Oxygen Therapy Flashcards
-Oxygen Therapy General Goals and Clinical Objectives
1.)Correct documental or suspected acute hypoxemia
-Increase alveolar and blood levels of O2
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2.) Decrease the work of breathing
-Patients report less dyspnea -Improve mental functions
3.) Decrease the work of the heart
-Hypoxia causes pulmonary hypertension and pulmonary vasoconstriction
-Puts stress on right side of heart
-Over time leads to right side heart failure (cor pulmonale)
-Assessing the Need
-Laboratory measurements
-Hemoglobin saturation (SPO2)
-PaO2 (fromABG)
-Specific clinical conditions
-Post operative -CO2 poisoning, cyanide posing, shock, trauma, acute MI, permaturity, lung disease -Bedside assessment (visual), tachypnea, tachycardia, cyanosis, distressed appearance -Restless, disorientation, digital clubbing
-Precautions and Hazards
-Oxygen toxicity
-Affects lungs and CNS -Effects depends on concentrations, length or exposure to oxygen, and underlying lung condition -Determined by PaO2 from ABG -Can occur within 24-48 hours at FiO2 pf 100% -Goal is to use the minimum amount required to achieve tissue oxygenation and wean as tolerated
-Precautions and Hazards
-Infants
-Retinopathy of prematurity (ROP) as resultof too much oxygen
-Precautions and Hazards
-Depression of Ventilation
-COPD patients, with chronic hypercapnia (High CO2 levels)
-Their normal response to increase CO2 levels are blunted -If you raise PaO2 too high with O2 this can knock out their drive to breathe, called hypoxic drive
-Precautions and Hazards
-Absorption Atelectasis
-High concentration of O2 washes out nitrogen from lungs and alveoli (lost surface tension)
-Because alveoli are perfused but not ventilated shunts increase
-Precautions and Hazards
-Fire hazards
-Operating rooms, and specific respiratory procedures
-Home care patients smoking with oxygen in use
-Low flow oxygen delivery systems
-Low flow systems (Variable performance) does not supply all patients inspired gas, provide variable and approximate FiO2 (affected by rate, depth and pattern)
LFODS Nasal cannula
-Most common used device
-Provides oxygen with flow rate 6LPM or less in adults = (Humidify with flows at 4LPM or greater) and 2 LPM or less for infants
-Because of variable FiO2 being delivered
-Rule of thumb to estimate FiO2 being delivered
-Lier flow * 4 than add 20 n(20 added for concentration in room air around us)
LFODS Nasal Catheter
-Sort plastic tube with several holes
-Advanced along floor of nasal passage until just seen behind uvula
-No longer used, replaced by th nasal cannula
LFODS Transtracheal Catheter
Teflon catheter implanted between 2nd and 3rd tracheal ring
-Used for patients who do not like the unaesthetic appearance of something on their face or nose. Requires less than liter flow normally
LFODS Simple Mask
-Body of mask gathers and stores O2
-If oxygen inputs ceases, can breathe through open parts -Flow of 5-10 LMP, with an approximate FiO2 of 30-60% -Flow must be greater than 5LMP to flush out exhaled CO2 -If required flows greater than 10LPM, choose another device
LFODS Partial Rebreather Mask
-A simple mask with 300-600 ML reservoir bag attached
-No valve between mask and reservoir mas, no valves over exhalation parts (no valve period) -First 1/3rd of exhalaled gases flow into the reservoir remaining 2/3rds exit through the ports -Minimum flow of 8-15LPM, FiO2 into range of 40-70-% -Flow must be high enough to prevent bag from collapsing on peak inspiration if it collapses, than increase the flow
LFOD Non rebreather mask
-One way valves between mask/ bag keeps exhaled gasses from flowing into bags (bag only fills with o2)
-Minimum flow of 10-15LPM, FiO2 rage 60-80% theoretically can give 100% with a tight fitting mask and all 3 valves in place -Flow must be high enough to prevent the bag from collapsing on peak inspiration. If it collapse then increase the flow
