Flashcards in Oxygen Delivery, Ventilation and Intercostal Drains Deck (56):
What is oxygen therapy?
Administration of oxygen at a concentration greater than that found in environmental atmosphere?
What is the concentration of oxygen at room air?
What are some of the indications for oxygen therapy?
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
What are some problems with O2 therapy?
1. O2 toxicity
2. Suppression of ventilation
3. Danger of fire
When can O2 toxicity occur?
Can occur with FlO2 >50% longer than 48 hours
In which patients is suppression of ventilation particularly problematic?
What does suppression of ventilation lead to?
Will lead to increased CO2 and carbon dioxide narcosis
Why is there a danger of fire with O2 therapy?
O2 is flammable
What is an important problem of O2 therapy in neonates?
- blindness due to vasoconstriction and ischemia (premature infants)
What is resorption atelectasis?
= 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
What does FIO2 mean?
Fraction Inspired Oxygen
What amount of oxygen is delivered via nasal cannula?
Low flow: 24-44%
Nasal cannula: what are the priority nursing interventions that should be followed?
- check frequently that both prongs are in the clients nares
- never deliver more than 2-3L/min to client with chronic lung disease
Advantages of nasal cannula:
- client able to talk and eat with oxygen in place
- easily used in home setting
Disadvantages of nasal cannula:
- may cause irritation to the nasal and pharyngeal mucosa
- if oxygen flow rates are above 6L/min variable FIO2
What amount of oxygen is delivered via simple face mask?
Low flow: 35-60%
Simple face mask: what are the priority nursing interventions that should be followed?
- 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
Advantages of the simple face mask:
Can provide increased delivery of oxygen for short period of time
Disadvantages of the simple face mask:
- tight seal required to deliver higher concentration
- difficult to keep mask in position over nose and mouth
- potential for skin breakdown (pressure, moisture)
- uncomfortable for patient while eating or talking
- expensive with nasal tube
What amount of oxygen is delivered via a partial rebreather mask?
Low flow: 75-80% oxygen
Partial rebreather mask: what priority nursing interventions should be followed?
- set flow rate so mask remains two-thirds full during inspiration
- keep reservoir bag free of twists or kinks
Advantages of a partial rebreather mask:
Client can inhale room air through openings in mask if oxygen supply is briefly interrupted
Disadvantages of a partial rebreather mask:
- requires tight seal (eating and talking difficult, uncomfortable)
- not as drying to mucous membranes (because of reservoir bag)
What amount of oxygen is delivered via a non-rebreather mask?
Low flow: 80-100%
Non-rebreather mask: what priority nursing interventions should be followed?
- 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
Advantages of non-rebreather mask
- delivers highest possible oxygen concentration
- suitable for patient breathing spontaneously with severe hypoxemia
Disadvantages of non-rebreather mask
- impractical for long term therapy
- malfunction can cause CO2 build-up
- feeling of suffocation
What amount of O2 is delivered via a Venturi Mask?
Oxygen from 40-50%
Venturi mask: what priority nursing interventions should be followed?
- requires careful monitoring to verify FIO2 at flow rate ordered
- check that air intake valves are not blocked
Advantages of a Venturi Mask:
- delivers most precise oxygen concentration
- doesn't dry mucous membranes (humidity)
Disadvantages of a Venturi Mask:
- risk for skin irritation
- produce respiratory depression in COPD patient with high oxygen concentration (50%)
What happens after 0-1 minutes without oxygen?
What happens after 0-4 minutes without oxygen?
Brain damage not likely
What happens after 4-6 minutes without oxygen?
Brain damage possible
What happens after 6-10 minutes without oxygen?
Brain damage very likely
What happens after >10 minutes without oxygen?
Irreversible brain damage
What are some of the features of inadequate ventilation?
- fast or slow rate
- irregular rhythm
- abnormal lung sounds
- reduced tidal volume
- use of accessory muscles
- cool, pale, diaphoretic, cyanotic skin
What are 4 of the basics of oxygen therapy?
- most difficult airways will still be manageable using basic airway maneuvers
Basic airway adjuncts: oropharyngeal
- keeps tongue from blocking oropharynx
- eases suctioning
- used with BVM
- patients without gag reflex (unconscious patient)
Basic airway adjuncts: nasopharyngeal
- maintains patency of oropharynx
- patients with gag reflex
- should not be used with head trauma (can go into brain if trauma)
What is the most important airway skill?
BVM ventilation: when is it used?
- always the first response to inadequate oxygenation and ventilation
- the first "bail-out" maneuver to a failed intubation attempt
- attenuates urgency to intubate
What does BVM stand for?
Bag Valve Mask
How much oxygen is delivered via BVM?
How is a BVM used?
With airway adjuncts and / or advanced airways
- requires practice and proficiency
- 16 breaths / min
- give time to exhale
- squeeze about ⅔ not emptying bag
What are the golden rules of bagging?
- 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
What are chest tubes used for?
To correct life threatening conditions caused by excess of fluid and / or air in the intrapleural space
What is a pneumothorax?
A collection of air in the pleural space
What can cause a pneumothorax?
- central line placement
- chest surgery
- trauma to the chest wall
- traumatic intubation
- mechanical ventilation
How does a tension pneumothorax develop?
If air continues to collect in the chest, the pressure can rise and push the whole mediastinum over to the other side
What is a haemothorax?
A collection of blood in the pleural space
What can cause a haemothorax?
- chest surgery
- central line placement
- chest trauma
What is an empyema?
Inflammatory fluid and debris within intrapleural space. Usually results from untreated bacterial pneumonia.
What are other causes of empyema? (other than untreated bacterial pneumonia)
- thoracic trauma
- rupture of lung abscess into the pleural space
- extension of mediastinal or abdominal infection
- iatrogenic at time of thoracic surgery
At the bedside how should the chest drain be managed?
- 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