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Lab Lecture > Oxygen Therapy > Flashcards

Oxygen Therapy Flashcards

1
Q

Difference between high flow and low flow?

A

You know exactly how much FiO2 is being delivered.

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2
Q

Hypoxia vs. hypoxemia?

A

Hypoxia: low O2 in tissue

Hypoxemia: low O2 in blood

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3
Q

Cause of peripheral cyanosis?

A

Peripheral ⬆️ O2 intake

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4
Q

Areas of central cyanosis?

A

Skin, mucous membranes, lips, tongue, and nail beds (associated with arterial desaturation)

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5
Q

Mild hypoxemia PaO2 range?

A

60-79 mmHg

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6
Q

Mild Hypoxemia SaO2 values?

A

90-94%

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7
Q

Moderate hypoxemia PaO2 range?

A

40-59 mmHg

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8
Q

Moderate Hypoxemia SaO2 values?

A

75-89%

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9
Q

Severe hypoxemia PaO2 range?

A

<40 mmHg

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10
Q

Severe Hypoxemia SaO2 values

A

<75%

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11
Q

Mild hypoxemia symptoms?

A

Tachycardia
Tachypnea
Headache
SOB
Coughing
Wheezing
Confusion

Cyanosis:
Skin
Fingernails
Lips

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12
Q

Early stage: severe hypoxia/hypoxemia

A

Skin color change:
Blue-cherry red

Confusion
Cough
⬆️ HR
Rapid breathing

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13
Q

Later stage: Severe hypoxia/hypoxemia

A

Sweating
Severe SOB
Bradycardia
Bradypnea
Lethargic

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14
Q

Chronic Response to Hypoxia?

A

Pulmonary vasoconstriction

Pulmonary hypertension ⬆️ work of the right side of the heart (JVD)

O2 can reverse

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15
Q

Condition for Medical Oxygen Use

A

Anesthesia
COPD
Cyanosis
Shock
Severe Hemorrhage
Carbon monoxide poisoning
Major trauma
Cardiac/respiratory arrest

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16
Q

Nasal catheter flow?

A

1/4-6L/min

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17
Q

FiO2 for nasal catheter?

A

0.22-0.45

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18
Q

How often should nasal catheter be replaced?

A

Every 8 hours

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19
Q

Nasal cannula flow rate?

A

1/4-6L/min

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20
Q

Nasal cannula FiO2 delivery factor?

A

How much the patient inhales and mouth breathing

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21
Q

At what flow rate for the nasal cannula should a bubbler be used?

A

4L/min and up

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22
Q

FiO2 delivery for the nasal cannula?

A

22-45%

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23
Q

How many FiO2 increases per 1L/min?

A

4%

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24
Q

Advantage of nasal cannula?

A

Used on adults ➡️ infants
Easy to apply
Disposable
Low cost
Well tolerated under 6L/min

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25
Q

Disadvantages of nasal cannula

A

Unstable FiO2
Easily dislodged
Flow ⬆️ 6L/min may be uncomfortable
Can dry nose and cause bleeding
Polys or deviated septum can block flow

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26
Q

Best use for the nasal cannula?

A

Stable pt. Who need low FiO2
Home care needing long term O2 therapy

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27
Q

Flow rate for salter high flow NC

A

1-15L/min

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28
Q

When should a humidifier be used with a salter high flow NC?

A

Above 4L/min

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29
Q

Flow rate for the Transtracheal catheter

A

1/4-4L/min

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30
Q

Transtracheal catheter FiO2 delivery difference compared to NC?

A

Uses 40-60% less O2 to oxygenate the same amount

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31
Q

Complication and task for Transtracheal catheter?

A

Careful maintenance and cleaning

Infection is a possibility

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32
Q

Advantages of Trans tracheal catheter?

A

Reduce O2 flow required for saturation

Improves activity and mobility

Improves physical, social, and psychological function

Improves compliance (daily duration of O2 use)

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33
Q

Trans tracheal catheter disadvantages

A

Requires mandatory outpatient surgical procedure

Potential for infection

Tracheal irritation

Mucus accumulation

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34
Q

By what percent can reservoir cannulas reduce O2 use

A

50-75%

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35
Q

Is humidification used with reservoir cannula?

A

Not usually (can’t be used)

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36
Q

How much O2 does reservoir cannula hold?

A

20ml during exhale

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37
Q

How much is the flow reduced with the reservoir cannula?

