Quiz 4 Oxygen Therapy and Respiratory Care Chapter 87

Venturi mask

* high flow device via mask * large windows on the sides of mask * provide consistent oxygen delivery from 24-50% * windows allow high flow of room air with low flow of oxygen * does NOT requie humidifier

Care for the client receiving mechanical ventilation

- Assisting the client on a mechanical ventilator - Weaning the client from the ventilator

tracheostomy

- Insertion of the tracheostomy tube - Care of the tracheostomy tube

Therapeutic oxygen

- Necessary when a client is unable to obtain sufficient oxygen for the body's needs because of a breathing or blood deficiency - Excess oxygen can be harmful and thus oxygen is prescribed as a medication and is administered under controlled conditions

Types of ventilation in Positive Pressure Ventilator

- Volume ventilation - Pressure ventilation - Assisted-breath ventilation - Controlled-breath ventilation

sources of oxygen

- Wall outlets - Oxygen cylinders - Oxygen strollers - Oxygen concentrators - Hyperbaric chamber

Purpose of Aerosol Mist Treatment

- adds humidity - hydrates thick sputum - administers bronchodilators, anti inflammatory, antiasthma, antibiotics

Oxygen Delivery Devices

* The clients who is having difficulty breathing - Type of device used - critically important when administering oxygen - Primary concern - delivery of the desired concentration (percentage) of oxygen * Low-flow Devices - do not provide exact oxygen concentrations - the client's breathing pattern influences the concentration of oxygen obtained * High-flow Devices the oxygen percentage is constant

Determination of Respiratory Status

* Use of the pulse oximeter - convenient monitor that measures the amount (percentage) of oxygen saturation in the blood - noninvasive; it can be used continuously or intermittently - the oximeter is read as percent oxygen saturation (O2 sat)

Goals of Oxygen Therapy

* Increasing the concentration (or percentage) of oxygen the client inhales helps to - reverse hypoxemia - decrease the work of the respiratory system - decrease the heart's work in pumping blood

Oxygen Strollers

* Liquid oxygen portable unit in a small cylindrical container * Safer for use - requires knowledge of equipment

Oxygen Therapy

* Oxygen - A gaseous element that is essential to life * Therapeutic oxygen - Necessary when a client is unable to obtain sufficient oxygen for the body's needs because of a breathing or blood deficiency - Excess oxygen can be harmful and thus oxygen is prescribed as a medication and is administered under controlled conditions

Hazards of Oxygen Therapy

* Oxygen toxicity - Manifested as changes in lung tissue - Causes vision difficulties in newborns - Affects ventilatory drive control mechanisms, weakening the stimulus to breathe - Local tissue irritation to the nose, mouth, mucosa * Contact with any combustible material can ignite an explosive (flash) fire. - Smoking, anything that can ignite a spark are prohibited when O2 is used * Administration of oxygen is prescribed by the doctor based upon his evaluation of a client's need for oxygen

Nursing Observations for Client Receiving Oxygen

* Rate, depth, and character of respirations * Difficulty in breathing * Lung sounds * Client level of comfort * Anxiety or restlessness * Pulse rate * Arterial blood gases (ABG) * Pulse oximeter readings * Electronic monitoring * Evidence of cyanosis * Oxygen delivery system for proper fit and usage * Proper documentation of equipment settings and observations * Condition of client whose oxygen is discontinued

Characteristics of Oxygen

* Room air is composed of 21% oxygen * Additional oxygen that may be needed by certain individuals is classified as supplemental (Therapeutic) oxygen * Oxygen is necessary for survival

Hyperbaric Chamber

* Stimulates deep sea diving by increasing ATMOSPHERIC PRESSURE (method called - Hyperbaric Oxygenation -HBO) or High Pressure Oxygenation * Used to treat: - Air or gas embolism - Carbon monoxide poisoning - Anaerobic infection (gangrene) - Administer some types of radiation therapy for CA - Perform some surgeries especially heart surgery - Crush injuries or traumatic ischemias - Enhance wound healing in necrotizing soft tissue infections, compromised skin grafts and flaps, thermal burns and chronic osteomyelitis

Oxygen Cylinders or Tanks

* Tanks are usually color coded - indicate gas it contains - GREEN - medical oxygen * Contained high pressure - Careful handling * Pressure valve/gauge indicates amount of pressure in the tank in psi (pressure per square inch

