Skills Quiz 3 (FINAL) studyguide

Week 7: Oxygenation O2 Administration

Main Types of Oxygen Administration

Nasal Cannula (NC):

  • Flow Rate: Up to 6 L/min

  • FiO2 Range: 24-44%

  • Description: A device with two prongs that fit comfortably in the nostrils, allowing patients to breathe easily while receiving supplemental oxygen.

  • Advantages: Comfortable for prolonged use, allows patients to eat and drink while in use, and is suitable for patients requiring low to moderate levels of supplemental oxygen.

  • Disadvantages: Limited amount of oxygen delivered; can cause nasal irritation or discomfort over time; effectiveness can be compromised if prongs are not positioned correctly.

  • When to Use: Ideal for patients needing low to moderate supplemental oxygen without severe respiratory distress.

  • Common Mistakes: Improper placement of the prongs can lead to inadequate oxygen delivery; incorrect flow rate settings can cause discomfort or inadequate relief.

Oxymizer (Reservoir Cannula):

  • Flow Rate: Up to 15 L/min

  • FiO2 Range: 28-82%

  • Description: A specialized nasal cannula with a reservoir that conserves oxygen, allowing for higher FiO2 delivery while maintaining comfort for the patient.

  • Indications: Used in patients who require higher amounts of oxygen concentration than what is delivered by a standard NC.

Simple Face Mask:

  • Flow Rate: 10-15 L/min

  • FiO2 Range: 40-60%

  • Description: A mask that covers the nose and mouth, equipped with vents on the sides to allow exhaled air to escape.

  • Advantages: Delivers a higher concentration of oxygen than NC, helping to meet the needs of patients with moderate respiratory insufficiencies.

  • Disadvantages: Less comfortable than NC; potential for anxiety in patients due to feeling of confinement; may impact eating and drinking.

  • When to Use: Best for patients who require a higher concentration of oxygen and can tolerate the mask.

  • Common Mistakes: Failure to ensure the mask is sealed properly against the face can significantly reduce the effective oxygen delivery; incorrect flow rates can either cause barotrauma or inadequate oxygenation.

Venturi Face Mask:

  • Flow Rate: 4-15 L/min (varies by adapter)

  • FiO2 Range: 24-50%

  • Description: A mask designed to deliver a precise concentration of oxygen by mixing oxygen with room air through different adapters.

  • Advantages: Provides accurate and controlled oxygen delivery, essential for patients with specific needs like COPD.

  • Disadvantages: Can be cumbersome and requires careful monitoring and adjustment of the flow rate; potential for inaccurate dosing if the adapter isn’t correct.

  • When to Use: Primarily used for patients with COPD or other conditions that necessitate carefully controlled oxygen levels.

  • Common Mistakes: Using the wrong adapter or failing to ensure an adequate fit can lead to compromised oxygenation.

Non-Rebreather Mask (NRB):

  • Flow Rate: 15 L/min to keep the bag inflated

  • FiO2 Range: 60-100%

  • Description: A mask equipped with a one-way valve, which prevents exhaled air from entering the bag, enabling delivery of high concentrations of oxygen.

  • Advantages: Provides rapid high levels of oxygen, suitable for emergency situations.

  • Disadvantages: Not suitable for prolonged use or for patients who feel claustrophobic; care must be taken to keep the reservoir bag inflated at all times.

  • When to Use: Used in emergencies that require immediate high concentrations of oxygen, such as acute respiratory distress.

  • Common Mistakes: If the bag is not fully inflated, the mask will not deliver the needed oxygen concentration; proper sealing against the face is essential.

High-Flow Nasal Cannula (HFNC):

  • Flow Rate: Up to 60 L/min

  • FiO2: Up to 100%

  • Description: A high-flow system that delivers a precise amount of oxygen at high flow rates, capable of providing heated, humidified oxygen to improve patient comfort.

  • Indications: Beneficial for patients with significant respiratory distress requiring high oxygen levels and humidity.

Non-Invasive Positive Pressure Ventilation (NIPPV):

  • CPAP: Up to 60 L/min, FiO2: Up to 100%

  • BiPAP: Up to 60 L/min, FiO2: Up to 100%

  • Description: Ventilation delivered via a mask that provides assistance with breathing without the need for intubation.

  • Indications: Used for patients with obstructive sleep apnea or acute respiratory failure who do not need invasive intubation.

Oxygen in COPD Patients

  • Administration of oxygen should be approached with caution to prevent hypercapnic respiratory failure which can occur if oxygen levels are too high.

  • Target saturations: 88-92%, allowing for safer management of CO2 retention.

