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Nursing Skills
Test 2 - LP 5
Question | Answer |
---|---|
What is the FiO2 of room air? | 21% |
What is used to increase a patient’s FiO2 | Supplemental Oxygen |
Insufficient oxygen available to meet the metabolic needs of the body’s tissues and cells | Hypoxia |
Deficiency of oxygen in the arterial blood | Hypoxemia |
What six things do you access to determine if O2 therapy is needed? | Lung sounds, behavior changes, vital signs, pulse ox, skin/mucosa, ABG |
What behavior changes do you see in someone who needs Oxygen? (3) | Confusion, lethargy, irritable |
Someone who is hypoxic has a increased/decreased pulse and respirations? | Increased |
What specifically does pulse ox measure? | Percentage of hemoglobin saturated with O2 |
What color does the skin turn when there is a decrease in o2 levels? | Pallor |
Where do we access cyanosis? (3) | Mouth, fingers, toes |
Invasive procedure drawing blood from artery to quantify changes in 02 and CO2 that affect acid base balance | Arterial Blood Gases |
What does Sa02 stand for? | Arterial oxygen saturation |
What does Sa02 reflect? | % of hemoglobin bound to oxygen |
Where can pulse ox clip be applied to? (3) | Finger, toe, earlobe |
What is considered a normal pulse ox? | 95% |
What population of people may have a lower pulse ox which would be considered normal for them? (3) | COPD, children, elderly |
What factors can interfere with obtaining an accurate pulse ox? (3) | Talking, holding breath, nail polish |
Patient’s pulse rate on pulse rate must be compared with______. | Radial pulse |
What do you do if pulse ox results are low? | Reapply to another site |
If using continuous pulse ox monitoring, what should you do? | Assess skin integrity and relocate sensor every 2-4 hours. |
Is O2 an explosive? | No but it supports combustion |
How are oxygen cylinders stored? | Upright secured |
What should you do before transporting a patient on O2? | Check the level in the cylinder |
Should you give a patient with chronic COPD high levels of oxygen? Why? | No, cuts out their drive to breathe |
How many liters are typically ordered for O2 therapy? | Two to Three |
Does 02 therapy need a md order? | Yes |
Can oxygen be applied to a patient in an emergency situation without an order? | Yes |
Oxygen is ordered in Liters per ____. | Min |
Oxygen may be ordered to maintain a ______. | Pulse ox call |
Who has more responsibility the respiratory therapist or RN? | Nurse |
Use for low O2 concentrations 1-6L/min. 24-48% FiO2 | Nasal Cannula |
Most comfortable and common delivery system | Nasal Cannula |
Use for 6-10L/min (30-50% FiO2) short term | Simple Face Mask |
What are disadvantages of face masks? (4) | Can feel claustrophobic, cause skin breakdown, can't talk or eat, hot and confining |
Delivers exact preset FiO2, despite breathing pattern, 4-10L(24-50% FiO2) | Venturi Mask |
Type of oxygen delivery system that can be humidified (2) | Venturi Mask, Partial Rebreather Mask |
Disadvantages of Venturi Mask | FiO2 may be decreased if mask not snug |
Delivers increased FiO2 , 6-15L/min (35-60% Fi02) | Partial Rebreather Mask |
Reservoir fills on exhalation & almost collapses on inhalation | Partial Rebreather Mask |
Disadvantages of Partial Rebreather mask | May twist or kink |
Delivers highest possible FiO2 without intubation. 6-15L/min (60-100%) | Nonrebreathing mask |
What is difference between nonrebreathing mask and partial rebreathing mask? | 2 one-way valves to prevent rebreathing exhaled air. |
Disadvantages of nonrebreathing mask | Bag malfunction that can lead to increased CO2 and suffocation. |
Can provide up to 100% oxygen therapy at greater than normal atmospheric pressure | Hyperbaric Oxygen Chamber |
What type of clients receive hyperbaric treatments? (3) | Wound care, smoke inhalation, decompression syndrome |
What deliver options are there for pediatrics? (5) | Oxygen tent, Incubator, Oxygen hood, Nasal cannula, simples mask held near face |
Comfort measures for nasal cannula? (3) | Apply a water-soluble lubricant to areas of irritation around nares, Apply ear protectors, Reposition cannula so it does not come in contact with irritated areas |
Can oxygen be humidified? | Yes |
What type of nasal spray can be provided to someone on oxygen therapy? | Isotonic saline |
What positions promotes optimum lung expansion | Semi-Fowler’s or high Fowler’s |
Persons with COPD may be most comfortable in what position? | Three point stance |
Describe what is meant by cough and deep breathing method of promoting oxygen intake. | Position patient upright and instruct to take 2 slow deep breaths (in via nose & out via mouth) After deep breathing, have patient inhale- hold breath & then cough deeply from diaphragm |
Describe how the peak flow meter is used. | Instruct client to take a deep breath & place meter mouthpiece in mouth & make a firm seal Have them blow out as hard/fast as possible—do this procedure 3 times and record highest number |
What type of oxygen is a smaller unit filled from a larger stationary unit. Most portable and expensive unit. | Liquid oxygen |
What type of oxygen Extracts O2 from room air, concentrates and delivers prescribed liter flow—economical but not portable. | Oxygen concentrator |
What type of oxygen is available in large H cylinders (lasts 50 hrs @ 2L) Cylinder tanks –can be put on a stand and are easy to pull along as patients ambulates. | Compressed oxygen |
Nasal cannulas are replaced how often or clean with? | Weekly, mild soap and water |