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103-theme 4 > principles of oxygen therapy and sleep apnoea > Flashcards

principles of oxygen therapy and sleep apnoea Flashcards

1
Q

what are some sources of oxygen treatment? 4

how is it delivered?

A
  • oxygen cylinders
  • wall supply
  • oxygen concentrators
  • liquid oxygen
  • litres/ minute
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2
Q

describe oxygen cylinders? 6

A
  • widely available, home and institutional
  • various sizes
  • limited length of supply
  • suitable for limited/ short duration treatment
  • relatively expensive
  • 100% oxygen supply
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3
Q

describe wall supply? 4

A
  • in hospital only
  • central supply piped into clinical areas
  • may not be available in clinical areas (clinic rooms)
  • supply 100% oxygen
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4
Q

describe oxygen concentrators? 5

A
  • mains operated machine
  • molecular sieve removed nitrogen
  • oxygen predominant gas >90% concentration
  • regional suppliers with franchise for isolation and support
  • use in the home or when out
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5
Q

describe liquid oxygen? 4

A
  • more highly compressed
  • larger gaseous volume per cylinder volume
  • allow higher flow rates
  • well developed in the US and parts of Europe
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6
Q

name 3 patient interfaces for spontaneously breathing patients?
how can these be measured? 2

A
  • nasal cannula
  • uncontrolled masks ( Hudson, non-rebreathe)
  • controlled makes ( fixed percentage Venturi)
  • litres/ min
  • percentage inspired oxygen
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7
Q

describe a nasal cannula? 7

A
  • well tolerated
  • accepts flow rates of 1-4l/ min
  • delivers 24-40% oxygen
  • % delivered depends on multiple factors
  • used for not critically ill patients. with mild hypoxaemia
  • can’t provide humidified oxygen
  • can dry out nose
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8
Q

describe a Hudson mask? 4

A
  • delivers 30-60% O2
  • flow rate of 5-10l/min
  • mixing of O2, room air and exhaled air mask
  • used less often
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9
Q

describe a non-rebreathe mask? 3

A
  • delivers 85-90% oxygen with 15L flow rate
  • one way valve in the bag stops mixing with room sit and patient rebreathe for expired air
  • used for acutely unwell patients- step down as soon as possible
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10
Q

describe a Venturi mask? 2

A
  • controlled oxygen

- Venturi valve allows delivery of a fixed concentration of oxygen

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11
Q

describe the clinical indications for using oxygen as a drug? 5

A
  • oxygen is a treatment for hypoxaemia, not breathlessness
  • acutely hypoxaemic patients
  • chronically hypoxaemic COPD patients with acute exacerbation
  • chronically hypoxaemic COPD patient who are stable
  • palliative use in advanced malignancy
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12
Q

what are the target oxygen saturation’s for
normal young adult
over 70 years

A

96-98%
94-96%
there needs to be a balance between what is safe and what is normal

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13
Q

what else do we have to do for these patients besides increase their oxygen saturation 5

A
  • secure and maintain airway patency
  • enhance circulation
  • avoid or reverse respiratory depressants
  • establish reason for hypoxaemia and treat
  • if not improving ventilate
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14
Q

who is at risk of hypercapnia if given a high does of Oxygen? 4

A
  • chronic hypoxic lung disease- COPD, cystic fibrosis
  • chest wall disease
  • neuromuscular disease
  • obesity related hypoventilation
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15
Q

how do we assess response to treatment for patients with CO2 retention? 4

A
  • arterial blood gases check frequently
  • adjust dose of oxygen accordingly
  • if not improving may need non invasive ventilation
  • not nasal cannula, dangerous as inspired oxygen percentage varies according to the patients respiratory characteristics
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16
Q

how do we prescribe oxygen? 5

A
  • on a drug chart
  • state target oxygen saturation range
  • state delivery device
  • state the dose- flow rate or percentage of inspired oxygen
  • patients may carry an oxygen treatment card
17
Q

