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Flashcards in Oxygen Therapy Deck (72):
1

FiO2

Fraction of inspired oxygen

2

PaO2

Partial pressure of O2 in arterial blood (80-100)

3

SpO2

Saturation of O2 on hemoglobin (95-100%)

4

PaCO2

Partial pressure of CO2 in arterial blood (35-45)

5

Room air is what % oxygen?

21%

6

What is the respiratory drive COPD?

Low PaO2

7

Nasal cannula flow rate

1-6 L/min

8

Nasal cannula O2 concentration

24-44% FiO2

9

What oxygen delivery device is used with chronic lung dz or pts needing long term O2 therapy?

Nasal Cannula

10

Nasal Cannula Care

Ensure correct placement
Asses for nasal mucosa irritation
May use water-soluble lube

11

Simple face mask flow rate

5-8 L/min
Minimum of 5L to avoid CO2 inhalation

12

Simple face mask O2 concentration

40-60% FiO2

13

What O2 delivery device is used for short-term O2 therapy or in emergency?

Simple face mask

14

Care for simple face mask

Ensure mask fits correctly
Watch for aspiration risk and skin breakdown
Emotional support for claustrophobic pts

15

Partial Rebreather flow rate

6-11 L/min

16

Partial Rebreather O2 concentration

60-75% FiO2

17

What O2 delivery device is used to give higher concentrations of O2 and has no flaps?

Partial Rebreather

18

How much exhaled tidal volume does a pt rebreathe with a partial rebreather?

1/3

19

How much must the reservoir bag remain inflated in a partial rebreather mask?

2/3

20

Tidal Volume

Lung volume of O2 displaced btw inhalation & exhalation in a single breath; ~500 mL air inspired

21

Nonrebreather Mask flow rate

10-15 L/min

22

Nonrebreather Mask O2 concentration

80-95% FiO2

23

Which O2 mask is used for unstable pts who may require intubation?

Nonrebreather

24

Which mask has a one-way valve with flaps?

Nonrebreather

25

What is the purpose of the valve in a nonrebreather mask?

Valve lets pt get needed O2 from reservoir bag & prevents exhaled air from re-entering

26

What is the purpose of the flaps in a nonrebreather mask?

Flaps prevent entry of room air into mask & allows exhaled air to leave mask

27

Reservoir bag must remain inflated how much in a nonrebreather?

2/3

28

Venturi Mask flow rate

4-10 L/min

29

Venturi Mask O2 concentration

24-50% FiO2

30

Which O2 device delivers most accurate O2 concentration without intubation and is used for pts with chronic lung dz?

Venturi Mask

31

What should you watch for with use of a venturi mask?

Dry mucous membranes

32

What is the purpose of the adapters on a venturi mask?

Adapters only allow a certain amount of air to enter the mask & mix with the O2

33

CPAP

“Continuous Positive Airway Pressure”
-Can use O2 or air
-Pts often bring home machines to hospital
-If newly ordered, must encourage compliance

34

How does CPAP work?

By opening up collapsed alveoli

35

What O2 device is used in pts with post surgery atelectasis, COPD, pulmonary edema, sleep apnea?

CPAP

36

BiPAP

“Bi-level Positive Airway Pressure”
-Pts use at home like CPAP
-Pts often bring home machines to hospital

37

-Cycles different pressures at inspiration & expiration
-Delivers a set inspiratory positive airway pressure
-During exhalation, delivers a set end-expiratory pressure
-Improves overall tidal volume, decreases respiratory rate, relieves dyspnea

BiPAP

38

What is often attempted prior to intubation?

BiPAP

39

Tracheostomy Tubes

-Permanent (metal or plastic) or disposable (plastic)
-Cuff used in acute care setting or on vent
-Cuff does not fully prevent aspiration

40

What allows pt to speak when inner cannula is removed & cap placed?

Fenestrated tube

41

What is not always accurate with trachs?

Pilot balloon

42

What do you always do before capping the trach tube?

Deflate the cuff

43

Purpose of cuff in trach

Allows for positive pressure in the lungs, decreases aspiration risk, seals area around trach so air can’t pass

44

How does tube obstruction of trach occur?

