Respiratory Care Modalities Lecture PDF

 Administration of oxygen at a concentration greater than that found in the environmental atmosphere. Goal: Provide adequate transport of oxygen in the blood while decreasing the work of breathing and reducing stress on the myocardium.  Factors affecting transport of 02 to tissues: ü...

 Administration of oxygen at a concentration greater than that found in the environmental atmosphere. Goal: Provide adequate transport of oxygen in the blood while decreasing the work of breathing and reducing stress on the myocardium.  Factors affecting transport of 02 to tissues: ücardiac output üarterial oxygen content üconcentration of hemoglobin ümetabolic requirements. Indications Hypoxemia-a decrease in the arterial oxygen tension in the blood S/Sx: ü changes in mental status ü Dyspnea ü increased BP ü changes in heart rate and rhythm ü central cyanosis (late sign) ü Cool extremities  Hypoxia-a decrease in oxygen supply to the tissues and cells that can also be caused by problems outside the respiratory system. S/Sx: ü Lack of coordination and impaired judgment. ü Fatigue ü Drowsiness ü Apathy, inattentiveness, and delayed reaction TERMINOLOGIES Flow Rate- is the number that we dial up on the oxygen flow metre, usually between 1-15L/min. – Unit of measurement: Liters per Minute L/min LPM TERMINOLOGIES CONCENTRATION- percentage of oxygen that a person inhales from room air or from other sources.  What is the concentration of the air you are breathing right now?  What is the concentration of the oxygen being delivered through the oxygen flow metre as soon as you turn it on? The oxygen flow metre is connected to either a bottle of oxygen or a medical wall supply. This oxygen is pure: it is 100% oxygen! Therefore, anything that comes out of that oxygen flow metre has a concentration of 100%.  If I have the oxygen flow rate set at 1L/min, I will have 1L/min of how many percent oxygen ?  If I have the oxygen flow rate set at 5L/min, I will have 5L/min of how many percent of oxygen?  If I have the oxygen flow rate set at 15L/min, I will have 15L/min of how many percent of oxygen ?  Fraction of inspired oxygen (FiO2) – is an estimation of the oxygen content a person inhales and is thus involved in gas exchange at the alveolar level.  Portable System (cylinders/tanks) Wall Outlets Oxygen Tank Parts üRegulator üHumidifier üCylinder/Tank üFlow Meter üFlow Adjuster Wall Wall outlets Outlets  Oxygen administered from a cylinder or wall-outlet system is dry. Humidifiers prevent mucous membranes from drying and becoming irritated and loosen secretions for easier expectoration. Indicated for liter flow over 4 L/min (LPM) Provides 20% to 40% humidity OXYGEN DELIVERY SYSTEMS  1. Nasal cannula (nasal prongs) a. Flow rates of 1 to 6 L/min, providing approximate oxygen concentrations of 24% (at 1L/min) to 44% (at 6L/min). b. Flow rates higher than 6L/min do not significantly increase oxygenation, because the anatomic reserve or dead space (oral and nasal cavities) is full. c. Used for the client with chronic airflow limitation (CAL) and for long-term oxygen use. d. Effective oxygen concentration can be delivered to both nose breathers and mouth breathers with the use of a nasal cannula.  1. Nasal cannula (nasal prongs) Implementation a. Place the nasal prongs in the nostrils, with the openings facing the client. b. Add humidification as prescribed when a flow rate higher than 2 L/min is prescribed. c. Check the water level and change the humidifier as needed. d. Assess the client for changes in respiratory rate or depth. e. Assess the mucosa because high flow rates have a drying effect and increase mucosal irritation. f. Assess skin integrity, because the oxygen tubing can irritate the skin. g. Provide water-soluble jelly to the nares PRN. 2. Simple face mask a. Used to deliver oxygen concentrations of 40% to 60% for short-term oxygen therapy or to deliver oxygen in an emergency. b. A minimal flow rate of 5-8 L/min 2. Simple face mask Implementation a. Be sure the mask fits securely over the nose and mouth because a poorly fitting mask reduces the FI02 delivered. b. Assess skin and provide skin care to the area covered by the mask, because pressure and moisture under the mask may cause skin breakdown. c. Monitor the client closely for risk of aspiration, because the mask limits the client’s ability to clear the mouth, especially if vomiting occurs. d. Provide emotional support to decrease anxiety in the client who feels claustrophobic. e. Consult with the physician regarding switching the client from a mask to a nasal cannula during eating. 