What to use if the Client Who Is Unable to Breathe

* The ambu-bag or manual resuscitator or manual resuscitation bag * Endotracheal tubes * Ventilatory support - negative pressure ventilator - positive pressure ventilator * Positive Pressure Ventilator - Volume ventilation - Pressure ventilation - Assisted-breath ventilation - Controlled-breath ventilation * Care for the client receiving mechanical ventilation - Assisting the client on a mechanical ventilator - Weaning the client from the ventilator * Tracheostomy - Insertion of the tracheostomy tube - Care of the tracheostomy tube * Home care of the mechanically ventilated client

Oxygen Concentrator

* Used in homes and extended care settings * They compressed room air and extract O2 * Provide concentrated oxygen flows, 1-5 LPM * Safer, more convenient * No need to refill * Needs periodic maintenance by technician * Electricity to operate * Not portable

Low flow devices

- do not provide exact oxygen concentrations - the client's breathing pattern influences the concentration of oxygen obtained

Synchronized Intermittent Mandatory Ventilation (SIMV)

- gives the client a preset number of mechanical breath at a certain volume in addition to the client own respiratory effort - machine controlled breaths are decreased in volume or rate

simple mask

- mask fits over mouth and nose - low flow device that delivers 40 - 60% oxygen at 6 -10 LPM A reservoir of oxygen. It is designed to fit over a client's nose and mouth.

Partial rebreathing mask

- mask with a bag and NO valves on the outside of the mask and between the bag and mask - delivers 60 -90% - oxygen is adjusted to maintain the bag at least one third inflated A mask similar to the nonrebreathing mask but without a one-way valve between the mask and the reservoir; room air is not drawn in with inspiration; residual expired air is mixed in the mask and rebreathed.

nasal cannula

- nasal prongs - two small tubes that fit the nostrils - delivers 24 - 44% oxygen at 1- 6 LPM A device that delivers low concentrations of oxygen through two prongs that rest in the patient's nostrils.

Non-rebreathing mask

- similar to PRM but with valves on the outside of the mask and between the bag and mask - delivers 90-100% oxygen - flow rate adjusted to keep the bag inflated at least one third full - increased risk for oxygen toxicity because of high oxygen concentration preferred way of giving oxygen in the prehospital setting to patients who are breathing adequately but are suspected of having or showing signs of hypoxia; 10-15 L/min; up to 90% oxygen

Low-Flow Delivery Systems

-nasal cannula -simple mask -partial rebreathing mask -non-rebreathing mask

how much you inflate the bag in partial rebreather and non rebreather mask

1/3

positive pressure breathing

A breathing system in which air is forced into the lungs.

Oxygen

A gaseous element that is essential to life

cystic fibrosis

A genetic disorder that is present at birth and affects both the respiratory and digestive systems. causing a lot of secretion

Types of Oxygen Masks

A. Partial-rebreathing mask. B. Nonrebreathing mask. C. Venturi mask.

The Client Who Is Unable to Breathe steps by steps to put the ET tube

Bag, valve, mask device, laryngoscope, and endotracheal tube. A bag valve mask device (e.g., AMBU-bag) is used when the client cannot breathe without respiratory assistance. In the photo, note the adult-sized mask and the blue air reservoir of the AMBU-bag. The mask of the AMBU-bag can be used over the mouth and nose. If an endotracheal tube (ET) is in the client's trachea, the mask is removed and the AMBU-bag is connected directly to the ET. The silver-colored laryngoscope, which is inserted into the oropharynx, assists placement during the insertion of the ET.

Is the following statement true or false? It is important to use a humidifier with a venturi mask and ensure that the windows of the mask are not exposed to room air.

False A humidifier must not be used with a venturi mask, as significant back-pressure may activate the safety pressure valve on the humidifier, causing it to burst. the large amount of room air that a venturi mask uses will humidify the gas adequately. The nurse must also ensure that the windows of the venturi mask remain exposed to room air. sheets or blankets must not cover the windows or the end of the adapter to prevent occlusion of the oxygen flow, which would alter the desired oxygen concentration.

Is the following statement true or false? Both the partial-rebreathing and the nonrebreathing masks are classified as high-flow system oxygen administration devices because they can deliver high concentrations of oxygen.