From secretions or cuff displacement

45

S/S of trach tube obstruction

Dyspnea, noisy respirations, difficulty inserting suction cath

46

How do you prevent a trach tube obstruction?

Prevent by cough & deep breathe, humidified O2, trach care, suctioning

47

Trach post op complications

Tube Obstruction
Tube dislodgment
Pneumothorax
SubQ Emphysema
Bleeding
Infection

48

When is trach tube dislodgment an emergency?

If it occurs within the first 72 hours post op
-Difficult to replace because trach has not matured

49

How to prepare/care for tube dislodgment

-Keep correct size spare trach cannula at bedside
-Ambulate pt until Rapid Response Team arrives

50

How do you care for trach tube dislodgment after 72 hours post op?

Use Kelly clamp to reopen stoma
Insert trach cannula with obturator
Remove obturator & assess for Bilateral BS and airflow through trach

51

Pneumothorax

-Air in chest cavity from lung apex
-Confirm with chest x-ray

52

Subcutaneous Emphysema

From a tear in trachea that allows air to leak out into surrounding tissue
Palpate around trach – crackling
Notify MD immediately

53

When do you monitor cuff pressure for trachs?

-In ICU
-Confirm with chest x-ray

54

Cuff pressure ranges for trachs

14-20 mmHG or 20-30 cm H2O

55

What happens if cuff pressure is too high?

It can block capillary blood flow & cause ischemia

56

Why use humidified air with trachs?

Bypasses natural humidifiers in nose & mouth
Will see fine mist in trach collar or t-piece
May use air warming device also

57

Trach suctioning

-Maintains patent airway
-Sterile procedure
-Pre-oxygenate & hyperinflate/hyperventilate
-Each suction should be less than 15 seconds
-Hyperoxygenate after suctioning
-Maximum number of suction passes

58

Why might hypoxia occur with trach suctioning?

-Prolonged suctioning
-Catheter too large
-No hyperoxygenation before, during, or after suction
-Excessive suction pressure
-Too frequent suctioning

59

What do you avoid w/ trach suctioning?

-Hypoxia
-Tissue Trauma
-Infection
-Vagal stimulation or bronchospasm

60

Why might tissue trauma occur during trach suctioning?

Not using correct techniques
-twirl cath when removing
-only suction when withdrawing cath
-lube with saline first
-suction no more than 15 sec

61

Why might infection occur with trach suctioning?

-No sterile technique
-Suction mouth AFTER suction trach
-Don’t use yaunker on trach

62

Vagal or Bronchospasm from trach suctioning?

Vagal=bradycardia, hypotension, dysrhythmias
STOP SUCTION & hyperoxygenate
May need bronchodilator if bronchospasm

63

Purpose of trach care

-Keeps area free of secretions
-Maintains patent airway
-Be careful not to dislodge cannulas

64

What can we do to encourage bronchial hygiene?

-Turn Q2hr
-TCDB
-Chest percussion
-Postural drainage
-Avoid glycerin… changes pH in mouth & promotes bacteria growth
-Secretions can accumulate above cuff; once deflated – enters lungs

65

How can you reduce the risk of aspiration?

-Small frequent meals
-Don’t rush eating
-No meal when fatigued
-Thicken all liquids
-Position upright
-Deflate cuff during meals – inflated can interfe with food passage through esophagus
-Small controlled liquid volume (spoon)

66

Trach care procedure

Look at skill review sheet

67

Bronchial & Oral Hygiene

-Helps keep airway patent
-Prevents bacterial growth
-Avoid glycerin swabs or mouthwash with alcohol
-Oral suctioning (Yankauer)

68

Trach Nutrition care

-Difficulty swallowing
-Keep HOB elevated at least 30 min after meal
-Small, frequent meals

69

Trach communication

-Can speak if no cuff or if fenestrated tube with cap
-Alternative ways to communicate
-Emotional support & patience

70

How to verify placement of an endotracheal tube

-CXR
-Expiratory CO2

71

Endotracheal Intubation

-For patients in severe respiratory distress
-Done with ET tube & laryngoscope
-Connected to Ventilator
-Often kept sedated

72

Why provide oral care to intubated pts?

To prevent VAP