Week 2: Oxygenation

Question 1

What is included in a standard respiratory assessment?

Answer 1

Difficulty breathing?
SOB at rest or ambulating?
Cough/sputum?
Nailbeds/Mucous membranes pink?
Breath sounds clear/equal?

Question 2

What is included in a focused resp assessment?

Answer 2

General appearance
color (central/peripheral)
RR/rhythm/depth
resp effort/dyspnea
tracheal position/thorax
chest expansion/symmetry
Cough/sputum production
Breath sounds
adventitious sounds
O2 Sat
O2 therapy/CT/CPAP/Trach

Question 3

Examples of adventitious sounds?

Answer 3

Crackles (rales)
Death Rattle
Pleural Friction Rub
Rhonchi/Sonourous wheeze
Stridor
Wheeze: sibilant/sonorous

Question 4

Examples of abnormal respiratory patterns?

Answer 4

Cheye Stokes breathing
Kussmaul Breathing
Agonal or Guppy breathing

Question 5

High flow oxygen inspiratory flow

Answer 5

Met/exceeded

Question 6

High flow oxygen ventilatory rate

Answer 6

does NOT affect FiO2 - more predictable

Question 7

How is high flow Oxygen measured?

Answer 7

In % (titrate 5-10%)

Question 8

Types of high flow oxygen devices?

Answer 8

Aerosol/Star Wars/Venturi/Trach Masks/Face Tent/T-piece/Airvo/Optiflow

Question 9

Low flow inspiratory

Answer 9

Flow is not met

Question 10

Low flow oxygen ventilatory patterns

Answer 10

Influences FiO2 - more variable

Question 11

How is low flow oxygen measured?

Answer 11

in L/min (titrate 1-2L)

Question 12

Examples of low flow oxygen devices?

Answer 12

NP, Simple mask, Non rebreather mask

Question 13

How often does an AquaPak Humidified O2 system need to be changed?

Answer 13

Q7 Days

Question 14

What is the air entrapment port for AquaPak Humidified O2 System?

Answer 14

28-98 FiO2

Question 15

What does the aerosol mask do?

Answer 15

Administers a specific FiO2 (determined by air entrapment port)

Question 16

What does the corrugated tubing do in an aerosol mask?

Answer 16

collect moisture

Question 17

What do exhalation ports do in an aerosol mask?

Answer 17

Allow air from the room if the oxygen were to be inadequate

Question 18

What is a Star Wars mask?

Answer 18

regular aerosol mask with two pieces of 6” corrugated tubing used a reservoirs on either side

Question 19

What does the Star Wars mask generally require?

Answer 19

A double flow system

Question 20

What is a trach mask?

Answer 20

Placed around the neck and tracheostomy (or stoma) to ensure adequate oxygen and humidification delivery

Question 21

What is the FiO2 with trach mask

Answer 21

imprecise (single or double flow)

Question 22

What is the T - piece?

Answer 22

Attach to endotracheal tube or tracheostomy tube
- single or double flow
- PRECISE FiO2

Question 23

What is nursing care with oxygen devices?

Answer 23

Label equipment (name + date)
clean masks/prongs
assess straps
observe for pressure sores
resp/cardio assessment
adequate sterile water
assess tubing and empty excess water PRN

Question 24

What are some difficulties with the older styles of High Flow Oxygen?

Answer 24

1. Transporting patients
2. Eating
   - NP at 6L or mask in between bites
3. Speaking
4. Comfort

Question 25

What is an optiflow/airvo for?

Answer 25

Used for client with profound hypoxemia and/or mucociliary clearance difficulties

Question 26

What is the temp for gas with an optiflow?

Answer 26

Heated and humidified at 37 degrees

Question 27

Benefits of optiflow/airvo?

Answer 27

NOT an AGMP more comfortable pt can eat and drink precise O2 concentration decreased WOB promotes ciliary movement and secretion clearance

Question 28

Airvo 2 flow range

Answer 28

2-60l/min

Question 29

Airvo 2 FiO2 range

Answer 29

0.21-1.0

Question 30

Optiflow flow range

Answer 30

10-60 L/min

Question 31

Optiflow FiO2 range

Answer 31

0.28-1.0

Question 32

How to calculate how long a cylinder will supply O2 to your patient

Answer 32

Psi x 0.28/ L/min

Question 33

What is PSI?

Answer 33

What's left in the tank

Question 34

What patients is the oropharyngeal airway used on?

Answer 34

Only patients with altered LOC (stimulates gag reflex)

Question 35

How often is mouth care provided with oropharyngeal

Answer 35

Q2H or as per protocol (may need suctioning PRN)

Question 36

How often does oropharyngeal need to be pulled out and assessed?

Answer 36

Q8H

Question 37

How to measure the oral airway

Answer 37

1. Center of mouth to angle of jaw 2. from corner of mouth to earlobe

Question 38

Steps to insert oral airway?

Answer 38

INVERT, INSERT, ROTATE, LOCATE

Question 39

What patients get the nasopharyngeal route

Answer 39

more alert clients (tolerated better) - NOSY NANCY

Question 40

How often should the nato airway be repositioned If required?

Answer 40

Q8H

Question 41

How to measure nasal airway

Answer 41

clients earlobe to tip of nostril

Question 42

steps to insert nasal airway

Answer 42

1. Done gloves 2. Measure 3. Lubricate 4. Along nostril floor slight twist towards back of opposite eyeball

Question 43

What is a tracheostomy

Answer 43

An opening made for a tube via a surgical incision in the trachea just below the larynx

Question 44

Components of a trach tube?

Answer 44

Outer cannula with flange inner cannula obturator

Question 45

What is a cuffed trach

Answer 45

have inflatable cuff that provides airtight seal between tube and trachea

Question 46

Assessment pieces of a pt w a trach?

Answer 46

Focused resp presence of drainage appearance of stoma (redness, swelling, purulent, door)

Question 47

When are chest tubes indicated?

Answer 47

1. Pressure on lung interferes with expansion 2. when negative pressure needs to be restored 3. when air or fluid needs to be drained 4. maybe for chronic conditions

Question 48

Where are chest tubes generally inserted?

Answer 48

Upper anterior thorax for pneumothorax and lower lateral chest wall for fluid

Question 49

how often should chest tube site be assessed?

Answer 49

Q4H

Question 50

Safety beside equipment for chest tubes

Answer 50

2 clamps (non tooth) sterile water vaseline gauze 4x4 sterile dressing waterproof tape

Question 51

What is sputum

Answer 51

Mucous secreted from the lungs, bronchi, and trachea

Question 52

What is cytology for sputum collection

Answer 52

identify origin, structure, function, and pathology of cells

Question 53

What is AFB for sputum

Answer 53

Acid Fast Bacillus: a type of bacteria that causes TB requires serial collection often for 3 consecutive days (test for TB)

Question 54

What is FiO2?

Answer 54

The concentration of oxygen being inhaled by the patient