Summary Nur 335 Exam 2 study guide

NUR 335 EXAM 2

CHAPTER 7
Low flow delivery devices include
- Nasal cannula
- Simple face mask
- Partial breather mask
- Nonrebreather mask
 Oxygen amount varies depending on the pt respiratory patterns
 The supplemental oxygen is mixed with room air, which lowers oxygen level that is actually
delivered to the patient.
 FRACTION OF INSPIRED OXYGEN (FIO2) is the true amount of oxygen delivered to pt
Nasal Cannula
Most commonly used device, it’s also more comfortable, easy to use and less expensive
 Used for pt who requires low level of oxygen and also works for pt who has adequate ventilation
but requires higher oxygen concentration that what is available in room air.
 Most common used
- Hospital
- Extended care unit
- Home setting
 OXYGEN CONCENTRATION; 24 % TO 44 % (6 L/MIN)
 PT with chronic lung disease
 Long term oxygen therapy
 COPD – pt who retains CO2 will use lower amount of oxygen ( 1-2 L/min), this way does not
lose his or her hypoxic drive to breath
 Humidification can be used to avoid irritation
 We assessed the back of the ear where the tube is placed for skin breakdown
Face mask
- For pt who requires a higher oxygen concentration
- Types of face mask
 Simple face mask
 Partial rebreather mask
 Nonrebreather mask
- They are hard to use in claustrophobic pt
- Assess for skin breakdown under the mask and behind the ear
- The disadvantage of the mask is that it needs to be removed for the pt to eat
- Pt is place in a nasal cannula when eating



Simple face mask
- Used when the pt need moderate amount of oxygen to maintain adequate PaO2 LEVEL.

, - 40 % to 60 % flow rate 5 and 10 L/min
- The higher flow rate assist the pt from rebreathing exhaled CO2 that can be retained in the mask
- Rebreathing exhaled CO2 may lead to complications such as hypoxemia



Partial Rebreather Mask
- Mask with a reservoir bag attached
- Pt breaths in the oxygen from the reservoir bag, on exhalation, the bag refills with oxygen and
the exhaled gases exit through small holes on both side of the mask
- 50 % to 75 % (8 to 10 L/min)
- Useful for short term oxygen therapy

Nonrebreather mask
Similar to partial rebreather mask except this mask has one way valves
- Reservoir bag must be kept inflated at one third to one half full on inspiration so the pt receives
the optimal amount of oxygen
- 90% flow rate (10L/min)

HIGH FLOW DELIVERY DEVICES
- Venturi mask
- Aerosol mask
- Tracheostomy collar
- T- piece adapter
- Face tent
 Deliver set oxygen concentration regardless the pt breathing pattern
 Humidity is provided
 Oxygen source is by humidifier that allows oxygen concentration to be humidified before
reaching the pt
 Provide oxygenation of 24 % to 100%

VENTURI MASK
- Most commonly used in high flow, because delivers an oxygen concentration is most accurate
- 24 % to 60 % by using different adapters; flow rate 2 to 15 L/min
- The adapter indicates flow rate of oxygen that should be maintained
- Mask is fitted to the face and adaptor is attached to the bottom of the mask
- Some venturi mask have an adapter with a dial
- Pt with chronic lung disorder benefits from this device because this device delivers more
accurate oxygen concentration to the pt on inspiration.

AEROSOL MASK
- For pt who requires high humidity concentration
 Pt who have been extubated (discontinuation of an endotracheal tube ETT)

,  Upper airway surgery
 Thick secretions
- Delivers aerosol therapy that includes humidification or medications in order to liquify secretions
for easier removal.
 Humidify respiratory tract
 Relieve bronchospasm
 Reduce edema of the respiratory tract

TRACHEOSTOMY COLLAR
- For pt with a tracheostomy
- Allows humidified oxygen to be delivered to the pt
- High humidity with the prescribed oxygen concentration
- Small mask that fits over pt tach site
- Flow rate is 10 L/min
T- PIECE ADAPTER
- Used when weaning a pt from the mechanical ventilator who still has an endotracheal,
nasotracheal, or tracheostomy tube in place.
- Connects oxygen source with humidification to the ETT

FACE TENT
-device used for pt who have a facial trauma or burn or have an upper airway surgery.
- Allows delivery of oxygen mixed with a mist.
- 24% to 100% with flow rate of 10 L/min
- Pt who are claustrophobic

NONINVASIVE POSITIVE-PRESSURE VENTILATION
- NPPV
- Delivers positive pressure to the airway without the use of an artificial airway to keep the alveoli
open.
- Positive pressure is delivered by
 Nasal mask
 Full face mask
 Nasal pillow
- EXAMPLE; CPAP AND BIPAP
- The constant pressure keep the alveoli open during inhalation and exhalation
- Usual range for CPAP IS 5 TO 15 CM H2O

LONG TERM OXYGEN THERAPY
- May be indicated for treatment of hypoxemia in pt with a diagnosis of
 COPD or with specific clinical conditions associated with hypoxemia such as HF, cystic
fibrosis or sleep apnea
- Long term therapy is for

,  Pa2O level less than or equal to 55 mm Hg
 an SaO2 level less than or equal to 88% in pt breathing room air
 PaO2 of 55 to 59 MM Hg
 Sao2 less than or equal to 89 % with a specific clinical condition
- Transtracheal oxygen therapy is another option for long term oxygen therapy and delivers
oxygen directly into the trachea using a small, flexible plastic catheter

OXYGEN DELIVERY
- Is available in
 Liquid
 Compressed oxygen
 Or as an oxygen concentrator

COMPLICATIONS OF OXYGEN THERAPY
- Oxygen toxicity
- Can develop as the result of an oxygen concentration administration equal to or greater than
50% over 24 to 48 hr
- This can cause damage to the alveolar capillary membrane and inactivate surfactant production
in the lungs CAUSING THE ALVEOLAR TO COLLAPSE
- This can make it very difficult to reinflate the alveoli, and they become filled with fluid or blood
- Can lead to
 PULMOMNARY EDEMA
 ATELECTASIS
 HEMORRAGE
 ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS)
- MAINTING PAO2 LEVEL WITHIN NORMAL RANGE

ABSORPTION ATELECTASIS
- Occurs when high levels of oxygen are administered and cause alveoli to collapse.
- High level of oxygen causes the nitrogen to be “washed out” of the alveoli
- Oxygen diffuses from the alveoli into the blood stream causing the alveoli to collapse

WHEN OXYGEN THERAPY IS PRESCRIBE GREATER THAN 4 L VIA NASAL CANNULA HUMIDIFICATION
SHOULD BE ADDED

WHEEZE Musical Air squeezed through narrowed
High pitched passages caused by secretions,
Squeaking bronchospasm, edema,
inflammation
CRACKLES Loud. Low pitched On inhalation, air comes in contact
Bubbling with secretions in the trachea and
Gurgling sounds large bronchi