| Question | Answer |
| What are the major goals of oxygen therapy | relieve hypoxemia, pneumonia, v/q mismatch, decrease work of breathing asthma or copd, decrease work of the heart MI pulm edema |
| Hypoxemias effects on the circulatory system result in | peripheral vasodilation patient feels warm, pulm vasoconstriction shunting in lung or increase PVR, tachycardia which is primary for hypoxemia |
| What causes the patient to be confused, lethargic, agitated and disoriented | cerebral hypoxia |
| How do you treat cerebral hypoxia | with oxygen therapy and relief of tissue hypoxia the therapist can expect a clearer sensorium or a more alert patient |
| What are the hazards and complications of oxygen therapy, fire hazard | o2 supports combustion causing a fire to burn hotter and more rapidly |
| What are the hazards and complications of oxygen therapy, retinopathy of prematurity (retrolental fibroplasia) | blindness occurring in premature infants and newborns as a result of high pao2 not high fio2 |
| What are the hazards and complications of oxygen therapy, o2 induced hypoventilation | complication of oxygen therapy in the patient who breathes on a hypoxic drive (COPD) |
| What are the signs of o2 induced hypoventilation | decreased RR and VT, increased pao2, increased pco2, decreased ph, patient sensorium lethargic, sleepy confused |
| What is the treatment for o2 induced hypoventilation | decrease level of inspired oxygen, do not place on ventilator because of hypercarbia |
| What is o2 toxicity | too much oxygen pt receive high FIO2 >60 for periods of 12-24 hours |
| What are the signs and symptoms of o2 toxicity | nausea, vomiting, systernal chest pain and tightness, refractory hypoxemia, tachypnea, decreased surfactant production, dereased compliance, pulm edema |
| What is absorption atelectasis | rapid changes in FIO2 that causes atelectasis to form therefore change FIO2's gradually in 5-10% increments |
| What are the safety rules for oxygen therapy | no smoking, o2 in use signs, all electrical appliances should be grounded, never oil equipment |
| What does the appropriate choice of O2 depend on | blood gases, RR, tidal volume, ventilatory pattern, patient cooperation (low flow or high flow system) |
| What do the high flow systems supply | the patients entire inspired volume |
| What do the low flow systems supply | part of the patients inspired volume |
| What are the qualifications for a low flow system | tidal volume 300-700ml, RR <25/min, regular ventilatory pattern |
| What to you need for a low flow system order | physicians signature, oxygen humidifier, no smoking sign, oxygen source and flowmeter, do not neet an oxygen analyzer |
| What does the doctors order require | percent or flow, type of device, duration of oxygen use, doctors signature |
| What do the respiratory therapy notes require | time and date of set up, check function and routine usage checks |
| Low flow cannula FIO2 | .24-.45 |
| Low flow cannula flow | 1-6 lpm |
| In a cannula for every 1 lpm increases | the FIO2 by 4% |
| What is the most appropriate initial oxygen device for COPD patients with stable respiratory rates and tidal volumes | nasal cannula |
| What is oxygen conservation cannulas or reservoir cannula | maintain FIO2 at lower levels by using a reservoir, used commonly in the home setting |
| What is a transtracheal oxygen catheters TTO2 | method of delivering long term low flow oxygen therapy directly into the airway by a surgically implanted catheter, inserted between the 2nd and 3rd tracheal rings |
| What does a transtracheal oxygen catheter allow | upper airways and trachea to act as a reservoir for oxygen during exhalation therefore decreasing oxygen usage and increasing excercise tolerance and improved oxygenation |
| What are the hazards involving the actual insertion procedure of a TTO2 | brochospasm, bleeding, abscess, pneumothorax, airway obstruction and subcutaneous emplysema |
| If a patient becomes SOB or has encreased WOB with a TTO2 device | the catheter could be obstructed with secretions and you would need to flush the catheter |
| What is the FIO2 of the simple mask low flow device | .40-.55 |
| What is the flow of the simple mask low flow device | 6-10 lpm |
| When using a simple mask the flow must be | greater than 5 lpm to flush out exhaled CO2 |
| What is the FIO of a partial rebreather mask low flow device | .60-.65 |
| What is the flow of a partial rebreather mask low flow device | 6-10 lpm |
| What is a high flow device | provides patients evtire inspired volume 100% |
| What is the FIO2 of a non rebreather mask high flow device | .21-1.0 |
