Egan’s Chapter 18 & 38 Study Guide:
- What does FiO2 stand for?
- What does FdO2 stand for?
- What does PaO2 stand for?
- What does PAO2 stand for?
- What does SpO2 stand for?
- What does SaO2 stand for?
- How do you determine when O2 therapy is needed?
- What is the most common mode of respiratory care?
- Most medical gases are considered a type of what?
- What is the overall goal of the RT?
- What are specific clinical objectives for oxygen therapy?
- What do respiratory therapists do in terms of drugs?
- How does oxygen therapy correct hypoxemia?
- What is the most tangible objective of O2 therapy?
- What else does O2 therapy help relieve besides hypoxemia?
- How does the cardiopulmonary system compensate for hypoxemia?
- Arterial hypoxemia causes an increase in what?
- What does hypoxemia cause?
doespulmonary vasoconstriction and pulmonary hypertension cause?
- What does O2 toxicity
- What factors determine the harmful effects of oxygen therapy?
- When would effects of CNS such as twitching occur?
- In patients with chronic
hypoxemiathe increased workload over a long period of time can lead to what?
- What is Hypoxemia?
- What is hypoxia?
- What can hypoxemia lead to if it isn’t taken care of?
- Can a person have hypoxia without having hypoxemia?
- What are the four types of hypoxemia?
- What is anemic hypoxia caused from?
- What is stagnant hypoxia caused from?
- What is
histotoxichypoxia caused from?
- What is hypoxemic Hypoxia caused from?
- What is the desired result of oxygen therapy?
- What are the symptoms of oxygen toxicity?
- What is oxygen toxicity?
- What is hypoventilation?
- Why does there have to be more of a caution with COPD patients?
- What is ROP (Retinopathy of Prematurity?
- What is absorption atelectasis?
patients areat more of a risk for absorption atelectasis?
- What are the 5 hazards of oxygen therapy?
- What are some factors to consider when selecting the equipment for oxygen therapy?
- What are the three types of delivery systems?
- What is a Low flow system?
- What are the depending factors of oxygen delivered for low flow systems?
- When a
patientstidal volume increases what happens in a low flow system?
isthe criteria for low flow system?
devices areconsidered low flow systems?
- What is the desired range for FiO2 for nasal cannula low flow systems?
- What is a nasal cannula?
- What are advantages of nasal cannulas?
- What are disadvantages of nasal cannulas?
- What kind of patients are nasal cannulas best used for?
- What problems can occur when using nasal cannula?
- Where should the nasal catheter be when placed correctly?
- What are the advantages of a
- What are the disadvantages of a
- What is a reservoir system?
- What are the devices considered as reservoir systems?
- What are the advantages of simple masks (aka reservoir masks)?
- What is
FiO 2range of simple masks?
- Why must a simple mask run
at atleast 5 LPM?
- Study table 38-6 for trouble shooting with simple masks and partial and
- What are some advantages of a partial rebreathing mask?
- When are partial rebreathing masks used?
- What are some advantages of a
- When are nonrebreathing masks used?
- What is a high flow system?
- What is the range for FiO2 in high flow systems?
- What are two types of air entrainment systems (high
- What is the range for FiO2 in a venti/venture mask?
- In the venti mask
systemwhat does the smallest jet provide?
- When is a T piece/ T tube used?
- When is a Trach collar used?
- When is a face tent used?
- When is an aerosol face mask used?
- What is an oxygen blender?
- What helps oxygen blenders function?
- What is another name for oxygen tents?
- What are croup tents used for?
- What FiO2 is available when using oxygen tents?
- What are the physiological effects of hyperbaric oxygen therapy?
- When is Helium therapy needed?
- How do you calculate
a 80/20mixture of heliox?
- How do you calculate a 70/30 mixture of heliox?
- What are the two types of reservoir cannulas?
- What is the advantage of a reservoir cannula?
doesReservoir cannulas operate?