LFOD Oxymask
-High efficient “open” mask system that eliminates the need for closed design, valves and reservoirs
-During patient inhalation, oxygen flow is mixed with room air drawn in through the mask openings -Delivers oxygen concentrations from 24%-90% FiO2 at flows ranging from minimum 1LPM up to 15 LPM
LFOD Oxymizers/ Reservoir cannulas
-Utilize a pendent or pouch to store/ conserve oxygen
-Many patients require lower FiO2 with this device
LFOD Standard high flow nasal cannula (green salter cannula)
-For patients needing more than 6 LPM on nasal cannula
-Provides only cool humidity at flows from 6-15 LPM and must be filled with sterile water -Even though the name is “high flow cannula” this is not a high flow device! Saying high flow only means you can set a higher LPM than the standard 1-6 LPM on flowmeter
High Flow Oxygen delivery
-High flow device systems (Fix performance)
-Supply a given oxygen concentration at a flow that meets or exceeds the patients peak inspiratory flow/demand (provides precise FiO2)
HFOD Air entrainment Mask (AEM) (Venti Mask)
-adjustable ports to regulate amount of air mixed with oxygen
-Restricted orifice through which O2 flow at high velocity -Air entrainment by shear forces at boundary of O2 flow (Bernoulli : Effects/ Venturi) -Body of mask has ports for exhalation and excess flow -Larger the orifice (oxygen port) lower velocity, less air entrainment so higher FiO2 (Color Coded %) -Smaller Orifice (oxygen port) higher velocity, more air entrainment, so lower FiO2 (Color Codes) -Some mask have a set orifice size (oxygen port) and therefore will have adjustable air entrainment ports: In this case the larger the air entrainings openings the lower the Fi02 and the smaller the air entrainment opening the higher the FiO2 -How to increase total flow, increase the flow of oxygen -Change in velocity= Change in air entrainment -Changing the flowmeter does not alter the FiO2 , its set!
HFOD Air entrainment Nebulizer (large Volume jet neb/ aerosol device, nerosol generator)
-FiO2 determined by entrainment port size, 30% -100% FiO2
-Added benefits of the ability to add humidification and heat control. -High flow only when delivers enough flow to meet the patients demand (if not then increase the flow)
HFOD Heated high flow nasal cannula (Airvo, Vapothera)
-Gaining more favor as opposed to mask therapy
-Utilize larger nasal prongs and can provide flows up to 60 lpm (flow, not FiO2) for adults and 1-8 LPM flow for neonates with FiO2 set (21%-95%) -Creates an increased upper airway positive pressure similar to CPAP -Used with humidification via high efficiency heated humidifiers to help with mucosal drying and comfort
HFOD Oxygen Blender
-Air and oxygen enter the blender and go through pressure regulators that exactly match the pressure of the two gasses
-Gas flows through precision proportioning va;ves blending air/ oxygen to what you set -Alarm when either gas source fails -Must analyze oxygen at 100%, 21%
HFOD Oxygen enclosures
-Oxygen tents
-Used mostly for children with croup or cystic fibrosis -Problems, wide swings in FiO2 with openings/ closings -12- 15 LPM = 40- 50% FiO2 must analyze FiO2 close to face -Oxygen Hood -Best method of administration of concentrated FiO2 to infants -Used less since the arrival of the infant nasal cannula -Can deliver 21-100% FiO2, hood needs flow of more than or equal to 7 LPM to clear exhaled CO2 -Incubators -8 -15 LPM Variable FiO2 or 40-50% with temperature control
HFOD Hyperbaric Oxygen Therapy (Hyperbaric Chamber)
-Therapeutic use of oxygen at pressure greater than atmospheric pressure
-Goal is to dissolve more gas into the blood and body tissue of the patient -Indicated for treatment of carbon monoxide poisoning (CO), air embolism, decompression sickness and accelerated healing of wounds, burns or infections
