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NRSG 202 > week 2 - high flow oxygen, sputum collection, airways > Flashcards

week 2 - high flow oxygen, sputum collection, airways Flashcards

1
Q

What are the benefits to high flow oxygen devices?

A
  • FiO2 delivery consistent/ predicable
  • humidified
  • flow exceeds peak inspiratory needs, FiO2 not affected by ventilatory pattern changes
  • can be single or double flow
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2
Q

describe humidifiers

A
  • devices that add water vapor to inspired air/ oxygen
  • water vapor can be cool or heated
  • should use sterile water
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3
Q

what are humidifiers designed to do?

A

add moisture to the mucous membranes and loosen secretions

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4
Q

describe double flow system

A
  • 2 oxygen flowmeters deliver oxygen, one at 15L/min and other according to needs
  • system joined by a “100% O2 tee” > has port to connect line from second flowmeter
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5
Q

what is another name for aerosol masks?

A

venturi mask

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6
Q

describe aerosol masks

A
  • administers specific FiO2

- used for precise medium FiO2 delivery

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7
Q

in regards to aerosol masks how is the specific FiO2 determined?

A

by air entrainment port on nebulizer

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8
Q

What does the exhalation ports in the aerosol masks allow?

A

patient to breath in air form the room if the oxygen is inadequate

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9
Q

What does the Star Wars mask look like and ensure?

A
  • aerosol mask + 2 6inch pieces of corrugated tubing attached to reservoirs
  • ensures client receives less air from exhalation ports
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10
Q

describe the Star Wars mask

A
  • delivers precise higher FiO2
  • generally requires double flow system
  • ensure flow meter(s) set as direct by RT
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11
Q

describe a trach mask

A
  • placed around neck/ tracheostomy to ensure adequate oxygen/ humidification delivery
  • single or double flow
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12
Q

What should a “T”-piece have?

A

6 inch reservoir tubing attached to the other side of the “T”

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13
Q

What is a “T”-piece used for?

A
  • to attach to endotracheal tubes or tracheostomy tubes

- single or double flow

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14
Q

to effectively deliver bronchodilators to patient, what should you use?

A

metered dose inhaler (MDI) with an aerochamber and mask adaptor if needed

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15
Q

What should not be added to a high flow device?

A

bronchodilators > ineffective

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16
Q

if a patient is on high flow what does this mean if they need to be transported?

A
  • can’t be transported with high flow O2 devices
  • collaborate with RT or physician
  • NRM may be an option
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17
Q

if a patient is on high flow and they want to eat what does this mean/ look like?

A
  • may need to disconnect temporary
  • apply nasal prongs at 6L/min
  • have mask beside patient to use between bites
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18
Q

if a patient is on high flow and they want to eat what does this mean if on a double flow system?

A
  • leave set up

- use portable 02 tank for nasal prongs

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19
Q

Who usually sets up a high-flow oxygen system?

A

RT

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20
Q

describe oxygen concentrators

A
  • removes nitrogen/ other agents to purify air
  • generate medical grade oxygen
  • unlimited supply as long as battery has power
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21
Q

describe oxygen tanks

A
  • limited amount of oxygen compressed in them
  • inhaled by user until run out
  • refillable
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22
Q

What is the equation to calculate how much time is left in an O2 tank?

A

PSI ____ x conversion factor divided by L/min client requires

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23
Q

You are transporting your patient, who has emphysema, from your unit to radiology for a CXR. Without oxygen at 6 L/min, your patient’s O2 saturation on room air drops to 86%. It will take you approximately 30 minutes to get there, have the CXR and get back to the ward. The portable O2 tank you grabbed has 500 psi left in it with a conversion factor of 0.28. Do you have enough oxygen in the portable tank for the trip?

A

psi X conversion/ L/min

500x0.28/6L/min

23mins

do not have enough time

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24
Q

describe optiflow/airvo oxygen therapy

A
  • high flow oxygen delivery system

- used for clients with profound hypoxemia/ mucociliary clearance difficulties

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25
Q

What does optiflow/airvo oxygen therapy provide?

