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Respiratory Block: Chest Trauma > Oxygen Delivery, Ventilation and Intercostal Drains > Flashcards

Oxygen Delivery, Ventilation and Intercostal Drains Flashcards

1
Q

What is oxygen therapy?

A

Administration of oxygen at a concentration greater than that found in environmental atmosphere?

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2
Q

What is the concentration of oxygen at room air?

A

21% oxygen

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3
Q

What are some of the indications for oxygen therapy?

A
  1. Documented hypoxemia
  2. Severe respiratory distress (acute asthma or pneumonia)
  3. Severe trauma
  4. COPD (including chronic bronchitis, emphysema and chronic asthma)
  5. Smoke inhalation
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4
Q

What are some problems with O2 therapy?

A
  1. O2 toxicity
  2. Suppression of ventilation
  3. Danger of fire
  4. Infection
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5
Q

When can O2 toxicity occur?

A

Can occur with FlO2 >50% longer than 48 hours

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6
Q

In which patients is suppression of ventilation particularly problematic?

A

COPD patients

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7
Q

What does suppression of ventilation lead to?

A

Will lead to increased CO2 and carbon dioxide narcosis

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8
Q

Why is there a danger of fire with O2 therapy?

A

O2 is flammable

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9
Q

What is an important problem of O2 therapy in neonates?

A

RETROLENTAL FIBROPLASIA

- blindness due to vasoconstriction and ischemia (premature infants)

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10
Q

What is resorption atelectasis?

A

= alveolar collapse (when 100% oxygen is given)

  • No N2 left to splint alveoli once all O2 goes out
  • after approx. 15 minutes blood N2 is depleted
  • poorly ventilated and well perfused units become atelectatic
  • Don’t give 100% O2 unless you absolutely have to
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11
Q

What does FIO2 mean?

A

Fraction Inspired Oxygen

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12
Q

What amount of oxygen is delivered via nasal cannula?

A

Low flow: 24-44%

1-6L/min

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13
Q

Nasal cannula: what are the priority nursing interventions that should be followed?

A
  • check frequently that both prongs are in the clients nares
  • never deliver more than 2-3L/min to client with chronic lung disease
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14
Q

Advantages of nasal cannula:

A
  • client able to talk and eat with oxygen in place

- easily used in home setting

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15
Q

Disadvantages of nasal cannula:

A
  • may cause irritation to the nasal and pharyngeal mucosa

- if oxygen flow rates are above 6L/min variable FIO2

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16
Q

What amount of oxygen is delivered via simple face mask?

A

Low flow: 35-60%

6-10L/min

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17
Q

Simple face mask: what are the priority nursing interventions that should be followed?

A
  • monitor client frequently to check placement of mask
  • support client if claustrophobia is concern
  • secure physician’s order to replace mask with nasal cannula during meal time
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18
Q

Advantages of the simple face mask:

A

Can provide increased delivery of oxygen for short period of time

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19
Q

Disadvantages of the simple face mask:

A
  • tight seal required to deliver higher concentration
  • difficult to keep mask in position over nose and mouth
  • potential for skin breakdown (pressure, moisture)
  • wasting
  • uncomfortable for patient while eating or talking
  • expensive with nasal tube
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20
Q

What amount of oxygen is delivered via a partial rebreather mask?

A

Low flow: 75-80% oxygen

6L/min

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21
Q

Partial rebreather mask: what priority nursing interventions should be followed?

A
  • set flow rate so mask remains two-thirds full during inspiration
  • keep reservoir bag free of twists or kinks
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22
Q

Advantages of a partial rebreather mask:

A

Client can inhale room air through openings in mask if oxygen supply is briefly interrupted

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23
Q

Disadvantages of a partial rebreather mask:

A
  • requires tight seal (eating and talking difficult, uncomfortable)
  • not as drying to mucous membranes (because of reservoir bag)
24
Q

What amount of oxygen is delivered via a non-rebreather mask?

A

Low flow: 80-100%

6-15L/min

25
Q

Non-rebreather mask: what priority nursing interventions should be followed?

A
  • maintain flow rate so reservoir bag collapses only slightly during inspiration
  • check that valves and rubber flaps function properly (open during expiration)
  • monitor SaO2 with pulse oximeter
26
Q

Advantages of non-rebreather mask

A
  • delivers highest possible oxygen concentration

- suitable for patient breathing spontaneously with severe hypoxemia

27
Q

Disadvantages of non-rebreather mask

A
  • impractical for long term therapy
  • malfunction can cause CO2 build-up
  • suffocation
  • expensive
  • feeling of suffocation
  • uncomfortable
28
Q

What amount of O2 is delivered via a Venturi Mask?

