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CNUR 103 > Unit 5: Oxygen therapy, pt safety, and adverse events > Flashcards

Unit 5: Oxygen therapy, pt safety, and adverse events Flashcards

1
Q

Ventilation

A

mechanical process of breathing&raquo_space; moving air in and out of lungs ie. inspiration and expiration

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2
Q

Diffusion

A

exchange of 02 and C02 in alveoli

  • 02 diffuses from alveoli into capillaries
  • C02 diffuses from capillaries into alveoli
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3
Q

Transportation

A

of 02 and C02 to and from cells/tissues

  • O2 combines with hemoglobin to be carried to tissues
  • C02 carried in RBCs (65%); hemoglobin (30%); and in plasma (5%)
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4
Q

Impaired ventilation

A
  • Obstructed airway
  • Infections that cause increased secretions and inflammation
  • Head injury or drugs that affect CNS control of breathing
  • Trauma or diseases that affect muscles of respiration or alter intrapleural pressure: eg. spinal cord injury, muscular dystrophy, chest wound
  • Decreased lung compliance with aging impairs inspiration
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5
Q

Impaired Diffusion

A
  • Destruction of alveoli due to COPD
  • Pulmonary edema (eg. with CHF)
  • Infections, collapse of lung
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6
Q

Impaired transportation

A
  • Anemias, hemorrhage
  • Decreased cardiac output
  • Pulmonary embolism
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7
Q

Symptoms of hypoxemia

A
  • Tachycardia
  • Elevated BP
  • Tachypnea = hyperventilation
  • Dyspnea, SOB
  • Pallor&raquo_space; cyanosis
  • Vasodilation within Brain and Heart
  • Vasoconstriction within skin, muscles and viscera
  • Polycythemia (with chronic hypoxemia)
  • Look pale, diaphoretic
  • May be very anxious, restless, agitated
  • Gasping between words while talking
  • Confusion, change in mental status
  • Lethargic, impaired judgement
  • Tripod body positioning
  • Accessory muscle use
  • Flaring of nostrils
  • Substernal/intercostal retractions
  • Cool extremities
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8
Q

Blood gas analysis

A

Taken most often from the radial artery

 Measures pH of the blood, the partial pressure of carbon dioxide and oxygen, and the bicarbonate level.

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9
Q

 Respiratory Rate x Tidal Volume = Minute Ventilation

A

 This is an average minute volume and breathing pattern for a HEALTHY adult

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10
Q

Low flow O2

A

 Delivered oxygen gets diluted by room air
 Concentration of oxygen uncertain
 Concentration affected by client’s respiratory rate and depth
 Nasal prongs, simple mask, non-rebreather or partial rebreather mask, face tent

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11
Q

High flow O2

A

 Delivered oxygen gets diluted by room air
 Concentration of oxygen uncertain
 Concentration affected by client’s respiratory rate and depth
 Nasal prongs, simple mask, non-rebreather or partial rebreather mask, face tent

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12
Q

Nasal prongs

A 
	Most basic form of 02 therapy
	Runs between 1-6LPM, giving
	FiO2s of approximately 24-40%
	A low flow device, which means…
Fi02 affected by how the patients is breathing.
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13
Q

Simple mask

A

 Runs between 6-10 LPM, for FiO2s of approximately 35-50%.
 Need minimum 6 LPM in order to flush the exhaled carbon dioxide from the mask.
 Used when a patient is mouth breathing, or just needs a small boost in oxygen more than the nasal prongs can provide.
 A confused patient often won’t appreciate the hard plastic digging into their face.
 Also a Low Flow device

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14
Q

Face tent

A

(trauma/burns/unable to wear cannula)

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15
Q

Venturi device

A

 Provides 24-50% FiO2, the 02 flow you set is dependent on which insert is used – is labeled on each on the plastic inserts.
 Works by ‘air entrainment’ – fast jet of oxygen brings in the surrounding room air
 Not used very much anymore – only for patients that require a very specific FiO2.
Considered a High Flow device – the FiO2 the patient receives is predictable

