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Oxygen Therapy
Oxygen Therapy: Administration and Managment
| Question | Answer |
|---|---|
| What is the goal of oxygen therapy? | To maintain adequate tissue oxygenation while minimizing cardiopulmonary work. |
| What are the objectives of oxygen therapy? | To treat hypoxemia. To decrease symptoms of hypoxemia To decrease cardiopulmonary workload. |
| How do you assess need of oxygen therapy? | Assess ABG Assess underlying problem or condition. (history) Physical Assessment |
| It is important to beware of conflicting information. You must always... | Treat the patient and not the numbers |
| What are the hazards of oxygen therapy? | oxygen toxicity Depression of ventilatory drive absorption atelectasis Bronchopulmonary dysplasia retrolental fibroplasia |
| What is oxygen toxicity? | High exposure to oxygen that results in an increased concentration of oxygen and causes and over production of free radicals that damage the epithelial tissues. |
| What are two factors that contribute to oxygen toxicity? | Fi02 and exposure time |
| What does oxygen toxicity primarily affect? | The lungs and CNS CNS- tremors, twitching, convulsions PNS- Pneumonia, Pulmonary fibrosis |
| What is absorption atelectasis? | Nitrogen washout, damage to type II pneumocytes |
| What is Bronchopulmonary dysplasia? | (BPD) is found in premature babies |
| What is retrolental fibroplasia? | scar tissue in the eyes |
| What is considered a high oxygen concentration? | A concentration greater than 60%. |
| What are the two oxygen delivery systems? | Low Flow Systems High Flow Systems |
| Low flow systems | have variable FI02 Does not meet the patients flow rate demand FI02 is just an estimate |
| What are some examples of a low flow system? | Nasal Cannula Reservoir Cannulas Nasal Catheter Transtracheal oxygen simple mask Partial rebreathing mask non-rebreating mask |
| High flow systems | Fixed FI02 Meets patient's flow rate demand |
| High Flow system examples | Air entrainment mas i.e. Venturi Mask Air Entrainment Nebulizer |
| What's special about the nasal cannula? | It's the most commonly used oxygen therapy device |
| The nasal cannula handles flow rates | up to 6 Liters/Minute (adult) |
| Estimating Fi02 with nasal cannula | 1 L/minute=24% Fi02 Each additional liter increases Fi02 4% |
| In nasal cannulas can you use a bubble humidifier? | Yes, at flow rates set at 4 L/min and greater |
| Are pediatric and infant sizes available in the nasal cannula? | yes |
| What's a special nasal cannula? | Reservoir cannulas (conserving devices) They suppliment the fi02 and are rarely seen |
| Is there a high flow nasal cannula? | Yes it is rarely seen and it comes with a special bubble humidifier that can handle high flow. |
| Nasal cannulas replaced what device? | Nasal catheters |
| Nasal catheters can handle flow rates up to? | 6L/Minute |
| Estimating percentage of nasal cannulas | 1 L/minute=24% fio2 Each additional liter increases Fi02 4% |
| The bubble humidifiers are used for flow rates | Set at 4L/min and greater |
| Are there pediatric and infant sizes available for nasal catheters? | Yes |
| Transtracheal oxygen is | inconspicuous/ Rare Is designed for long term oxygen therapy. Commonly used with a bubble humidifier. |
| Why is the transtracheal oxygen more efficient than a nasal cannula? | Oxygen delivery directly to the trachea. |
| What happens to flow rates? | They can be reduced by 50% |
| What are disadvantages to transtracheal oxygen? | Requires a minor surgery Infection Bleeding Subcutaneous emphysema Must be cleaned frequently damage to catheter requires replacement over time. Not covered by all insurance agencies |
| The simple mask is | More commonly used by EMT's |
| What are the flow rate requirements? | 6-10 liters per minute |
| What fi02 values can the simple mask achieve | 35%-50% |
| Can a bubble humidifier be used with a simple mask? | Yes but the flow rate requirement for the simple mask is 6 L/minute and you do not want the bubble humidifer to go past 6 or 7 or it will alarm |
| Are there pediatric sizes available for the simple mask? | Yes |
| What is the difference between an aerosol mask/simple mask? | The aerosol mask has larger holes on the side. The simple mask have small holes on the side. |
| What are the two types of rebreathing masks? | Non-Rebreathing/Partial rebreathing mask |
| What does the non-rebreathing mask have? | 2 check valves |
| What are the flow rate requirements for the non-rebreathing mask? | Enough to keep the bag inflated |
| What fi02 values can be achieved with the non-rebreathing mask? | 60-80% |
| Can a bubble humidifier be used with both rebreathing masks?? | yes |
| Are pediatric sizes available? | yes |
| What is the flow rate requirement for partial-rebreathing masks? | enough to keep the bag inflated |
| What fi02 values can the partial rebreather mask achieve? | 40-60% |
