Oxygen therapy

Question 1

what are the three indications for insertion of an artificial airway (oral airway)

Answer 1

• Decreased level of consciousness
• airway obstruction
• to help in the removal of tracheobronchial secretions

Question 2

What is the purpose of an oral airway?

Answer 2

• Prevents obstruction of the trachea by displacement of the tongue into the oropharynx. Maintains the tongue in normal position.

Question 3

How do you measure correct size for oral airway?

Answer 3

Measuring distance from the corner of the mouth to angle of the jaw just below the ear.

• Length is equal to distance from the flange of the airway to tip

Question 4

What happens when the airway is too small?

Answer 4

Tongue is not held in anterior portion of the mouth

Question 5

What happens when airway is too big?

Answer 5

May force tongue towards the epiglottis and obstruct airway

Question 6

What is the goal of oxygen therapy?

Answer 6

• receive an optimal arterial oxygen tension by giving lowest possible amount of effective dose of oxygen to avoid toxicity

• used in variety of settings to relieve or prevent tissue hypoxia

Question 7

Is oxygen considered a medication?

Answer 7

yes, treat it like a drug

Question 8

What are possible side effects of oxygen?

Answer 8

atelectasis or oxygen toxicity

Question 9

What does a physician’s order for oxygen therapy include?

Answer 9

• O2 flow rate (FiO2)

Or

• O2 therapy protocol for O2 titration
• order may also include: specific O2 saturation goal (i.e., >90%); delivery system required; and when it is to be administered (e.g. continuous, with exercise, nocturnal).

Question 10

What are some reasons why we would use supplemental oxygen therapy?

Answer 10

• Decreases in oxygen carrying capacity =low levels of hemoglobin (anemia)
• Decreased inspired O2 concentration (obstruction, hypovolemia)
• Increased metabolic rate = increased demands for O2

Question 11

What is SpO2

Answer 11

Peripheral capillary oxygen saturation

• Estimated amount of oxygen in blood being bound/carried by percentage of oxygenated hemoglobin compared to total amount of hemoglobin

Question 12

What is FiO2

Answer 12

concentration of oxygen that person inhales

• Devices we use and how people breath can impact FiO2

Question 13

what are the 10 rights of medication administration?

Answer 13

1. The right medication
2. The right dose
3. The right patient
4. The right route
5. The right time and frequency
6. The right documentation
7. The right reason
8. The right to refuse
9. The right patient education
10. The right evaluation

Question 14

What are the normal levels of SpO2 for average person vs COPD

Answer 14

Normal: 92-98%

COPD: 88-92%

Question 15

Does oxygen require an order?

Answer 15

yes

Question 16

What do you have to do before transporting patient receiving oxygen?

Answer 16

When it is necessary to transport a patient receiving oxygen therapy at flow rates greater then 8LPM to achieve an O2 concentration (FiO2) of greater than 40%: consultation with a Registered Respiratory Therapist (RRT) to determine stability for transport

Question 17

Are oxygen therapy devices one time use?

Answer 17

yes

Question 18

Can you administer O2 in an emergency situation?

Answer 18

In an emergency situation (such as signs of acute respiratory distress), an RN, LPN or Registered Respiratory Therapist may initiate oxygen therapy without a physician’s order. A physician must be notified immediately.

Question 19

List some safety measures to ensure are in place when administering oxygen

Answer 19

• Inform patient, visitors, roommates and all personnel that smoking is not permitted in areas where oxygen is in use
• Ensure all electrical equipment in room is functioning corrected and properly grounded. An electric spark in presence of oxygen can start fire
• Locate closest fire extinguisher
• Know fire procedures and evacuation route for area
• Check oxygen level of portable tanks before transporting patient to ensure enough oxygen in tank exist to complete transport
• Oxygen cylinders are secured to prevent tipping/falling

Question 20

what are the concentrations delivered and flow rate for a low flow nasal cannula?

Answer 20

• 24-28% concentration = 1-2L/min flow
• 32-36% concentration = 3-4L/min
• 40-44% concentration = 5-6L/min

Question 21

what are the pros of low flow nasal cannula?

Answer 21

• It’s convenient and easy to set up. Can deliver both high and low Fi with variable Fo
• comfortable

Question 22

What are the cons of low flow nasal cannula?

Answer 22

• Higher than 4 L / min can dry the mucosa (humidification is needed)
• Skin breakdown over ears and in nares from too tight application
• Easily dislodged

Question 23

what are the concentrations delivered and flow rate for a high flow nasal cannula?

Answer 23

• 5L = 50%
• 10L=62%
• 15L= 80%

Question 24

What are the pros for high flow nasal cannula?

Answer 24

• For patients who cannot tolerate a face mask for prolonged periods

Question 25

What are the cons of high flow nasal cannula?