A

50%

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38
Q

Does pt. need to take breaths through the nose?

A

Yes

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39
Q

Disadvantages of pendent reservoir cannulas?

A

Can be heavy

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40
Q

Disadvantages of reservoir cannula?

A

Pt. Object appearance

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41
Q

Liters for simple mask?

A

5-10L/min

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42
Q

FiO2 of simple mask?

A

35-50%

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43
Q

What causes FiO2 variability in simple mask?

A

Air dilution through mask ports
Input flow
mask volume
Extent of leakage
Breathing patterns

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44
Q

Advantages of simple mask?

A

Infants-adults
Quick and easy application
Disposable
Low cost

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45
Q

Disadvantages of simple mask?

A

Uncomfortable/ claustrophobia
Must be removed to eat or drink
Prevents heat loss
Blocks vomit

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46
Q

Best use of the simple mask?

A

Emergencies
Short term therapy requiring moderate FiO2

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47
Q

Partial rebreather FiO2 delivery?

A

40-70%

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48
Q

Minimum L/min of partial rebreather?

A

6-10L/min

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49
Q

Partial rebreather advantages?

A

Moderately high FiO2
Infants-adults
Quick, easy application
Disposable
Low cost

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50
Q

Disadvantages of partial rebreather?

A

Potential of suffocation
Uncomfortable/claustrophobia
Must be removed for eating and drinking
Prevents heat loss
Blocks vomit

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51
Q

Best use for the partial rebreathing mask?

A

Emergencies
Short term moderate FiO2

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52
Q

Non-rebreathing mask FiO2?

A

60-80%

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53
Q

Minimum non-rebreathing flow?

A

10L/min to flush

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54
Q

Which is more used between the partial and non rebreathing?

A

Non-rebreathing

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55
Q

How does Non-rebreathing work?

A

Has one-way valves that prevents rebreathing

Slightly negative pressure closes expiratory valves while opening inspiratory valves

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56
Q

Advantages of non-rebreathing mask?

A

High FiO2
Infants to adults
Quick and easy application
Disposable
Low cost

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57
Q

Disadvantages on non-rebreathing

A

Potential of suffocation
Uncomfortable/claustrophobia
Must be removed to eat or drink
Prevents heat loss
Blocks vomit

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58
Q

Best use for non-rebreathing mask?

A

Emergencies
Short term high FiO2
Heliox therapy

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59
Q

Guidelines for low flow assembly?

A

Use bubbler above 4L/min

Line up threads

With heated humidifier or Neb use large-bore corrugated tubing with water traps/drain to avoid blockage by condensation

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60
Q

Liters for flush?

A

40-60

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61
Q

Interface for entrainment?

A

Mask
T-piece
Trachea collar
Tent

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62
Q

What principle does entrainment use?

A

Bernoulli principal

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63
Q

Principal of operation for air entrainment

A

Direct high pressure through a small nozzle or jet surrounded by air entrainment ports

Amount entrained depends on size of port and velocity of O2 at jet

Bigger ports and jets = less FiO2 and more flow.

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64
Q

Cause for variability in FiO2 delivery from entrainment?

A

Air to O2 ratio

Amount of flow resistance downstream from the mixing site

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65
Q

FiO2 range for air entrainment?

A

24-50%

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66
Q

Air entrainment liter range?

A

2-15L/min

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67
Q

Can you deliver less liters than in the air entrainment piece?

A

No, FiO2 is no longer guaranteed

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68
Q

Inspiratory peak flow need formula?

A

Minute ventilation (3)

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69
Q

Delivered flow calculations?

A

100-FiO2/FiO2-21 (add one)

Multiple by liters on piece or ideal

70
Q

Can you deliver 100% FiO2 with entrainment?

A

No. Not able to meet the patients inspiratory flow needs.

71
Q

Advantages of Venturi

A

Easy to apply
Disposable
Inexpensive
Stable precise FiO2

72
Q

Disadvantages of Venturi

A

Limited to adults use

Uncomfortable

Noisy

Must be removed for eating

FiO2 greater than or equal to 35% not assured

73
Q

Best use for Venturi?

A

Unstable patient requiring a precise FiO2

74
Q

Types of bland aerosolize delivery devices?

