What is Nebulised therapy?
Oxygen therapy
- Delivers medication to the lungs via inhalation.
o This means the medication can be more localised than systemic. - Involves passing air under pressure through liquid medication, turning it into fine droplets that are inhaled.
- The driving gas is either compressed air (most common) or oxygen.
what drugs can be delivered via a nebuliser?
Oxygen therapy
o Saline (sterile water with a percentage of dissolved water)
o Mucolytics (break down mucus)- dornase alpha and N-acetylcysteine (NAC)
o Bronchodilatants- salbutamol and ipratropium
o Steroids- budesonide
o Antibiotics- colomycin and tobramycin
what is hypertonic saline?
Oxygen therapy
o 7%
o Nebulised BD
o Risk of bronchoconstriction
o Osmotic, so draws water into the airways
o Pertussive so encourages cough
what is normal saline?
Oxygen therapy
o Very common
o PRN
o A more intense humidification
o 0.9%
what are mucolytics?
Oxygen therapy
- Often used for COPD
- Dornase alpha
o Enzyme taken OD/BD
o Breaks down genetic material in sputum to thin it.
o The enzyme requires 30-60 minutes to take effect.
o May increase rates of exacerbations in Bx.
what are mechanical ventilators?
Oxygen therapy
- Used in anaesthesia and for most patients in intensive care.
- Primarily used for respiratory failure (failure to oxygenate or ventilate), airway protection (neuromuscular weakness or unconsciousness), and oxygen and ventilation failure.
- Modern ventilators have multiple modes that tailor to the patient’s condition.
what are different settings on a ventialtor?
Oxygen therapy
- tidal volume
- peep
- mode
- rate
- Fio2
what complications can occur due to ventilators?
Oxygen therapy
- Nosocomial infection
- Muscle weakness/ deconditioning
- Pressure ulcers
- Dependence
- Haemodynamic compromise
what is weaning method 1?
Oxygen therapy
The proportion of breathing performed by the ventilator is gradually reduced, letting the patient perform a greater amount of breathing until no longer dependent on the ventilator.
what is the conventional criterea that needs to be met before weaning can occur?
Oxygen therapy
o **Clinical **
The condition is altering and improving; the patient must also be cooperative
o **Mechanical **
Adequate respiratory mechanics such as tidal volume, respiratory capacity, minute ventilation and hemodynamic stability.
o **Biomechanical parameters **
ABG values must be in normal ranges
what is weaning method 2?
Oxygen therapy
The patient can be allowed to breathe spontaneously, completely unaided for progressively longer periods of time (full ventilation occurs between these stages) until the ventilator is no longer needed. T-piece method or SBT.
what is a physios role after weaning?
Oxygen therapy
o Positioning
o Therapeutic exercises
o Transfers
o Walking re-education
o Duration and frequency of mobility sessions
what is a Nasal Cannulae and what are its pros and cons?
Oxygen Therapy
- 1-5 L/min
- Can eat, drink and speak
- Cheap and easy setup
- Can be drying to the nose, sore on the ears and can’t give very high FiO2.
- Fixed flow device.
what is a fixed performative device?
Oxygen Therapy
the FiO2 is known
what is a fixed flow device?
Oxygen Therapy
o You know how many litres per minute of oxygen are being flowed into the tube (L/min); however, you don’t know the FiO2 of the patient.
what is a normal facemask and what are its pros and cons?
Oxygen Therapy
- 5-10 L/min
- Delivers higher FiO2, good for mouth breathers.
- Potentially more drying to the lungs than a nasal.
- Can’t eat or drink.
- Fixed flow device
what is a venturi valve and what are it’s pros and cons?
Oxygen Therapy
- Can give 0.24-0.6 FiO2
- Gives a definitive FiO2, less dependent on the patient’s ventilation.
- Can give higher FiO2.
- Maks can be drying if not humidified.
- Fixed performance device
what is the venturi effect?
Oxygen Therapy
oxygen flows through a narrow opening, causing an increase in velocity. This causes a pressure drop and pulls in room air, meaning the patient receives a fixed FiO2.
what is a non-rebreathe mask or reservoir mask and what are its pros and cons?
Oxygen Therapy
- Used in emergencies.
- Gives high FiO2, up to 0.9+
- Not for long-term use as it must be set to 15 L/min.
- Fixed flow device
what is a high flow nasal oxygen machiene and what are its pros and cons>
Oxygen Therapy
- Delivers a set Fi02 (up to almost 1.0) and a set flow rate (up to 60L/min).
- Active warmed humidification, slight positive pressure (PEEP), washout of CO2 in the upper airway.
- High flow rates may be difficult to tolerate, causing nasal irritation and swallowing.
- Fixed performance device.
why can giving to much oxygen be dangerous to a patient on scale 2?
Oxygen Therapy
because they have chronic CO2 retention meaning the delivery of more oxygen can lead to further retention and lead to the folowing conditions:
- desensitisation of central chemoreceptos
- haldane effect
- reversal of HPVC
what is desensitisation of central chemoreceptors?
Oxygen Therapy
- Chemoreceptors sensitive to H+ become desensitised.
- As a result, chronically high levels of CO2 no longer cause increased ventilation.
- Pulmonary chemoreceptors sensitive to O2 now cause the drive to breathe.
what is the haldane effect?
Oxygen Therapy
- Higher levels of O2 in venous blood mean there is less carrying capacity for CO2.
- As a result, CO2 isn’t expired.
what is the reversal of HPVC?
Oxygen Therapy
- Supplemental O2 can cause increased blood flow to otherwise poorly ventilated areas of the lungs.
- This worsens gas exchange.
-
Blood Physiology19
-
Aeterial blood gases29
-
Patient Assessments21
-
ABCDE's35
-
Respiratory Conditions24
-
Pharmacology18
-
X-rays9
-
Positioning and Postural Drainage13
-
Palpation and Breathing Exercises20
-
Oxygen Therapy24
-
Infection5
-
Pulmonary Sugery14
-
Manual Techniques and suctioning6
-
Active Cycle of Breathing and Airway Clearance9
-
Pneumonia8
-
Rib Fractures6
-
Cardiac Surgeries18
-
Chest Drainage5
-
Abdominal Surgery7
