Skills Flashcards (Oxygenation PowerPoint)
1
Q
Soft-intensity, low-pitched, “gentle sighing” sounds made by air moving through smaller airways (bronchioles and alveoli).
What breathing sound would you call this?
A
Vesicular Breathing Sounds
2
Q
Moderate-intensity and moderate-pitched “blowing” sounds created by air moving through larger airway (bronchi).
What breathing sound would you call this?
A
Bronchovesicular Breathing Sounds
3
Q
High-pitched, loud, “harsh” sounds created by air moving through trachea.
What breathing sound would you call this?
A
Bronchial (Tubular) Breathing Sounds
4
Q
Name off a buncha normal breathing sounds:
A
Vesicular Breathing Sounds
Bronchovesicular Breathing Sounds
Bronchial (Tubular) Breathing Sounds
5
Q
Give a description of Rales:
A
Crackle Breathing Sounds.
Best heard on inspiration.
May not be cleared with coughing.
6
Q
Give a description of Rhonchi:
A
Gurgle Breathing Sounds.
Low-pitched, moaning or snoring sounds.
Best heard on expiration.
May be altered with cough.
7
Q
Give a description of Friction Rub Breathing Sounds:
A
Grating / Creaking Sounds.
Heard with both inspiration + expiration.
8
Q
Give a description about what a Wheeze is:
A
High-pitched musical sounds.
Best heard on expiration.
Not usually altered by cough.
9
Q
What is the cause of Rales?
A
Air passing through fluid or mucous
10
Q
What is the cause of Rhonchi?
A
Air passing through narrowed air passages
11
Q
What is the cause of Friction Rub?
A
Rubbing together of inflamed pleural surfaces
12
Q
What is the cause of Wheezing?
A
Air passing through constricted bronchus
13
Q
At what location is it possible to auscultate Rales?
A
Bases of Lower Lungs
14
Q
At what location is it possible to auscultate Rhonchi?
A
Predominate Over Trachea + Bronchi
15
Q
At what location is it possible to auscultate a Friction Rub?
A
Lower Anterior + Lateral Chest
16
Q
At what location is it possible to auscultate a Wheeze?
A
All Lung Fields
17
Q
What kind’s of people is oxygen therapy prescribed for?
A
Pt’s with Hypoxemia, Hyper-Ventilation, Loss of Lung Tissue, Anemia, Blood Loss
18
Q
What are some things that the Primary Care Provider should specify when giving Oxygen Therapy?
A
Concentration, Method of Delivery, Liter Flow per Minute (LPM).
May prescribe for titration to achieve therapeutic level.
19
Q
When giving oxygen therapy, what flow should the humidifier be set to in order to prevent drying?
A
High Flow (Over 4 LPM)
20
Q
It is common to titrate 02 in order to-
A
Keep sats above a certain level (Like > 92%)
21
Q
How much humidity do humidifiers add?
A
20-40%
22
Q
What do Humidifiers prevent?
A
The drying of mucous membranes and therefore decrease risk of irritation and nose bleeds
23
Q
What may help to loosen secretions for easier expectoration?
A
Humidifiers
24
Q
Is oxygen addictive?
A
Nah
25
What % oxygen is room air?
21% Oxygen
26
Most people are only ordered how much oxygen?
28% Oxygen Concentration at 2 LPM
27
What can excessive amount of oxygen intake lead to?
Pulmonary tissue damage, increase in ventilator time, and longer hospitals stays
28
You should always use the highest concentration needed to achieve desired blood oxygen saturation.
True or false?
False, always use the lowest.
29
List the different types of oxygen delivery devices:
Cannula
Tracheal Mask
Face Masks:
Simple
Partial Rebreather
Non Rebreather
Venti Mask
Oxygen Face Tent
30
What should you never use in the nose for dryness when using oxygen because it causes burning?
Vaseline / Petroleum Jelly
31
How many LPM is Low Flow?
1-6 LPM
32
What oxygen concentration is given with 1 LPM via a Nasal Cannula?
1 LPM would have 24% Oxygen
33
What oxygen concentration is given at 2 LPM via a Nasal Cannula?
What about 3 LPM?
2 LPM would have 28% Oxygen.
3 LPM would have 32% Oxygen.
4 would be 36%, etc.