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16
Q

Non-rebreather

A

 Used to deliver high Fi02s in a hurry – trauma, transports, sudden desaturations
 The reservoir bag acts as a store of oxygen with a valve that prevents exhalation into the bag
 Run at the flow that keeps the bag from deflating when the patient takes a breath.
 Provides Fi02 of between 60-80%.
 Low flow device

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17
Q

Cold nebulizer

A

 Adds humidity to the oxygen we provide! Humidity prevents drying of the airways, making it much more comfortable for the patient.
 Is attached to an aerosol mask, a dial on the top is adjusted for the FiO2 we want. The flowmeter should be set to at least 10LPM.
 Filled with sterile water, and provide FiO2 between 35-50%. If you need higher than 50% this device should not be used!
 Fixed performance device

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18
Q

Misty Ox

A

 Step up from the Cold Neb, provides Fi02 from 60-96%. Also attached to an aerosol mask, and runs through sterile water. Flow meter should be set to maximum, or flush.
 Fixed performance device

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19
Q

Optiflow system

A

 Newer system – provides high flow heated humidity oxygen through a nasal cannula. Attached to a high pressure oxygen source.
 High pressure(50psi) Oxygen and Medical Air are blended together to achieve FiO2 from 21-100% at flow rates of 20-60LPM.
 Much more comfortable for patients, they are able to eat and talk more easily than with a mask.

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20
Q

Things impacting which O2 delivery we choose

A

 Typically we want to see an oxygen saturation greater than 90%.
 Patients on oxygen for an extended period of time should either be on nasal prongs or a humidity providing device.
 The least invasive choice will increase patient compliance with the treatment.
 Oxygen is a drug! The lowest FiO2 that provides the desired results is often what should be administered.

21
Q

Incentive spirometry

A 
	Used to encourage deep breathing in post-op patients, those with decreased mobility, immobilized
	Client should be sitting upright
	Procedure:
	Exhale
	Lips tight around mouthpiece
	Take slow, deep breath in to elevate ball(s) in chamber
	Hold breath – 2 to 6 seconds
	Exhale
	Do 10 times, every hour
22
Q

Pursed lip breathing

A
  • Back pressure while breathing to transmit into the lungs; stents open airway
23
Q

Stationary concentrator

A
  • dilutes room air / concentrates – nitrogen gets attached
  • don’t always have to have an oxygen tank
  • but not most mobile and is very energy source costly
24
Q

Portable O2 concentrator

A
  • separates nitrogen and concentrated on oxygen for patient

- ran on battery – limitation is battery life

25
Q

Home fill station

A
  • also concentrator – room air to high concentrated oxygen

- can fill a few tanks before going out

26
Q

Nx diagnoses for O2

A

 Impaired gas exchange (actual or risk for) {O2 or CO2)
 Impaired ventilation
 Inability to fulfill family and/or work related roles r/t respiratory compromise
 Anxiety r/t dyspnea
 Insomnia r/t orthopnea
 Activity intolerance

27
Q

Nx interventions for impaired O2

A 
	Positioning
	Frequent position changes
	Encouraging ambulation
	Comfort measures
	Fluids and humidification
	Encouraging deep breathing & coughing (DB&C)
28
Q

Government initiatives for patient safety

A
  • Quality Health Council

- Canadian Patient Safety Institute (CPSI)

29
Q

Near miss

A
  • An event that is caught before it reached the patient
30
Q

Adverse event

A

An event that results in harm to patient that is unrelated to their medical condition and can be prevented.

31
Q

Critical incident

A

An adverse event that results in a significant physical impairment or loss of life.