Answer 25

- Uses special high-flow tubing only available through Respiratory Therapy or on Crash Cart - May be drying to mucous membranes - Skin breakdown over ears

Question 26

what are the concentrations delivered and flow rate for a simple face mask?

Answer 26

- 5-6L = 40% - 6-7L= 50% - 7-8L= 60%

Question 27

What are the pros of simple face mask?

Answer 27

- Higher Fi is possible because mask acts as additional oxygen reservoir - Can attach to a nebulizer to deliver medications and humidity

Question 28

What are cons of simple face mask?

Answer 28

- Patient is unable to eat, speech may be muffled - Flow must be > 5 L / min to avoid dangerous CO2 build up, rebreathing of CO2 will occur - For short term therapy (<12 hrs)

Question 29

what are the concentrations delivered and flow rate for a venturi mask?

Answer 29

``` 24% - blue 28% - white 31% - orange 35% - yellow 40% - red 60% - green ``` - flow is as per color-coded value (4-12L)

Question 30

What are pros for venturi mask?

Answer 30

- Mask entrains room air to achieve a consistent and precise oxygen concentration - Helpful for patients with COPD who require low, constant oxygen concentrations

Question 31

What are cons for venturi masks?

Answer 31

- Hot and confining - For short term therapy - Interferes with communication and eating

Question 32

what are the concentrations delivered and flow rate for a face tent mask?

Answer 32

10-15L - 40%

Question 33

What are pros for face tent mask?

Answer 33

For patients with facial trauma or claustrophobic

Question 34

what are the concentrations delivered and flow rate for a partial rebreathing mask?

Answer 34

10L 40-70%

Question 35

What are the characteristics with partial rebreathing mask?

Answer 35

- Reservoir bag must remain inflated - No one way valve between mask and bag - For severe/acute distress

Question 36

what are the concentrations delivered and flow rate for a non-rebreathing mask?

Answer 36

10L 60-80%

Question 37

What are the characteristics of a non-rebreathing mask?

Answer 37

- >12 L will cause “whistle” - Reservoir bag must remain inflated - For severe/acute distress - 3 valves – one each side of mask, one way valve prevent CO2 from entering reservoir - Closed system, so if no O2 given (runs out), patient can suffocate

Question 38

What is the difference between low flow and high flow devices?

Answer 38

low flow: - Provide oxygen in concentrations that vary with patient’s respiratory pattern - Also known as variable performance – as the FiO2 fluctuates based on breathing pattern High Flow: - deliver oxygen rates above normal respiratory flow rate and therefore provide a fixed FiO2 (fraction of inspired air) regardless of patient breathing pattern and inspiratory flow - Aka fixed performance- specific fiO2 delivered because device exceeds the flow the patient breathes in

Question 39

What are some examples of low flow devices?

Answer 39

- Nasal cannulas, - simple face masks - reservoir masks - non-rebreathing mask - face tent mask

Question 40

What are some examples of high flow devices?

Answer 40

- Venturi mask | - large volume or high flow cold neb devices

Question 41

what is the purpose of a higher volume of oxygen reservoir?

Answer 41

the higher the volume of oxygen reservoir, the more oxygen the patient has to draw from, which provides a higher FiO2 to the patient

Question 42

what is humidified oxygen?

Answer 42

the respiratory therapist will attach the vessel containing sterile water directly to the oxygen flow meter

Question 43

What is a large volume nebulizer (humidifers) used for?

Answer 43

Large volume nebulizers (humidifiers) are used for patients requiring higher flow oxygen. An aerosol mask is used, with larger bore, aerosol tubing.

Question 44

What are some nursing considerations for administration of humidified oxygen?

Answer 44

- normal to see mist flowing from the patients mask - Because the tubing is larger, water tends to build up in the dependent loop. - Do not drain excess water back into the nebulizer; detach the aerosol tubing and empty in to another receptacle (cup). - A t-piece and “tusks” may be added to an aerosol mask to prevent the client’s inhalation of room air through the side holes in the mask - Do not transport patients with humidified oxygen as there is a risk that spilling of the sterile water into the oxygen tubing could lead to aspiration

Question 45

what is nebulization?

Answer 45

Adding moisture or medication to inspired air by mixing particles with air and moisture improves clearance of pulmonary secretions

Question 46

What are the characteristics of a fixed device cold nebulizer?

Answer 46

- High flow device - Can provide 28, 30, 35, 40, 45, 50, 75, 100% based on dial - 10-15L/min - Not recommended for patients that require high oxygen demands (fiO2 over 40) - Not used for transport

Question 47

What are the characteristics of fixed device high flow cold nebulizer?

Answer 47

- Provides fixed oxygen concentration - 60,65,70,75% of O2 - Flow rate: 15L/min? all the way to the top