| Are pediatric sized available in the partial-rebreathing mask? | yes |
| Does the partial rebreathing mask have check valves? | no |
| What are factors that alter the performance of low flow systems and increase the Fi02 | Higher oxygen input Mouth-closed breathing Low inspiratory flow low tidal volume slow respiratory rate |
| What are factors that affect performance of low flow systems and decrease fi02 | Lower oxygen input mouth-open breathing high inspiratory flows High tidal volume fast respiratory rate |
| The air entrainment is a high flow device. It is also known as | Venti mask, Venturi mask |
| The Fi02 depends on? | The size of entrainment port Velocity of the gas |
| A blocked entrainment port on the venti mask will | increase the Fi02 |
| What are the Fi02 ranges for the venti mask? | 24%-60% |
| It might be difficult to provide fixed fi02 at high | Fi02 setting |
| Can the air entrainment mask be used with a bubble humidifier? | No, humidity must be proveided with bland aerosol set up attached to mask for humidity therapy |
| Are pediatric venti masks available? | yes |
| The jet orifice on the venti mask changes what 2 things? | Fi02 and Flow |
| If bed sheets cover the Venti Mask what happens? | The fi02 increases and the flow decreases |
| The air entrainment nebulizer is... | The large volume jet nebulizer |
| Fi02 and flow rate requirements on the air entrainment nebulizer depend on what? | The size of the air entrainment port |
| If the entrainment port becomes blocked or water condenses in the tubing what will happen with the air entrainment nebulizer? | The fi02 will increase |
| What are the fi02 ranges for the air entrainment nebulizer? | 28%-98% |
| The air entrainment nebulizer can provide 21% by attaching what to the flow meter? | air |
| What attachments can be used with the air entrainment nebulizer? | aerosol mask, trach collar, face tent, t-tube, tents, and oxyhoods Pediatric sizes are available |
| What is one thing about high fi02 settings on the air entrainment nebulizer? | It can be difficult to provide a fixed fi02 at high fi02 settings. |
| What are some disadvantages of oxygen masks? | Claustrophobia Muffled Speech Difficulty eating and drinking Blocks vomitus in unconscious patient Potential suffocation hazard |
| How do you troubleshoot if no gas flow can be detected? | See if gas is turned on. Look for kinking in tubing look for a leak. |
| How do you troubleshoot patient constantly removing mas? | Try to find a comfortable option if possible. |
| How do you troubleshoot the resivoir bag collapsing during inhalation? | Increase the flow of oxygen |
| How do you troubleshoot the reservoir bag remaining inflated during inhalation? | Mask may not have a tight fit. Inspiratory valve jammed/reversed. Flow may be too high |
| How do you handle a patient that develops sores or irritation over face and ears? | Use rubber cushions |
| How do you troubleshoot the humidifier pop-off sounding? | Look for obstruction, kinking, flow may be too high |
| How do you troubleshoot no humidity/aerosol coming from the system? | Check the water level Look for faulty equipment. |
| What are factors used to select appropriate oxygen device? | Objectives of therapy (short term/long term) Performance characteristics of set up (high flow/low flow) Individual needs of the patient and patient characteristics. (Age, LOC, Breathing Pattern, Presence or absense of a tracheal airway) |
| Oxygen blenders | Replace manual titration of fi02 using an oxygen and airflow meter. |
| How are oxygen blenders powered? | Pneumatically |
| Oxygen blenders can | achieve any fi02 |
| What does the oxygen blender contain? | A proportioning module for blending oxygen and air. |
| The oxygen blender has one alarm. What does it do? | Notify in case of loss of gas supply |
| Other things for oxygen blenders | It's accurate and precises Requires 50 PSI source Flow meter attachments are available |
| What are the two most common analyzers used in respiratory care? | Electrochemical Galvonic fuel cell |
| Electrochemical | Polarographic (Clark)electrode Commonly used in ABG machines and transcutaneous monitors Requires a battery for power |
| The electrochemical, polarographic clark electrode | has a 10-30 second response time, |
| The galvonic fuel cell | Is commonly used in ventilators and hand held analyzers |
| The galvonic fuel cell gets a result in | 60 seconds and needs no external power |
| The galvonic fuel cell will require calibration. | It uses 21% or 100% calibration gases |
| The galvonic fuel cell may be one point or two point calibration. | One point- Room Air Two Point- Room air and 100% Oxygen |
| Hyperbaric therayp | Inreases the pa02 wound healing around since the 1600's Based on boyles law |
| Indications of hyperbaric therapy | Air embolism C02 poisoning Wound Healing |
| Hazards of hyperbaric therapy | Tempanic Membrane rupture. |
Created by:
kparkerlehman
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