  • Controlled Oxygen Delivery: Using devices like the Venturi mask is critical for accurate dosing; avoid high flow rates that could exacerbate CO2 retention or lead to respiratory acidosis.

  • Monitoring: Regular arterial blood gas (ABG) checks are necessary to assess oxygen and carbon dioxide levels.

  • Caution: Over-administration of oxygen may worsen breathing difficulties due to CO2 buildup in patients with COPD.

Common Mistakes in Oxygen Administration

  1. Incorrect Flow Rate: Can lead to patient discomfort or failure to achieve desired oxygen saturation.

  2. Failure to Monitor Saturation Levels: This can result in dangerous complications, including hypoxemia or hypercapnia.

  3. Inadequate Humidification: Can lead to mucosal dryness and irritation, worsening patient discomfort.

  4. Wrong Device Selection: Selecting inappropriate devices can result in inadequate oxygen therapy.

  5. Improper Placement: Masks and cannulas must be positioned correctly to function effectively.

Trach Management and Care

Basic Principles

  • Airway Patency: Regular cleaning and suctioning are necessary to prevent obstructions and maintain airway clearance.

  • Infection Prevention: Adopting strict aseptic techniques and routinely changing dressings help mitigate infection risks.

  • Proper Humidification: Use humidified oxygen or nebulizers to maintain moisture in the airway.

Trach Change Procedure

Pre-Procedure

  1. Explain the procedure to the patient and gather all necessary supplies (replacement tube, sterile water, suction equipment).

  2. Position the patient comfortably and ensure proper hand hygiene and PPE are used.

Intra-Procedure

  1. Suction the old tube to clear the airway, remove the old tracheostomy tube, and promptly insert the new tube while confirming its placement using bilateral breath sounds and existence of air movement.

Post-Procedure

  1. Monitor the patient for signs of respiratory distress and document the procedure and any observations.

Management Differences: Fresh vs. Established Trach

  • Fresh Trach: Increased vigilance needed for signs of bleeding or infection; frequent dressing changes required.

  • Established Trach: Regular cleaning routines are crucial, along with assessments for complications and timely tube changes when indicated.

Indications for a Tracheostomy

  • Indications encompass issues like airway obstruction, prolonged mechanical ventilation needs, challenges with secretion management, surgical or traumatic airway interventions, neurological disorders, and situations requiring airway protection.

Types of Tracheostomy Tubes

  • Cuffed: Utilized primarily for enforced ventilation; the cuff prevents aspiration and can be inflated/deflated to maintain appropriate pressures (20-30 cmH₂O).

  • Uncuffed: More suitable for patients requiring normal airflow and effective management of secretions.

  • Fenestrated: Allows airflow through openings that facilitate speech while maintaining oxygenation.

Passy-Muir Valve

  • A one-way speaking valve that allows airflow to redirect through the vocal cords, aiding in speech for patients with tracheostomies.

Emergency Supplies for Accidental Decannulation

  • Kits should include spare tubes, an obturator, suction equipment, an ambu bag, and appropriate dressing supplies. The protocol for accidental decannulation generally involves calling for help, ensuring the airway remains open, and attempting to reinsert the tube when feasible.

Trach Suctioning

Basic Principles of Suctioning

  • Clear the airway effectively, prevent infection, and minimize trauma to surrounding tissues.

Steps for Trach, Nasal, Oral Suctioning

  1. Gather necessary supplies: suction catheter, gloves, saline, suction machine.

  2. Pre-oxygenate the patient for 30 seconds to 3 minutes, positioning them appropriately to facilitate the procedure.

  3. Insert the catheter into the tracheostomy or nostril without applying suction; apply suction intermittently while withdrawing the catheter.

  4. Post-care includes reoxygenation, assessment of the patient’s condition, and documentation of the procedure.

Indications for Suctioning

  • Clear indications include visible secretions, ineffective cough, abnormal breath sounds, and any sign of respiratory distress.

Contraindications

  • Caution must be exercised in cases with severe bleeding disorders, bronchospasm, epiglottitis, or recent surgeries.

Evaluating Effectiveness

  • Improvement can be gauged through stabilization of breath sounds, effective oxygen saturation levels, and reduced work of breathing.

Urinary Catheter Insertion and Maintenance

Indications

  • Utilized in cases of urinary retention, following surgical procedures, for incontinence management, bladder irrigation needs, and in critically ill patients requiring close monitoring.

Contraindications

  • Conditions such as urethral injury, severe stricture, or active infection warrant avoidance of catheterization.

