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

Question 1

Ventilation

Answer 1

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

Question 2

Diffusion

Answer 2

exchange of 02 and C02 in alveoli

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

Question 3

Transportation

Answer 3

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%)

Question 4

Impaired ventilation

Answer 4

• 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

Question 5

Impaired Diffusion

Answer 5

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

Question 6

Impaired transportation

Answer 6

• Anemias, hemorrhage
• Decreased cardiac output
• Pulmonary embolism

Question 7

Symptoms of hypoxemia

Answer 7

• 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

Question 8

Blood gas analysis

Answer 8

Taken most often from the radial artery

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

Question 9

 Respiratory Rate x Tidal Volume = Minute Ventilation

Answer 9

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

Question 10

Low flow O2

Answer 10

 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

Question 11

High flow O2

Answer 11

 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

Question 12

Nasal prongs

Answer 12

	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.

Question 13

Simple mask

Answer 13

 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

Question 14

Face tent

Answer 14

(trauma/burns/unable to wear cannula)

Question 15

Venturi device

Answer 15

 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

Question 16

Non-rebreather

Answer 16

 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

Question 17

Cold nebulizer

Answer 17

 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

Question 18

Misty Ox

Answer 18

 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

Question 19

Optiflow system

Answer 19

 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.

Question 20

Things impacting which O2 delivery we choose

Answer 20

 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.

Question 21

Incentive spirometry

Answer 21

	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

Question 22

Pursed lip breathing

Answer 22

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

Question 23

Stationary concentrator

Answer 23

• 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

Question 24

Portable O2 concentrator

Answer 24

• separates nitrogen and concentrated on oxygen for patient

- ran on battery – limitation is battery life

Question 25

Home fill station

Answer 25

- also concentrator – room air to high concentrated oxygen | - can fill a few tanks before going out

Question 26

Nx diagnoses for O2

Answer 26

 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

Question 27

Nx interventions for impaired O2

Answer 27

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

Question 28

Government initiatives for patient safety

Answer 28

- Quality Health Council | - Canadian Patient Safety Institute (CPSI)

Question 29

Near miss

Answer 29

- An event that is caught before it reached the patient

Question 30

Adverse event

Answer 30

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

Question 31

Critical incident

Answer 31

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

Question 32

Swiss Cheese Model

Answer 32

 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

Question 33

Domino effect

Answer 33

 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

Question 34

Iceberg model

Answer 34

 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

Question 35

Culture of safety

Answer 35

```  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 ```

Question 36

Enhancing a culture of safety

Answer 36

- Risk Management - Quality Improvement - Reporting - Disclosure Process - Interprofessional - Communication - Investigation:Root Cause Analysis

Question 37

Falls

Answer 37

 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

Question 38

SAFE

Answer 38

- Safe Environment - Assist with Mobility - Fall Risk Reduction - Engage Client and Family

Question 39

Restraints

Answer 39

 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

Question 40

Physical restraint:

Answer 40

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

Question 41

Guidelines related to use of restraints

Answer 41

 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

Question 42

Mechanical restraints

Answer 42

 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.

Question 43

Environmental restraint

Answer 43

 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).

Question 44

Side-effects of restraints

Answer 44

```  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 ```

Question 45

Restraint alternatives

Answer 45

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

Question 46

Examples of restraint alternatives

Answer 46

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

Question 47

Potential risks of bed rails

Answer 47

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

Question 48

Codes and their meanings

Answer 48

```  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 ```