A

Jet Nebulizers
Cool
Heated

Ultrasonic Nebulizer

75
Q

Principal of Operation of cool large volume jet Nebulizers

A

Pneumatic

Liquid aerosols generate by passing through small jet

Low pressure at the jet draws fluid up reservoir to top of the siphon tube where it sheared off and shattered into liquid particles

Largest unstable particles fall out of suspension

Remaining particles leave thru outlet port carried away by gas stream

76
Q

Assessment of adequate aerosol delivery

A

Delivered relative humidity is 100% if condensate is seen in tubing near airway

Must see mist befit putting interface on patient

No mist indicates air dilution/ not enough flow

This turns a high flow to a low flow

77
Q

Indications for cool, bland aerosol therapy?

A

Upper airway edema

Laryngotracheobronchitis

Subglottic edema

Post-op upper Aw management

Presence of a by-passed upper Aw

Need for sputum or mobilize secretions

78
Q

Flow for Oxymask?

A

1-flush

79
Q

FiO2 for OxyMask?

A

24-90%

80
Q

Cause for variation in FiO2 from OxyMask?

A

Respiration rate
Depth of breathes
Distance of diffuser

81
Q

How does Virtual reservoir system work?

A

Virtual reservoir formed by a vortex of O2 flow to patients pt. nose and mouth through pin and diffuser

Open design allows CO2 to escape

82
Q

Advantages of OxyMask?

A

Higher humidity room air is brought in negating humidification

Feels less confining

Allows: communication, drinking, and talking

83
Q

Blending-system HHFNC principal of operations?

A

Two 50 psi pass through dual pressure regulator that matches pressures

Gas flows to a precision proportioning valve

Proportional size allow control over relative concentration of each gas

84
Q

Devices that use O2 blender?

A

Heated high flow O2
NIV
Ventilator
Hoods

85
Q

Temperatures capable with heated humidifier?

A

30-39 degrees Celsius

86
Q

Relative humidity delivered from heated humidifier?

A

Up to 100%

87
Q

What is the point of the heated wire in the heated humidifier?

A

Reduce condensation in tubing

88
Q

Hazards for heated humidity?

A

Electrical shock

IF NOT SET PROPERLY:
Hypothermia
Hyperthermia
Burns to clinician and patient
Tubing melt down

Pooled contamination can result in:
Pt./ventilator asynchrony
Tracheal lavage
Nosocomial infection

89
Q

Types of HHFNC

A

Vapotherm precision flow system
Airvo
Fisher and paykel’s optiflow

90
Q

FiO2 range for HHFNC

A

24-95%

91
Q

Adult-infant HHFNC flow range?

A

Adults 1-60L/min
Children 1-20L/min
Infant 1-8L/min

92
Q

PEEP and flow purpose with HHFNC?

A

Generates a distending positive airway pressure

The higher flows washout anatomical deadspace

93
Q

Advantages of the HHFNC?

A

Easy to apply

Provides gas at BTPS without condensation

Meets/exceeds non-rebreather performance

Decreases anatomical deadspace (CO2 washout)

94
Q

Disadvantages of HHFNC?

A

Stable precise FiO2 requires special cannula and humidification

Can create CPAP

Potential electrical risk

Some units associated with contamination/infection

95
Q

Best use for the HHFNC?

A

An alternative for the non-rebreather

An alternative for nasal CPAP

To facilitate weaning from mechanical ventilation

PATIENTS WITH:

Claustrophobia
Facial burns
Hypothermia

96
Q

Why we choose nasal cannula?

A

Comfortable so preferred by patients

Even though they aren’t as effective we are more ensured compliance

97
Q

Tracheotomy patient is on a LVN but is on his way to an X-ray?

A

Patient must be switched to a venti-trach collar

98
Q

Pt. has a low SpO2 <85: initial and target device?

A

Non-rebreather or oxymask (emergency mask)

Eventually HHFNC

99
Q

Oxygen hazards

A

Oxygen toxicity
Absorption atelectasis
Abolition of hypoxia drive
Retinopathy of prematurity

100
Q

What is oxygen toxicity?

A

Over production releases free radicals by cellular metabolism

This can overwhelm the body’s antioxidant system and kill cells

This will trigger MAC and Neutrophils which will release inflammatory mediators that worsen injury

101
Q

Signs of oxygen toxicity?

A

Pleuritic chest pain
Sub-sternal heaviness
Coughing
Dyspnea

102
Q

What is Absorption atelectasis?

