Skills Exam 8 – Oxygenation (ATI) – Flashcards
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hypoxia
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a reduced supply of oxygen to tissues below physiological levels despite adequate perfusion of the tissue by blood
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hypoxemia
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a diminished amount (reduced saturation) of oxygen in arterial blood
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hypercapnia
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an excess of carbon dioxide in the blood
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fraction of inspired oxygen (FiO2)
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the oxygen level inhaled by or delivered to the patient, expressed in a percentage of atmospheric air
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flow rate
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the quantity of oxygen delivered in liters per minute
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flow meter
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a device used to control the rate of oxygen being delivered in liters per minute
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face tent
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a soft, oxygen-delivery mask that fits under the patient's chin, loosely covers the mouth and nose, and is held in place by an adjustable elastic strap
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dyspnea
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difficult or labored breathing
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cyanosis
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a bluish discoloration, especially of the skin and mucous membranes, due to excessive concentration of deoxyhemoglobin (hemoglobin not combined with oxygen) in the blood
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continuous positive airway pressure (CPAP)
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a noninvasive, ventilation-assistance modality that provides a set positive airway pressure throughout the patient's respiratory cycle
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carbon dioxide
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an odorless, colorless gas resulting from the oxidation of carbon, formed in the tissues and eliminated by the lungs
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bradypnea
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an abnormally slow respiratory rate, usually less than 10 respirations per minute
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bi-level positive airway pressure (BiPAP)
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a noninvasive, ventilation-assistance modality that provides higher airway pressure during inspiration and lower pressure during expiration, usually delivered by a face mask
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atelectasis
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airlessness or collapse of a lung, usually as a result of hypoventilation or obstruction
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apnea
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cessation of respiration
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incentive spirometer
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a resistive breathing device that helps patients exercise their breathing muscles
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intubation
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the insertion of a tube into a body canal or cavity, as in endotracheal intubation
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manual resuscitation bag
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a hand-held device consisting of a flexible air chamber attached to a face mask via a shutter valve and used to provide ventilation to a patient who is not breathing or who is breathing inadequately; often referred to by the common brand name, Ambu bag
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mechanical ventilator
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breathing assistance provided by a ventilator, one of various types of devices that support and maintain respiratory function
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naris
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one of the two external orifices of the nose; nostril (plural: nares)
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nasal cannula
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a common oxygen-delivery device consisting of a length of tubing with two small prongs that are inserted into the patient's nares
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noninvasive ventilation
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a type of breathing assistance used to maintain positive airway pressure and improve alveolar ventilation without the need for an artificial airway
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nonrebreather mask
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an oxygen-delivery apparatus used to deliver high flow rates and high concentrations of oxygen via a mask that fits snugly over the patient's mouth and nose
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oxygen
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a tasteless, odorless gas that comprises 21% of atmospheric air and is used by the body to maintain adequate cellular function
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oxygen mask
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a device that fits over the patient's nose and mouth and delivers oxygen, humidity, and/or heated humidity
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oxygen tent
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a canopy that surrounds the patient, providing oxygen, humidification, and a cool environment to help control body temperature
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oxygen therapy
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the delivery of oxygen for therapeutic purposes
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partial nonrebreather mask
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an oxygen-delivery apparatus similar to a nonrebreather mask, but with a two-way valve allowing the patient to rebreathe exhaled air
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positive-pressure ventilation
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a technique that uses a mechanism such as a mechanical ventilator to force air into the lungs to provide breathing assistance
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pulse oximeter
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a noninvasive device that measures oxygen saturation indirectly via a finger or ear probe with a light-emitting diode (LED) and a photo detector attached by a cable to the device
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pulse oximetry
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the measurement of oxygen saturation indirectly via a finger or ear probe with a light-emitting diode (LED) and a photo detector attached by a cable to the oximeter device
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simple face mask
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an oxygen-delivery apparatus used for patients who require a moderate flow rate for a short period of time via a plastic mask that fits snugly over the mouth and nose
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t-tube
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a t-shaped conduit with a piece that connects an oxygen source to the patient's artificial airway
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tachypnea
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abnormally rapid breathing
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tidal volume
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the amount of air normally breathed in and out with each respiratory cycle either spontaneously or delivered via mechanical ventilation
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tracheostomy
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an opening created by a surgical incision into the trachea for the purpose of establishing and maintaining an airway
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tracheostomy collar
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a small oxygen-delivery apparatus that fits over a tracheostomy site and is held in place by an adjustable elastic strap that fits around the patient's neck; also called a tracheostomy mask
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tracheostomy mask
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a small oxygen-delivery apparatus that fits over a tracheostomy site and is held in place by an adjustable elastic strap that fits around the patient's neck; also called a tracheostomy collar
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ventilation
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the process of the exchange of air between the lungs and the environment, including inhalation and exhalation
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Venturi mask
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an oxygen-delivery apparatus consisting of a mask with holes on each side that allow exhaled air to escape and color-coded entrainment ports that are adjustable to allow regulation of the concentration of oxygen delivered
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In the early stages of hypoxia, the patient is often....
