T1-Ch 25: Concepts of Care in Oxygen Therapy and Tracheostomy Care Flashcards
Most patients with hypoxia require an oxygen flow of _____L/min via nasal cannula or up to _____% via Venturi mask to achieve an oxygen saturation of at least 95%
2-4 L/min
40%
For a patient who is hyperemic and has chronic hypercarbia the FiO2 delivered is adjusted to correct the hypoxemia and achieve generally acceptable oxygen saturation between ____-_____%
88-92%
Humidification should be used at rates of _____ L/min or higher
4L/min
Patients on oxygen should be checked in these locations ever Q____ for skin break down (3)
Q4-8 hrs
-ears
-face
-back of neck
Oral care for patients on oxygen is Q___hrs and as need
Q8 hrs
Clean cannula or mask Q ___ hrs
Q 4-8 hrs
Nasal canula
________ L/min
________ %
1-6 L/min
24-44%
Oxygen-conserving cannula
________ L/min
________ %
8 L/min
30-50%
Simple face mask
________ L/min
________ %
6-12 L/min
35-55%
Partial non-rebreather mask
________ L/min
________ %
10-15 L/min
60-90%
Venturi mask
________ %
24-50%
High-flow nasal cannula
________ L/min
Up to 60 L/min
CPap/BiPap
________ %
21-100%
Oxygen delivery system:
Inexpensive, disposable, simple
nasal cannula
Oxygen delivery system:
Long-term use at home
oxygen-conserving cannula
Oxygen delivery system:
Short periods of use
Simple face mask
Oxygen delivery system:
Short periods of use
humidified
partial no-rebreather mask
Oxygen delivery system:
Provides a specific amount of oxygen
Venturi mask
Oxygen delivery system:
Provides a wide range of FiO2
High-Flow nasal cannula
Oxygen delivery system:
cannot use in artificial airway patients
CPap/BiPap
Low-flow oxygen delivery devices (4)
-Nasal Canula
-Oxygen-conserving cannula
-Simple facemark
-Partial non-rebreather
High-flow oxygen delivery device (2)
-Venturi mask
-High-flow nasal cannula
Noninvasive ventilation device (2)
-CPap
-BiPap
Pre-op care for tracheostomy
education regarding the procedure
tracheostomy procedure (3)
-incisions are made through the neck and tracheal rings to enter the trachea
-tracheostomy tube is inserted and secured with sutures
-chest x-ray determines proper placement
Post-op care for tracheostomy (3)
-ensure a patent airway
-confirm bilateral breath sounds
-hourly respiratory assessment
Possible tracheostomy complications (6)
-tube obstruction
-tube dislodgment/ accidental decannulation
-tracheomalacia
-tracheal stenosis
-tracheosophageal fistula (TEF)
-trachea-innominate artery fistula
Prevention of tracheal tube obstruction (4)
-cough/deep breath
-providing inner cannula care
-humidifying oxygen
-suctioning
Tube dislodgment/
accidental decannulation prevention (1)
secure the tube in place
Tube dislodgment in the first ____ hours after surgery is an emergency because:
72 hours
tracheostomy tract has not matured
What to do if tracheal tube becomes dislodged:
-Extend patients’ neck and open the tissue of the stoma with a curved Kelly clamp to secure the airway
-with the obturator inserted int to he tracheostomy tube, quickly and gently replace the tube, and remove the obturator
-check the airflow through the tube and for bilateral breath sounds
constant pressure exerted by the cuff causes tracheal dilation and erosion of cartilage, leading to loss of tissue integrity
tracheomalacia
narrowed tracheal lumen is caused by scar formation from irritation of tracheal mucosa and impaired tissue integrity but he cuff
tracheal stenosis
excessive cuff pressure causes erosion of the posterior wall of the trachea and loss of tissue integrity; causes a hole between the trachea and the anterior esophagus
tracheosophageal fistula (TEF)
Patients with _______ and tracheas are at highest risk for TEF
NG tube
poorly positioned tube causes its distal tip to push against the lateral wall of the trachea
trachea-innominate artery fistula
trachea-innominate artery fistula: continuous pressure causes _______ and ______ in the innominate artery
necrosis and erosion
trachea-innominate artery fistula is a:
medical emergency
T/F: bleeding the first few days after trachea placement is a medical emergency
false; bleeding can be expected first few days
To prevent infection _____ should be used while suctioning trachea
sterile technique
To prevent infection, stoma should be assessed Q_____ for s/s of infection
Q8