Insertion Steps

  1. Collect relevant supplies, explain the procedure to the patient, and position them accordingly.

  2. Aseptic technique: Clean and lubricate the catheter before gentle insertion, inflating the balloon as necessary, ensuring secure placement.

  3. Thorough documentation of the insertion process and any observations.

Management Concepts

  • Emphasize maintaining sterility throughout the procedure, continuous output monitoring, and preventing infection.

Potential Complications

  1. Infection (CAUTI): Stringent aseptic techniques are essential to minimize risk.

  2. Bladder Spasms: Administer antispasmodics as needed.

  3. Urethral Trauma: Ensure the use of an appropriate catheter size and technique.

  4. Blockage: Regularly flush the catheter and assess the hydration status of the patient.

What to Do if Sterility is Broken

  • If sterility is compromised during the procedure, restarting the process is necessary to maintain safety standards.

Nutrition

Basic Elements of Nutrition

  • Carbohydrates: Primary energy source for bodily functions.

  • Proteins: Essential for growth, tissue repair, and overall cellular function.

  • Fats: Important for energy; assist in various physiological processes and cell functionality.

  • Vitamins: Organic compounds vital to various metabolic processes.

  • Minerals: Inorganic elements necessary for numerous bodily functions including bones, teeth, and overall enzymatic activity.

  • Water: Crucial for hydration and the many biochemical reactions of the body.

Nutrition and Wound Healing

  • Adequate intake, specifically of calories, proteins, vitamins, and minerals, is essential in optimizing wound healing and preventing infections.

Enteral vs Parenteral Feeding

  • Enteral Feeding: Ideal for patients with functioning gastrointestinal tracts; various feeding tubes can be utilized for delivery of nutrients.

  • Parenteral Feeding: Delivered intravenously for patients with non-functioning GI tracts; TPN is often used to provide comprehensive nutritional support.

Aspiration Precautions

  • During and after feeding, ensure the head is elevated and monitor tube placement equipment while also being vigilant for signs of distress.

Nursing Priorities and Patient Education

  • Development of SMART goals to facilitate effective interventions for tube placement issues, challenges arising from complications, and comprehensive education regarding care and nutrition management.

NG Tube Insertion

Steps for Insertion

  1. Gather all required supplies, explain the procedure clearly, and position the patient appropriately for insertion.

  2. Measure the tube’s necessary length, lubricate the tip, insert it properly while instructing the patient to swallow for easier passage.

  3. Confirm placement and secure the tube effectively to prevent dislodgement.

Assessment Pre and Post Insertion

  • Monitor the patient for signs of respiratory distress, verify accurate tube placement, assess abdominal status, and document each step of the process.

Possible Complications

  1. Nasal Trauma: Stop and assess the insertion site if complications arise.

  2. Aspiration: Immediate verification of tube placement before administering feeds, monitoring for respiratory compromise is essential.

  3. Tube Displacement: Immediate reassessment and securement of the tube when needed.

Bowel Elimination: Colostomy vs Ileostomy

Definitions

  • Colostomy: Surgical creation of an opening (stoma) that brings a section of the large intestine through the abdominal wall for the expulsion of waste.

  • Ileostomy: Surgical opening bringing a section of the small intestine (ileum) through the abdominal wall.

Effluent Consistency Based on Location

  • Colostomy: Typically produces semi-formed to formed stool.

  • Ileostomy: Produces liquid to pasty effluents based on the site of the stoma.

Assessment Methods

  • Regular inspection of the abdomen and stoma, along with assessment of skin integrity around the stoma area are critical for success.

Pouching Steps

  1. Gather necessary supplies, carefully remove the old pouch and clean the area thoroughly.

  2. Fit the new barrier and pouch accurately, documenting all procedures and observable changes during the pouch change.

Signs and Patient Education

  • Educate patients on stoma care, outline signs of potential complications, and provide dietary recommendations for optimal health and wellbeing.

Documentation and Patient Education

Importance of Documentation

  • Critical for legal protection, effective communication, continuity of care, quality improvement, and accurate billing.

Quality Nursing Documentation

  • Documentation must adhere to principles of accuracy, completeness, timeliness, objectivity, and standardization to ensure it serves its purpose effectively.

Incident Reporting

  • Reports should include an objective description of events, detailed information surrounding the incident, follow-up actions taken, and assurance of confidentiality.

Role of Nurse in Patient Education

  • Involves assessing patient needs, developing educational plans, implementing instructional strategies, and evaluating patient understanding of information provided.

Addressing Learning Barriers

  • Utilize multisensory approaches to enhance understanding, simplify complex information, and provide support for patients facing learning obstacles.