Oxygen therapy and care of the Patient with a Pulmonary Embolism

Question 1

what is oxygen therapy

Answer 1

administration of oxygen at a concentration greater than room air which is 21% at sea level.

Question 2

Goal of oxygen therapy

Answer 2

to increase the availability of O2 in lungs, reduce the effort of breathing, reduce cardiac stress.

Question 3

PEEP

Answer 3

Positive end expiratory pressure

Question 4

What does PEEP DO ?

Answer 4

maintains airway pressure above atmospheric at the end of expiration used with or without mechanical ventilation.

Question 5

CPAP

Answer 5

continuous positive airway pressure

Question 6

what does CAP?Peep do?

Answer 6

Help prevent micro atelectesis by maintaining a slightly positive airway pressure and maintaining slightly expanded lung tissue.

Question 7

What is Low Flow

Answer 7

room air and supplemental 02

Question 8

What are Low Flow options

Answer 8

Nasal Cannula, simple mask, partial re-breather, non-rebreather

Question 9

What is High Flow

Answer 9

Total inspired air

Question 10

High Flow delivery options

Answer 10

Venturi Mask, Mechanical Ventilation

Question 11

What is the difference between high and low flow?

Answer 11

High flow is measured exactly, low flow is impossible to measure because there’s a mixture of room air. Unknown O2 concentration.

Question 12

What can nurses apply in Emergency situations?

Answer 12

Nurses can apply low flow O2 in emergency situations, including nasal cannula, simple mask, re-breather, non-rebreather.

Question 13

Condition Normal 95-100%

Answer 13

nothing

Question 14

Mild Hypoxemia 91-94%

Answer 14

NC 1-6L/Min Simple Mask 5-10L

Question 15

Moderate hypoxemia 86-91%

Answer 15

Partial rebreather 6-10L
Nonrebreather 10L
Venturi 4-10L

Question 16

Severe Hypoxemia <85%

Answer 16

Partial rebreather 6-10L

nonrebreather 10L

Question 17

what are signs of O2 toxicity

Answer 17

Headaches, substernal discomfort, dyspnea, alveolar atelactesis, paresthesia, fatigue, malaise, confusion, profressive breathign difficulties, refractory hypoxemia.

Question 18

Nursing assessments for O2 toxicity

Answer 18

chest tightness, Respiratory rate, breth sounds, O2 sat, numbness tingling of extremities, activity level, general attitude, change in menation.

Question 19

Nursing interventions for O2 toxicity

Answer 19

Monitor flow, monitor time, assess before treatment, assess for change during therapy, ensure correct dose.

Question 20

When should the patient notify their PCP

Answer 20

When they have frequent headaches, increased anxiety, blue tinge to lips and nailbeds, drowsiness, confusion, restlessness. slow shallow difficult irregular breaths.

Question 21

Patient O2 safety precautions

Answer 21

NO OPEN FLAMES, no combustible products, exercise care with electrical devices, use explosion proof plugs, careful with storage and bumping cylinders together, keep well ventilated, post no smoking sign.

Question 22

What is a pulmonary Embolism?

Answer 22

An embolus that clogs an artery in the pulmonary vascular system

Question 23

What is the vascular problem with a PE?

Answer 23

Blood flow is obstructed and there is poor perfusion of the lung tissue.

Question 24

What is the respiratory response to a PE?

Answer 24

The air can get into the lungs but can’t get into blood stream because of the obstruction and causes shortness of breath.

Question 25

Where to PE’s originate?

Answer 25

in the venous system.

Question 26

How is a PE diagnosed?

Answer 26

Chest x ray will show a dilated Pulmonary artery. spiral PT scan. EKG will show sinus tachycardia. Ventilation perfusion scan.

Question 27

What test rules out blood clot?

Answer 27

the D-dimer test

Question 28

What is the gold standard test for a PE diagnosis?

Answer 28

Pulmonary angiogram, allows for direct vizualization, uses dye.

Question 29

Risk factors for PE

Answer 29

50+, venous stasis, prolonged immobility, hypercoagulability, history of thrombophlebitis, damage to vessel walls, orthopedic surgery, diseases, constrictive clothing, supplemental estrogen.

Question 30

How quickly can a PE kill?

Answer 30

1 hour

Question 31

Priorities with a PE

Answer 31

Early recognition, size, location, and amount of lung tissue affected. EARLY TREATMENT

Question 32

Human response to a PE

Answer 32

non-specific, non-diagnostic, anxiety, fear, sudden pleuitic substernal chest pain, pain worse with deep breaths, worsens with exertion but doesn’t recede with rest. Cough, crackles or rub near area of embolus, sudden dyspnea when clot lodges, syncope, tachycardia, tachypnea, diaphoresis.

Question 33

What is the Pulmonary Embolism Severity Index?

Answer 33

indication for outcome of patient with PE based on risk factors. gives prediction of mortality for 30 days. rate 1 though 5.

Question 34

What is nursing care to prevent PE?

Answer 34

Identify risk factors, early ambulation, repositioning, active/passive leg exercises. AE hose, SCD, change IV sites, Patient education, recognize clinical presentation.

Question 35

What are Independent emergency nursing interventions for PE?

Answer 35

VS, lung sounds, respiratory rate, O2 low flow, high flowlers position, EKG

Question 36

What are ordered emergency nursing interventions for PE?

Answer 36

IV access, Labs for H&H, lytes, d-dimer, Medications: morphine, sedation, anti-anxiety

Question 37

What is the goal of emergency EP treatment?

Answer 37

stabilize pulmonary and cardiovascular systems.

Question 38

What are emergency management steps

Answer 38

protect airway, manage pain, confirm diagnosis, pharmacology (Thrombolytic or anticoagulation), surgery.

Question 39

What types of surgery are done for PE?

Answer 39

Transvenous catheter embolectomy, implantation of umbrella filter.

Question 40

What are Post PE nursing interventions for embolectory of umbrella?

Answer 40

routine post op care

Question 41

What are nursing interventions for PE care?

Answer 41

Monitor labs, monitor pulmonary parameters. monitor respiratory effort, evaluate assessment against previous data, alert PCP as necessary, patient education.