34
Give me a description about the Nasal Cannula:
It’s used for clients with chronic airflow limitations or for long term use. Most commonly used oxygen therapy device. Inexpensive. Doesn’t interfere with eating or talking
35
What do you need to watch out for with pt’s who are on a Nasal Cannula?
Watch for skin irritation and breakdown in the nares, around ears, neck, and face
36
When should Humidification be used for pt’s on a Nasal Cannula?
When giving them 4 LPM or higher
37
What are the interventions needed for a pt who needs a Nasal Cannula?
Place prongs in nostrils with openings facing the client.
Add humidification as prescribed (should be used when using liter flows above 4 LPM for client comfort).
Check water levels and change humidification PRN.
Provide water soluble jelly to nares PRN.
38
What are some things that you’d need to assess for a pt who has a Nasal Cannula?
Assess client for changes in respiratory rate and depth.
Assess mucosa for drying/irritation.
Assess skin integrity; oxygen tubing may irritate especially around the ears can cause Pressure Wounds.
39
How much oxygen should a Simple Oxygen Mask deliver?
40-60% Oxygen Concentration at 5-8 LPM.
A Simple Mask should be over 6 LPM to wash out the exhaled CO2.
40
How much oxygen should a Simple Rebreather Oxygen Mask deliver?
40-60% Oxygen Concentration at 6-10 LPM
41
The bag must not deflate for a Partial Rebreather Oxygen Mask, if it does, what should you do?
Increase the LPM
42
What are some interventions for a Simple Oxygen Mask?
Make sure mask fits properly over nose and mouth.
Assess skin and provide skin care to area covered by the mask.
Monitor for aspiration; mask may limit client’s ability to clear mouth.
Provide emotional support (may feel claustrophobic).
Switch to nasal cannula during meals after consultation with HCP to approve switch.
43
What are some interventions for a Partial Rebreather Oxygen Mask?
Make sure reservoir doesn’t twist or kink (bag will deflate).
Adjust flow rate to keep bag 2/3 full during inspiration.
44
How much oxygen should a Nonrebreather Oxygen Mask deliver?
95-100% Oxygen Concentration at 10-15 LPM
45
How much oxygen should a Venturi Oxygen Mask deliver?
LPM Varies Per Manufacturer (Oxygen Concentration is 24% to 40-50 %)
46
If your pt has a non-rebreather mask, then you should make sure that it-
Doesn’t Deflate
47
A Venturi Mask will have a dial to set the percentage of oxygen if it has an LPM of-
4-10
48
What type of oxygen masks are used in clients who are deteriorating and might require intubation?
Nonrebreather Oxygen Masks
49
What are some interventions for Nonrebreather Oxygen Masks?
Remove mucus or saliva from mask.
Assess and monitor client’s respiratory status closely.
Ensure flaps are intact and functional.
Monitor for suffocation if reservoir kinks or oxygen source disconnects.
50
What kind’ve masks provide high flow oxygen delivery?
Venturi Oxygen Masks
51
What kind’ve interventions are there for pt’s with Venturi Oxygen Masks?
Monitor client to ensure accurate flow rate of oxygen concentration.
Keep orifice of adapter open/uncovered for proper delivery.
Ensure mask fits snugly.
Ensure tubing free of kinks.
Assess client for dry mucous membranes.
52
How much oxygen does Aerosol Oxygen Therapy provide?
30-50% Oxygen Concentration at 4-8 LPM
53
You have a pt who’s taking Aerosol Oxygen Therapy. What should you monitor?
Monitor their skin for dryness
54
How should a Face Tent be put on? What should you monitor for?
Face tents fit over the client’s chin with the top extending halfway across the face. Keep facial skin dry.
55
What 3 oxygen devices fall under the category of Aerosol Oxygen Therapy devices?
Face Tents, Face Masks, Trach Masks
56
What kind’ve oxygen device would you give to infants or young children with respiratory issues like Croup?
A Croup Tent
57
What are some interventions for a Croup Tent?
Make sure they know to not have any electrical toys in the tent.
May have to change the sheet often to keep the bed dry.
