NUR 220- Oxygenation & Tissue Perfusion

background O2 admin basics

room air is 21% oxygen, oxygen is considered a medication

Oxygen delivery systems basics

low-flow systems

• variable performance

• reservoir systems

High-flow systems

• fixed performance

Flow meter

the part that attaches to the wall

has a green “Christmas Tree” or oxygen nipple and nut adapter, which helps the O2 tubing connect properly to the oxygen source

• when reading the flow meter, you read from the center of the ball

Nasal Cannula

• 2 prongs (one for each nostril- POINT DOWN)

• 1 to 6 L/min; 24 to 44%

• humidifier to 4L and above

advantages of Nasal cannula

• patient able to talk and eat

• safe and simple

• easily tolerated

Disadvantages of Nasal Cannula

• unable to use w/ nasal obstruction

• can dislodge from nares easily

• excessive dryness- HUMIDIFIER

High-Flow Nasal Cannula

15 to 40 L/min; 60 to 90%

• humidified

• high flow system

Advantages of High-Flow Nasal Cannula

• more oxygen provided

• patient still able to talk and eat

Disadvantages of High-Flow Nasal Cannula

same as the simple nasal cannula

Non-rebreather mask

• 10 to 15 L/min; 60 to 100%

• valves \reservoir bag

Advantages of non-rebreather mask

delivers the highest possible O2 concentration

Disadvantages of non-rebreather mask

• claustrophobia

• eating and talking inhibited

• malfunction can cause CO2 buildup

Partial rebreather mask

• 6 to 15 L/min; 70-90%

• valves

• reservoir bag

Advantages of partial rebreather mask

can inhale room air

Disadvantages of partial rebreather mask

• eating and talking difficult

• claustrophobia

Venturi Mask

• accurate oxygen concentration

• Venturi = very accurate O2

• 4 to 12 L/min; 24 to 60%

Advantages of Venturi Mask

• delivers precise oxygen concentration

• doesn’t dry mucous membranes

Disadvantages of Venturi Mask

• uncomfortable

• skin irritation

background for CPAP & BiPAP

continuous versus Bi-level

procedural concerns CPAP & BiPAP

interprofessional collaboration

Documentation concerns for CPAP & BiPAP

your overall assessment

what is oxygen toxicity

damage that happens from breathing in too much extra O2

symptoms of oxygen toxicity

coughing, dyspnea, chest pain, substernal heaviness

ways to prevent oxygen toxicity

1. choosing correct O2 device

2. titrating O2 and weaning patient

endotracheal tube (ETT)

• endo = in (going into the trachea)

• also called ET tube

• this is most common type of artificial airway

When to use endotracheal tube

• general anesthesia

• congenital malformations of the upper airway

• mechanical ventilation

oropharyngeal airway

• oro = mouth

• choose the correct size!!!!!!

  • too big = airway blocked

  • too small = airway wont open

when to use oropharyngeal airway

• only when the patient is unconscious!!!!

• want to prevent the tongue from covering the epiglottis

nasopharyngeal airway

• naso = nose

• also called nasal trumpet

• great for suctioning the airway without damaging the nostrils

When to use nasopharyngeal airway

• preferred over an oropharyngeal airway

• soft tissue obstruction of the upper airway

• if there is any mouth trauma

  • DONT USE WITH SEVERE HEAD INJURY OR FACIAL INJURY

tracheostomy

• ostomy = surgical opening

• long term option

• require regular cleaning and replacement

• only artificial airway that a patient can be discharged home with

tracheostomy care

• top nursing priority = maintaining a patient airway

• tube obstruction is high the first 72 hours postop

• after NEW tracheostomy: 1 finger to fit under ties

• at the bedside

  • manual resuscitation bag

  • tracheostomy tube of the same size and type

  • tracheostomy insertion tray

  • obturator

other therapies

chest physiotherapy, chest tubes, IS, TED hose, SCDs