NURS 353 (O2 and PE)

Oxygen therapy

administration of oxygen at a concentration greater than room air

21%

what is the standard amount of oxygen in the air at sea level

increase O2 availability to lungs and tissues

reduce efforts of breathing

reduce cardiac stress

what is the goal of oxygen therapy

Low-flow

room air and supplemental oxygen

consists of unknown or inconsistent O2 concentration

traditional nasal cannula

simple mask

partial rebreather mask

non-rebreather mask

low-flow delivery options

high-flow

total inspired air

precise O2 concentration

venturi mask

high-flow nasal cannula

mechanical ventilation

delivery options for high-flow

nasal cannula

low supplemental O2

1-6 L

Non-rebreather

one way valves and O2 reservoir

everything inhaled is fresh

Venturi mask

open valves and no reservoir

have adapters that give % and what to set flow meter at

clinical indicators

correct application

appropriate O2 regulation

what to know about O2 for emergency use

% of inspired O2

what to set flow meter at

what do the venturi adapters tell you

91-94%

mild hypoxemia

nasal cannula or simple mask

what O2 Tx would you use for mild hypoxemia

5-10 L/min

how much O2 does the simple mask deliver

86-91%

moderate hypoxemia

partial rebreather

nonrebreather

venturi mask

what O2 Tx would you use for moderate hypoxemia

6-10 L/min

how much O2 does the partial rebreather deliver

10 L/min

how much O2 does the nonrebreather deliver

4-10 L/min

how much O2 does the venturi mask deliver

<85%

severe hypoxemia

partial rebreather

nonrebreather

what temporary measure would you use for severe hypoxemia while preparing to intubate

High flow nasal cannula

newer form of high flow O2 therapy that meets or exceeds inspiratory flow demand

heat or humidify for comfort

frequent client assessment

what must you do with high flow nasal cannula

PEEP

maintains airway pressure above atmospheric airway pressure at end of expiration

keeps alveoli open

spontaneous or mechanical ventilation

what can PEEP be used with

CPAP

maintains positive airway pressure throughout whole respiratory cycle

keeps airway open maximally

only with spontaneous ventilation

when can CPAP be used

BiPAP

delivers two levels of pressure

duirng inhalation

when is the higher pressure delivered with BiPAP

COPD, sleep apnea, pneumonia

what is BiPAP used for

prevents micro atelectasis

allows lower % of O2 to be effective

benefits of PEEP/CPAP/BiPAP

headaches

substernal discomfort

dyspnea

alveolar atelectasis

paresthesia

malaise

resp difficulty

refractory hypoxemia

manifestations of oxygen toxicity

monitor O2 flow setting

monitor total therapy time

ensure correct dose

treat other S/Sx

interventions with oxygen toxicity

frequent headaches

increased anxiety

blue tinge to lips/nails

drowsiness

new confusion

restlessness

change in breathing pattern

what to tell pt to notify provider of with O2 therapy

no open flames

no combustible products

explosion-proof plugs

avoid bumping cylinders

keep in well-ventilated area

No smoking signs

safety precautions with O2 therapy

cold extremities

hypothermia

hypovolemia

what can lead to false low oxygen sat readings

anemia

carbon monoxide poisoning

what can lead to false high oxygen sat readings

fewer RBCs to fill up

why can anemia lead to false high readings of O2

exhale normally

what to do first with IS

inhale slowly and deeply

what to do with IS once you close your lips around it

hold breath for 5 seconds

what to do when you can inhale no longer with IS

Pulmonary Embolism

embolus that clogs an artery in the pulmonary vascular system

blocks blood flow to the lungs

what does a pulmonary embolism do

in the venous system

where do pulmonary emboli typically originate

SOB d/t O2 being unable to get into bloodstream

what is the resp response to a pulmonary emboli

Chest X-ray

shows dilated pulmonary artery

Spiral CT scan

common diagnostic test for PE, 360 view of the chest

D-Dimer

rules out blood clot

<0.5 mcg/mL

What is indicative of a negative d-dimer test

V/Q Scan

comparison of air and blood in each of specific lung fields

Pulmonary Angiogram

the gold standard that allows for direct visualization of obstruction via fluroscopy

accurate assessment of perfusion deficit

requires specially trained team

what is the problem with pulmonary angiogram

50+

venous stasis

prolonged immobility

hypercoagulability

previous Hx of thrombophlebitis

damage to vessel walls

orthopedic surgery

risk factors for PE

hip surgery

what type of ortho surgery is at higher risk for PE

one hour from onset

how long does it take death to result from PE

anxiety

chest pain

cough

crackles

sudden dyspnea

tachycardia

tachypnea

diaphoresis

symptoms of PE

identify risk factors

early ambulation

reposition frequently

SCDs

change IV sites

pt education

prevention of PE

VS

lung sounds

resp rate/effort

O2 (low flow)

high fowler’s

EKG to r/o MI

emergency PE interventions

transvenous catheter embolectomy

what can be done for major/massive OE

labs and dosing as ordered

S/Sx of bleeding

OTCs

alert HCPs

interventions for anticoagulation meds