False Both the partial-rebreathing mask and the nonrebreathing mask can deliver high concentrations of oxygen; however, they are both classified as low-flow system oxygen administration devices because it is difficult to get the mask to fit tightly enough to ensure 100% oxygen delivery.

Tracheostomy Tube in Place

Figure 87-4 The diagram shows a tracheostomy tube in place. Note the inflatable cuff (a balloon) near the bottom of the tracheostomy tube, to stabilize and seal the trachea as well as to protect against air leakage and aspiration of gastric contents. It is directly connected to a smaller pilot balloon by a cuff inflation line, thus it is inflated as the interior cuff inflates. Also notice that the tracheostomy tube is in the trachea which is anterior (in front of) the esophagus.

intermittent positive pressure breathing

IPPB- forces room air or oxygen rich air combined with medications into the the client's airway

hypostatic pneumonia

Pneumonia caused by stasis of secretions related to inactivity

positive pressure ventilator

Pushes air into the lungs through a circuit that joins the machine and the client

True or False Both endotracheal tubes and laryngoscope blades come in various sizes (e.g., child, small adult, adult).

True

True or False Laryngoscope and endotracheal tube. A laryngoscope is used during the insertion of an endotracheal tube (ET). Both endotracheal tubes and laryngoscope blades come in various sizes (e.g., child, small adult, adult). The ET tube in the photo has a guidewire already inserted. The ET is then ready for insertion along side of the laryngoscope, which is in the client's oropharynx. When the ET has been verified for correct placement, its small cuff is inflated, which stabilizes the ET inserted inside the trachea. A special endotracteal guard (not shown) or tape holds the ET in place.

True

True or False its about consistency and accuracy determing high flow and low flow

True

True or False without oxygen within 3 minutes neurons is gonna die

True

Is the following statement true or false? A nurse must always be aware of exactly what type of oxygen delivery system is being utilized.

True A healthcare facility may stock only one type of multipurpose mask, which is adapted according to specific needs of the client. a three-in-one mask setup can be established to become a simple mask, a partial-rebreathing mask, or a nonrebreathing mask. Therefore, it is important that the nurse be aware of exactly what type of oxygen delivery system is being utilized.

Is the following statement true or false? A nurse should provide the client on ventilator with communication aids.

True Clients on ventilators are usually sedated, which will decrease their responsiveness and ability to communicate. sedation may also depress respiratory effort. in addition, artificial airways prevent clients from speaking. The nurse should be sensitive to the needs of these clients. for clients on long-term ventilation, use various communication aids (e.g., chalkboard, letter-pointing board, magic slate) and continue to talk to the clients, explaining everything that is being done.

negative pressure breathing

a breathing system in which air is pulled into the lungs

The nurse applies oxygen at 2L/min via nasal cannula as prescribed for a client with dyspnea and an oxygen saturation of 90%. What is a priority nursing action after oxygen administration for this client? a. adjust the amount of oxygen flow every 4 hours. b. continually monitor the client's respiratory status c. remove the oxygen cannula when ambulating in the room d. maintain the client in the supine position

b. continually monitor the client's respiratory status

Ambu bag

a hand-held device that is used to manually breathe for the patient on a temporary basis

a nurse has been providing suctioning and tracheostomy care in a client receiving mechanical ventilation. What should be the maximum number of seconds duration for each interval of suctioning? a. 10 b. 20 c. 30 d. 40

a. 10

a nurse is caring for a client who is receiving IPPB. What should the nurse assess for in this client? Select all that apply a. dizziness b. bradycardia c. headache d. nausea e. pressure ulcers

a. dizziness c. headache d. nausea

A nurse is assisting a healthcare provider perform pulse oximetry on a client. What sites, if used by the healthcare provider, would indicate correct placement of the probe? Select all that apply. a. forehead b. nasal bridge c. chest d. fingertip e. eyelid

a. forehead b. nasal bridge d. fingertip

a nurse who is new to the healthcare facility is becoming familiar with the wall outlet system used in the facility. Which measure should the nurse employ? a. practice inserting the adapter into the outlet b. reduce the outlet pressure to a safe level c. push gently to ensure the adapter is locked in place d. keep the wall outlets upright at all times

