Studydroid is shutting down on January 1st, 2019



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What are the indicators for O2 tx?
  • correct acute hypoxemia
  • ↓ symptoms of chronic hypoxemia (↑WOB)
  • ↓ myocardial workloasd
 
When correcting acute hypoxemia O2 tx is most effective when treating low PaO2 due to what?
Low PAO2
When correcting acute hypoxemia O2 tx may be used in treating what?
  • Anemic Hypoxia
  • PaO2 < 89 with normal Hb
  • CaO2 < 18%

 
Under the AARC guidline O2 tx is given with a SaO2 of what?


SaO2 < 90%
Hypoxemia stimulates peripheral chemoreceptors causing increase in what?
  • Respiratory rate
  • VT
O2 tx reduces stimulation of peripheral chemoreceptors and reduces WOB that can increase what?
  • Mental function in COPD Patients
  • Exercise tolerance
In a hypoxemic patient the cardiopulmonary system compensates for hypoxemia by ↑ ventilation and ↑ the QT.  What happens when the patient is given O2?
  • ↓ ventilation demand
  • ↓ the workload of the heart
How does hypoxemia affect the heart?
  • ↑ cardiac rate
  • ↑ contraction
What does a pulse oximeter used for?
Checks:
  • Heart rate
  • Gas saturation
When assessing the need for O2 tx what are some examples of laboratory documentation?
  • PaO2
  • SaO2
  • SpO2
 
When assessing the for O2 tx what are examples of specific clinical problems?
  • CO poisoning
  • Patient in shock
  • Post Op
  • Myocardial infartion
When assessning the need for O2 tx what are examples for clinical findings at bedside?
  • Cyanosis
  • Tachypnea
  • Tachycardia
  • Confusion
What are the hazards of O2 tx?

  • O2 Toxixity

  • Depression of ventilation (O2 induced hypoventilation)

  • Retrolental fibroplasia (RLF)

  • Retinopathy of prematurity (ROP)

  • Absorbtion atelectasis

O2 toxicity primarily affects what?

  • Lungs

  • CNS (Central nervous system)

What are the 2 factors that determine harmful affects of O2 Toxicity?
  • PO2
  • Exposure time
What causes O2 toxicity?

  • High FIO2 levels

  • Long exposure time

What can occur with an FIO2 greater than 50% for longer than 24 hours?
O2 toxicity
What can manifest from O2 toxicity?
  • Pulmonary edema and consolidation
  • atelectasis
  • hyaline membrane formation
Chronic hypercarbonic (hypercapnic) patients have high CO2 with relatively normal pH what can this lead to?What kind of patients does this occur in?
  • Polycythemia
  • ↑ blood viscosity
  • increased left ventricular flow (workload)
COPD patients with chronic hypercapnia
In chronically hypercapnic patients that no longer respond to central chemorecptors stimulation, what does their body respond to for ventilation?
Peripheral chemoreceptors
In chronically hypercapnic patients that no longer respond to central chemorecptor stimulation are mainly stimulated by a PaO2 of what?
PaO2 < 60
In chronically hypercapnic patients how can giving too much O2 decrease ventilation?
By knocking out chemoreceptors
What age and type of patient does Retrolental fibroplasia (RLF) occur in?  What can this cause?
  • Neonates up to 1 month are at risk 
  • Neonates with low birth weight (premature)
What can cause Retrolental fibroplasia?
PaO2 > 80mmHg fo extended periods of time
What PaO2 is recommended by the American Academy of Pediatrics to reduce ROP (Retinopathy of Prematurity)?

PaO2 < 80 mmHg
In patients with ROP high PaO2 causes vasoconstriction in retinal vessels leading to what?
Necrosis of the blood vessels, new blood vessels form but are not very strong and tend to hemorrage causing scarring of the retina leading to blindness.
What are the 2 necessary componets to absorption atelectasis?
  • High FIO2
  • Some type of obstruction
When properly selecting O2 devices what must a RT know?
The devices performance and individual capabilities of each device
What are the indications for a low flow O2 delivery device?

  • Patients with Vt 300mL-700mL
  • RR < 25 breaths per minute
  • consistent regular breath pattern



To ensure a stable FIO2 with varying patients demands O2 delivery systems must maintain what?

A flow that equals the patients peak flow.
What factors can influence a patients FIO2 when using a low flow device?

  • Patients ventillatory pattern
  • Respiratory rate
  • VT
  • I:E ratio (inspiratory:Expiratory ratio)
  • Flow of gas from the device
  • Reservoirs (Anatomical and System)
When using a low flow device if VT ↑, why does FIO2 ↓?

More entrained room air and ↑ in inspiratory flow

When using a low flow device if VT ↓, why does FIO2 ↑?
Less entrainment of R/A
When using low flow devices as RR ↑ FIO2 ↓ due to what?

Less filling time of the reservoir
When using low flow devices if RR ↓ FIO2 ↑ due to what?

More time filling the reservoir
Why do low flow systems have a variable performance?
  • FIO2 varies from breath to breath
  • Unpredictable (cannot deliver a specific FIO2
  • Immeasurable (cannot be measured)
What are the types of low flow devices?
  • Nasal cannula
  • Nasal catheter
  • Transtracheal catheter
  • Reservoir cannula
  • reservoir masks (Simple mask, Partial Rebreather, and non rebreather mask)
What are the advantages for using a nasal cannula?
  • Economical (Cheap)
  • Comfortable
  • Patient is able to eat, drink, talk, and cough
What are the disadvantages of using a nasal cannula?
  • Impresise FIO2
  • Obstructed airway with cannula placed might interfere with with O2 Delivery
  • Dry nasal Mucosa
What are the flow ranges for a nasal cannula?
  • Adults: 1/4L/m-8L/m
  • Infants ≤ 2L/m
With children what can a nasal cannula turn into?
High flow device
Bubblers can only be used with what O2 delivery system?
Nasal cannula
why wouldn't a RT cut the nasal cannula prongs?
Changes the entrainment ratio
When is a bubbler applied to a nasal cannula?
  • When the flow is > 4L/m
  • With children
  • When patients complain of dry nose
When using a nasal cannula how come flows > 6L/m gennerally don't significantly increase?
A fill of anatomical reservoir
When using a nasal cannula how is FIO2 estimated?
"Rule of 4" (4·Liter flow)+20
When using a nasal cannula, what can cause FIO2 to vary?


Patients ventilatory patterns
When using a nasal cannula what has been shown to not significantly affect O2 delivery?


Mouth breathing
What are flow and FIO2 ranges for nasal catheter?
  • Flow: 1/4L/m-8L/m
  • FIO2: 22%-45%



How is a nasal catheter inserted?
Using a water soluble lubricant until just above oropharynx
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