A
  • heated/ humidified gas at 37 degrees at low and high flows through nasal, mask or tracheostomy interface
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26
Q

What does optiflow/airvo oxygen therapy simulate?

A
  • balance of temp/ humidity that occurs in healthy lungs

- aids in proper secretion management/ clearance

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27
Q

in regards to optiflow/airvo oxygen therapy describe the adult nasal interface

A
  • comes in 3 sizes (small, med, lrg)

- should not be more than 1/2 the diameter of clients nares

28
Q

What are the ranges for optiflow?

A

flow range
10-60L/min

FiO2 range
0.28-1.0

29
Q

What are the ranges for Airvo 2?

A

flow range
2-60L/min

FiO2 range
0.21-1.0

30
Q

What are the benefits of optiflow/airvo?

A
  • more confortable
  • clients can eat/ drink
  • precise O2 concentration
  • decreased WOB
  • promotes ciliary movement/ secretion clearance
31
Q

What are the benefits of the heat and humidity of optiflow and airvo?

A

prevents:

  • airway water loss
  • airway cooling
  • thickened secretions
  • nasal irritation/ bleeding
32
Q

Can optiflow and airvo be used as an adjunctive therapy? With that?

A
  • yes

- in treatment of respiratory failure, distress or oxygen failure

33
Q

What are indictions of optiflow and airvo use?

A
  • difficulty with much-ciliary clearance
  • client can’t tolerate partial re-breather mask
  • clients with airborne precautions who require increased O2 levels without aerosol particles being generated
34
Q

describe the initiation of optiflow/ airvo oxygen therapy

A
  • requires doctor order
  • intimated by RT or CCN only
  • maybe initiated by RN in rural areas that do not have RT or CCN on site
35
Q

describe titration of optiflow/ airvo oxygen therapy

A
  • titrated by RT or CCN only

- maybe titrated by RN in rural areas that do not have RT or CCN on site

36
Q

what will the RT and CCN monitor in regards to optiflow/ airvo oxygen therapy?

A
  • very pending on client status

- must be monitored by RT or CCN at least once every shift

37
Q

what will the RN monitor in regards to optiflow/ airvo oxygen therapy?

A
  • resp assessment/ vital signs every 4hrs or PRN for first 24hrs
  • after 24hrs monitor less determined by team
  • changes in WOB, oxygenation
  • setting, flow, temp and sterile water bag at least every 4hrs
38
Q

while monitoring a client on optiflow/ airvo oxygen therapy the RN notices trending of cardiorespiratory decline what do they do?

A

notify RT or CCN and MRP as required

39
Q

while monitoring a client on optiflow/ airvo oxygen therapy the RN should be looking at what regarding the humidifier?

A

should be on the invasive mode unless client has a trach or aerosol mask on

40
Q

optiflow/ airvo oxygen therapy documentation should include what?

A
  • resp assessment
  • cardiovascular assessment
  • VS and O2 SAT
  • FiO2 setting
  • flow rate setting
  • settings/ functions verified/ documented every 4hrs
41
Q

in regards to optiflow/ airvo oxygen therapy what does respiratory medication look like?

A
  • contact RT if required support of best route for delivery

- if RT contact not available administer via MDI with spacer

42
Q

in regards to optiflow/ airvo oxygen therapy what does transporting a client look like?

A
  • not usually transported with optiflow/airbo

- contact RT to accompany client if RT not available RN must accompany

43
Q

in regards to optiflow/ airvo oxygen therapy what needs to be taken into consideration in regards to rates of FiO2?

A
  • low FiO2 less than or equal to 0.40
  • may use NP, bi-flow mask, or SM per client requirements
  • rates of high FiO2 >0.40 should use NRM
44
Q

describe infection control for oxygen therapy

A
  • all O2 equipment is single patient use
  • label all equipment with date/ patient name
  • change equipment when visibly soiled
  • change large volume nebulizer bottle/ water q24hrs
  • change aqua pack system q7 days
  • prefilled bottles used until empty then changed
  • change nebulizer tubing/ mask weekly/prn
  • don’t drain water back into bottle from corrugated tubing
45
Q

what does nursing care include for oxygen therapy?

