Lab 11 - Oxygen Titration

Question 1

Describe simple face mask flow rate and approx FiO2

Answer 1

-Set up 5-8L/min (40-60% FiO2) -> variable performance device (estimated FiO2)
-Short term use as cant eat, drink or talk with it on
-Never have below 5L/min because their will be CO2 build up in the mask because it does not filter properly (watch for drowsiness)
-See short term after surgery

Question 1

Describe nasal prongs flow rate and approx FiO2

Answer 1

-Need to face into the nares
-Can deliver up to 6L/min (44%)
-Estimated FiO2 (variable performance device)
-More comfortable and can still eat on them, cheap, easy to titrate
Disadvantages:
-Don’t want patients smoking on them
-Can get skin breakdown under nose or behind ears (no lying on tubing)

Question 2

Describe venturi mask flow rate and approx FiO2

Answer 2

-Fixed performance device and will give exact FiO2 by using colored ports
-Has a medication port you can take the colored port out to give inhaled medications (remember to return port after)
-Cant eat on it but can drink by putting straw through a hole
-Difficult to adjust (need 2 free hands to adjust and need port pieces in a pocket)
-Delivers low to moderate FiO2 (24-55%)

Question 3

Describe non-rebreather mask flow rate and FiO2

Answer 3

Non-rebreather mask:
-Can be set 10-15L/min and need bag 2/3 filled up or else they are not getting oxygen (60-90% FiO2 -> variable performance device)
-If see patient with it they are very sick and they are critically ill (bad sign) and should not do anything with them

Question 4

Describe oxymizers flow rate and approx FiO2

Answer 4

NOTE: Not usually available in acute care but a patient may bring one in with them

Question 5

Describe bag valve mask

Answer 5

Bag valve Mask (manual resuscitation bag):
-Emergency device because patient status is deteriorating
-Fills to 100% oxygen (depends on how good the seal is) and patient does not need to be breathing spontaneously as it delivers breaths for the patient
-The mask can come off and tach to a tracheal tube
-May also be used if electricity goes down

Question 6

Describe high flow face mask FiO2 and flow rate

Answer 6

-Gives close to 100% oxygen and like the venturi you can pick the import to give a specific FiO2 (fixed performance device)
-Cannot put patient on this (doctor has to order it and RT applies it -> mechanical ventilation also same thing)

Question 7

Describe nasal high flow therapy flow rate and approx FiO2

Answer 7

Question 8

What are some additional considerations of oxygen administration and titration

Answer 8

Question 9

What is the purpose of medical orders with oxygen admin and titration

Answer 9

Question 10

What is the criteria that needs to be met for long term oxygen use

Answer 10

Question 11

What variable and fixed oxygen device would you use for low, moderate and high desired FiO2 levels

Answer 11

Question 12

What is the criteria needed to be able to switch the type of oxygen device being used

Answer 12

-You must be authorized/rostered
-Hospital policy
-Oxygen ordered by doctor or nurse
-Need to use clinical reasoning

Question 13

Answer 13

2LNP: 2 L nasal prongs

1. Chart -> blood pressure (vitals), medications, pre, during and post surgery notes, medical history, baseline mobility, need to know if she is on oxygen at baseline, smoker, pain levels -> on oxygen because was on anaesthesia and may have post-op atelectasis
2. Vitals, SPO2, IPPA, Postural Control, ROM, weight shifting activities/sit-to-stand, strength, 4+1 assessment, sensory screen (myotome/dermatomes)
3. Oxygen tank and nasal prongs because there is enough wiggle room when she is doing exercise (delivers up to 6L) and is sitting comfortably at 96% -> reassess when sitting, standing, and having them weight shifting to ensure no changes
4. Gait aid, wheel chair, simple face mask/non-rebreather, stat monitor 
5. No her vitals are still within normal range and she is feeling fine but will continue to monitor. Don’t want to give too much as oxygen induced hypercapnia and trying to ween patient off oxygen.
6. Her vitals are still fine I wouldn’t make any adjustments. SPO2 is fine and her HR is at a level normal for doing activity, normal SOBOE
7. Yes PTA can perform if delegated by us and she is stable (as long as you are rostered). Would go through precautions/specific parameters (monitor SPO2, give distance and if drops below 94% then stop) and giving  and steps at the beginning and ensure they are comfortable with doing it. Then get them to check in after to let you know how things go and also you can check in on the patient after also. 8. Would take more precautions with exercise and walking because they will have a lower cardiac reserve. Wouldn’t have PTA walking them, would do it myself. Would ensure have a device for emergencies in case oxygen levels dip. Any change in medical status you need to look at the orders.

Question 14

Answer 14