Oxygenation

Question 1

S&S of aspiration

Answer 1

• Coughing or Choking sounds when eating
• Wet voice
• Throat clearing
• Pocketing food in cheeks
• Sudden changes in lung sounds
• ↓ O2 lvls

Question 2

Hypoxia (what, occurs when, causes, early signs, late signs)

Answer 2

• What: lack of oxygen in tissues
• Occurs when: there’s inadequate supply of O2 to cells ⇒ prevents them from properly functioning
• Causes:
  
  • ↓↓↓ blood O2 levels (hypoxemia)
  • Reduced blood flow to tissues
  • Inability of cells to use O2 effectively
• Early Signs:
  
  • Restlessness
  • Irritability
  • Dyspnea
  • Accessory muscles use
  • Nasal flaring
  • Adventitious lung sounds
  • Tachycardia
  • Tachypnea
  • HTN
  • Pallor
• Late Signs:
  
  • ↓ LOC
  • Bradypnea
  • Dysrhythmias
  • Bradycardia
  • Hypotension
  • Cyanosis

Question 3

Hypoxemia (what, occurs when, causes)

Answer 3

• What: ↓↓↓ level of O2 in blood
• Occurs when: blood doesn’t contain enough O2 to meet body’s needs
• Causes:
  
  • ↓ O2 intake from lungs (ie. due to respiratory problems)
  • ↓ O2 production in lungs (ie. due to lung disease)
  • ↓ O2 dissociation from hemoglobin (ie. due to anemia)

Question 4

Pulse Oximetry Information

Answer 4

• Check pulse oximetry: norm is 95% – 100%
• Caution if pt has darker skin → this is less accurate !!!
• Pts w/ COPD → has pulse ox of high 80s – low 90s
• Factors influencing readings:
  
  • Moving around
  • If fingers are cold
  • Have anemia
  • Have poor circulation
  • Wearing nail polish
  • Melanin in skin affects light absorption of device (Can lead to overlooking conditions such as…)
    
    • Hidden hypoxemia ⇒ can lead to organ failure and death
    • Low O2 lvls ⇒ can lead to organ failure and death

Question 5

Resp meds

Answer 5

• Nebulized bronchodilators: albuterol
• Inhaled/Oral/IV steroids: to decrease inflammation and open-up airways
• Mucolytics: breaks up secretions for mobilization
• Low-dose anti-anxiety: slows resp rate, promotes deeper breaths and better gas exchange, and prevents resp alkalosis

Question 6

Oxygenation Devices info abt FiO2, side-effects, safety precautions

Answer 6

• Room air: 21% O2
  
  • Aka fraction of inspired oxygen (FiO2) = 21%
  • When using supplemental O2, each 1 liter is approximately about 3 additional percentage points on top of that room air
  • Ie. 1 L per NC is 3% + 21% of room air = FiO2 of 24% (1L is ~ 3% added to room air = 24%)
• Always use lowest FiO2 necessary to achieve pt’s oxygenation goal to avoid O2 toxicity !!!
  
  • Ie. it pt is on 2L NC w/ pulse ox reading of 91% and is a non-COPD pt w/ goal of >95% pulse ox → you can titrate up or increase flow rate to 6L to get a 99% pulse ox reading, but it’s best to just titrate up by 4L to get pulse ox reading of 96% to still reach goal and reduce risk of O2 toxicity
• Supplemental O2 is drying to nasal passages → humidification recommended, esp for pts on anticoagulants and antithrombotics who are at greater risk of bleeding and can have nosebleeds
• Safety precautions:
  
  • Can easily cause fire
  • Tanks can explode

Question 7

Nasal Cannula (NC) L/min, Pros, Cons

Answer 7

• 1 – 6 L/min (24 – 44% FiO2)
  
  • Pts on ≥ 4 L/min → needs humidifier
• Pros:
  
  • Effective at low flow rates
  • Easily tolerated
  • Can eat/talk easier vs. mask
• Cons:
  
  • Drying
  • Easily dislodged
  • Not effective for mouth breathers

Question 8

Simple Mask L/min, Pros, Cons

Answer 8

• 6 – 12 L/min (30 – 50% FiO2)
• Pros:
  
  • Good for mouth breathers
  • Delivers higher O2 concentration
• Cons:
  
  • CO2 retention risk if not set properly
  • Claustrophobia
  • Challenging to eat/talk

Question 9

Non- Rebreather Mask L/min, Pros, Cons

Answer 9

• 10 – 15 L/min (60 – 90%)
• Pros:
  
  • Good for mouth breathers
  • Delivers higher O2 concentration bc of the bag of reservoir waiting to be inhaled
• Cons:
  
  • CO2 retention if set below 10L if not set properly
  • Claustrophobia
  • Challenging to eat/talk

Question 10

High-Flow O2 L/min, Pros, Cons

Answer 10

• 1 – 60 L/min (up to 100% FiO2)
• Pros:
  
  • Can eat/talk easier vs masks
  • Positive pressure/force to help ventilate
• Cons:
  
  • Large nasal cannulas
  • Drying
  • Uses bedside machine

Question 11

Ventilation Support: CPAP & BiPAP Pros + Cons

Answer 11

• CPAP: mostly for inhalation that delivers continuous pressure to keep airways open during inspiration to ventilate lungs
• BiPAP: for inhalation and exhalation that delivers delivers continuous pressure to keep airways open during inspiration to ventilate lungs + keeps a little bit of pressure during exhalation to keep airways open longer to allow for longer gas exchange in alveoli
• Pros:
  
  • Help those w/ trouble ventilating but not necessarily oxygenating (some pts just need airways open and their gas exchange is fine)
  • Serves specific purpose
  • Has variety of mask options
• Cons:
  
  • Claustrophobia
  • Masks are uncomfortable
  • Can be dislodged when eating

Question 12

For Pts Who Are in Severe Respiratory Distress Fast Interventions

Answer 12

• Raise HOB ≥ 45* (preferably 90*)
• Apply & titrate up O2 for PO ≥ 95% or as high as possible w/ their given O2 device
  
  • Ie. if pt alrdy on NC → titrate up to max 6L
• Stay w/ pt if they’re you’re pt → calm and reassure them
• Coach to take slow, deep breaths
• Call for stat breathing tx if ordered
• Suction airway if secretions present
• Call provider