a. practice inserting the adapter into the outlet

The nurse is caring for a client who is intubated and mechanically ventilated. What is a priority nursing intervention? a. provide oral care every 2 hours b. suction the client every hour c. apply petroleum jelly to the lips to prevent dryness d. deflate the cuff and reposition the tube

a. provide oral care every 2 hours

Supplemental oxygen is able to be delivered to the client by several methods. Why do clients prefer to use the nasal cannula? a. the nasal cannula is less confining than other methods b. the flow meter can be set as high as 10 L/min using the cannula c. the nasal cannula is less drying to the nasal mucosa than other methods d. the nasal cannula is the most reliable method of oxygen administration

a. the nasal cannula is less confining than other methods

continous positive airway pressure (CPAP)

allows inspiratory and expiratory airway pressure to be maintained above atmospheric pressure, helps keep lungs always inflated although breathing is spontaneous

A nurse is performing pulse oximetry on a client in order to measure the oxygen saturation in the blood. Which intervention should the nurse perform? a. explain that there might be slight pain from the needle prick b. attach the pulse oximetry probe to the client fingertip c. document the oximetry reading as liters per minute d. avoid using the pulse oximeter continuosly

b. attach the pulse oximetry probe to the client fingertip

The nurse is applying an oxygen cannula to a client with pneumonia. What information should the nurse be sure to include when reinforcing education about oxygen administration? Select all that apply. a. use an electric razor instead of a straight razor around oxygen b. do not use oils around oxygen, especially on hands c. no smoking around oxygen d. do not adjust the cannula after it is applied e. discontinue the oxygen if there is nasal dryness

b. do not use oils around oxygen, especially on hands c. no smoking around oxygen d. do not adjust the cannula after it is applied

A client is hospitalized with a diagnosis of COPD exacerbation. The healthcare provider orders oxygen at 8 L/min via a Venturi mask. Which is an important nursing intervention for the client receiving this method of oxygen administration? a. ensure the bag does not collapse during inhalation b. ensure that the windows on the mask remain exposed to room air c. ensure humidification is provided d. ensure the mask is used only in the ICU or during one-to-one client care

b. ensure that the windows on the mask remain exposed to room air

a nurse is caring for a client who is receiving mechanical ventilation. Which of the following supplies are necessary at the client's bedside? Select all that apply a. mini-nebulizer with mask b. manual breathing bag c. extra tracheostomy tube d. aerosolized medications e. a 10 ml syringe

b. manual breathing bag c. extra tracheostomy tube e. a 10 ml syringe

a nurse is caring for a client who is receiving IPPB treatment. Which measure should the nurse employed to ensure that mucus is removed? a. encourage forceful exhalation b. perform airway suctioning c. provide IPPB for 2 to 4 minutes d. assist the client to lie supine on the bed

b. perform airway suctioning

A nurse is caring for a client receiving supplemental oxygen. Which assessments are important? Select all that apply. a. the client's fluid intake b. the client's respiration rate, depth, and character c. the client's heart rate d. the client's pulse oximetry reading e. reddened pressure areas under the straps

b. the client's respiration rate, depth, and character c. the client's heart rate d. the client's pulse oximetry reading e. reddened pressure areas under the straps

a nurse is suctioning the Airways in a client who recently underwent tracheostomy. Which measure should the nurse employ when inserting the suction catheter? a. apply suction while inserting the catheter b. assist the client to lie in a supine position c. insert the catheter until the client coughs d. suction for no longer than 20 second intervals

c. insert the catheter until the client coughs

The nurse is working with a client receiving supplemental oxygen therapy. The nurse would expect which goal to be included in the client's nursing care plan? a. weakens the stimulus to breathe b. increases the work of the respiratory system c. reverses hypoxemia d. increases the heart's workload

c. reverses hypoxemia

A client with COPD is admitted with an exacerbation of the disease and requires a low-level consistent oxygen concentration. What method of oxygen delivery will the nurse apply? a. partial-rebreathing mask b. nonrebreather mask c. venturi mask d. nasal cannula

c. venturi mask

negative pressure ventilator

chamber with head out used in the 50's during polio outbreak. (ex. iron lung)

Pressure Support Ventilation (PSV)

constant pressure is applied as the person inspires, thus lessenning the effort needed to breath

