Oxygen Therapy Flashcards
FiO2
Fraction of inspired oxygen
PaO2
Partial pressure of O2 in arterial blood (80-100)
SpO2
Saturation of O2 on hemoglobin (95-100%)
PaCO2
Partial pressure of CO2 in arterial blood (35-45)
Room air is what % oxygen?
21%
What is the respiratory drive COPD?
Low PaO2
Nasal cannula flow rate
1-6 L/min
Nasal cannula O2 concentration
24-44% FiO2
What oxygen delivery device is used with chronic lung dz or pts needing long term O2 therapy?
Nasal Cannula
Nasal Cannula Care
Ensure correct placement
Asses for nasal mucosa irritation
May use water-soluble lube
Simple face mask flow rate
5-8 L/min
Minimum of 5L to avoid CO2 inhalation
Simple face mask O2 concentration
40-60% FiO2
What O2 delivery device is used for short-term O2 therapy or in emergency?
Simple face mask
Care for simple face mask
Ensure mask fits correctly
Watch for aspiration risk and skin breakdown
Emotional support for claustrophobic pts
Partial Rebreather flow rate
6-11 L/min
Partial Rebreather O2 concentration
60-75% FiO2
What O2 delivery device is used to give higher concentrations of O2 and has no flaps?
Partial Rebreather
How much exhaled tidal volume does a pt rebreathe with a partial rebreather?
1/3
How much must the reservoir bag remain inflated in a partial rebreather mask?
2/3
Tidal Volume
Lung volume of O2 displaced btw inhalation & exhalation in a single breath; ~500 mL air inspired
Nonrebreather Mask flow rate
10-15 L/min
Nonrebreather Mask O2 concentration
80-95% FiO2
Which O2 mask is used for unstable pts who may require intubation?
Nonrebreather
Which mask has a one-way valve with flaps?
Nonrebreather
What is the purpose of the valve in a nonrebreather mask?
Valve lets pt get needed O2 from reservoir bag & prevents exhaled air from re-entering
What is the purpose of the flaps in a nonrebreather mask?
Flaps prevent entry of room air into mask & allows exhaled air to leave mask
Reservoir bag must remain inflated how much in a nonrebreather?
2/3
Venturi Mask flow rate
4-10 L/min
Venturi Mask O2 concentration
24-50% FiO2
Which O2 device delivers most accurate O2 concentration without intubation and is used for pts with chronic lung dz?
Venturi Mask
What should you watch for with use of a venturi mask?
Dry mucous membranes
What is the purpose of the adapters on a venturi mask?
Adapters only allow a certain amount of air to enter the mask & mix with the O2
CPAP
“Continuous Positive Airway Pressure”
- Can use O2 or air
- Pts often bring home machines to hospital
- If newly ordered, must encourage compliance
How does CPAP work?
By opening up collapsed alveoli
What O2 device is used in pts with post surgery atelectasis, COPD, pulmonary edema, sleep apnea?
CPAP
BiPAP
“Bi-level Positive Airway Pressure”
- Pts use at home like CPAP
- Pts often bring home machines to hospital
- Cycles different pressures at inspiration & expiration
- Delivers a set inspiratory positive airway pressure
- During exhalation, delivers a set end-expiratory pressure
- Improves overall tidal volume, decreases respiratory rate, relieves dyspnea
BiPAP
What is often attempted prior to intubation?
BiPAP
Tracheostomy Tubes
- Permanent (metal or plastic) or disposable (plastic)
- Cuff used in acute care setting or on vent
- Cuff does not fully prevent aspiration
What allows pt to speak when inner cannula is removed & cap placed?
Fenestrated tube
What is not always accurate with trachs?
Pilot balloon
What do you always do before capping the trach tube?
Deflate the cuff
Purpose of cuff in trach
Allows for positive pressure in the lungs, decreases aspiration risk, seals area around trach so air can’t pass
How does tube obstruction of trach occur?