A

High O2 will prevent nitrogen which usually keeps alveoli’s open

Also, since no diffusion of N2 into capillaries, venous pressure drops.

103
Q

Greater than what FiO2 is a risk of absorption atelectasis?

A

Any FiO2 greater then 50%

104
Q

What is Abolition of hypoxic drive?

A

Small amount of COPD patients will not be able be triggered by high CO2 decreasing ventilation by 20% increasing CO2 20-23mmHg

They rely on low O2 for ventilation

105
Q

Broncho-pulmonary dysplasia

A

Affects newborns (premature) and infants

Results from damage of lungs from vent and supp O2

Most babies recover, but some have long term breathing difficulties

106
Q

Intraventricular hemorrhage in infants

A

Concentration of O2 can cause vasodilation in premature infants which can altar cerebral blood flow

107
Q

Retinopathy of prematurity/Retrolental Fibroplasia?

A

Causes retinal vasoconstriction leading to necrosis of the blood vessels

New vessels form

Hemorrhage of vessels causes scarring behind retina

Scarring can lead to retinal detachment and blindness

Infants up to one month

108
Q

How to prevent O2 hazards?

A

Monitoring close
Weaning
Accept low O2 in pop. (Infants and COPD)

109
Q

Capacity of bulk systems?

A

Greater than 20,000 cubic feet

110
Q

Alternative names of bulk supply containers?

A

Stand tanks, vessels, or dewars

111
Q

Bulk gas delivery?

A

Liquid O2 passes through vaporizer

Now gas goes through reducing valve dropping pressure to 50 psi

112
Q

Bodies/agencies in charge of design, construction, and delivery?

A

National Fire Protection Association

The American Society of Mechanical Engineers

Bureau of Explosives

The Joint Commission

113
Q

Where is the bulk primary shut off valve?

A

Exit at the point where the main distribution pipe leaves the bulk supply

114
Q

Description and Function of Bulk System?

A

Generally backup or reserve systems

Alternating or manifold cylinder supply system (“H” cylinders together in series)

Once empty, replaced with full

115
Q

Bulk Gas Delivery System regulating body ?

A

Regulated by NFPA

116
Q

Piping distribution systems include?

A

Pipes
Pressure relief valves
Zone valves
Alarms
Station outlets or terminal units

117
Q

What pipes are used for distribution systems

A

Seamless “K” or “L” copper or brass pipes

118
Q

Labels on piping

A

Labeled with type and flow direction every 20’

119
Q

Pipes?

A

Main line:
Connects to operating supply

Risers:
Connect to main line

Branch lines:
Travel from risers to individual rooms

120
Q

What are pressure relief valve set at?

A

50% greater than normal line pressure

121
Q

Safety features/ test done for O2 piping Systems?

A

Pressure tested, checked for leaks, and checked for cross connections

Test on primary and reserve systems and their switch over mechanisms conducted

Pressure valves, zone valves and terminal units are monitored

122
Q

What does the National Fire Protection Association regulate?

A

Where system can be located in relationship to buildings surrounding structures

123
Q

What Does The American Society of Mechanical Engineers Regulate?

A

How systems are designed and construction of the storage containers

124
Q

What Does The Bureau of Explosives Regulate?

A

Regulates the pressure relief valves used in the system

125
Q

What is The Joint Commissions Job?

A

Ensures that hospitals are complaint with regulations

126
Q

Thorpe Tube Function and Structure?

A

Attach to 50 psi source

Measures true flow. Involves fluid and gravity dynamics

1-40 or 60 L/min (flush)

Diameter increases from bottom to top

When flowmeter is on follow pushes against float

As float rises flow around it increases due to wider diameter beneath

127
Q

Compensated Thorpe Tube

A

Have a needle valve downstream from float

Gas moves through float so density remains constant regardless of back pressure (kink)

128
Q

What are cylinders made of?

A

Steels, aluminum, or chrome molybdenum

129
Q

How much pressure does a cylinder hold?

A

Excess of 2,000 psi

130
Q

Most frequently used tank size?

A

E tank

131
Q

Helium tank color?

A

Brown

132
Q

Hydrogen tank color?

A

Red

133
Q

Nitrogen tank color?

A

Black

134
Q

Carbon dioxide tank color?

A

Grey

135
Q

Air tank color?

A

Yellow or black and white

136
Q

Carbon dioxide and oxygen tank color?