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restless and confused and might report feeling anxious. The patient's vital signs might also vary from baseline, with heart rate, respiratory rate, and blood pressure elevated
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The degree of hypoxia the patient is experiencing usually determines .....
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The degree of hypoxia the patient is experiencing usually determines what signs and symptoms he or she will exhibit
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In the late stages of hypoxia, the patient is likely to develop....
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hypotension, bradycardia, and metabolic acidosis. The patient may also develop cyanosis, a bluish discoloration of the skin and mucous membranes.
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For patients who have chronic hypoxia, the manifestations differ. These patients often have ....
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clubbing of their fingers and toes, peripheral edema, right-sided heart failure, and an oxygen saturation below 87%.
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hypoxia is left untreated, the patient's condition can deteriorate, resulting in....
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a decrease in activity level, an increase in confusion, a decrease in level of consciousness, and possibly coma.
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When patients with COPD receive oxygen at too high a flow rate.....
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Carbon dioxide narcosis (a complication that causes confusion, tremors, convulsions, and coma) can result. This complication can ultimately lead to respiratory arrest if left untreated.
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If a patient is not improving with oxygen therapy,....
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check to make sure the equipment is functioning properly, the correct oxygen delivery device is in use, and the flow rate is set correctly.
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If Pt. is on O2 therapy and showing S&S of hypoxia......
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Perform a respiratory assessment along with a complete set of vital signs, including oxygen saturation indicated via pulse oximetry. After assessing your patient, also document the patient's skin color, level of consciousness, and other signs and any manifestations of hypoxia. **perform a skin assessment where the oxygen-delivery device comes into contact with the patient's skin. Inspect the nose, the ears, and under the chin for redness, irritation, and skin breakdown.
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If you need to adjust the flow rate to improve O2 stats....
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Because oxygen is considered a medication, you must obtain an order from the provider before adjusting the flow rate
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Consider humidification if....
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the flow rate is 4 L/min or more
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To help alleviate dryness of the mucous membranes for patient receiving O2....
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consider humidification, ncreasing the patient's fluid intake, if not contraindicated, and providing oral care frequently
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Initiating oxygen therapy requires several pieces of equipment, which includes....
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A flow meter, extension tubing, an oxygen-delivery device, and if the flow rate is more than 4 L/min, sterile water for humidification.
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The flow meter
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attaches to the oxygen outlet and regulates the amount of oxygen delivered to the patient **attached to the oxygen outlet, designated by a green "oxygen"
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At the bottom of the flow meter is an adapter commonly called ....
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a "Christmas tree." **This adapter connects the extension tubing and oxygen-delivery device to the flow meter.
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The device used often depends on....
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why the patient is receiving oxygen, the flow rate (L/min) prescribed, and the length of time the patient will receive oxygen therapy
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Depending on the flow rate prescribed, humidification might be required. This is usually accomplished by......
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attaching a bottle of sterile water to the oxygen-delivery equipment. As the oxygen bubbles through the water, it picks up moisture and helps keep the patient's mucous membranes from becoming dry. Be sure to replace the sterile water at least every 24 hours or according to the facility's policy.
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A variety of oxygen-delivery devices are available for administering oxygen therapy. Which device to use often depends on.....
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the degree of hypoxia the patient is experiencing and any underlying respiratory diseases, such as chronic obstructive pulmonary disease (COPD). It is also important to consider the patient's age, level of consciousness, presence of an artificial airway, and environment (hospital or home) when choosing an oxygen-delivery device.
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A nasal cannula delivers oxygen concentrations of....
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22% to 50% with flow rates from 1 to 6 L/min through the cannula **The exact concentration inspired depends on the flow rate and on the patient's rate and pattern of breathing and the depth of respirations.
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A nasal cannula is usually used for patients who are......
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noncritical with minor breathing problems and for patients who cannot or will not wear an oxygen mask. ***Because this device administers low-flow oxygen, humidification is rarely required.
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A simple mask is usually used for patients who require....
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a moderate flow rate for a short period of time.
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A simple mask has the ability to deliver oxygen concentrations of....
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40% to 60% with flow rates from 6 to 10 L/min. ***Because carbon dioxide can build up in the mask at low flow rates, do not use a flow rate lower than 6 L/min with this type of mask.
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A nonrebreather mask can deliver oxygen concentrations of...
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60% to 95% with flow rates from 10 to 15 L/min. **This provides the patient with an oxygen concentration of nearly 100%. ***
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A Venturi mask is most often used for...
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critically ill patients who require administration of a specific concentration of oxygen.
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A Venturi mask can deliver oxygen concentrations from _____ to ____......
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24% to 60% with flow rates from 4 to 12 L/min. Because this device delivers a precise oxygen concentration and carbon dioxide buildup is minimal, it is commonly used for patients who have COPD. Humidification is usually unnecessary with this device.
