Student Clinical Knowledge Evaluation 1 Flashcards
Oxygen Therapy: Indications (5)
- Documented hypoxemia (PaO2 < 60 mmHg, SaO2 < 90%)
- Suspected hypoxemia
- Severe Trauma
- Short term therapy or surgical intervention
- Acute Myocardial Infarction (MI)
Oxygen Therapy: Hazards/Complications/Precautions (5)
- Depression of Ventilation
- Retinopathy of Prematurity (ROP)
- Absorption Atelectasis (Nitrogen Washout)
- Oxygen Toxicity
- Fire Hazard
O2 Hazard: Depression of Ventilation
Occurs when CO2 retainers have a PaO2 > 60mmHg. They quit breathing. CO2 retainers’ breath on a hypoxic drive. They use their peripheral chemoreceptors to breathe. When a CO2 Retainers PaO2 is between 30 - 60 mmHg their respiratory rate increases. Normal breathing adults use central chemoreceptors to breathe. Anytime their CO2 levels increase their respiratory rate increases. If a CO2 retainer PaO2 is > 60mmHg, their peripheral chemoreceptors do not kick in and they stop breathing.
O2 Hazard: Retinopathy of Prematurity (ROP)
Occurs when premature infants < 28 days of age have a PaO2 of > 80 mmHg. This high oxygen level in the blood causes retinal vasoconstriction which leads to necrosis of the blood vessels. New vessels form and these hemorrhages too, causing scarring behind the retina leading to retinal detachment and blindness.
O2 Hazard: Absorption Atelectasis (Nitrogen Washout)
Occurs when a patient is on > 50% oxygen. causes nitrogen to be removed from the alveolus which causes atelectasis to occur. Nitrogen provides stability in the alveolus. When the patient gets too much oxygen the nitrogen is washed out and the stability of the alveolus is lost and starts to shrink until atelectasis occurs. Room air has 78% nitrogen, 21% oxygen, and 1% other gases
O2 Hazard: Oxygen Toxicity
Occurs when a patient is on > 50% oxygen for > 24hrs. Oxygen free radicals which are a byproduct of cellular metabolism are released and cause cell damage. Patient will experience chest pain, decrease Vital Compacity (VC), decreased lung compliance, decreased Diffusion of Lung Compacity of CO2 (DLCO), and increased PAaO2. CXR patchy infiltrates.
Nasal Cannula: State the FiO2 with a specific liter flow
1L, 2L, 3L, 4L, 5L, 6L
Flow Rate Range
FiO2 Range
1L = 24% FiO2
2L = 28% FiO2
3L = 32% FiO2
4L = 36% FiO2
5L = 40% FiO2
6L = 44% FiO2
Flow Rate Range: 1-6 LPM
FiO2 Range: 24% -44%
Nasal Cannula: List three things that affect FiO2 and how
- Tidal Volume (Vt): Increasing the Vt decreases the FiO2 by pulling in more room air.
- Inspiratory Flow: Increasing the patient’s inspiratory flow decreases the FiO2 by pulling in more room air.
- Respiratory Rate (RR): Increasing the RR decreases the FiO2 by giving the nasal cavity less time to fill.
Venti Mask: What happens if the port is blocked?
You get an increase in FiO2 and a decrease in total output flow.
Partial Rebreather (PRB) / Nonrebreather (NRB)
1. FiO2 Ranges
2. Flow Rate
3. Troubleshoot when bag is flat or will not stay inflated
- PRB: 40% - 70% NRB: 60% - 90%
- Minimum 10 LPM
- Increase the flow or the device is not meeting the patient’s inspiratory demands.
High Flow vs. Low Flow Devices: Explain the difference between high flow and low flow devices.
- High flow devices deliver a precise FiO2 and meet or exceed the patient’s inspiratory demand.
- Low flow devices run at a low flow rate and the FiO2 is variable.
Pulse Oximetry: Indications (3)
- Adequacy of arterial saturation
- Assesses response to treatment
- Monitor saturation during procedures
Pulse Oximetry: Hazards/Complications/Precautions (2)
- Pressure sores from Pulse Ox device
- False Negatives
Pulse Oximetry: Things that can affect accuracy (5)
- Ambient Light
- Dark Skin Pigmentation
- Dark Nail Polish
- Abnormal Hgb CO (Reads High)
- Abnormal Hgb Anemia (Reads Low)
Suctioning: Indications (2)
- To remove secretions in patients with an ineffective cough
- Maintain a patent airway (open AW)
Suctioning: Hazards/Complications/Precautions (4)
- Hypoxemia: Minimize by preoxygenating patient. Minimize by using a closed suction technique
- Dysrhythmia (Cardiac): Bradycardia/Tachycardia, if either occurs, stop suctioning, administer O2 and ventilation
- Mucosal Tears (Trauma): Limit amount of negative suction pressure used. Use shallow suctioning method
- Infection: Perform good Standard Precautions
Suctioning Pressures:
100 - 120 mmHg: Adult
80 -100 mmHg: Child
60 - 80 mmHg: Infant
Suctioning (Sx) Catheter Size
Catheter Size = ID Size
3/2 Example: You have a size 8.0 Tube. 83/2 = 24/2 = 12
Therefore, you would suggest a size 12 F suction catheter
Bland Cool Aerosol: Indications (3)
- Laryngotracheobronchitis (LTB)
- Subglottic Edema
- Post Extubation
Bland Heated Aerosol: Indications (2)
- Bypassed Upper Airway
- Sputum Specimen
Bland Aerosol: Hazards/Complications/Precautions (5)
- Infection
- Bronchospasms
- Overhydration
- Patient discomfort
- Caregiver exposure to airborne contagions
Bland Aerosol: Puffing or No mist indications, how to troubleshoot
- Puffing: Check for water in tubing
- No Mist (3): Increase the flow, check water level, check capillary tube is connected
SVN/MDI: Indications (3)
- Deliver medications
- Mobilize secretions
- Decrease WOB. Wheezing
SVN/MDI: Hazards/Complications/Precautions (5)
- Adverse reaction to meds
- Infection
- Bystander exposure
- Drug reconcentration
- Hyperventilation
SVN/MDI: Patient is lightheaded and dizzy during treatment. What is the problem and what can you do to help?
- The patient is hyperventilating. You will want to stop and reinstruct the patient.
IS: Indications (3)
- Conditions predisposing to atelectasis (abd/thoracic Sx, post Op)
- Treat atelectasis
- Patients w/restrictive lung disease (Quadriplegia)
IS: Hazards/Complications/Precautions (4)
- Hyperventilation and respiratory alkalosis
- Bronchospasm
- Barotrauma
- Discomfort (inadequate pain control)