3. Partial Rebreather Mask a. A partial rebreather mask consists of a mask with a reservoir bag that provides an oxygen concentration of 70% to 90%, with flow rates of 6 to 15 L/min. b. The client rebreathes one third of the exhaled tidal volume, which is high in oxygen, thus providing a high fraction of inspired oxygen (FI02). 3. Partial Rebreather Mask Implementation a. Make sure that the reservoir does not twist or kink, which results in a deflated bag. b. Adjust the flow rate to keep the reservoir bag inflated two-thirds full during inspiration, because deflation results in decreased oxygen delivered and rebreathing of exhaled air. 4. Nonrebreather Mask a. A nonrebreather mask provides the highest concentration of the low-flow systems and can deliver an FI02 greater than 90%, depending on the client’s ventilatory pattern. b. It is most frequently used in the client with deteriorating respiratory status who might require intubation. c. The nonrebreather mask has a one-way valve between the mask and the reservoir (exhalation valves) and two flaps over the exhalation ports 4. Nonrebreather Mask d. The valve allows the client to draw the entire quantity of oxygen from the reservoir bag. e. The flaps prevent room air from entering through the exhalation ports. f. During exhalation, air leaves through these exhalation ports while the one-way valve prevents exhaled air from reentering the reservoir bag. FI02 delivered: 60% to 100% FI02 at a liter flow that maintains the bag two-thirds full. Nonrebreather Mask 4. Nonrebreather Mask Implementation a. Remove mucus or saliva from the mask. b. Assess the client closely. c. Ensure that the valve and flaps are intact and functional during each breath. d. Valves should open during expiration and close during inhalation. e. Suffocation can occur if the reservoir bag kinks or if the oxygen source disconnects. 4. Venturi Mask a. The venturi mask delivers the most accurate oxygen concentration. b. Its operation is based on a mechanism that pulls in a specific proportional amount of room air for each liter flow of oxygen. c. An adapter is located between the bottom of the mask and the oxygen source; the adapter contains holes of different sizes that allow only specific amounts of air to mix with the oygen. d. The adapter allows selection of the amount of oxygen desired. FI02 delivered: 24% to 55% FI02 with flow rates of 4 to 10 L/min. 4. Venturi Mask Implementation a. Monitor closely to ensure an accurate flow rate for specific FI02. b. Keep the orifice for the Venturi adapter open and uncovered to ensure adequate oxygen delivery. c. Ensure that the mask fits snugly and that tubing is free of kinks because the F102 is altered if kinking occurs or if the mask fits poorly. d. Assess the client for dry mucous membranes; humidity or aerosol can be added to the system. 5. Face tent, Aerosol mask, Tracheostomy collar, and T-piece FI02 delivered: 24% to 100% FI02 with flow rates of at least 10 L/min. 5. Face tent, Aerosol mask, Tracheostomy collar, and T-piece a. Face tent - Fits over the client’s chin, with the top extending halfway across the face. - The oxygen concentration varies, but the face tent is useful instead of a tight-fitting mask for the client who has facial trauma or burns. 5. Face tent, Aerosol mask, Tracheostomy collar, and T-piece b. Aerosol mask - Used for the client who requires high humidity after extubation or upper air-way surgery or for the client who has thick secretions. 5. Face tent, Aerosol mask, Tracheostomy collar, and T-piece c. Tracheostomy collar and T piece -The tracheostomy collar can be used to deliver high humidity and the desired oxygen to the client with a tracheostomy. - A special adapter, called T piece, can be used to deliver any desired FI02 to the client with a tracheostomy or ET tube. COMPLICATIONS  Complications!  Complications!  Complications! DANGER! Flow Type Volume Type