From secretions or cuff displacement
S/S of trach tube obstruction
Dyspnea, noisy respirations, difficulty inserting suction cath
How do you prevent a trach tube obstruction?
Prevent by cough & deep breathe, humidified O2, trach care, suctioning
Trach post op complications
Tube Obstruction Tube dislodgment Pneumothorax SubQ Emphysema Bleeding Infection
When is trach tube dislodgment an emergency?
If it occurs within the first 72 hours post op
-Difficult to replace because trach has not matured
How to prepare/care for tube dislodgment
- Keep correct size spare trach cannula at bedside
- Ambulate pt until Rapid Response Team arrives
How do you care for trach tube dislodgment after 72 hours post op?
Use Kelly clamp to reopen stoma
Insert trach cannula with obturator
Remove obturator & assess for Bilateral BS and airflow through trach
Pneumothorax
- Air in chest cavity from lung apex
- Confirm with chest x-ray
Subcutaneous Emphysema
From a tear in trachea that allows air to leak out into surrounding tissue
Palpate around trach – crackling
Notify MD immediately
When do you monitor cuff pressure for trachs?
- In ICU
- Confirm with chest x-ray
Cuff pressure ranges for trachs
14-20 mmHG or 20-30 cm H2O
What happens if cuff pressure is too high?
It can block capillary blood flow & cause ischemia
Why use humidified air with trachs?
Bypasses natural humidifiers in nose & mouth
Will see fine mist in trach collar or t-piece
May use air warming device also
Trach suctioning
- Maintains patent airway
- Sterile procedure
- Pre-oxygenate & hyperinflate/hyperventilate
- Each suction should be less than 15 seconds
- Hyperoxygenate after suctioning
- Maximum number of suction passes
Why might hypoxia occur with trach suctioning?
- Prolonged suctioning
- Catheter too large
- No hyperoxygenation before, during, or after suction
- Excessive suction pressure
- Too frequent suctioning
What do you avoid w/ trach suctioning?
- Hypoxia
- Tissue Trauma
- Infection
- Vagal stimulation or bronchospasm
Why might tissue trauma occur during trach suctioning?
Not using correct techniques
- twirl cath when removing
- only suction when withdrawing cath
- lube with saline first
- suction no more than 15 sec
Why might infection occur with trach suctioning?
- No sterile technique
- Suction mouth AFTER suction trach
- Don’t use yaunker on trach
Vagal or Bronchospasm from trach suctioning?
Vagal=bradycardia, hypotension, dysrhythmias
STOP SUCTION & hyperoxygenate
May need bronchodilator if bronchospasm
Purpose of trach care
- Keeps area free of secretions
- Maintains patent airway
- Be careful not to dislodge cannulas
What can we do to encourage bronchial hygiene?
- Turn Q2hr
- TCDB
- Chest percussion
- Postural drainage
- Avoid glycerin… changes pH in mouth & promotes bacteria growth
- Secretions can accumulate above cuff; once deflated – enters lungs
How can you reduce the risk of aspiration?
- Small frequent meals
- Don’t rush eating
- No meal when fatigued
- Thicken all liquids
- Position upright
- Deflate cuff during meals – inflated can interfe with food passage through esophagus
- Small controlled liquid volume (spoon)
Trach care procedure
Look at skill review sheet
Bronchial & Oral Hygiene
- Helps keep airway patent
- Prevents bacterial growth
- Avoid glycerin swabs or mouthwash with alcohol
- Oral suctioning (Yankauer)
Trach Nutrition care
- Difficulty swallowing
- Keep HOB elevated at least 30 min after meal
- Small, frequent meals
Trach communication
- Can speak if no cuff or if fenestrated tube with cap
- Alternative ways to communicate
- Emotional support & patience
How to verify placement of an endotracheal tube
- CXR
- Expiratory CO2
Endotracheal Intubation
- For patients in severe respiratory distress
- Done with ET tube & laryngoscope
- Connected to Ventilator
- Often kept sedated
Why provide oral care to intubated pts?
To prevent VAP