A
  • clean face mask
  • assess straps, label
  • observe for pressure sores
  • complete resp assessment
  • ensure high flow devices have adequate sterile water/ assess setting level
  • assess tubing for excess water/ empty as needed
46
Q

what does discontinuation for optiflow/airvo look like?

A
  • requires doctor order
  • discontinued by RT/ CCN only
  • can be discontinues by RN in rural setting if RT or CCN not available
47
Q

What is the discontinuation for optiflow/airvo implemented?

A
  • when FiO2 is less than 0.4 and set flow is less than 20L/ min
  • O2SAT within acceptable limits
48
Q

why are oral and nasal airways inserted?

A

to maintain a patent air passage for clients whose airway has become or may become obstructed by secretions or tongue

49
Q

describe oral and nasal airways

A
  • easy to insert to
  • low risk of complications
  • various sizes
  • nasal needs to be lubricated before insertion
50
Q

When should oropharyngeal airways be used?

A

can stimulate gag reflex so should be used on clients with altered level of consciousness

51
Q

What are things that should and shouldn’t be done with a oropharyngeal airway

A
  • do not tape airway in place
  • mouth care every 2hrs or per protocol
  • can use suction if needed
  • remove/ assess mouth every 8hrs
52
Q

how do you insert an oral airway?

A
  • wash hands/ use gloves
  • place client in supine/ semi fowlers
  • airway distal tip pointing up, open mouth/ insert airway along tongue
  • when distal end reaches soft palate rotate 180 degrees
53
Q

how do you measure the oral airway for an oral airway?

A

measure oral airway from the centre of the mouth to angle of the jaw or form the corner of the mouth to the earlobe

54
Q

describe nasopharyngeal airways

A
  • nasal airways tolerated better
  • insert through nares
  • provide frequent oral/ nasal care
  • reposition airway in the other name every 8hrs if required
55
Q

how do you insert a nasopharyngeal airway?

A
  • wash hands/ use gloves
  • place client in supine/ semi-fowlers
  • lubricate nasopharyngeal airway with water soluble lube
  • insert into the nostril vertically along the floor of the nose with a light twisting action
  • aim towards to back of the opposite eyeball
56
Q

how do you measure the nasopharyngeal airway for an oral airway?

A
  • form the clients earlobe to the tip of the nostril

- make sure the diameter of the airway is not larger than the nostril

57
Q

What is sputum?

A

mucous secretion from the lungs, bronchi and trachea

58
Q

how do you collect a sputum sample?

A
  • client needs to breathe deeply/ cough up to 15-30mL of sputum into container
  • specimens transported to lab
  • document
59
Q

What are the different types of sputum collection?

A
  • sputum for C&S
  • cytology
  • AFB (acid-fast bacillus)
  • sputum to assess for effectiveness therapy
60
Q

in regards to the different types of sputum collection, describe sputum for C&S

A

identify organisms and drug sensitivities

61
Q

in regards to the different types of sputum collection, describe cytology

A
  • identify origin, structure, function, and pathology of cells
  • often requires serial collection of 3 early morning specimens
62
Q

in regards to the different types of sputum collection, describe AFB (acid-fast bacilllus)

A
  • requires serial collection often 3 consecutive days

- test for TB

63
Q

When is the best time to collect a sputum sample?

A
  • in the morning prior to breakfast

- offer mouth care do not use mouth wash

64
Q

After collecting a sputum sample what do you need to label the container with?

A
  • clients label
  • date/ time of collection
  • collection source (sputum)
  • required test
65
Q

after collecting a sputum sample what do you need to document?

A

sputum collection including:

  • amount
  • colour
  • odour
  • consistency
  • presence of hemoptysis

NRSG 202 (11 decks)

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