- What is a laboratory sign of cyanide
- Read thru chapter 18 lecture notes
- Practice math problems
- Fraction of Oxygen in inspired air
- Fraction of delivered oxygen by oxygen therapy devices
- Partial pressure of oxygen in arterial blood
- Partial pressure of oxygen in the alveoli
- Oxyhemoglobin saturation measured by pulse oximetry
- Oxyhemoglobin calculated by ABG machine
- If a patient is over 28 days old and their PaO2 is less than 60
mmHGor their SpO2 is less than 90%, if it is a neonate patient if the PaO2 is less than 50 mmHGthe SpO2 is less than 88 % or the capillary PO2 is less than 40 mmHG, another reason for O2therapy is based offthe clinical problem or condition such as patients with carbon monoxide poisoning, shock, trauma, acute myocardial infarction and some premature infants, And the third way to tell if a patient needs oxygen therapy is if the patient is experiencing tachypnea, tachycardia, cyanosis, or have distressed appearances
- Gas Therapy
- To maintain adequate tissue oxygenation while minimizing cardiopulmonary work
- Correct documented/suspected acute hypoxemia decrease symptoms associated with chronic hypoxemia decrease the workload that hypoxemia imposes on the cardiopulmonary system
- They recommend/administer dosages, monitor responses, alter therapy when needed, and record/document
- It increases oxygen in the alveolar and the blood
- Correction of hypoxemia
- Oxygen therapy can help relieve symptoms associated with certain lung disorders such as COPD patients
- There will be an increase in ventilation and cardiac output
- Cardiac output
- Pulmonary vasoconstriction and pulmonary hypertension
- An increased workload on the right side of the heart
- Lungs and central nervous system (CNS)
- PO2and exposure time
- When a patient breathes oxygen at a pressure greater than 1 atm
- Ventricular failure
- The lack of oxygen in the arterial blood
- The lack of oxygen in the tissues
- Anemic Hypoxia, Stagnant (circulatory) Hypoxia, Histotoxic Hypoxia, and Hypoxemic Hypoxia
- It is caused by a decreased carrying capacity of blood for oxygen examples include anemia which is decreased levels of Hb normal level is 12-16, carbon monoxide poisoning, excessive blood loss, methemoglobin which is from toxic drug reactions, and iron deficiency
- It is caused from a diminished capillary perfusion caused by a decreased heart rate, decreased cardiac output, shock , emboli, and polycthemia
- It is caused from an impaired oxidative enzyme mechanism that won’t allow the tissues to use oxygen due to cyanide poisoning, nicotine poisoning, or alcohol poisoning there is an increase of venous PO2 levels (PvO2)
- It is caused by the lack of oxygen in the blood caused from V/Q mismatch, inadequate oxygen in the inspired air, alveolar hypoventilation, atelectasis, pulmonary edema, and anatomic right to left shunt.
- A decreased work of breathing and increased SaO2 the SaO2 in normal patients should be 95 % or higher but for chronic CO2 patients it should be 90%
- 0 to 12 hours substernal chest pain begins, 12 to 24 hours decreased vital capacity occurs, 25 to 30 hours decreased lung compliance and a decrease in blood oxygenation, and 30 to 72 hours there is a decreased diffusing capacity
- It is an overproduction of oxygen free radicals
- It is a depression of ventilation that suppresses the hypoxic drive ( found in COPD patients)
- COPD patients normal responses to high partial pressure of carbon dioxide is blunted so the primary sensor to take breathes is the lack of oxygen if given too much O2 they will stop breathing because their brain has no sensor telling them there is a need to breathe
- It is also called Retrolental fibroplasia this is found in premature infants or underweight infants that receive increased FiO2 for a long time. This is caused from retinal vasoconstriction which leads to necrosis of blood vessels. New blood vessels form and increase in number hemorrhage causes scarring behind the retina which can lead to retinal detachment and blindness. It affects neonates up to one month
- It is collapsing of the lungs caused by FiO2’s greater than 50%, decreased nitrogen blood levels, pressure gradient between alveoli and blood causes alveoli to collapse
- Patients who are sedated or have central nervous system dysfunction or if patient has alveolar obstruction
