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Foundations Clinical > Oxygen Therapy > Flashcards

Oxygen Therapy Flashcards

1
Q

FiO2

A

Fraction of inspired oxygen

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2
Q

PaO2

A

Partial pressure of O2 in arterial blood (80-100)

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3
Q

SpO2

A

Saturation of O2 on hemoglobin (95-100%)

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4
Q

PaCO2

A

Partial pressure of CO2 in arterial blood (35-45)

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5
Q

Room air is what % oxygen?

A

21%

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6
Q

What is the respiratory drive COPD?

A

Low PaO2

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7
Q

Nasal cannula flow rate

A

1-6 L/min

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8
Q

Nasal cannula O2 concentration

A

24-44% FiO2

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9
Q

What oxygen delivery device is used with chronic lung dz or pts needing long term O2 therapy?

A

Nasal Cannula

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10
Q

Nasal Cannula Care

A

Ensure correct placement
Asses for nasal mucosa irritation
May use water-soluble lube

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11
Q

Simple face mask flow rate

A

5-8 L/min

Minimum of 5L to avoid CO2 inhalation

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12
Q

Simple face mask O2 concentration

A

40-60% FiO2

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13
Q

What O2 delivery device is used for short-term O2 therapy or in emergency?

A

Simple face mask

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14
Q

Care for simple face mask

A

Ensure mask fits correctly
Watch for aspiration risk and skin breakdown
Emotional support for claustrophobic pts

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15
Q

Partial Rebreather flow rate

A

6-11 L/min

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16
Q

Partial Rebreather O2 concentration

A

60-75% FiO2

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17
Q

What O2 delivery device is used to give higher concentrations of O2 and has no flaps?

A

Partial Rebreather

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18
Q

How much exhaled tidal volume does a pt rebreathe with a partial rebreather?

A

1/3

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19
Q

How much must the reservoir bag remain inflated in a partial rebreather mask?

A

2/3

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20
Q

Tidal Volume

A

Lung volume of O2 displaced btw inhalation & exhalation in a single breath; ~500 mL air inspired

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21
Q

Nonrebreather Mask flow rate

A

10-15 L/min

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22
Q

Nonrebreather Mask O2 concentration

A

80-95% FiO2

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23
Q

Which O2 mask is used for unstable pts who may require intubation?

A

Nonrebreather

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24
Q

Which mask has a one-way valve with flaps?

A

Nonrebreather

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25
Q

What is the purpose of the valve in a nonrebreather mask?

A

Valve lets pt get needed O2 from reservoir bag & prevents exhaled air from re-entering

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26
Q

What is the purpose of the flaps in a nonrebreather mask?

A

Flaps prevent entry of room air into mask & allows exhaled air to leave mask

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27
Q

Reservoir bag must remain inflated how much in a nonrebreather?

A

2/3

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28
Q

Venturi Mask flow rate

A

4-10 L/min

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29
Q

Venturi Mask O2 concentration

A

24-50% FiO2

30
Q

Which O2 device delivers most accurate O2 concentration without intubation and is used for pts with chronic lung dz?

A

Venturi Mask

31
Q

What should you watch for with use of a venturi mask?

A

Dry mucous membranes

32
Q

What is the purpose of the adapters on a venturi mask?

A

Adapters only allow a certain amount of air to enter the mask & mix with the O2

33
Q

CPAP

A

“Continuous Positive Airway Pressure”

  • Can use O2 or air
  • Pts often bring home machines to hospital
  • If newly ordered, must encourage compliance
34
Q

How does CPAP work?

A

By opening up collapsed alveoli

35
Q

What O2 device is used in pts with post surgery atelectasis, COPD, pulmonary edema, sleep apnea?

A

CPAP

36
Q

BiPAP

A

“Bi-level Positive Airway Pressure”

  • Pts use at home like CPAP
  • Pts often bring home machines to hospital
37
Q
  • 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
A

BiPAP

38
Q

What is often attempted prior to intubation?

A

BiPAP

39
Q

Tracheostomy Tubes

A
  • Permanent (metal or plastic) or disposable (plastic)
  • Cuff used in acute care setting or on vent
  • Cuff does not fully prevent aspiration
40
Q

What allows pt to speak when inner cannula is removed & cap placed?

A

Fenestrated tube

41
Q

What is not always accurate with trachs?

