Oxygen therapy and care of the Patient with a Pulmonary Embolism Flashcards
what is oxygen therapy
administration of oxygen at a concentration greater than room air which is 21% at sea level.
Goal of oxygen therapy
to increase the availability of O2 in lungs, reduce the effort of breathing, reduce cardiac stress.
PEEP
Positive end expiratory pressure
What does PEEP DO ?
maintains airway pressure above atmospheric at the end of expiration used with or without mechanical ventilation.
CPAP
continuous positive airway pressure
what does CAP?Peep do?
Help prevent micro atelectesis by maintaining a slightly positive airway pressure and maintaining slightly expanded lung tissue.
What is Low Flow
room air and supplemental 02
What are Low Flow options
Nasal Cannula, simple mask, partial re-breather, non-rebreather
What is High Flow
Total inspired air
High Flow delivery options
Venturi Mask, Mechanical Ventilation
What is the difference between high and low flow?
High flow is measured exactly, low flow is impossible to measure because there’s a mixture of room air. Unknown O2 concentration.
What can nurses apply in Emergency situations?
Nurses can apply low flow O2 in emergency situations, including nasal cannula, simple mask, re-breather, non-rebreather.
Condition Normal 95-100%
nothing
Mild Hypoxemia 91-94%
NC 1-6L/Min Simple Mask 5-10L
Moderate hypoxemia 86-91%
Partial rebreather 6-10L
Nonrebreather 10L
Venturi 4-10L
Severe Hypoxemia <85%
Partial rebreather 6-10L
nonrebreather 10L
what are signs of O2 toxicity
Headaches, substernal discomfort, dyspnea, alveolar atelactesis, paresthesia, fatigue, malaise, confusion, profressive breathign difficulties, refractory hypoxemia.
Nursing assessments for O2 toxicity
chest tightness, Respiratory rate, breth sounds, O2 sat, numbness tingling of extremities, activity level, general attitude, change in menation.
Nursing interventions for O2 toxicity
Monitor flow, monitor time, assess before treatment, assess for change during therapy, ensure correct dose.
When should the patient notify their PCP
When they have frequent headaches, increased anxiety, blue tinge to lips and nailbeds, drowsiness, confusion, restlessness. slow shallow difficult irregular breaths.
Patient O2 safety precautions
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.
What is a pulmonary Embolism?
An embolus that clogs an artery in the pulmonary vascular system
What is the vascular problem with a PE?
Blood flow is obstructed and there is poor perfusion of the lung tissue.
What is the respiratory response to a PE?
The air can get into the lungs but can’t get into blood stream because of the obstruction and causes shortness of breath.
Where to PE’s originate?
in the venous system.
How is a PE diagnosed?
Chest x ray will show a dilated Pulmonary artery. spiral PT scan. EKG will show sinus tachycardia. Ventilation perfusion scan.
What test rules out blood clot?
the D-dimer test
What is the gold standard test for a PE diagnosis?
Pulmonary angiogram, allows for direct vizualization, uses dye.
Risk factors for PE
50+, venous stasis, prolonged immobility, hypercoagulability, history of thrombophlebitis, damage to vessel walls, orthopedic surgery, diseases, constrictive clothing, supplemental estrogen.
How quickly can a PE kill?
1 hour
Priorities with a PE
Early recognition, size, location, and amount of lung tissue affected. EARLY TREATMENT
Human response to a PE
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.
What is the Pulmonary Embolism Severity Index?
indication for outcome of patient with PE based on risk factors. gives prediction of mortality for 30 days. rate 1 though 5.
What is nursing care to prevent PE?
Identify risk factors, early ambulation, repositioning, active/passive leg exercises. AE hose, SCD, change IV sites, Patient education, recognize clinical presentation.
What are Independent emergency nursing interventions for PE?
VS, lung sounds, respiratory rate, O2 low flow, high flowlers position, EKG
What are ordered emergency nursing interventions for PE?
IV access, Labs for H&H, lytes, d-dimer, Medications: morphine, sedation, anti-anxiety
What is the goal of emergency EP treatment?
stabilize pulmonary and cardiovascular systems.
What are emergency management steps
protect airway, manage pain, confirm diagnosis, pharmacology (Thrombolytic or anticoagulation), surgery.
What types of surgery are done for PE?
Transvenous catheter embolectomy, implantation of umbrella filter.
What are Post PE nursing interventions for embolectory of umbrella?
routine post op care
What are nursing interventions for PE care?
Monitor labs, monitor pulmonary parameters. monitor respiratory effort, evaluate assessment against previous data, alert PCP as necessary, patient education.
