OSCE: RESP Care Scenario Flashcards
(31 cards)
Discuss what you would do during the respiratory assessment.
1) Pull down gown
2) Visualize breathing
3) Auscultate directly on skin (not over the gown, but under it)
- Assess anterior AND posterior lung fields
- Listen to the lower lobes
- Assess for decreased air entry, adventitious sounds
- Compare bilaterally
When should a respiratory assessment be conducted?
In the morning head-to-toe assessment and as needed.
Monitor pt ongoing and as needed
Ex: you did resp assessment in morning but hours later, your pt complains of SOB, you need to redo your resp assessment
What does pulse oximetry tell you?
It measures how much oxygen is in the arterial blood system at any given time
- It describes the % of hemoglobin that’s filled w/ oxygen
- The finger probe is used to measure SPO2
What does a high SPO2 mean?
The higher the SPO2, the more hemoglobin is saturated w/ oxygen in the pt’s arterial blood system
What are the difficulties with pulse oximetry?
- Nail polish
- Cold extremities
- Impaired circulation
True or false: if you increase or decrease the pt’s O2, the change is prominent pretty quickly
True
Secs to mins
When are nasal prongs (NP) used?
It’s used for low O2 needs
What is the target SPO2 in KGH?
In general, KGH’s target is usually 92%, however, this depends on the pt and doesn’t apply to everyone (check their Kardex!)
What is the policy in regards to NPs?
We can go up to 6L/min
Start off low, though (ex: 1L/min). If it doesn’t work, reevaluate then increase the amount until you reach the target
Low O2 needs are best for nasal prong. If pt requires higher, consider using another method other than nasal prongs
As we get higher, it gets more uncomfortable for pts (hard on their mucous membranes -> drying and cracking)
As we get higher, it gets more uncomfortable for pts (hard on their mucous membranes -> drying and cracking). What is something to keep in mind when this occurs?
DON’T apply Vaseline to your pt’s face when they’re on oxygen!
- Petroleum-based products are highly flammable in the presence of O2. They can react violently and cause burning
True or false: if your pt’s O2 levels are critically low, you would need to consider the most effective treatment methods given the circumstances. Thus, nasal prongs will not ALWAYS be your first approach!
True
What are oxygen flowmeters? How do they work?
It’s oxygen usually on the wall behind the pt’s bed
1) Connect tubing to the bottom (it’s green) of it then incr or decr oxygen
- Not to be confused w/ another one attached to the wall that looks like it. That one is hospital air
2) Once tubing it attached, make sure to tighten up dial so no O2 leaks
3) Then turn the dial to the correct # (ex: 1L/min).
4) Increase O2 gradually and monitor effects. You don’t want to provide more O2 than is required
5) Sit/boost your pt up in bed to assist w/ O2 status
6) Encourage pt to breathe in through their nose
7) Encourage pt to cough and clear secretions
Discuss the NP application.
1) “Macaroni” noodles” points down
2) Wrap tubing around the back of the ears
- Don’t wrap the tubing around the back of the pt’s head (strangulation risk)
3) Tighten comfortably under chin
When are venturi (venti) masks used?
Switch to this device from NPs if your pt requires high O2
What are the pieces that come in the venti mask package?
1) Face mask w/ attachment on the bottom & an elastic band on the back.
2) Straight tubing w/ connector ends on each end
3) Blue corrugated tubing which connects to bottom of the face mask
- Need to add adaptor at the other end (different kinds)
• They come down to a little point where you connect the tubing
• Flow rate & O2 conc is imprinted in the base of adaptors for easy reference
• Blue = lowest O2 conc; orange = highest
A chart comes with the venti mask kit. What does it do?
A chart comes w/ the kit which says the recommended flow (colour of adaptor; flow rate you need to run through the O2 flow meter so you get the specified O2 conc in the last column
Ex: if you were to connect the blue adapter, you would need to be running O2 at 4 litres/min that give you a final of 24% being delivered to the pt
Keep in mind the conversion factor of if you’re using NP, what the NP L/min % Is equal to
- Ex: pt is on 1L/min NP, that = 24% which is equivalent to using the blue adaptor
- Ex: pt at 5L/min NP, that’s gonna show 40% O2 conc through the NP, which is equivalent to the pink adaptor at 8L/min
- Orange = highest conc at 10L/min for 50%
Blue: 4L = 24% Yellow: 4L = 28% White: 6L = 31% Green: 8L = 35% Pink: 8L = 40% Orange: 10L = 50%
What are the conversions of NP to % O2?
Conversions of NP to % O2
- 1L/min = 24 %
- 2L/min = 28 %
- 3L/min = 32 %
- 4L/min = 36 %
- 5L/min = 40 %
- 6L/min = 44 %
Example: you have to apply a venti mask with an orange adaptor (10L/min for 50% O2.
1) The holes in the adaptor allow room air to mix in with O2 that comes through centre of O2 tubing that’s connected
2) Connect adaptor to end of face mask blue tubing
3) Then connect the smaller O2 tubing to the adaptor and connect the other end to the wall
4) Dial up O2 to 10L
5) Attach mask to pt and tuck band behind head
What are small-volume nebulizers? What can we expect to provide through these nebulizers?
Nebulization is when you add med or moisture to the inspired air. It converts the drug into a mist which is then inhaled
- It allows meds to work locally in the lungs
We can expect to provide bronchodilators, mucolytic and corticosteroids through this method
What is something to look out for when giving nebulizers?
Meds can also be absorbed systemically, so be mindful of systemic effects
- Ex: Ventolin systemic effects = increased HR
When are nebulizers used?
Can be a duel order in the MAR
- May need to take med through MDI, but if that’s not working for them, you can then provide med through nebulizer (ex: order says puffer/neb)
They can be routine and/or PRN
- If on PRN, keep note of how often it’s being used, if they’re actually helping & how are they sounding after they use it compared to before use
True or false: since nebulizers are meds, the 3 med checks and med rights need to be done.
True
Nebulizer meds look & work the same way in clinical practice
- We have squeeze tubes which have a label at the front
- They are liquid meds
- It’s a twist off lid & you just squeeze it into the neb device
What are the supplies you’ll need when giving nebulizers?
Face mask (doesn’t have the blue tubing)
Nebulizer (twist off the top and put med inside)
Blue piece of the O2 tubing connects to the nebulizer
A patient is ordered to have 5mg of Ventolin and 250mcg of Atrovent provided through a nebulizer. Discuss the steps from start to finish.
1) Check compatibility first!
2) Get both meds (come in 1 tube each)
3) Twist lid off of nebulizer then twist off lid of one of the meds and squeeze inside neb.
- Do the same for the other med
4) Close neb lid
5) Connect neb to mask then connect the blue end of the tube to bottom of blue nebulizer. Then connect tube to wall (MEDICAL AIR, not oxygen)
6) If pt already has NP, you can leave it on
7) Put on mask
8) Increase the dial until you see a good mist coming out
9) Pt will be inhaling which lessens mist
- Encourage pt to take slow deep breaths
- The neb will break the med into a fine mist that the pt can inhale
11) You can flick the nebulizer if you see bubbles arising
12) It will take 10-15 mins for all the liquid to be gone
- Turn off air and take off mask
13) Reassess pt
- Full resp assessment
- See how they’re breathing now vs before
- Did it help?
14) Know which meds will assist w/ resp status of pt
- If pt has PRN meds ordered, they can be given in relation to the last PRN given
- Ex: on MAR, PRN is every hr for both those meds via neb so last was given at 6:30 so you can give it at 7:30 IN ADDITION to regularly scheduled neb med
15) Document
