Oxygenation Basics

NAP Exercises

Respiratory Pathway

Trachea, Bronchi, Bronchiole, Alveoli

5 adventitious sounds

Crackles, Rhonchi, Wheezing, Stridor, Pleural Friction Rub

Causes of Crackles

Mucus, Secretions, Fluids, COPD

Differentiate location of Fine Crackles from Coarse Crackles

Fine Crackles are from Alveoli, Coarse Crackles are from Bronchioles

Smaller Airways?

Alveoli, Bronchioles

Causes of Rhonchi

Mucus, Fluids, Secretions, COPD

Larger Airway?

Bronchi, Trachea

Does coughing relieve crackles?

No

Rationale: Crackles happen at smaller and deeper airway (alveoli, bronchioles) coughing is not enough to relieve it

Does coughing relieve Rhonchi?

Yes

Rationale: Rhonchi happen at bigger and superficial airway (Bronchi, Trachea) which is closer to the pharynx, hence coughing is enough to relieve it

Lodging of foreign particles in airway?

Aspiration

What neurological disease increases risk of aspiration?

Stroke

Rationale: If stroke hits the Posterior Inferior Cerebellar Artery, it can decrease blood flow to Vagus Nerve, which causes absent Gag Reflex, therefore pt can no longer protect their airway causing aspiration

Causes of Wheezing

Bronchospasm or Bronchoconstriction, asthma

High Pitched musical sound heard loudly during expiration

Wheezing

Causes of Stridor

Obstruction

most common obstruction in airway?

tongue

antonym of obstruction

patent

Definition: unobstructed, allows for free of passage of blood and oxygen

Causes of Friction Rub

Inflammation of Pleural Cavity

Dry grating or leathery sound

Pleural Friction Rub

Another word for Pleuritis

Pleurisy

What does SpO2 measures?

Measures Oxygen Saturation in a Hemoglobin

how many O2 molecules does 1 protein of Hgb contain?

4 O2 molecules

98% of SpO2 in a patient, what does this mean

98 Hgb protein out of 100 Hgb protein carries 4 O2 molecule, making the SpO2 of the patient adequately saturated

Fraction of Inspired Oxygen

FiO2

FiO2 in room air

21%

FLOW Mnemonic

Flow Rate

Level of Need

Oxygen (FiO2)
When to wear

TID meaning

Total Inspiratory Demand

Definition of TID

In 1 min, how many L of oxygen does a normal healthy person inhale?

TID amount

30 L

Indications for: nasal cannula, simple face mask, and non rebreather mask

Spontaneous Breathing

Rationale: if a person can no longer breathe on their own, there can be no negative pressure inside their thorax to let the delivered O2 be sucked into the alveoli, hence proper oxygenation cannot occur without proper ventilation or movement of air w/o spontaneous breathing

> pt who cannot breathe on their own uses BVM or mechanical ventilator to artificially provide positive pressure and assist the flow of O2 to be pushed into the LRT

Basic Physics: Air flows from area of higher concentration to area of lower concentration

O2 Safety Precautions

no petroleum products at all times

Rationale: petroleum products are derived from oil which is combustible, and can harm pt

Alternative for petroleum jelly to lubricate the nares: Water Based Lubricant (KY Jelly)

T or F: choose the least invasive but the most effective type of Oxygenation

True

Low Flow Devices

Nasal Cannula
Simple Face Mask
Partial Rebreather Mask

Non Rebreather Mask

Flow rate of Nasal Cannula (Min - Max)

1 - 6 Liters

contraindication for Nasal Cannula

Mouth Breather

Nasal Cannula FiO2

24% - 44%

Why >6 L of oxygen is contraindicated in Nasal Cannula

Dries Nasal Mucosa

antonym of exacerbation (worsen)

stable

Flow Rate of Simple face Mask

6 - 10 L

FiO2 of Simple Face Mask

40% - 60%

Absolute Minimum of Flow Rate of Simple Face Mask

5L

Rationale: <5L of flow rate in simple face mask can cause CO2 retention inside the mask which can cause the pt to rebreathe expelled CO2 and can poison the patient

flow rate of partial rebreather masK?

6 - 10 L

why a low flow device is called a partial rebreather mask, how does it work?

during expiration, 1st portion of exhaled air contains O₂-filled air from the lungs called dead space air and a small amount of O2 which will go into the reservoir bag and 2nd portion of exhaled air contains CO2 rich air from lungs which will go out of the reservoir bag.

Pt will not rebreathe all the exhaled air, only partially

FiO2 of Partial Rebreather

40 - 70 %

Flow rate of Non Rebreather Mask

10 - 15 L

fiO2 of Non Rebreather Face Mask

80 % - 100%

Absolute minimum flow rate of Non Rebreather Face Mask

10L

Rationale: the pt has no other source other than the reservoir bag, if the flow rate of NRFM is <10L, it can deflate the bag completely and suffocate the pt

Priority Nursing Intervention for Pt with non rebreather face mask

always check the flow rate (not <10L) and bag is not deflated

Flow rate of Venturi Mask

depending on color adaptor

Provides precise, controlled, and exact concentration of O2

Venturi Mask

Gold Standard Oxygenation Contraption for COPD and asthmatic patient

Venturi Mask

T or F: You need MD or Respiratory Therapist orders for Venturi Mask?

True

Different Colors of Venturi Face Mask

“Bread With Yolk Rises Gracefully”

Blue
White
Yellow
Red

Green

Different Colors of Venturi Face Mask (Blue) = Flow Rate & FiO2

2L, 24%

Different Colors of Venturi Face Mask (Red) = Flow Rate & FiO2

10 L, 40%

Different Colors of Venturi Face Mask (Yolk) = Flow Rate & FiO2

8 L, 35%

Different Colors of Venturi Face Mask (White) = Flow Rate & FiO2

4 L, 28%

Different Colors of Venturi Face Mask (Green) = Flow Rate & FiO2

15 L, 60%

flow rate of High Flow Nasal Cannula

60L

FiO2 of High FLow Nasal Cannula

100%

last resort before EndoTracheal Intubation

High Flow Nasal Cannula

Used to Wean Off from EndoTracheal Intubation

High Flow Nasal Cannula

what can humidify high flow nasal cannula to prevent drying of nasal mucosa to prevent nasal epithelial cell inflammation and irritation

AirVO

Intervention for Oxygenation

Assess Pt, Assess RR, Match device to pt condition

pt w/ pulmonary edema, auscultated, nurse expects what adventitious sounds?

fine crackles

discontinuous, fine, high pitched sounds at the end of inspiration at the lung bases

fine crackles

pt w/ bronchitis hears coarse, low pitched rumbling sounds during expiration that clears somewhat after coughing

Rhonchi

pt w/ asthma in acute exacerbation, nurse auscultated pt, hears high pitched musical sound predominantly during expiration

Wheezing

Normal RR for Adults

12 - 20

Normal RR for newborn

30 - 60

Normal Spo2 of a healthy person

>95%

Normal Spo2 of pt w/ COPD

88% - 92%

why high flow oxygenation is contraindicated for PT w/ COPD

Depress the Respiratory Drive of the Pt

why Beta-2 adrenergic antagonist or any non-selective Beta Adrenergic Receptor Antagonist is contraindicated for pt with asthma

Exacerbate the asthma by inducing drug related bronchospasm