A

Oxygen from 40-50%

4-15L/min

29
Q

Venturi mask: what priority nursing interventions should be followed?

A
  • requires careful monitoring to verify FIO2 at flow rate ordered
  • check that air intake valves are not blocked
30
Q

Advantages of a Venturi Mask:

A
  • delivers most precise oxygen concentration

- doesn’t dry mucous membranes (humidity)

31
Q

Disadvantages of a Venturi Mask:

A
  • uncomfortable
  • risk for skin irritation
  • produce respiratory depression in COPD patient with high oxygen concentration (50%)
32
Q

What happens after 0-1 minutes without oxygen?

A

Cardiac irritability

33
Q

What happens after 0-4 minutes without oxygen?

A

Brain damage not likely

34
Q

What happens after 4-6 minutes without oxygen?

A

Brain damage possible

35
Q

What happens after 6-10 minutes without oxygen?

A

Brain damage very likely

36
Q

What happens after >10 minutes without oxygen?

A

Irreversible brain damage

37
Q

What are some of the features of inadequate ventilation?

A
  • fast or slow rate
  • irregular rhythm
  • abnormal lung sounds
  • reduced tidal volume
  • use of accessory muscles
  • cool, pale, diaphoretic, cyanotic skin
38
Q

What are 4 of the basics of oxygen therapy?

A
  1. Position
  2. OPA
  3. BVM
  4. Suction
    - most difficult airways will still be manageable using basic airway maneuvers
39
Q

Basic airway adjuncts: oropharyngeal

A
  • keeps tongue from blocking oropharynx
  • eases suctioning
  • used with BVM
  • patients without gag reflex (unconscious patient)
40
Q

Basic airway adjuncts: nasopharyngeal

A
  • maintains patency of oropharynx
  • patients with gag reflex
  • should not be used with head trauma (can go into brain if trauma)
41
Q

What is the most important airway skill?

A

BVM ventilation

42
Q

BVM ventilation: when is it used?

A
  • always the first response to inadequate oxygenation and ventilation
  • the first “bail-out” maneuver to a failed intubation attempt
  • attenuates urgency to intubate
43
Q

What does BVM stand for?

A

Bag Valve Mask

44
Q

How much oxygen is delivered via BVM?

A

> 90%

45
Q

How is a BVM used?

A

With airway adjuncts and / or advanced airways

  • requires practice and proficiency
  • 16 breaths / min
  • give time to exhale
  • squeeze about ⅔ not emptying bag
46
Q

What are the golden rules of bagging?

A
  • anybody (almost) can be oxygenated with a bag and a mask
  • the art of bagging should be mastered before the art of intubation
  • manual ventilation skill with proper equipment is a fundamental premise of advanced airway Rx
47
Q

What are chest tubes used for?

A

To correct life threatening conditions caused by excess of fluid and / or air in the intrapleural space

48
Q

What is a pneumothorax?

A

A collection of air in the pleural space

49
Q

What can cause a pneumothorax?

A
  • central line placement
  • chest surgery
  • trauma to the chest wall
  • traumatic intubation
  • mechanical ventilation
50
Q

How does a tension pneumothorax develop?

A

If air continues to collect in the chest, the pressure can rise and push the whole mediastinum over to the other side

51
Q

What is a haemothorax?

A

A collection of blood in the pleural space

52
Q

What can cause a haemothorax?

A
  • chest surgery
  • central line placement
  • chest trauma
53
Q

What is an empyema?

A

Inflammatory fluid and debris within intrapleural space. Usually results from untreated bacterial pneumonia.

54
Q

What are other causes of empyema? (other than untreated bacterial pneumonia)

A
  • thoracic trauma
  • rupture of lung abscess into the pleural space
  • extension of mediastinal or abdominal infection
  • iatrogenic at time of thoracic surgery
55
Q

At the bedside how should the chest drain be managed?

A
  • keep drain below the chest for gravity drainage
  • this will cause a pressure gradient with relatively higher pressure in the chest
  • fluid, like air, moves from an area of higher pressure to lower pressure
  • same principle as raising an IV bottle to increase flow rate
56
Q

How does the drain prevent air and fluid from returning to the pleural space?

A
  • basic concept
  • straw attached to chest tube from patient is placed under 2cm fluid (water seal): always put 500mls H2O into drain
  • just like a straw in a drink, air can push through the straw but air can’t be drawn back up the straw

Respiratory Block: Chest Trauma (2 decks)

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