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oxygen therapy slide set 2
Terms in this set (78)
What are the indications for oxygen therapy for patients on room air?
1. Pa02 less than 60 mmHg
2. Sa02 less than 90%
3. Pa02 or Sa02 below desirable range for a specific clinical situation
What are contraindications of oxygen therapy?
1. wi. with a few exceptions no specific contraindication to 02 therapy exist when indications are present
2. certain delivery devices are contraindicated such as nasal cannulas and nasopharyngeal catheters in pediatric and neonal patients with nasal obstruction
What can Pa02 greater than or equal 60 mmHg?
1. Ventilator depression may occur rarely in spontaneously breathing patients with elevated Pac02
Wha are the three basic designs that exist for oxygen delivery systems?
1. low flow systems
2. reservoir systems
3. high flow systems
How is clinical performance of a device analyzed?
1. how much 02 can the system deliver
2. does the delivered Fi02 remain fixed or vary under changing patients demands
A system that provides all of the patients inspired gas and FI02 is stable is considered a _________ device of Fi02
A system that provides only part of the patients inspired gas is considered _________________.
What can happen when a patients Fi02 is greater than 0.5: (50%)
1. absorption atelectasis
2. O2 toxicity
3. depression of colliery or leukocyte function may occur
In premature infants Pa02 greater than 80 mmHg contribute to
retinopathy of the premature
A patient entrains room air along with oxygen as a part of spontaneous breath is considered a _______ Fi02 device
The larger the patients breath the lower the FI02 in a ___________ device
Low flow system nasal catheter developers an Fi02 of _________ to _______
0.24 to 0.40
What is the flow rate of a low flow system?
1/4 to 8 LPM
What determines the FI02 of a patient who is on a Nasal cannula?
1. how much room air the patient inhales in addition to 02
When should you use a humidifier when having a low flow system?
less than 4 L/min
FI02 range for a NASAL cannula low flow:
1 LPM--- FI02 0.24
TAKE 1 LPM and start at 0.24 and FI02 will increase by 0.4
FI02 range for a high-flow Nasal Catheter?
15 LPM--FI02 -1.0
What is an example of a specialized procedure that a low flow system would be used?
How often should a low flow system nasal catheter should be replaced?
every 8 hours and
placed in opposite nares
what does a low flow system Nasal Catheter Fi02 of _______
0.22 to 0.45
A high flow nasal cannula delivers a FI02 of ________ % at 15 LPM with their mouth closed
What is placed in the trachea through the neck by the physical?
Thranstracheal catheter uses _______ to _______- less 02 to achieve the Same Pa02 by nasal cannula
40 to 60%
What is the flow rate of trastracheal catheter?
1/4 to 4 L/min
What is complication and what is required for upkeep of transtracheal catheter?
2. maintenance and cleaning
What is the oxygen concentration that a transtracheal catheter use?
A. 1 L/M-
B. 15 L/M
C. 22 to 45%
What can make the concentration of a low flow system vary?
the amount of air dilution
What increases a LOW flow system FI02?
1. higher input
2. mouth closed breathing
3. low inspiratory flow
4. low tidal volume
5. slow rate of breathing
6. small minute ventilation
7. Long inspiratory time time
What decreases a FI02 in a low flow FI02 ?
1. Lower 02 input
2. mouth-opened breathing
3. High inspiratory flow
4. High tidal volume
5. Fast rate of breathing
6. Large minute Ventilation
7. Short inspiratory time
8. Low I:E ratio
What two devices are designed to conserve oxygen?
The use of oxygen can be lowered as muchs as ____ to blank ___ when using a conservative oxygen reservoir and humidification is not usually needed with this devices
1. 50 to 75%
What are the most commonly used reservoir system?
1. simple mask
2. partial rebreathing mask
3 nonrebreathing mask
what is the input of flow rant for a adult simple mask?
5 t0 10 L/min
What is the Fi02 range of a simple mask?
0.35 to 0.50
What is the Fi02 range fo a partial rebreathing mask?
0.40 to 0.70
What is the Fi02 of a Non rebreathing mask?
0.70 to 1.0 (100%)
it can vary from
what mask from rebreathing his or her oxygen when using a non rebreathing mask?
one way valve
Where is the inspiratory and expiratory valves work with a rebreathing mask?
Inspiratory valve located on top of bag
expiratory valve covers the exhalation ports
What do the inspiratory valves and expiratory valves do?
1. inspiration- slight negative mask pressure closes the expiratory valves preventing air dilution and the inspiratory valve opens providing 02 the patient
What are the common problems with reservoir mask?
1. device displacement
2. system leaks and obstructions
3. improper flow adjustment
4. skin irritation
We should at least provide a flow rate of ______ with a high flow system.
The average peak inspiratory flow during ventilation is approximately ____ times the minute volume
In high flow systems what two variables is the Fi02 dependent on?
1. air to 02 ratio
2. amount of flow resistance downstream from the mixing site
What does decreased flow resistance cause?. and what does it do?
