation
Decrease work of breathing
Correct inadequate breathing patterns
Improve oxygenation
what ventilator setting affect the amount of air being moved in and out of the lungs (ventilation) and what ABG values are affected
tidal volume: size of each breath
rate: number of breaths per minute
affect PaCO2 and indirectly pH
name some ventilation modes
Assist Control (AC)
Synchronized Intermittent Mandatory Ventilation (SIMV) or (IMV)
Pressure Support Ventilation (PSV)
describe assist control (A/C)
Ventilator delivers a preset tidal volume at a preset rate. The patient will never get fewer breaths than the preset rate. The patient CAN trigger an additional breath and then the ventilator kicks in and delivers the full preset tidal volume
describe Synchronized Intermittent Mandatory Ventilation (SIMV/IMV)
Ventilator delivers a preset volume at a preset rate. In between mandatory breaths, the patient can breathe spontaneously, with a pressure-supported breath. However, the tidal volume of the patient-initiated breaths will only be as large as the patient is strong enough to inspire.
advantages of SIMV
Helps keep respiratory muscles active and coordinated
Can be used as a weaning mode. As the patient improves, the preset rate is decreased, and the patient assumes greater responsibility for breathing on his/her own.
If the patient stops breathing for any reason, he/she will still receive the preset volume at the preset rate.
describe pressure support
when on IMV or Spontaneous breathing trial, this “boost” from the ventilator increases spontaneous breath volume and makes it easier for the patient to inspire.
It is meant to overcome the increased airway resistance afforded by the ETT, so the patient does not have to work as hard to initiate a breath. This facilitates weaning, and the amount of support is gradually reduced as the patient is weaned.
Positive pressure to augment patient’s inspiratory efforts
May be used with SIMV or during breathing trial
May be used as the primary mode of ventilation
Weaning modality
what vent settings affect oxygenation
FiO2 (Fraction of Inspired Oxygen)
PEEP (Positive End Expiratory Pressure)
what is FiO2
Fraction of Inspired Oxygen
The percentage of oxygen delivered via the ventilator
30-100%