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A face tent is often used as...
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an alternative to an aerosol mask, especially for patients who report feeling claustrophobic with an aerosol mask.
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A face tent delivers oxygen concentrations of _____ to _____......
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28% to 100% with flow rates from 8 to 12 L/min. ****This device is convenient for delivering both humidification and oxygen; however, it is difficult to control the concentration of oxygen administered since the actual concentration of oxygen depends on the rate and depth of the patient's respirations.
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A manual resuscitation bag is used to....
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provide high concentrations of oxygen to a patient prior to a procedure, such as suctioning or intubating, and during respiratory or cardiac arrest. It can also be used to assist patients who are breathing but not adequately.
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Thacheostomy collar/mask is....
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A small mask that fits over the patient's tracheostomy site.The mask has an exhalation port that remains patent at all times and a port that connects to the oxygen source with large-bore tubing. The flow rate is usually set at 10 L/min, with a nebulizer set at the appropriate oxygen concentration.
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Noninvasive ventilation, an alternative to mechanical ventilation is used to.....
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Maintain positive airway pressure and to improve alveolar ventilation without the need for an artificial airway.
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Noninvasive ventilation is commonly used for patients who have
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Congestive heart failure, sleep disorders, and pulmonary diseases to improve oxygenation, reduce and reverse atelectasis, reduce pulmonary edema, and improve cardiac function. ***The two types of noninvasive ventilation are CPAP and BiPAP.
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Continuous positive pressure ventilation (CPAP) provides a....
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set positive airway pressure throughout the patient's breathing cycle.
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CPAP is commonly used for patients who experience....
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sleep apnea because the continuous positive pressure keeps the airway open and prevents the upper airway from collapsing. ***The usual CPAP pressure is between 5 and 20 cm of water.
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Bilevel positive airway pressure (BiPAP)..
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provides assistance during inspiration and keeps the airway from closing during expiration. **The benefits of BiPAP include an increase in the amount of air in the lungs at the end of expiration, reduced airway closure, and improved oxygenation
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Oxygen tents and hoods are usually used for
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pediatric patients who have airway inflammation, croup, or other respiratory infections.
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Oxygen tents provide....
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oxygen, humidification, and a cool environment to help control body temperature.
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The oxygen hood consists of...
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a disposable vinyl box that fits over the child's head.
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Oxygen hood provides...
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warm humidified oxygen at a specific temperature.
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When using a hood, it is important to ensure....
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that there is enough space between the curve of the hood and the child's neck to allow carbon dioxide to escape.
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An oxygen hood delivers an O2 concentration of _____ to _____
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a 28% to 85% oxygen concentration varying with the flow rate, which can be set at 5 to 12 L/min.
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An oxygen tent can provide oxygen concentrations of...
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up to 50% with flow rates from 10 to 15 L/min.
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Objective measures of the effectiveness of oxygen therapy include...
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the patient's vital signs, arterial blood gas analysis, pulmonary function tests, ECG tracings, physical examination findings, and functional status. **Any evaluation should consider the patient's specific condition, health status, progress, expected outcome, and the patient's perceptions.
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Typically, you'd replace the water in the oxygen nebulizer, which is used to deliver humidification to the patient, when...
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the level is low or at least every 24 hours.
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Tap water can be used in a nebulizer, but sterie water is preferred. Why?
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Remember that particles of water are directly inspired into the patient's airway. This means that any chemicals or pollutants in regular tap water are likely to enter the patient's lungs. If the quality of the tap water is in question, or when administering humidification to acutely or critically ill or immunocompromised patients, use sterile water.
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What is Hyperbaric oxygen therapy?
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Hyperbaric oxygen therapy delivers 100% oxygen within a pressurized chamber. Increased pressure combined with the increase in oxygen content dissolves oxygen into the blood and all other body tissues and fluid at up to 20 times the normal concentration.
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S&S of oxygen toxicity?
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Signs and symptoms of oxygen toxicity result from its effects on the central nervous system (CNS) and pulmonary system. * CNS manifestations of oxygen toxicity include pallor, sweating, nausea, vomiting, seizures, muscle twitching, vertigo, tinnitus, hallucinations, visual changes, anxiety, respiratory changes, and decreased levels of consciousness. * Pulmonary signs and symptoms of oxygen toxicity include substernal chest pain, shortness of breath, dry cough, and pulmonary edema or fibrosis
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Documentation for oxygen therapy should include the following and any additional information pertinent to the administration of oxygen:
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•the date and time oxygen therapy was initiated •the method by which oxygen is being delivered (cannula, simple mask) •the flow rate in liters per minute •the patient's response to oxygen therapy •the condition of the patient's skin where the delivery device rests (ears, nose) •respiratory assessment findings before and after oxygen therapy was initiated •the patient's response to oxygen therapy and any adverse reactions •any patient and family teaching done