1. back pressure
A. volume of entrained air
B. total flow output of the devices
The lower the entrained air the delivered ____________ _______
02 concentration increases
When the total flow output decreases the effect on Fi02 _____
When entrainment ports of a air entrainment device become obstructed what happens?
1. delivered 02 concentration increases
2. total output flow decreases
3. the net effect is a variable FI02
What are the three main features of a high flow nasal cannula?
1. delivers a high Fi02
2. meets or excess the patients minute ventilation, and acts as a fixed oxygen delivery device
3. generates a distending positive airway pressure
What are examples of a High flow nasal cannula?
1. Vapotherm Precision Flow System
2. Fisher and Paykels Optiflow
What system allows precise control over both Fi02 and total flow output?
Air and 02 enter the blender and pass through dual pressure regulators that exactly math the pressures is called ?
What provides precise control over relative concentration when using oxygen blenders?
1. Varifying size of the air and o2 inlets
What is the best method for delivering controlled oxygen to infant?
What are the 3 ps of selection of oxygen delivery system?
2. patient consideration
3. performance of the device
What is the general purpose of all 02 therapy is to increase ________ sufficiently to correct arterial hypoxemia
The therapeutic use of 02 at pressures greater than _________
A ________ is a large tank capable of holding a dozen or more people
What are the indications for hyperbaric oxygen therapy?
1. decompression sickness
2. air or gas embolism
3. carbon monoxide and cyanide poising
4. acute traumatic ischemia (compartment syndrome crush injury
5. Acute peripheral arterial insufficiency
6. Intracranial abscesses
7. Crush injuries and suturing severed limbs
8. clostridial gangrene
9. Necrotixing soft tissue infection
10. ischemic skin graft or flap
What are the chronic conditions of hyperbaric oxygen?
1. diabetic wounds of lower extremities and other non breathing wounds
2. refractory osteomylitis
3. actinomycosis (chronic systemic abscess)
radiation necrosis (HBO as an adjunct to conventional treatment
A patient with C0 poisoning breathing room air(0.21) only it will take more than 5 hours to remove only one half of the carboxyhemoglobin in the blood
Breathing 100% oxygen reduces the half life to 80 minutes
The half life of carboxyhemoglobin under HBO at ATA is 23 minutes
Carbon monoxide poisoning
what is a complication that can occur with certain cardiovascular procedures lung biopsy hemodialysis and central line placement?
What is the typical therapy for air embolism and how long?
1. immediate pressurization in air
2. 6 ATA for 15 to 20 minutes
3. 2.8 ATA with prolonged oxygen treatment
What are the complication of and hazards of HBo`
2. Oxygen toxcity
What are examples of barotrauma?
1. ear or sinus trauma
2. tympanic membrane rupture
3. alveolar over distention and pneumothorax
4. gas embolism
What are examples of Oxygen toxicity?
1. CNS toxic reaction
2. Pulmonary toxic reaction
What are example of other complications and hazards of HBO?
reversible visual changes
decreased cardiac out put
What are benefits of nitric oxide therapy?
1. blood flow to the lung
2. reduces shunting
3. improves oxygenation
4. decreases pulmonary vascular resistance
5 lower cost alternative drug therapies include inhaled epoprostenol sodium
What are potential indications for Nitric oxide
2. Persistent pulmonary hypertension in newborn
3. pulmonary hypertension after cardiac surgery
4. cardiac transplantation
5. acute pulmonary embolism
7. Congenital diaphragmatic hernia
8. Sickle cell disease
9 Testing pulmonary vascular responsiveness
What are adverse effects associated with nitric oxide therapy?
1. poor or paradoxical response
3. increased left ventricular filling pressure
4. complications of certain cardiac anomalies (coarctation of the aorta
5. rebound hypoxemia, pulmonary hypertension
Helium oxygen therapy can do what for a patient?
helium is based solely on its low density and it can decrease work of breathing for patient with airway obstruction
How should hello be administrated?
tight fitting non rebreathing mask with high flow
When using helium oxygen therapy why would 02 flowmeter be inaccurate?
because of the low density of helium
What is the correction factor for helium o2 mixture is?
80:20 mixture is 1.8
The factor for a 70:30 for helium 02 mixture is
helix therapy of 80:20. you need to give the patient an aerosol treatment using 8 liters per minute what would the liter flow be?
8 L/M divided by 1.8 = 4.44 or 4lpm
You have a patient on heliox therapy using a 70:30 mix. You need to give an aerosol treatment with heliox using a flowrate of 6 L/min. What would you need to set the flowmeter at to achieve an actual 6 liters per minute?
6l/pm divided by 1.6= 3.75 (4 L/Min
What are hazards of heliox therapy?
1. poor vehicle for aerosol transport
2. reduces effectivness of coughing
3. badly distorts patients voice
What are uncommon but uses of carbon dioxide oxygen therapy (CARBOGEN) therapy?
2. carbon monoxide poisoning
3. preventing complete washout of C02 during 4. cardiopulmonary bypass
What are the mixtures of CARBOGEN therapy?
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