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98 terms

medical gas therapy

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What are the three indications for Oxygen Therapy
Hypoxemia, Increase WOB, Icreased Miacardial work
3 goals of Oxygen Therapy
treat or prevent hyoxemia, decreased work of breathing, decreased myocardial work
3 ways to assess the need for Oxygen Therapy?
Lab Measurments (ABG, SPO2) Clinical indicators (COPD MI) Bedside assessment (level of concesinous color etc)
Air is made up of?
20.95 % Oxygen and 78.1% nitrogen
what is room air FIO2
21%
4 precautions/possible complications when adminstering Oxygen
1. Oxygen induced hypoventilation (Respiratory Depression) Absorbtion Atelectasis 3. Retinopathy of prematurity ROP 4. Oxygen toxicity
What levetoy do you want to keep to avoid oxygen induced hypoventilation
Maintain PAO2 between 55-65 torr FIO2 should not exceed .28%
What levels do you need to maintain to avoid ROP
Maintain PAO2 < 80 torr
What level do you need to maintain to avoid oxygen toxicity
FIO2 < 60%
What are the 6 clinical signs for oxygen toxicity
cough, substernal pain, dyspenia, lethargy, vomiting, refectory hypoxemia
What is the goal of o2 therapy?
to use the lowest possible FIO2 while monitoring the PaO2 to be sure of adequate tissue oxygenation
how often do you monitor a patient receiving a FIO2 <40%
within 12 hours of initiation
how often do you monitor a patient with a FIO2 > 40%
within 8 hours
How often do you monitor a patient with acute MI
within 72 hours
How often do you monitor a patient with COPD
within 2 hours
how often do you monitor a neonate
within 1 hour
what are the two categories for the devices of Oxygen Therapy
Low flow or High flow
In order to determine which device to use, you must know
how much oxygen the device can deliver and whether the FIO2 remains fixed or varies with changing patient demands
Define low flow
a system that has an unpredictable and variable because of its design and it doesn't meet the patients inspiratory demands
What are the indications for a low flow system
RR < 25, Regular and consistent breathing pattern, tidal volume between 300-700ml
Define nasal canula
consist of 2 prongs connected to small-bore tubing
What is the FIO2 and corresponding L flow for nasal canula
1 L = .24, 2L = .28, 3L= .32, 4L=.36, 5L=.40 6L=.44
when do you use humidity with a nasal canula
flows>3 or when the patient complains of nasal drying
what are the conveniences of the NC
you can talk, able to eat and drink, more comfortable
define nasal catheter
a soft plastic tube with several holes at the tip inserted gently into a nasal passage until visualized behind and above the uvula, it is then taped to the bridge of the nose
what is the gas flow of a nasal catheter
1/4 to 8 LPM, FIO2 0.22-0.44
what are disadvantages of the nasal catheter
possible gagging/air swallowing resulting in aspiration and difficult to insert
when is a nasal catheter used
when a NC is difficult to use (bronchoscopy) or for long term infant therapy
define transtracheal catheter
surgically inserted into the trachea and held in position by a chain necklace, small bore tubing is connected to a flowmeter.
what is the gas flow for the transtracheal catheter
1/4 to 4 LPM FIO2 0.22-0.35
What is the advantage of the transtracheal catheter
increased patient mobility
what are the disadvantages of transtracheal catheter
high cost for the surgical procedure, risk of infection
what is the gas flow for the simple mask
Gas flow 5-12 LPM FIO2 0.35 to 0.55
what is the minimum flow rate of a simple mask and why
5 l per min to prevent CO2 rebreathing
what is the gas flow for the partial rebreathing mask
8-15 lpm FIO2 0.35 to 0.60
On a PRB flow rate should be set so that what happens
bag collapses no more tha 1/2 on inspiration
what is the gas flow for the Non Rebreathing Mask
8-15 LPM FIO2 100%
What makes a device high flow
it is designed to provide for the patients insperatory demands
When are high flow systems indicated
whenever consistent and predictable FIO2 is required and when patient does not meet low flow criteria
define Venturi Mask AEM
has exhalation ports on mask, an injector used to set the FIO2 and a reservoir
explain the settings on the AEM
gas flow depends on FIO2 ordered, FIO2 0.24 to 0.50, the venture entrains room air into ports, it is the most precise means of delivering 02, FIO2 will vary with back pressure (caused by resistance to flow)
FIO2 on AEM at 3LPM
24, 28, 26, 31
FIO2 on AEM at 6 LPM
35, 40, 50
FIO2 on the air entrainment nebulizer
28, 35, 40, 50, 70, 98
what is the use for an air entrainment nebulizer
adds humidity to artificial airways, setting up aerosol mask, t adaptor and face tent
what are the gas flows for an aerosol mask
8- 15 lpm FIO2 0.21-1.0 (mist should show at all times)
When is a Face tent used
used primarily for patients with facial trauma or burns, or those who can not tolerate a mask
what are the gas flows for a face tent
8-15 lpm FIO2 0.21-0.40
When is a T adaptor used
on intubated and trached patients
What are the gas flows for a T adaptor
8-15 lpm FIO2 0.21-1.0
What must also be used with a T adaptor
a 50 ml (6") reservoirt tubing to prevent air from entering T-piece decreasing FIO2 to patient
what are the gas flows for a Trah mask/colllar
10-15 lpm FIO2 0.35 -0.60
what is the calculation for determining patient's inspiratory demands
(VT x RR) = Ve x 3 = inspiratory demands in liters/ minute
What are hazards/complications of Oxygen devices
Fire, Dehydration, Aspiration, Disconection, Pressure ridges, reddened skin
How can you minimize or eliminate hazardss/ccomplicattions
