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38 Cards in this Set

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  • Back
Specific clinical objectives for Oxygen therapy are?
1. Correct documented or suspected acute Hypoxemia
2. Decrease the symptoms associated with chronic hypoxemia
3. Decrease the WL hypoxemia imposes on the Cardio-Pul. system
How does Oxygen correct Hypoxemia?
By raising alveolar and blood levels of oxygen.
How does C-P system compensate for Hypoxemia?
By increasing ventilation and C.O.
What are some of the advantages of Supplemental O2?
1. Relieve dyspnea with COPDer
2. Improve mental function
3. decrease demand on the heart and lungs.
4. Reduce High ventilatory demand and WOB.
What does Hypoxemia Cause?
Vasoconstriction
Pulmonary hypertenstion.
Pulmonary vasoconstriction and Hypertension increase workload on which side of heart?
a. Right
B. Left
Right
Indications for O2 therapy?
1. Documentated Hypoxemia
Adults, children, and infants >28days: PaO2 <60mmhg or SaO2 <90%
Neonates: PaO2 <50mmhg,SaO2 <88%
2. Acute care situations in which hypoxemia is suspected
3. Severe Tramua
4. AMI
5. Short-term therpay
If O2 is needed for hypercapnic patients, what PaO2 levels may depress the ventialtory drive?
PaO2 >60mmHg
FIO2> 60% for long-period of time can cause what complications in patients?
1. Absorption Atelectasis
2. Oxygen toxicity
3. ciliary or leukocyte depression
In Pre-mies, what PaO2 levels can cause ROP?
PaO2 levels >80mmHg.
Why is important to watch high O2 levels with paients who have Ductal heart Lesions?
It could close or constrict the Ductus Arterious.
What 3 physiologic parameters should be monitored with O2 therpay?
PaO2, SaO2, SpO2
When initiating O2 therpay for COPDer, when should you check the status of that patient O2 ?
within 2hours of starting therapy
How often should you check O2 delivery systems?
Daily
What are 3 basic ways to determine the need for Oxygen therapy?
1. LAB TEST (ABG)
2. CLINICAL PRESENTATION
3. symptoms of cyanosis, tachypnea, distressed appearance
What are examples of patients who need O2 therapy do to hypoxemia?
1. post- op patiens
2. CO poisoning (high mmHg)
3. Cyanide poisoning
4. shock
5. trauma
6. AMI
Oxygen Toxicity primarily affects what 2 systems?
Pulmonary (lungs)and CNS.
What 2 primary factors determine the harmful effects of oxygen?
1. PO2
2. exposure time
O2 toxicity effects the CNS how?
1. tremors
2. twitching,
3. Convulsions
Patients with High PO2 for a prolonged exposure has symptoms of ?
Bronchopneumonia
Some clincial findings with Prolonged O2 exposure?
1. Patchy infiltrates and usually are most prominent in the lower lung fields
What are some physicogical effects of long O2 exposure?
1. Capillary endothelium damage
2. Interstital edema
3. thickens the A-C membrane
4. type I alveolar cells are destroyed
5. type II cells proliferate.
What follows the Exudative stage of Long O2 exposure?
1. Low V/Q mismatch
2. Physiological shunting
3. hypoxemia
In the end stages of O2 exposure, what are the under affects?
Hyaline membrane forms, with pulmonary fibrosis and hypertension develop.
Oxygen free radicals are byproduct of what?
cellular metabolism
What protects us from this free radicals?
Superoxide dismutase
What are some antioxidants that protect us from free radicals?
Vit. E, C and Beta-carotene.
During Oxygen toxicity cell damage occurs which causes a immune response. In return does what to the Pulmonary system?
Causes tissue infiltration by Neutophils and Macrophages.
A RULE OF THUMB, what is the limited time a patient can be exposed to HIGH O2?
100% oxygen to less than 24 hours.
What is the goal of titrating O2?
70% in 2 days; and 50% within 5 days.
For infants, what are the 2 main diseases that with form with High O2 levels?
Retinopathy of prematurity
Bronchopulmonary dysplasia
Decrease in ventilation of nearly _______ have been observed IN COPDer when PaO2 increase by how much?
20%; and 20-23mmHg
With COPDer's, what is blunted and the primary stimulus to breathe is?
CO2; O2
High blood levels in COPDers may do what?
disrupt normal V/Q balance and cause an increase in dead space to tidal volume (Vds/Vt) ratio and increase in PaCO2.
Describe the affects of high oxygen blood levels in pre-mies?
Cause retinal vasoconstriction, which leads to necrosis of the blood vessels. Which leads to scaring and retinal detachment and blindness
At what age does ROP affect neonates?
up to Approximately 1 month of age.
What are some other underlying factors contributing to ROP of the Newborn?
Hypercapnia, hypocapnia, intraventricular hemorrhage, infection, lactic acidosis, anemia, hypcalemia and hypothermia
The risk of absorption atelectasis is greatest when?
Patients breathing low Vt as a result of sedation, surgical pain or CNS dysfunction.