Oxygen therapy and ventilators

Question 1

What is the indication of oxygen therapy

Answer 1

hypoxemia

Question 2

Goal of therapy

Answer 2

PaO2 > 60

SaO2 > 90%

Question 3

PaO2

Answer 3

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

Question 4

SaO2

Answer 4

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%

Question 5

Low Flow Systems

Answer 5

Nasal cannula
Simple face mask
Partial rebreather mask
Nonrebreather mask

Question 6

High Flow systems

Answer 6

Ventimask (air entrainment mask)

Question 7

Nasal Cannula

Answer 7

Delivers 1-6 L

Question 8

Simple face mask

Answer 8

5-8L

Question 9

Partial nonrebreather

Answer 9

6-15

Question 10

Non rebreather

Answer 10

60-100% FiO2

Question 11

Ventimask

Answer 11

4-10L most precise

Needs to be warmed and humidified oxygen

Question 12

Complications of Oxygen therapy

Answer 12

oxygen toxicity
carbon dioxide retention
absorption atelectasis
combustion

Question 13

Oxygen toxicity

Answer 13

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

Question 14

Nursing management of oxygen therapy

Answer 14

ensuring oxygen is being delivered as ordered
observing for complications of therapy
must transfer patients with oxygen if they are on oxygen

Question 15

What is the purpose of an artificial airway

Answer 15

to keep the patients airway open

Question 16

Indications for endotracheal tubes

Answer 16

upper airway obstruction
apnea
high risk of aspiration
ineffective clearance of secretions
respiratory distress

Question 17

What is needed to intubate

Answer 17

consent (unless emergent) 
ET tube
Stylet 
Ambu bag
IV access
suction 
tape

Question 18

Oral endotracheal tube advantages

Answer 18

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

Question 19

Nasal endotracheal tube advantages

Answer 19

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

Question 20

Nasal endotracheal tube contraindications

Answer 20

facial fractures
suspected basilar skull fractures
post op cranial surgeries
sinusitis

Question 21

Endotracheal tube complications

Answer 21

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

Question 22

Tracheostomy

Answer 22

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

Question 23

Nursing Management of the artificial airway

Answer 23

Humidification 
Maintaining correct tube placement
Cuff management 
Monitoring oxygenation and ventilation 
Maintaining tube patency/ suction 
Providing oral care/ skin  integrity 
Fostering comfort and communication

Question 24

Humidification

Answer 24

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

Question 25

Maintaining Correct tube placement

Answer 25

• 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

Question 26

Passy Muir Valve

Answer 26

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

Question 27

Complications of suctioning

Answer 27

• hypoxemia
• atelectasis
• bronchospasm
• dysrhythmias
• airway trauma

Question 28

Extubation

Answer 28

removal of the endotracheal tube

this can be catastrophic and usually complicates recovery

Question 29

Decannulation

Answer 29

removing the tracheostomy this is easier for the patient to pull out
- COVER THE STOMA WITH A DRY DRESSING

Question 30

Extubation complications

Answer 30

• unplanned extubation
• aspiration
• sore throat
• stirdor
• hoarseness
• odynophagia