by proper set up of equipment and timely patient equipment checks at least once per shift
what should be checked during a patient equipment check
Connections, water levels, humidity can be seen, bag on NRB and PRB, flow meter and mist is on correct setting, RR and WOB, SPO2, check for vommit
oxyhood (head box) gas flows should be set at
a minimum of 7lpm to prevent accumulation of CO2 FIO@ 0.21 to 1.0
what are the disadvantages of the Oxyhood
high noise levels, reduced visibility, damp bedding under infants head inaccessibility to infant for good nursing care without loss of FIO2
what is a Croupette
a clear plastic canopy with back housing container for ice, and a jet nebulizer
what are the gas flows for a croupette
12-15 lpm, FIO2 can be maintained at about 0.40
Disadvantages of a Croupette
pooling of FIO2 at bottom of enclosure causing FIO2 to be higher, if edges of tent are not sealed tighttley, FIO22 will bbe inconsistent
what is a Isolette (incubator)
a clear, plexiglass chamber with ports on the sides to access the infant
What are disadvantages of the Isolette
Unstable FIO2s and has mainly been replaced by the oxyhood and servo-controlled radiant warming heaters,
WHen is an Isolette your best choice
infants needing a NTE only
What is a oxygen tent
a plastic sheet canopy similar to the croupette in function and design only much larger
gas flow of the oxygen tent
12-15lpm provides FIO2 of 0.40-0.50
what are hazards of enclosures
fire, toys must be limited to stuffed animals that can not ignite a fire, suffocation
Oxygen Analyzer
Analyzed FIO2 to check accuracy, calibrated at 21 and 100%, to check the FIO2 that the patient iss actually reeceiving FIO2 analysis should be performed as close to the pattient ass possible
Oxygen Blenders
Used when the conventional AEN are unable to meet the patients inspiratory demands, provide flow inn excesss of 60lpm, aare pron to inaaccuraccy and ffailure so should be monitored uusing an 02 analyzeer att least oonce per shift
Tandem AEn
used when a single air entainment unit does not meet the patients inspiratory demand 2 units may be combinedd en tanndem to provide the requireed FIO2
hypoxemia
an inadequate amount of oxygen in the blood
Two types of hypoxemia
Responsive, and Refactory
Hypoxia
is inadequate amount of oxygen to the tissue (dependent on ventilation of the lungs, diffusion into the blood, traansportaation of 02 to the tissue, and upttake and utilizzation off 02 att the cellular level
anemic hypoxia
the capacity of the blood to carry 02 is decreased Example Carbon monoxide poisoning treatment ggive 100% 02 viaa NBR, or HBO
Stagnet Hypoxia
(Circulatory) 02 content and carrying capacity are normal but capillary perfusion is diminished
histotoxic hypoxia
inability of tissue to utilize 02 (ex alcohol poisoning)
hypoxemia hypoxia
lack of 02 in the blood
Hyperbaric Oxygen Therapy HBO
uses a special chamber to deliver therapeutic oxygen at pressures greater than 1 atmosphere
what are indications for HBO
Decompression sickness, Gas or air embolism, CO poisoning, Cyanide poisoning, problem healing wouunds, iscchemic skin grafts, trauumatic crush injuries,, necorotizzing soft tisssue infection, gangrene
Complications and hazards of HBO
barotrauma, oxygen toxicity, fire, sudden decompression, claustrophobia
what are indication fo Heli/Ox
To manage large airway obstruction like COPD, acute upper airway obstruction of various origin, post exxtubation stridor in pediatrri trauma patients, refactory viraal crop
what is the mixture of Heli?ox
must be mixed with at least 20% oxygen most common mixture is 80% helium 20% oxygen 70/30 if trreating hypoxemia
what are the conversion factors for Heli/ox
80/20 = 1.8 70/30=1.6
what are hazords and complications for Heli//ox
impaired secretion clearance, distorted high pitched voice, hypoxemia
what are indications for Carbon Dioxide/Oxygenn
stroke, Migraines, stop seizure, CO poisoning
How does CO2/02 work
by increasing cerebral blood flow
what is the CO2/02 mixture
5/95 No more than 5% CO2 should ever be used
side effects of CO2/02
increased HR, Cerebral vasodilatation, dyspnea, dizziness, headache, muscle tremors, nasal irritation
side effects of CO2 toxicity
nausea, vomiting, disorientation, elevated BP
Contraindications for CO2/02
compromised central respiratory centers, severe COPD
indications for Nitric Oxyde
Persistent Pulmonary Hypertension of the newborn, cardiac and lung transplant, acute pulmonary embolism, CCOPD and chronic ffibroosis, bronchodialation, conngeital ddiaphragmatic hernnia, ccongenitall heart disease, ARDS
indications for Home Oxygen
SA02< 88% PaO2 55 or lower, or SAO2 < 89% PaO2 56-59 with diagnosis of specific disease
what should be considered when choosing a hhome oxygeen systtem
liter flow, duration of usage, patients mobility, daily activities, patients strength, eye sight, and ability to read and understand written insturctions
what cylinder can be used for home oxygen and when shoulld they bee used
a-k, when it is low flow 0.5-2 lpm less than 24 hours per day or on prn basis
when should a liquid oxygen system be used
for active patients with liter flows of 0.5-6lpm and a prescription for use > 12 hours per day
When is a concentrator good for home oxygen
home bound patients with letter flow of 1-5 lpm with prescriptions for use >24 hours per day
how does a concentrator work
draws in room air, then physically separates the nitrogen from the oxygen and stores the oxygen in a small accumulator
how is the separation process accomplished in a concentrator
throgh a molecular sieve that contains sodium-aluminum silicate pellets that absorb nitrogen, carbon dioxide and water vapor