Oxygen therapy and ventilators Flashcards
What is the indication of oxygen therapy
hypoxemia
Goal of therapy
PaO2 > 60
SaO2 > 90%
PaO2
Measured by ABG
Peripheral blood
Normal is 80-100
Describes the amount of partial pressure of oxygen in arterial blood and the amount of oxygen dissolved in arterial blood plasma
SaO2
Measured by pulse ox
measure a percentage of the amount of hemoglobin which are oxygenated in the arterial blood
This is your arterial measurement
Normal is >95%
Low Flow Systems
Nasal cannula
Simple face mask
Partial rebreather mask
Nonrebreather mask
High Flow systems
Ventimask (air entrainment mask)
Nasal Cannula
Delivers 1-6 L
Simple face mask
5-8L
Partial nonrebreather
6-15
Non rebreather
60-100% FiO2
Ventimask
4-10L most precise
Needs to be warmed and humidified oxygen
Complications of Oxygen therapy
oxygen toxicity
carbon dioxide retention
absorption atelectasis
combustion
Oxygen toxicity
Fio2 of 50% or greater for greater than 24 hours
convulsions grand mal seizures without warning
tunnel vision
ringing in the ears
nausea mild to severe
twitching of the face muscles (most common)
irritability
dizziness vertigo or disorientation
Nursing management of oxygen therapy
ensuring oxygen is being delivered as ordered
observing for complications of therapy
must transfer patients with oxygen if they are on oxygen
What is the purpose of an artificial airway
to keep the patients airway open
Indications for endotracheal tubes
upper airway obstruction apnea high risk of aspiration ineffective clearance of secretions respiratory distress
What is needed to intubate
consent (unless emergent) ET tube Stylet Ambu bag IV access suction tape
Oral endotracheal tube advantages
easier access avoid nasal and sinus complications allows for larger diameter tube WOB is decreased (larger tube less resistance) Suctioning Fiberoptic bronchscopy Preferred in emergencies Less trauma during intubation and if done nasally
Nasal endotracheal tube advantages
Easily secured and stabilized
Reduces risk of unintentional extubation
More comfortable than oral and better tolerated
Enables swallowing and oral hygiene
Facilitates communication
Avoids need for bite block
Prevents tune obstructioning by biting on the tube
Used in patients with spinal cord injuries and maxillofacial trauma
Nasal endotracheal tube contraindications
facial fractures
suspected basilar skull fractures
post op cranial surgeries
sinusitis
Endotracheal tube complications
nasal or oral inflammation and ulceration
sinusitis and otitis
Laryngeal and tracheal injuries
tube displacement
salivation is increased and swallow is difficult
Mouth care can be difficult
teeth can become chipped or moved
Tracheostomy
Tube placed in the trachea through the stoma in the neck
For long term intubation
2-10 days early tracheostomy
Avoids oral, nasal, pharyngeal ,and laryngeal complications
Can be done at the bedside by the doctor
Nursing Management of the artificial airway
Humidification Maintaining correct tube placement Cuff management Monitoring oxygenation and ventilation Maintaining tube patency/ suction Providing oral care/ skin integrity Fostering comfort and communication
Humidification
Use only body temperature water
Air is sent directly into the patients lungs, if we put humidified air that is less than their body temperature this will make the patient hypothermic quickly
Maintaining Correct tube placement
- Continuously monitoring the patient for proper placement
- If tube is dislodged it could end up in the pharynx or esophagus
- Maintain proper placement by putting an “exit mark’ on the ET tube at the teeth
- Observe for symmetric chest wall movement and listen for bilateral lung sounds
- If the tube is not properly positioned it is an emergency
- stay with the patient, maintain airway, support ventilation with an ambu bag, and call for the doctor to reposition the tube
- If the dislodged tube is not repositioned minimal or no oxygen will reach the lung and the tidal volume will be delivered all to one lung putting the patient at risk for pneumothroax
Passy Muir Valve
aids communication by allowing the patient to talk
also helps the patient with relearning normal breathing
CUFF ON TRACH HAS TO BE DEFLATED TO DO THIS
Suction first
you don’t deflate if they have had copious amounts of secretions, if the patient has had poor lung compliance this is not indicated
Complications of suctioning
- hypoxemia
- atelectasis
- bronchospasm
- dysrhythmias
- airway trauma
Extubation
removal of the endotracheal tube
this can be catastrophic and usually complicates recovery
Decannulation
removing the tracheostomy this is easier for the patient to pull out
- COVER THE STOMA WITH A DRY DRESSING
Extubation complications
- unplanned extubation
- aspiration
- sore throat
- stirdor
- hoarseness
- odynophagia