A

Grey shoulders and green body

137
Q

Nitric Oxide Tank Color?

A

Silver cylinder or teal and black

138
Q

Nitrous Oxide Tank Color?

A

Light Blue

139
Q

Oxygen Tank Color

A

Green or White

140
Q

What does the cylinder labeling tell us?

A

Industrial or medical

Hazards associated and how to prevent them

Proper handling, storage and first aid

Company that filled

UN number and pictogram

141
Q

Cylinder testing?

A

Hydrostatic testing every 5-10 years

Pressure testing at 3,000 psi

Dates of testing are engraved

142
Q

What must be Done Prior to Cylinder filling?

A

Cleanliness and safety must be ensured prior to filling

143
Q

Four Step Process of Filling Cylinder?

A

Prefilled inspection

Filling cylinder with gas

Check valve for leaks

Check purity standards

144
Q

Cylinder valves details?

A

Needed to attach equipment for delivery

To ensure no leak

For small cylinders attached to yoke

Made of chrome, brass and made to resist mechanical, chemical, and thermal effects of gas

145
Q

Three Types of Pressure Relief Valves?

A

Rupture disk:
Thin metal disc for certain pressure and breaks apart

Fusible disk:
Metal alloy that melts at 208-220 degrees Fahrenheit (97.8-104 Celsius)

Spring-loaded devices:
When pressure exceeds pressure pushes up on the spring and causes valve to be unseated

146
Q

Use of The American Standard Safety System?

A

Prevent wrong gas delivery

H or K tanks

147
Q

ASSS connection differences

A

Thread type and size

Right and left-handed threading

Internal and External threading

Nipple-seated design

148
Q

Use for Diameter Index Safety System?

A

Cylinders with pressure lower then 2000 psig

149
Q

Safety features for the DISSS

A

Contains a body, nipple, and a nut assembly

The shoulders of nipple allow nipple to unite

150
Q

Pin Index Safety System

A

Smaller cylinders(A through E)

Each gas has a specific pin index

Pressure above 2000psig

151
Q

Safety feature for PISS

A

Yoke not thread

Where yoke attaches to cylinder, has corresponding pins

2-5 for Oxygen
1-5 for Air

152
Q

“D“ cylinder conversion factor?

A

0.16

153
Q

“E” Cylinder Conversion Factor?

A

0.28

154
Q

“G” Cylinder Conversion Factor?

A

2.39

155
Q

“H or K” Cylinder Conversion Factor?

A

3.14

156
Q

Duration for Cylinder Formula?

A

Tank psi(factor)/liters

157
Q

Duration for Liquid Oxygen System Formula?

A

Convert pounds to volume by multiplying by 344 liters for each pound

Divide by liters

158
Q

Bulk system ideal conditions?

A

Either bank of high-pressure cylinders or industrial compressors (can be both)

At least two compressors needed on site

Compressed air cooled for vapor rain-out

159
Q

How Many Bulk Compressors on site?

A

At least two compressors needed on site

160
Q

How Many Valves Does a Direct Cylinder Valve Have?

A

A 3 port valve

161
Q

Direct Cylinder Valve in the normal position is?

A

Closed

162
Q

Direct Cylinder Valve Has a Button that?

A

Must be held down for as long as the cylinder is outstroked

163
Q

Rules for Handling Cylinders?

A

Secure

Do not use flammable material on regulators, cylinders, fittings, or valves

Crack or open slightly to remove dust before attaching regulator

Post no smoking

Store flammables separately from gas as that support combustion

164
Q

Reason for alteration of AW muscle tone?

A

CNS depression (drug O.D.)
Anesthesia
Cardiac arrest
Loss of consciousness
Sleep apnea

165
Q

Loss of consciousness diminishes what reflex’s?

A

Swallow
Gag
Laryngeal
Tracheal
Carinal

166
Q

Causes of partial or complete blockage of breathing passage?

A

Posterior displacement of tongue (most common)

Presence of foreign matter

Allergic reaction

Infection

Anatomical abnormalities

Trauma

167
Q

How can you assess patients patency?

A

Awake patients will let you know

Not awake listen for lack of breath sounds, or chest rise

168
Q

First step for AW management?

A

Airway positioning

169
Q

Will basic airway management protect against aspiration, vomit?

A

No it does not. Keep suction at hand

170
Q

What is the gold standard for securing the airway?

A

Intubation

Lab Lecture (3 decks)

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