what is LTOT? 4

A
  • long term oxygen treatment for at least 15 hours a day
  • for some patients with COPD
  • patient needs to be in stable state
  • no sooner than 4 weeks after an exacerbation
18
Q

what are the indications for the needs of LTOT? 6

A
  • COPD patients with pO2 <7.3 kPa
  • COPD patients with pO2 7.3<8 kPa and
  • secondary polycythaemia
  • nocturnal hypoxemia
  • peripheral oedema/evidence of right ventricular failure
  • evidence of pulmonary hypertension
19
Q

what are the benefits for LTOT? 7

A
  • improved long term survival
  • prevention of deterioration in pulmonary hypertension
  • reduction of polycythaemia (raised Hb)
  • improved sleep quality
  • increased renal blood flow
  • reduction in cardiac arrhythmias
  • improved quality of life
20
Q

what is portable oxygen? 4

A
  • may improve breathlessness in some patients
  • may extend the duration of LTOT
  • but most patients, breathlessness is not due to low pO2
  • we also need to consider the weight of the cylinders and the duration of the supply
21
Q

what is sleep apnea? 5

A
  • apnoea cessation of airflow for 10 seconds or longer
  • central= respiratory control centre= no respiratory effect
  • obstructive= the collapse of the pharyngeal airway during sleep
  • OSA=5 or more obstructive apnoea’s per hour
  • hypopnea= reduction in the airflow by 50% accompanied by desaturation of 4% and or arousal from sleep
22
Q

what is the prevalence of sleep apnoea? 3

A

2% women
4% adult men
increasing

23
Q

what are the risk factors of sleep apnoea? 6

A
  • male
  • obesity
  • neck circumference greater than 43cm
  • smoking
  • alcohol/ sedative use
  • pharyngeal abnormalities
24
Q

what is the cycle of sleep apnoea? 7

A
  • sleep
  • relaxation of muscles and tissues surrounding pharyngeal airway
  • collapse and obstruction of airway- snoring
  • apnoea
  • arousal
  • muscle tone returns- airway clears
  • resumption of breathing
25
Q

what are the clinical features of sleep apnoea? 7

A
  • snoring
  • nocturnal chocking/ waking with a start
  • unrefreshing
  • morning dry mouth
  • morning headaches
  • excessive daytime sleepiness- difficulty concentrating, irritability/mood changes, sleeping at an inappropriate time
  • nocturia
26
Q

what can be the complications of sleep apnoea? 2

A
  • right heart failure, secondary respiratory disease

- excess of red blood cells

27
Q

how do we investigate sleep apnoea? 3

A
  • repetitive apnoea’s and symptoms of sleep fragmentation with excessive daytime sleepiness
  • Epworth sleepiness scale
  • sleep studies
28
Q

what is polysomnography?

A
  • way to measure oxygen saturation during sleep
29
Q

what are the consequences of OSA? 7

A
  • increased risk of accidents
  • hypertension
  • type 2 diabetes
  • ischaemic heart disease
  • heart failure
  • stroke
  • death
30
Q

how can we manage OSA? 8

A
  • resolve signs and symptoms
  • improve sleep quality
  • patient education- don’t drive if sleepy
  • weight loss
  • avoid alcohol
  • treat contributing problems
  • mandibular advancement device
  • continuous positive airway pressure (CPAP)
31
Q

what is CPAP? 7

A
  • device generates airflow
  • positive pressure delivered to the airway via a mask
  • intraluminal pharyngeal pressure is a surrounding pressure
  • pharynx stays open
  • patients with mild OSAHS and additional co-morbidities
  • for patients with mild OSAHS and a high-risk profession
  • not for patients with mild OSAHS and no additional symptoms
32
Q

what are the benefits of CPAP? 2

A
  • symptoms resolve

- normalises BP

33
Q

what are the problems with CPAP? 4

A
  • adherence is an issue
  • airway drying/ irritation
  • mask problems
  • normally lifelong treatment

103-theme 4 (19 decks)

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