| When is a non rebreather mask used | to deliver 100% O2 in an emergency pneumothorax, CO poisoning, CHF, burns, He/O2 mixtures, CO2/O2 mixtures |
| How many valves does the non rebreather have | 3 one way valves |
| Flow rates for the non rebreather mask must be sufficient to keep the bag from collapsing, if the bag collapses | increase the flow |
| If a patient inhales and the bag of the non rebreather does not slightly contract then | the mask is not tight, seal mask or the valve is stuck, replace the mask |
| What is the air entrainment mask/ venturi mask | precise FIO2 concentrations available, ideal for COPD, patients with irregulare tidal volumes and rates and breathing patterns |
| In the air entrainment mask/venturi mask the FIO2 remains the same with | increases or decreases in the flow through the oxygen inlet |
| In the air entrainment mask/venturi mask the FIO2 increases | as the internal diameter of the gas injector increases, with increased resistance or obstruction downstream |
| In the air entrainment mask/venturi mask the FIO2 decreases | as the size of the air entrainment ports are increased, total flow increases as the size of the entrainment ports are increased |
| What is the FIO2 of the Briggs adapter | .21-1.0 depends upon the aerosol source, reservoir tubing should be utilized to maintain appropriate FIO2, if not the FIO2 will decrease due to entrained room air, should see aerosol from reservoir tubing |
| What do you do if the aerosol disappears when using the Briggs adapter T piece | increase the flow, add more reservoir tubing, set up a device to provide more flow(blender, tandem set up, change flow meter) |
| What is the delivered FIO2 for aerosol masks, trach collars, face tents | .21-1.0 depends upon the aerosol source and nebulizer output |
| What is the oxygen hood | clear plastic device that encloses the head of the infant for the O2 therapy and high humidity |
| What is the flow for the oxygen hood | 7-14 lpm to prevent CO2 buildup and allow controllecd FIO2 without sealing the infants neck around the hood |
| How do you monitor the use of an oxygen hood | overheating can cause dehydration and apnea, underheating can increase O2 consumptions, preferred method to analyze O2 continuously near the infants face |
| What factors are controlled when using a mist tent, oxygen tent, or croupette | oxygen concentration, temp, filtered gas, humidity and aerosol delivery |
| When using a mist tent, oxygen tent or croupette what do you run the flow at | 12-15 lpm to wash out CO2, FIO2 variable at .40-.50 and hard to control |
| When using a mist tent, oxygen tent or croupette if the FIO2 is fluctuating | make sure tent is tightly tucked in, source of aerosol is jet, ultrasonic or hydronamic nebulizer, monitor infants for fluid overload, weight gain |
| Incubator oxygen control is how much percent and how many liters | 40-50% and 8-15 lpm |
| What are the indicators for an incubator | filtered gas, temp control will maintain a neutral thermal environment |
| What are the hazards of the incubator | thermal burns, electical shock, o2 toxicity, fire, toxic inhalation, hearing damage |
| What are radiant warmers | open incubator ideal for code emergency and for easy access |
| What does a radiant warmer provide | neutral environment but will not decrease insensible water loss to premature infants due to evaporation |
| What is a CPAP mask | fits over the mouth and nose or just the nose, short term and temporary use for obstructive sleep apnea, co poisoning, pneumonia, post op atelectasis, difficult to maintain seal and tolerate |
| What is the nasal CPAP device | nasal prongs or nasal mask used with adults with obstructive sleep apnea |
| What is nasal CPAP useful with infants | they are obligate nose breathers, however can losse CPAP if the baby is crying so readjust the prongs |
| When troubleshooting loss of pressure indicates | leak or insufficient flow |
| When troubleshooting increased pressure indicates | obstruction, faulty exhalation CPAP or PEEP valve, with excessive flow a contunuous venting of the pop off valve will occur |
| What is hyperbaric oxygen therapy | increasing the po2 by increasing the barametric pressure |
| What diseases are treated using hyperbaric o2 therapy | co poisoning, tissue transplants/grafts, anaerobic infections like gas gangrene, decompression sickness bends |
| What is helium oxygen therapy | decreases the patients work of breathing by delivering low density gas that can easily maneuver around obstruction, used for patients with increased airway resistance, edema, foreign object obstruction, partial vocal cord paralysis |
| What are the concentrations used for Helium o2 therapy | 80% He/20% O2 or 70% He/30% O2 |
