Respiratory in class part 1

Overview of Oxygen Delivery and Assessment

• Importance of accurate oxygen delivery methods and calculations.

Oxygen Delivery Devices

• Nasal Cannula:

  • Maximum flow rate: 6 liters.

  • Always humidify oxygen above 4 liters to prevent drying.

• OxyMask:

  • Hole design allows lower flow rates (can be as low as 2 liters).

  • Cheater sheet available that indicates how many liters equates to specific oxygen percentages (e.g., 20%, 30%, etc.).

• High-Flow Nasal Cannula:

  • Useful for patients who need oxygen during meals while still requiring respiratory support.

  • Delivers precise oxygen concentrations.

Calculating Oxygen Concentration

• Convert percentage of oxygen (e.g., 21%) to decimal for calculations (e.g., 0.21).

• P/F Ratio:

  • Definition: Ratio of arterial oxygen partial pressure (PaO2) to the fraction of inspired oxygen (FiO2).

  • Example calculated ratio: 380.95.

• Importance of calculating FiO2 accurately for patient management.

ARDS (Acute Respiratory Distress Syndrome)

• Characterized by non-responsiveness to increased oxygen concentrations.

• Alveolar collapse and poor gas exchange leads to hypoxia.

• Benefits of prone positioning in ARDS patients:

  • Improves oxygenation by recruiting collapsed alveoli.

  • Changes the distribution of lung perfusion and ventilation.

• Nursing interventions for patients with ARDS include regular repositioning every 2 hours to facilitate gas exchange.

Understanding Hypoxia and Gas Exchange Mechanisms

• V/Q Mismatch:

  • Ratio indicates ventilation (V) and perfusion (Q) within the lungs.

  • High V/Q: Indicates good ventilation but poor perfusion (e.g., pulmonary embolism).

  • Low V/Q: Indicates poor ventilation, good perfusion (e.g., pulmonary edema).

• Shunt: Blood bypasses ventilated areas; unresponsive to supplemental oxygen. Examples of conditions causing shunt include ARDS.

• Dead Space: Functional area that is ventilated but not perfused (e.g., from pulmonary embolism).

Assessing for Complications

• Tracheal Deviation: Indicative of tension pneumothorax. Severe respiratory distress could follow.

• Flail Chest: Characterized by paradoxical movement of the chest wall during respiration due to multiple fractures.

• Important signs to look out for in respiratory failure include:

  • Mental status changes as an early indication of hypoxia.

Practical Scenarios and Questions for Nurses

• If a tracheostomy dislodges, prioritize actions based on retention sutures available.

• For patients with flail chest, monitor for paradoxical movements in the thoracic area.

• In an emergency situation, utilize suction catheters as needed when managing airway obstructions.

Summary of Key Concepts

• Understanding the mechanisms of oxygen delivery and their implications in diseases like ARDS and respiratory distress is critical.

• Proper oxygen delivery equipment and understanding of calculations for effective patient management is essential.