Week 9: Mechanical Ventilation - Start of Exam 3 Flashcards
Oxygen
A medication that needs an order to survive
Can have standing orders though or use in emergent situations
At what concentrations is O2 administered
ones higher than RA so greater than 21%
Goals of O2 Therapy
Decrease Workload of heart and lungs
Increase tissue perfusion
Adequate transport of O2
Nasal Cannula
low flow (1-5 L at 24-40%/ 6L at 44%) or high flow (10-15 L at 65-90%) device where nares need to be in the nose to work
Can be an issue with mouth breathers
air can be humidified or non-humidified
What is are important nursing interventions for nasal cannula?
Watching for COPD patients as their O2 goal is 88-92 %
Knowing that high flow nasal cannula are often better tolerated by children
Simple Mask
Has tubing like the nasal cannula but has vents that allow the exhaled CO2 to escape
A low flow device at 5-8 L/min at 40-60%
Nursing intervention/consideration for a simple mask
May need nasal cannula at meals
Those with calustrophobia hate the feeling
Partial Rebreather Mask
Has a reservoir bag for part of the patients exhaled air while also having vents like the simple mask allowing remained exhaled air to escape
Exhaled air trapped in bag mixes wiht 100% O2 for next inhalation so you rebreathe 1/3 of expired air allowing for O2 conservation
Also, the vents allow breathing in room air too if somehow O2 from the flowmeter is interrupted
BREATHING OUT SOME AIR BUT A MIX OF RA AND O2 COMES BACK
Does low flow 8-11 L at 50-75%
Nursing intervention for a partial rebreather mask
watching for kinks in bags and tubing
skin checks
Nonrebreather Mask
similar to partial rebreather but it has 2 one way valves not allowing any exhaled air rebreathing - only supplied O2 gets into the bag
need to plug the vent so bag fills with O2 and they do not suffocate
does Low flow 10-15 L at 80-95%
Which oxygen delivery system delivers the highest O2 concentration
Nonrebreather at 80-95% as no rebreathing of exhaled air occurs
Venturi Mask
Has a large tube with an O2 inline allowing pressure to drop and air to build up in side ports
Ports can be adjusted for very precise O2 concentration but need to be open (the liters and % on each venturi mask part)
What is the exception for COPD patients for O2 delivery systems
Venturi Mask
The most precise O2 delivery comes from what device
Venturi Mask
What are some other methods of O2 Therapy (beside delivery devices)
Nebulizer
IPPB
CPAP
Bi PAP
Ventilator
Nebulizer
Used to ain in bronchial hygiene by hydrating dried secretions, promoting expectoration of secretions, humidifying inspired O2 and delivering medication deep into lung fields
Can be with or without medication delivery
IPPB - Intermittent Positive Pressure Breathing
A machine that administers either RA or O2 at a pressure higher than atmospheric pressure
It also aids in delivery of inhaled medication like a nebulizer does
How does the Nebulizer and IPPB compare
Neither is better than the other, but IPPD can be used to treat atelectasis and promote airway clearance, especially in those not doing well with IS or chest physiotherapy
PAP - Positive Airway Pressure
a method of O2 therapy used to keep airways open by use of mild air pressure
can be used for sleep apnea including OSA, heart failure, and obesity hypoventilation syndrome
NIPPV
noninvasive positive pressure ventilation
includes PAP
2 types: BiPAP and CPAP
What patients is NIPPV good for
those who cannot undergo intubation or invasive ventilation with the goals of decreasing the work of the respiratory muscles and relieve dyspnea
CPAP - Continuous positive airway pressure
method to keep airways open by providing constant mild air pressure
it helps hold the airway open, mobilize secretions, treat atelectasis, and ease work of rbeathing
BIPAP - Bi Level Positive Airway Pressure
(Pressure Support Ventilation)
NOT a continuous set of pressure - there are 2 pressure settings
Amount og pressure provided changes whether patient is in inspiration or expiration and is indepenently adjusted for each
When does BIPAP deliver higher pressure and lower pressure?
Higher Pressure =Inspiration
Lower Pressure = Exhalation