58
Babies that require oxygen will require-
Oxygen Hoods
59
Oxygen hoods are analyzed by-
An Oxygen Analyzer
60
Too much oxygen to a baby will cause-
Blindness
61
Oxygen tanks are always what color?
Green
62
What should you always warn a pt who’s on an oxygen tank about?
Don’t smoke while on oxygen
63
How do you adjust the flow rate for an oxygen tank?
They have a regulator on them that you can use an Oxygen Wrench to turn.
(Righty-Tighty, Lefty-Losey)
64
Oxygen tanks have several-
Sizes and Forms
65
Oxygen Tanks are a Conserving Device that only give oxygen-
During Inspiration
66
What device can make oxygen out of air, so it doesn’t run on oxygen?
Concentrators
67
Can you use Concentrators in your home?
Yes
68
Most Concentrators only go up to how many LPM?
5 LPM
69
How many LPM can certain concentrators go up to?
Up to 10 LPM
70
Can humification be added to concentrators?
Yes
71
When do Concentrators need to be serviced?
Whenever they aren’t giving out the right amount of oxygen
72
What are things that you can do to prevent safety for a person on an in-home oxygen tank?
No Smoking Signs.
Have a designated smoking room away from the pt (And their equipment) or only smoke outside.
Teach about the hazards of smoking near someone while on oxygen.
Make sure electronic devices are in good condition (To avoid circuit sparks).
Avoid material that can generate static electricity.
Avoid the use of volatile, flammable materials near the pt.
Be sure that electric monitoring equipment, suction machines, and portable diagnostic machines are all electrically grounded.
73
What materials can generate static electricity?
What materials should be used instead for pt’s on Oxygen Tanks?
Woolen blankets and synthetic fabrics.
Cotton blankets should be used, and clients and caregivers should be advised to wear cotton fabrics.
74
What are some examples of volatile, flammable materials?
Oil, greases, alcohol, ether, and acetone
75
What does PASS stand for?
Pull the pin
Aim the nozzle at the base of the flame
Squeeze the handle
Sweep the nozzle from side to side at the base of the fire
76
What does the CPAP stand for?
Continuous Positive Airway Pressure
77
What oxygen device has only one set level of pressure?
CPAP
78
What does the BIPAP stand for?
Bi Level Positive Airway Pressure
79
Does the BIPAP give expiratory pressure or inspiratory pressure?
Both
80
Why might you give a pt a lower expiratory pressure?
To allow the pt to exhale against less force
81
Has inspiratory pressure rate, expiratory pressure and a RATE. Gives breaths per minute as prescribed by HCP =
BIPAP ST
82
CPAP delivers continuous positive airway pressure during-
Exhalation and Inhalation
83
The CPAP + BIPAP + BIPAP ST are all commonly used-
At Home + While Sleeping
84
What are the CPAP + BIPAP + BIPAP ST all used to treat?
What does it prevent?
Obstructive Sleep Apnea.
Prevents Endotracheal Intubation + Pulmonary Edema + Respiratory Failure
85
The CPAP + BIPAP + BIPAP ST are all forms of-
They all have to have their pressure-
Mechanical Ventilation.
Be prescribed by a HCP.
86
Do the CPAP + BIPAP + BIPAP ST use oxygen?
No, they use air pressure only to keep the airway open
87
How does the BIPAP help people with COPD?
It holds their airway open to allow for them to have a longer amount of time exhaling CO2 if they’re retaining too much of it.
88
Sleep apnea affects how many Americans?
What’s the most common type of sleep apnea?
12 Million.
Obstructive Sleep Apnea.
89
What are the risk factors for sleep apnea?
Being Male + Obesity + Being Over 40 Years Old
90
Used to deliver Aerosol Medications =
Nebulizer
91
How long does a Nebulizer usually take to use?
15 - 20 Minutes
92
What do you use for a Nebulizer?
A Mouth-Piece or a Mask
93
What should you instruct to a pt who has to use a Nebulizer?
Breathe normally through the mouth piece, take a deep breath every 30 - 60 seconds and hold for a count of 5 seconds for a better distribution of medication
94
What is Incentive Spirometry used to do?
Improve Pulmonary Ventilation
Loosen Secretions
Expand Collapsed Alveoli
Facilitate Respiratory Gas Exchange
Counteract the Effects of Anesthesia or Hypoventilation
95
What are Incentive Spirometry devices also called?