A

Pilot balloon

42
Q

What do you always do before capping the trach tube?

A

Deflate the cuff

43
Q

Purpose of cuff in trach

A

Allows for positive pressure in the lungs, decreases aspiration risk, seals area around trach so air can’t pass

44
Q

How does tube obstruction of trach occur?

A

From secretions or cuff displacement

45
Q

S/S of trach tube obstruction

A

Dyspnea, noisy respirations, difficulty inserting suction cath

46
Q

How do you prevent a trach tube obstruction?

A

Prevent by cough & deep breathe, humidified O2, trach care, suctioning

47
Q

Trach post op complications

A 
Tube Obstruction
Tube dislodgment
Pneumothorax
SubQ Emphysema
Bleeding
Infection
48
Q

When is trach tube dislodgment an emergency?

A

If it occurs within the first 72 hours post op

-Difficult to replace because trach has not matured

49
Q

How to prepare/care for tube dislodgment

A
  • Keep correct size spare trach cannula at bedside

- Ambulate pt until Rapid Response Team arrives

50
Q

How do you care for trach tube dislodgment after 72 hours post op?

A

Use Kelly clamp to reopen stoma
Insert trach cannula with obturator
Remove obturator & assess for Bilateral BS and airflow through trach

51
Q

Pneumothorax

A
  • Air in chest cavity from lung apex

- Confirm with chest x-ray

52
Q

Subcutaneous Emphysema

A

From a tear in trachea that allows air to leak out into surrounding tissue
Palpate around trach – crackling
Notify MD immediately

53
Q

When do you monitor cuff pressure for trachs?

A
  • In ICU

- Confirm with chest x-ray

54
Q

Cuff pressure ranges for trachs

A

14-20 mmHG or 20-30 cm H2O

55
Q

What happens if cuff pressure is too high?

A

It can block capillary blood flow & cause ischemia

56
Q

Why use humidified air with trachs?

A

Bypasses natural humidifiers in nose & mouth
Will see fine mist in trach collar or t-piece
May use air warming device also

57
Q

Trach suctioning

A
  • 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
58
Q

Why might hypoxia occur with trach suctioning?

A
  • Prolonged suctioning
  • Catheter too large
  • No hyperoxygenation before, during, or after suction
  • Excessive suction pressure
  • Too frequent suctioning
59
Q

What do you avoid w/ trach suctioning?

A
  • Hypoxia
  • Tissue Trauma
  • Infection
  • Vagal stimulation or bronchospasm
60
Q

Why might tissue trauma occur during trach suctioning?

A

Not using correct techniques

  • twirl cath when removing
  • only suction when withdrawing cath
  • lube with saline first
  • suction no more than 15 sec
61
Q

Why might infection occur with trach suctioning?

A
  • No sterile technique
  • Suction mouth AFTER suction trach
  • Don’t use yaunker on trach
62
Q

Vagal or Bronchospasm from trach suctioning?

A

Vagal=bradycardia, hypotension, dysrhythmias
STOP SUCTION & hyperoxygenate
May need bronchodilator if bronchospasm

63
Q

Purpose of trach care

A
  • Keeps area free of secretions
  • Maintains patent airway
  • Be careful not to dislodge cannulas
64
Q

What can we do to encourage bronchial hygiene?

A
  • 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
65
Q

How can you reduce the risk of aspiration?

A
  • 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)
66
Q

Trach care procedure

A

Look at skill review sheet

67
Q

Bronchial & Oral Hygiene

A
  • Helps keep airway patent
  • Prevents bacterial growth
  • Avoid glycerin swabs or mouthwash with alcohol
  • Oral suctioning (Yankauer)
68
Q

Trach Nutrition care

A
  • Difficulty swallowing
  • Keep HOB elevated at least 30 min after meal
  • Small, frequent meals
69
Q

Trach communication

A
  • Can speak if no cuff or if fenestrated tube with cap
  • Alternative ways to communicate
  • Emotional support & patience
70
Q

How to verify placement of an endotracheal tube

A
  • CXR

- Expiratory CO2

71
Q

Endotracheal Intubation

A
  • For patients in severe respiratory distress
  • Done with ET tube & laryngoscope
  • Connected to Ventilator
  • Often kept sedated
72
Q

Why provide oral care to intubated pts?

A

To prevent VAP

Foundations Clinical (10 decks)

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