32
Q

Swiss Cheese Model

A

 Slices = safeguards
 Holes = a weakness in each layer
 If those weaknesses align the harmful event travels through the safeguards and the “accident” may occur
 It takes multi-layered failures to lead to patient harm

33
Q

Domino effect

A

 Event takes on a form of a falling domino
 As it passes through a system layer a domino falls
 If the domino effect is not stopped eventually it will end in harm

34
Q

Iceberg model

A

 An approach to identify potential visible factors but also view the possible underlying, contributing factors:
 Situational factors
 Latent factors
 Help Identify the root cause which is usually a system failure
 System Failure:
 Faulty organizational process, system, operator, etc, that puts the healthcare worker/patient in harm
 A system wide approach will help learn from events and create solutions
 A system must learn from itself to correct itself
 Must create a culture of safety
 Work interprofessionally to collaborate with others in the healthcare team
 Communicate effectively regarding recognizing, responding to and disclosing of adverse events

35
Q

Culture of safety

A 
	Reporting Culture
- Trust that reporting will not be punished
	Informed Culture
- Continuously on verge of unacceptable
	Flexible Culture
- Adjusts the system
	Learning Culture
- Applies what is learned from within the culture
36
Q

Enhancing a culture of safety

A
  • Risk Management
  • Quality Improvement
  • Reporting
  • Disclosure Process
  • Interprofessional
  • Communication
  • Investigation:Root Cause Analysis
37
Q

Falls

A

 Falls are experienced by >1/3 of seniors
 Can lead to disability, chronic pain, loss of independence, ↓ quality of life and possibly death
 Direct healthcare cost ~ $2 billion annually
 Half of those who fall and # their hip will never be able to functionally walk again, 1/5 die within 6 months

38
Q

SAFE

A
  • Safe Environment
  • Assist with Mobility
  • Fall Risk Reduction
  • Engage Client and Family
39
Q

Restraints

A

 Refers to the physical, mechanical, or environmental means which are intended to prevent injury, manage responsive behaviors or physical movements which could cause bodily harm to the client or others
 Any one of numerous methods used to limit a client’s freedom of movement or immobilize the client

40
Q

Physical restraint:

A

 Attached to the patients body
 Cannot be removed easily by the patient
 Restrict patient’s movement
 Wrist restraint, vest restraint, waist restraint

41
Q

Guidelines related to use of restraints

A

 Attempt other methods
 Obtain an adequate history
 Conduct a physical exam
 Explain the plan to patient and caregiver
 Document rationale for use and use least restraint
 Adhere to applicable regulations, laws, and employer policies

42
Q

Mechanical restraints

A

 Any device, material, or equipment attached to or near a client which cannot be easily removed by the client and involuntarily restricts the client’s freedom of movement or normal access to his or her body.

43
Q

Environmental restraint

A

 Any barrier or device that limits or controls the locomotion of a client and thereby confines them to a specific geographic area or location
 This does not include a secured entrance to the unit or facility, or to a neighborhood (long term care).

44
Q

Side-effects of restraints

A 
	Decreased cognitive performance
	Increased confusion 
	Decrease in function- Muscle and bone atrophy
	Decreased walking ability
	Worsening pressure ulcers 
	Chronic constipation 
	Incontinence 
	Emotional distress, including loss dignity and independence, dehumanization, increased agitation and depression. 
	Increased behaviors
	Pain &injury
	Infection
	Hydration & nutritional status alterations
45
Q

Restraint alternatives

A

 An intervention that is used in place of or reduces the need for a restraint device

46
Q

Examples of restraint alternatives

A
  • Therapeutic management techniques
  • Bed/chair alarms
  • Hip protectors
  • Mattress on floor/low bed
  • Wander alert system, TABS monitor
  • Assistive rails
47
Q

Potential risks of bed rails

A 
	Bodily injury
	Skin bruising, cuts, scrapes
	Agitated behavior
	Fractures
	Strangulation
	Suffocation
	Feelings of isolation
	Feeling restricted
	Preventing the performing of regular activities
	Death
48
Q

Codes and their meanings

A 
	Code Blue….cardiac arrest/medical emergency
	Code red….fire
	Code white….violent patient
	Code yellow…missing patient
	Code green….evacuation
	Code orange…environmental disaster
	Code brown….chemical spill
	Code black….bomb threat
	Code purple…hostage taking

CNUR 103 (11 decks)

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