| How much greater is the flow when using Helium therapy | 1.8 times greater than the L/min on an oxygen flow meter with an 80/20 mixture |
| What is Nitric oxide therapy (NO) | relaxes the smooth muscle which improves blood flow to the alveoli to improve ventilation perfusion mismatch and decreases pulmonary vascular resistance, decreases pulm pressures and improve oxygenation |
| What are the indications for Nitric oxide therapy | primary and chronic pulmonary hypertension, pulmonary fibrosis, pulmonary embolism, repsiratory distress syndrome, congenital heart defects, persistent pulmonary hypertension of the newbron, chronic lung desease, heart/lung transplant, sepsis, sickle cell |
| What is the effective dose of Nitric oxide therapy | 2-20 ppm, starting dose 20ppm, delivered through mechanical ventilation and nasal cannula |
| When itric oxide is exposed to oxygen it can form citrogen dioxide, levels of nitrogen dioxide greater than 10ppm can result in | cellular damage and pulmonary edema and death |
| How do you discontinue nitric oxide therapy | carefully to prevent rebound effect, level should be decreased to the lowest possible dose 5ppm or less, patient should be able to maintain a good o2 level on FIO2 of .4 or less, always hyperoxygenate the patient before |
| What is the ASSS | american standard safety system used for high pressure threaded connections of the large cylinders (H) |
| What is the PISS | pin index safety system used for high pressure, yoke type connections of small cylinders (E) |
| What is the DISS | diameter index safety system used for low pressure <200 psi threaded connections on quick connect wall attachments |
| What do you do to the tank before adding the connections | crack, open and release some of the gas |
| When trouble shooting the oxygen cylinders if the patient states that no flow is sensed from the cannula, the patient should | be instructed first to verify the flow by inserting the cannula into a glass of water and checing for bubbles |
| What is the tank factor for an E cylinder | .28 l/psi or .3 |
| What is the tank factor for an H cylinder | 3.14 l/psi or 3.0 |
| What are bulk systems | supply a large group of oxygen outlets throughout the medical facility |
| What are the types of systems used to deliver a large supply of oxygen | cylinder manifolds, fixed cylinders, trailer units |
| What is liquid bulk oxygen | large liquid system located outside of the building |
| What are the advatages of liquid bulk oxygen | stores large quantities of oxygen that minimuzes storage space, provides an unlimited supply of oxygen to patients, backed up by a manifold system |
| What is the purpose of the reducing valve in single vs multi stage | to lower high pressure to a safe working pressure, the number of pressure relief devices corresponds to the number of stages |
| Preset and adjustable reducing valves | reduce culinder pressure to a working pressure, the spring tension is not adjustable and is set by the manufacturer, utilizes and Thorpe tube flowmeter, adjustable flowmeters utilized Bourdon gauge flowmeters |
| When trouble shooting reducing valves if the poppet valve operated by the spring and diaphragm fails then | the excess pressure is relieved through the pop off pressure relief device |
| When trouble shooting flowmeters if a massive leak occures after removing a flowmeter then | try reinserting it into the wall, contact personnel and supply supplemental oxygen |
| If the patient becomes dyspneic and thorpe tube reads zero or bourdon gauge reads higher | check for an obstruction or kinks in the tubing |
| When using the bourdon gauge flowmeter uncompensated what causes the coiled tube to straighten and the gear mechanism to change the position of the indicator to a higher value | back pressure |
| Which flowmeter is commonly used when transporting a patient | Bourdon gauge flowmeter |
| What is the pulse dose oxygen delivery system | used with low flow oxygen and connected to a 50 psi gas source, senses the start of inspiration and delivers oxygen only during inspiration |
| What is the purpose of air-oxygen proportioners or blenders | to control the mixing of air and oxygen to obtain a specific FIO2 |
| What are the components of a blender | low pressure alarm,indicates not getting enough pressure |
| What can the blender be used with to achieve precise FIO2 | non rebreather mask |
| What is the air compressor | used to provide air to patient without using an air cylinder, in hospital, out patient clinic or in the home setting, used to power a hand held nebulizer for a COPD patient in the home setting |
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Created by:
kaczenskis
on 2010-11-07