The nurse is gathering data for several clients. When obtaining pulse oximetry readings, the nurse determines that this method is ineffective for which client? a. a client on oxygen via nonrebreather mask b. a client with pneumonia c. a client with COPD d. a client with severe anemia

d. a client with severe anemia

A client presents to the emergency department with a diagnosis of asthma. The client is experiencing shortness of breath and wheezing. The healthcare provider orders albuterol via an aerosol mist treatment. What is the purpose of this method of administration? a. decreases humidity to assist with medication administration b. utilized for clients requiring asthma medications only c. provides delivery of medication to upper airway only d. administers bronchodilators to relax bronchioles narrowed by bronchospasms

d. administers bronchodilators to relax bronchioles narrowed by bronchospasms

A nurse is caring for a client who is receiving oxygen therapy. Which nursing intervention would the nurse include when caring for the client? a. keep the electrical call light switch within the client's reach. b. adjust the apparatus with well-oiled hands c. apply the mask before turning on the oxygen d. assist the client to move about in bed often

d. assist the client to move about in bed often

a nurse is caring for an asthmatic client who is receiving oxygen via a nasal cannula. What is the first step the nurse should take before administering oxygen? a. adjust the flow meter to the recommended flow rate b. insert the prongs of the nasal cannula into the client's nostrils c. encourage the client to breathe through the nose rather than the smooth d. attach the cannula with the connecting tube to the adapter on the humidifier

d. attach the cannula with the connecting tube to the adapter on the humidifier

A nurse is assisting the healthcare provider to perform a tracheostomy on a client. For what should the nurse assess in this client? a. headache and dizziness b. dysrhythmias and palpitations c. decreased pulse rate d. bleeding over the area

d. bleeding over the area

a nurse is caring for a client who is receiving oxygen via a Venturi mask. Which measure should the nurse employ to change oxygen concentrations? a. change the humidfier b. change the mask regulator c. change the settings on the adapter d. change the window openings

d. change the window openings

a nurse is caring for a client who is receiving oxygen with a simple mask. Which measure should the nurse undertake when caring for this client? a. turn the oxygen on after applying the mask b. ask the client not to move out of bed c. encourage the client to breathe through the mouth d. connect the mask tubing to the humidifier outlet

d. connect the mask tubing to the humidifier outlet

A nurse is providing respiratory care for a client who is receiving oxygen through a partial-rebreathing mask (PRM). What precautionary measure should the nurse employ in this client? a. connect the partial-rebreathing mask to a humidifier b. allow the mask to run at a specific oxygen flow rate c. apply the mask and set the recommended flow rate d. make sure the bag inflates during inhalation and exhalation

d. make sure the bag inflates during inhalation and exhalation

A nurse is providing care to a client being discharged from the hospital with plans to use an oxygen concentrator. Which would the nurse include in the discussion about oxygen concentrators? a. used to deliver about 5 LPM b. use dense liquid oxygen c. need to be refilled regularly d. need electricity to operate

d. need electricity to operate

inserting the suction catheter into the tracheostomy

dipping the suction catheter

Mini-Nebulizer

hand held apparatus for aerosol therapy, client inhales the medication in the form of a mist.

4 LPM in nasal cannula you need

humidification

What to use to clean the tracheostomy

hydrogen peroxide

laryngoscope

is used during the insertion of an endotracheal tube instrument used for visual examination of the larynx

Aerosol mist treatment

mini-nebulizer

How long to suction?

no more than 15 seconds

Parts of tracheostomy tube

outer cannula, inner cannula, obturator Parts of a tracheostomy tube. A typical tracheostomy tube has several parts. The tracheostomy tube has an inner cannula, which is inserted using an obturator (not shown). After being checked for placement, the cuff and its attached smaller pilot cuff (in the blue area) are inflated via the cuff inflator line. The inner cannula (bottom of photo) is removed once the outer cannula is inserted in the trachea. The oval white face plate rests against the neck. Small cloth ties are threaded into the holes on either side of the face plate and are tied together at the side (not the back) of the neck.

endotracheal intubation

placement of a tube through the mouth into the pharynx, larynx, and trachea to establish an airway

position concious suction tracheostomy

semi or high fowler position

position unconcoius suction tracheostomy

side lying (facing the nurse)

High flow devices

the oxygen percentage is constant

What are the high flow delivery systems

venturi mask, IPPB, aerosol mist treatment, CPAP