SMIs (Sustained Maximal Inspiration Devices)
96
How many types of Incentive Spirometry are there?
2.
Flow-Oriented.
Volume-Oriented.
97
What type of Incentive Spirometry consists of one or more clear chambers containing freely movable colored balls or disk. Disk or balls are elevated as client inhales. Does not measure volume of air inhaled =
Flow-Oriented
98
What type of Incentive Spirometry measure inhalation volume maintained by client? When client inhales, a piston-like plate or accordion pleated cylinder rises. The markings on the side indicate volume of inspiration achieved by client =
Volume-Oriented
99
Does an Incentive Spirometer absolutely have to be upright?
Yes
100
Should you exhale normally when using an Incentive Spirometer?
Yes
101
How do you use an Incentive Spirometer?
Seal your lips tightly around the mouthpiece.
Take in a slow deep breath for 2 seconds initially, increasing to 6 seconds (optimum). To keep the balls or cylinder elevated if possible.
Remove the mouthpiece and exhale normally.
102
What are things to avoid and note about Flow-Oriented Incentive Spirometry?
Avoid brisk, low- volume breaths that snap the balls to the top of the chamber.
Greater lung expansion is achieved with a very slow inspiration than with a brisk, shallow breath, even though it may not elevate the balls or keep them elevated while you hold your breath.
Sustained elevation of the balls or cylinder ensures adequate ventilation of the alveoli (lung air sacs).
103
What should you encourage a patient to do after they use an Incentive Spirometer?
Encourage them to cough.
Deep ventilation can loosen secretions, and coughing can promote their removal.
Relax and take several normal breaths before using the spirometer again.
104
Should you repeat Incentive Spirometry several times?
Yes
105
How often should you do Incentive Spirometry hourly?
4-5 Times Hourly (Or as prescribed. Often 10 Breaths an Hour)
106
What does the practice of Incentive Spirometry increase?
What does it maintain?
Increases Inspiratory Volume
Maintains Alveolar Ventilation
107
What should you clean an Incentive Spirometer with?
Water
108
How should you let an Incentive Spirometer dry?
Shake it until it’s dry
109
A forceful striking of the skin with cupped hands =
Percussion
110
What is Percussion used to do?
Dislodge Secretions
111
A series of vigorous quivering produced by hands placed against the chest =
Vibration
112
What is Vibration used to do?
Loosen Thick Secretions
113
Uses gravity to facilitate removal of bronchial secretions =
Postural Drainage
114
What is Postural Drainage?
Positioning to facilitate the expectoration of mucus
115
What is used to remove secretions from the airways?
Coughing + Deep Breathing
116
What does a Normal Forceful Cough involve?
Inhaling deeply and coughing twice while exhaling
117
Is a Normal Forceful Cough very effective?
It is Highly Effective
118
What are some Alternative Cough Techniques?
Forced Expiratory Technique or Huff Coughing
Pursed-Lip Breathing
119
When should coughing and deep breathing exercises be taught?
For pt’s with COPD, Chest Surgery, or Cystic Fibrosis
120
After you use a Bronchodilator, (If Prescribed) you should get your patient to-
Use Huff Coughing
121
What is Huff Coughing?
Inhale deeply and hold your breath for a few seconds, then cough twice while exhaling.
Lean forward and exhale sharply with a “huff” sound mid-exhalation.
Inhale by taking rapid short breaths in succession (“sniffing”).
Rest and breathe slowly between coughs.
122
Why do you always want to avoid prolonged episodes of coughing?
Because this may cause Fatigue & Hypoxia
123
You are using Huff Coughing. What does the first cough do? What does the second do?
The first loosens mucous.
The second expels secretions.
124
Helps to keep your airways open while moving secretions up and out of lungs =
Huff Coughing
125
What part of Huff Coughing prevents mucus from moving back into smaller airways?
The “Sniffing” Part
126
What is Pursed-Lip Breathing?
Breathe in through nose and exhale through pursed lips blowing slowly.
Tighten abdominal muscles to assist in exhalation.
127
Liquid oxygen tanks =
Green
128
Gas oxygen tank =
Silver
