Oxygen Therapy

Question 1

Oxygen Therapy Purpose

Answer 1

relieves hypoxemia and hypoxia

Question 2

Hypoxemia

Answer 2

low levels of oxygen in the blood

Question 3

Hypoxia

Answer 3

decreased tissue oxygenation

Question 4

Oxygen Therapy Goal

Answer 4

use lowest fraction of inspired oxygen for acceptable blood oxygen level without causing harmful side effects

Question 5

ABG analysis

Answer 5

an ABG sample reports the status of oxygenation and acid-base balance in the blood
-need to go on ice and brought to the lab immediately

Question 6

Capnography

Answer 6

the measurement of carbon dioxide in a pts exhaled breath over time. Monitors the Waves
-looks like a thick nasal cannula

Question 6

Capnography

Answer 6

the measurement of carbon dioxide in a pts exhaled breath over time. Monitors the Waves
-looks like a thick nasal cannula

Question 7

Oxygen Therapy: Interventions-Take Action

Answer 7

-Recognize: oxygen hazard
-Check: perscription
-Use: humidification if delivered at 4L/min or > (too make sure pt doesn’t get to dry)
-Check: skin for pressure points
-Provide: mouth care; lubricate nostrils, face, lips
-Clean: cannula, mask (soap & water, make sure its dry)
-Collaborate: collaborate with repository therapist

Question 8

Hazards and Complications of Oxygen Therapy

Answer 8

-Combustion
-Oxygen toxicity: concentration of O2 is too much for the pt
-Absorption atelectasis: crackles
-Drying of mucous membranes
-Infection: skin breakdown, dirty mask, humidification can create bacteria

Question 9

Oxygen Delivery Systems

Answer 9

Types used depends on:
-required oxygen concentration
-oxygen concentration that can be achieved by a delivery system
-importance of accuracy and control of the oxygen concentration
-pt comfort
-use of humidity
-pt mobility

Question 10

Low-Flow Oxygen Delivery Systems

Answer 10

-Nasal cannula (1-6L/min)
-Face-mask (simple, partial rebreather, non-rebreather)
-easy to use
-comfortable
-amount of oxygen delivered varies

Question 11

Nasal Cannula

Answer 11

-flow rates of 1-6L/min
-O2 concentration of 24-44%
-flow rate >6L/min does not increase gas exchange because anatomical dead space is full
-often used for chronic lung disease or long-term therapy

Question 12

Simple Facemask

Answer 12

-minimum of 5-8L/min
-deliver O2 up to 40-60% for short-term therapy
-ensure appropriate fit

Question 12

Partial Rebreather Mask

Answer 12

-flow rate 6-11L/min
-60-75% O2
-pt rebreathes one third exhaled tidal
-bag should be slightly inflated with inspiration

Question 13

Non-Rebreather Mask

Answer 13

-maintaining reservoir bag 2/3 full
-delivers highest O2 level (of the low-flow systems)
-can deliver FIO2 greater than 80-95%
-used for unstable pts who may require intubation
-ensure valves are patent and functional
-pt is very unstable, O2 is very low

Question 14

High-Flow Nasal Cannula

Answer 14

-30-60 L/min
-combination of heat and humidity minimizes damage to mucous membranes
-gives the best flow, with adapters

Question 15

Venturi Mask

Answer 15

-4-10L/min
-adaptor located between bottom of mask and O2 sources
-24-50%
-pulls in a proportional amount of room air for each liter flow of oxygen
-most accurate concentration without intubating pt

Question 16

T-Piece

Answer 16

-delivers desired FIO2 to clients with tracheostomy, laryngectomy, ET tube
-aerosol should appear on exhalation side

Question 17

noninvasive Positive-Pressure Ventilation (NPPV)

Answer 17

-uses positive pressure to keep alveoli open, improve gas exchange
-used to manage: dyspnea, hyperbarbia, and acute exacerbations of chronic ovstructive pulmonary disease, pulmonary edema, and acute asthma attacks

Question 18

CPAP (NPPV)

Answer 18

delivers a set of positive airway pressure throughout each cycle of inhalation and exhalation

Question 19

Volume-limited or flow-limited (NPPV)

Answer 19

delivers a set tidal volume with the pts inspiratory effort

Question 20

BiPAP (NPPV)

Answer 20

cycles different pressures at inspiration and expiration

Question 21

Transtracheal Oxygen Delivery (TTO)

Answer 21

-long-term delivery of O2 directly into lungs
-small flexible cath is passed into trachea through small incision
-flow rates prescribed for rest, activity

Question 22

Tracheotomy

Answer 22

surgical incision into trachea to create an airway to maintain gas exchange

Question 23

Tracheostomy

Answer 23

stoma (opening) that results from tracheotomy

Question 24

Tracheostomy Complications

Answer 24

-tube obstruction -tube dislodgment and accidental decannulation -pneumothorax -subq emphysema -bleeding -infection

Question 25

Preventing Tissue injury: Tracheostomy

Answer 25

-tissue injury can occur where the inflated cuff presses against the tracheal mucose -inflate the cuff to form a seal between the trachea and the cuff using the least amount of pressure -*check the cuff pressure once a shift

Question 26

Ensuring Air Warming and Humidification: Tracheostomy

Answer 26

-if humidification and warming are not adequate, tracheal damage can occur -inadequate humidity causes thick, dry secretions to occlude the airway and increase the risk of infection

Question 27

Suctioning: Tracheostomy

Answer 27

-suctioning maintains a patent airway and promotes gas exchange -consider best practices for airway suctioning -preoxygenation pt 3-5 minutes before suctioning -never suction more than 10-15 seconds -after, oxygenate pt -continue as needed for 3 passes

Question 28

Providing Tracheostomy Care: Assess

Answer 28

-assess for cyanosis -check O2 sat -assess the trach site -assess skin around the tracheostomy and neck -auscultate lung sounds

Question 29

Providing Tracheostomy Care: Secure

Answer 29

-secure using twill tape ties or commercial tube holders -change devices when soiled or at least daily to keep clean, prevent infection, and assess tissue integrity under ties

Question 30

Providing Bronchial and Oral Hygiene

Answer 30

-turn/ reposition q1-2 hrs, support out-of-bed activities, encourage early ambulation -coughing and deep breathing, chest percussion, vibration, and postural drainage promote pulmonary hygiene -avoid glycerin swabs or mouthwash containing alcohol for oral care, use sponge tooth cleaner or soft-bristle toothbrush moistened in water

Question 31

Ensuring Nutrition

Answer 31

-swallowing can be difficult -teach pt to keep head of bed elevated for at least 30 min after eating -small frequent meals -while eating cuff can be partially deflated, small/ slow bites -position upright while eating

Question 32

Maintaining Communication

Answer 32

-writing tablets -board w/ pictures and letters -flashcards -hand signals -smartphone -phrase questions with yes/no answers -mark central call light to indicate pt cannot speak -SLP

Question 33

Supporting Psychosocial Needs and Self-Esteem: Trach

Answer 33

-acknowledge frustration -use a normal tone of voice -provide social contact -allow sufficient time for communication -address changes in self-image

Question 34

Weaning Trach

Answer 34

-gradual decrease in tube size; ultimate removal of tube -cuff is deflated when the pt can mange secretions; does not need assisted ventilation -change from cuffed to uncuffed tube -capping -tracheostomy button

Question 35

Tracheostomy: Care Coordination and Transition Management

Answer 35

-pt should be able to provide self-care --Teach -trach tube care -shower shield -cover loosely with small cotton cloth during the day -increase home humidity -wear a medical alert bracelet -follow-up w/ ptovider