indications for oxygen therapy
To treat hypoxia/hypoxaemia.
The aim is to improve oxygen supply and reduce work of breathing.
2 types of oxygen delivery systems and examples:
High Flow:
eg. Venturi
Low Flow
eg. Nasal cannula, husdon mask, non rebreather
What is the Venturi masks Fio2 % and flow rate?
What are the benefits?
Fio2 24-50% (flow rate is colour coded and delivers)
Allows more control over oxygen concentration through colour coded attachments
24% and 28% commonly used on Co2 retainers as a starting point for titration to achieve oxygen saturation between 88-92%
What is the nasal cannulas Fio2 % and flow rate?
What are the disadvantages and advantages?
Fio2 22-40% at 0.5 -4L/min
Disadvantages > Not effective for mouth breathers, Fio2 is impacted by breathing pattern.
Advantages > Promotes comfort, communication, eating, drinking and no CO2 rebreathing.
What is the Hudson Masks Fio2 % and flow rate?
What are the disadvantages and advantages?
Fio2 40-60% at 5-10L/min
Suitable for Respiratory failure type 1 (Hypoxaemic)
Not suitable for Respiratory failure type 2 (co2 retainers), risk of co2 rebreathing
What is the Non Rebreathers Fio2 % and flow rate?
What are the disadvantages and advantages?
Fio2 60-90% at 10-15L/min
Most suited in emergency situations. Bag must be inflated before applying mask to face
what are the principles of Oxygen therapy?
- Nurses can initiate emergency oxygen therapy, however must obtain a prescription within 24 hours
- Patients commenced on acute 02 therapy should be closely monitored (Spo2, ABGs, Hbs, chest Xray, level on consciousness, vital signs)
- Oxygen should be titrated to the lowest concentration that meets oxygenation goals (88-92% type 1 respiratory failure, 94-98% all others)
- Oxygen should be prescribed cautiously to patients at risk of type 2 respiratory failure.
- Oxygen therapy should be reduced and ceased when patient reaches oxygen saturation goals.
Signs of oxygen toxicity
- Anxiety, nausea, vomiting, hallucinations, vertigo, seizures
- Dry cough, SOB, substernal chest pain, pulmonary oedema, pulmonary fibrosis.
What is a Nebulisers (delivery device) used for?
- Delivers drug with compressed air/oxygen (dependent on o2 saturation) in an aerosol form
- Can deliver large doses over a long period of time.
- Rapid absorption rate due to high vascularity of pulmonary capillary system
what are the side effects to using a nebuliser?
- Can cause skin irritation on face (eyes)
- Proportion of drug can be swallowed (stomach irritation)
- Leave foul taste which can be reduced with mouthwash after.
Salbutamol/Ventolin (Bronchodilator)
What is the adult dose, onset and half life?
1) Adult- 5mg, 4-6 hrly
2) onset 5-15 minutes
3) half-life of 2.7 - 5 hours
Salbutamol/Ventolin (Bronchodilator)
What is the mechanism of action, Contraindications, side effects?
1) Beta 2- adrenoreceptor agonist (bronchodilator)
2) Contraindicated in patients who have had previous sensitivity.
3) Reactions:
- Tachycardia, Tremor, palpitations
- Arrhythmias (with large doses)
- Headache, nausea, feeling of warmth
Ipratropium Bromide/Atrovent (Bronchodilator)
What is the adult dose, onset and half life?
1) Adult- 250-500mcg with 3mls NS, 6 hrly
(1ml if give with Salbutamol)
2) onset 3-5min,
3) half-life of 6 hours
Ipratropium Bromide/Atrovent (Bronchodilator)
What is the mechanism of action, Contraindications, side effects?
1) inhibits bronchomotor tone, causing dilation/relaxation of bronchial
2) Contraindicated in children under 12yrs patient who have hypersensitivity to atropine.
3) Reactions:
- Tachycardia, arrhythmias
- Dry mouth and throat, nausea
- Glaucoma is directly comes in contact with eye.
what is Amoxicillin? what is the adult dose?
respiratory
1)moderate spectrum antibiotic.
Microbiology testing and clinical judgement is required prior to initiation
2)Adult- 250mg 8 hourly (TDS)
Amoxicillin
what are the contraindications and reactions?
1) Contraindicated in patients with penicillin or cephalosporin sensitivity
2) Reactions:
- Anaphylaxis
- Rashes, urticarial
- Nausea, vomiting and diarrhoea
Paracetamol
what is the single dose? maximum dose?
what are the administration routes?
•
1) adult: 1 gram 4-6hrly
2) Max: 4 grams in 24hrs
3) peak: 20 - 120 mins
4) half life: 6 hours
5) routes: PO, IV, PR
Paracetamol
what are the indications?
What are the contraindications?
what are adverse effects?
1) Paracetamol is used as an analgesic/antipyretic,
2) Contraindicated when patient is taking other drugs that contain paracetamol.
3) Reactions (OVERDOSE):
- Nausea, vomiting and diarrhoea, diaphoresis
- Stomach cramps and pain, abdominal distension
- Unusual bleeding/bruising, blood in stools/urine
What is the treatment for paracetamol overdose?
- Stomach pump (1hr post ingestion)
- Administer Acetylcysteine to protect liver (4hrs post ingestion)
- Hepatic function test
