RN Oxygen Therapy
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| Hypoxemia and hypoxia | hypoxemia: low levels of oxygen in the blood. hypoxia: decreased tissue oxygenation, drive to breathe
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| Hazards and complications of oxygen therapy | O2 induced- pt whose main respiratory drive is hypoxia. absorption- collapsed alveoli when inc O2 and Dec nitrogen (79%). Toxicity- O2 in 50% for 24-48hr
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| Nasal canuala (low-flow) | 24-40% at 1-6L/min. ensure prongs are in nares properly. provide water-soluble jelly prn
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| simple facemask (low-flow) | 40-60% at 5-8L/min; flow must be at least 5L to flush mask. monitor closely for aspiration.
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| Partial rebreather mask (low flow) | 60-75% at 6-11L, flow rate high enough to maintain reservoir bag 2/3 full.
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| Venturi Masks (high flow) | most accurate O2 concentration. 24-50% usually 4-10L. perform constant surveilancce to ensure an accurate flow rate. assess the pt for dry mucous membrane
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| Aerosol mask, face tent | 24-100% with flow at least 10L/min. assess that aerosol mist escapes fron vents. empty condensation from tubing,
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| T-piece | 24-100% with flow at least 10L/min. assess that aerosol mist escapes fron vents. empty condensation from tubing. make sure humidifier creates enough mist.
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| subcutaneous emphysema | occurs when there is opening or teat in the trachea and air escapes into the tissue in the neck. can cause pulmonary edema
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| Tracheomalacia | constant pressure exerted byt the cuff causes tracheal dilation and the erosion of cartilage. increased amount of air required to maintain seal.
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| Tracheal stenosis | narrowed tracheal lumen is due to scar formation from irritation of tracheal mucosa by the cuff. stenosis is usually seen after the cuff is deflated. prevention is to prevent pulling on the tracheostomyy tube
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| tracheoesophageal fistula (TEF) | excessive cuff pressure causes erosion of the posterior wall for the trachea. A hole is created between the trachea and the anterior esophagus. the pt at highest risk also has a ng tube present
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| Trachea-innominate artery fistula | a malpositioned tube caused its distal tip to push against the lateral wall of tracheostomy, continued pressure causes necrosis and erosion of the innominate artery. this is a medical emergency
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| BiPAP | delivers a set inspiratory pressure as soon as the patient inspires, and a lower set end-expiratory pressure when pt begins to exhale
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| CPAP | delivers a continuous pressure throughout both inhilation and exhalation which help to open collapsed alveoli and the upper airway. used for sleep apnea, cardiac-induced pulmonary edema
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| medicare costs of continuous oxygen therapy | pt must have severe hypoxemia defined as a partial arterial pressure <88%
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