- Oxygen toxicity, depression of ventilation (hypoventilation), retinopathy of prematurity (rop), absorption of atelectasis, and fire hazards
- The severity and cause of hypoxemia, the patient age group (infant or adult), Degree of consciousness and alertness, presence or absence of tracheal airway, stability of minute ventilation, and mouth breathing vs. nose breathing patients
- Low Flow, Reservoir System, and High Flow
- It is a system where FiO2 is not constant and it changes with the patient’s breathing patterns, It provides supplemental oxygen to the airway at flows of 8 L/min
- Liter flow, ventilatory pattern, nasopharynx and oropharynx
- The FiO2 decreases along with an increased room air entrainment
- A consistent ventilatory pattern, tidal volume between 300 and 700 mL, respiratory rate less than 25
- Nasal cannula, nasal catheter, and
- 24-44% is the range; for 1 LPM its 21-24, 2LPM its 25-28, 3 LPM its 29-32, 4 LPM its 33-36, 5 LPM
its37-40, and 6 LPM its 41-44, for infants flows are limited to a maximum of 2 LPM
- It is a low flow system that is disposable it consists of two tips/prongs 1 cm long
- They are lightweight, comfortable, inexpensive, can be used on any age, best tolerated device
- Nasal mucosal drying and FiO2 varies, humidifier has to be used when flow is above 4LPM, they are not tolerated well by restless patients
- Stable patients needing low FiO2 and home care patients that need long term therapy
- The patient may pull on it or move it and it becomes out of place for the correct delivery or the tubing can become twisted, if no gas flow is felt the flowmeter may not be on or there may be a leak check flowmeter and connections, study table 38-5
- It should be just behind and above the uvula
- It expands anatomic reservoir and provides higher FiO2, increases mobility, the main advantage most patients look at is the fact that it is not as visible as other devices like the cannula so makes for a better conscious
- The disadvantages include high cost, it requires a physician to insert, and infection and mucus plugging
- It has a mechanism that gathers and stores oxygen between breaths, doesn’t supply total ventilatory needs, room air is drawn to provide flow, it is a low flow system just provides higher FiO2
- Reservoir cannulas, mask, and non rebreathing mask
- They are comfortable, simple, and inexpensive
- 35 – 50% FiO2 at flow of 5 to 12
- In order to prevent CO2 build up
- Study table
- Oxygen concentrations of moderate to high, it is quick and easy to use, disposable, and inexpensive
- During emergencies and for short term therapy that requires moderate to high FiO2
- Oxygen concentrations of moderate to high, it is quick and easy to use, disposable, and inexpensive
- During emergencies and for short term therapy requiring high FiO2s
- High flow systems are used when consistent and accurate FiO2 is needed, it is ok to use when ventilator pattern is not consistent, provides a flow that exceeds the peak inspiratory flow rate 60% LPM of flow is needed to be considered high flow
- The range is 21 to 100%
- Mask and Nebulizer
- The range is 40 to 42%
- The smallest jet provides the least amount of FiO2 but the greatest amount of air entrainment and more flow
- When a patient is intubated
- When a patient has a tracheostomy tube
- When a patient has facial trauma, burns, or can’t tolerate a mask
- Most common device used
- Oxygen blenders uses an air oxygen source gas each gas is proportionally matched through valves
- An alarm system that gives an audible warning when gas fails or drops to a preset pressure (these should be analyzed)
- Croup tents
- Croup, epiglottis, and cystic fibrosis
- 40 to 50% at 12 to 15 LPM
- Reduces bubbles in air embolism and decompression sickness, hyperoxia- dissolves more oxygen in plasma, vasoconstriction in burns,cerebal edema, and crush injuries, neovascularization- tissue repair in radiation induced injuries
- It is needed when a patient has acute upper airway obstruction, postextubation stridor, refractory viral croup or in other words when there is large airway obstruction
- Just divide the liter flow that is needed by 1.8
- Just divide the liter flow that is needed by 1.6
- Nasal reservoir and Pendant Reservoir
- Lower O2 usage, less discomfort because of lower flow rates, and increased mobility
- They store oxygen in a small membrane reservoir during expiration, patient inhales/draws the stored oxygen during inspiration
- Increased levels of PvO2