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163 Cards in this Set
- Front
- Back
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What is Cellular use of oxygen
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the oxidation ,reduction, and reaction requires oxygen which takes place in the cell
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What part of the cell produces ATP
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The Mitochondria
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How many ATP does Anaerobic Metabolism produce
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2 ATP
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How many ATP's are produced by Aerobic Metabolism
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38 ATP
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Formula for cellular respiration
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glucose+o2+2h20=co2+h20+energy rich compounds
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What are the Objectives of O2 Therapy?
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1.) to restore arteriole O2 tension to normal or satisfactory limits
2.) To provide adequate tissue oxygen 3.) To treat hypoxia or hypoxemia 4.) Decrease WOB (work of breathing) 5.)Decrease myocardial work |
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What is the normal value of an ABG on a normal person
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PaO2 80-100 torr
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normal value for some old people and range for mild hypoxemia
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PaO2 60-80 torr
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What is the range for Moderate hypoxemia
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PaO2 40-59
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What is the range for Severe Hypoxemia and also the end stage of COPD
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PaO2 < 40 torr
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SaO2 represents the degree to which the _______________?
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hemoglobin is saturated with O2
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What are some signs of acute hypoxia?
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Circulatory- increase heart rate and B.P.
Ventilatory RR will increase, inc in CO2 (hypercapnia) CNS effects- headache, drowsy, and disorientated, paranoid skin feels cool and clammy and cyanosis is present |
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What are some signs of Chronic Hypoxia?
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Polycythemia carries more RBC's
Chronic Tachycardia May or may not have cyanosis |
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What are the 2 types of hypoxias
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Hypoxic and Anxoic
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What does Hypoxic mean
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low levels of O2
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What does Anoxic mena
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No O2
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How does high altitude effect O2 levels
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Normal concentration is 21%, but Pp of atm. decreases as you increase
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Give an example of a diffusion defect?
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An increase in alveolar capillary distance= O2 molecule has to travel further: Ex. fibrosis, pneumonia, and CHF.
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COPD is known as a loss of surface area Explain
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we have 70 sq. metes of alveoli
COPD=loss of surface area=affects diffusion. |
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What happens if there is an Increase in dead space
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A decrease in the number of profused alveoli=clot or thrombosis
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What is Co poising?
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Where CO combines with the hemoglobin and has a chemical affinity of 250X>O2.
Co-Oximetry is the test used and blood is bright cherry red |
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What is Methemoglobinemia?
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Can't carry O2. (Co-oximeters measures for this type of hemoglobin)
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What is Sickle cell Anemia?
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Where hemoglobin molecules are genetically altered and can't carry O2
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What is Anemia?
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Iron poor blood
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What is Stagnant or Circulatory Hypoxia?
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Where there is a dec in blood flow therefore a dec in O2 transport
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What is Shock?
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A decrease in blood pressure
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What is tissue hypoxia?
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blood not being pushed into the peripheral
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What are 2 kinds of shock and what do they mean?
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1.) Hypovolemic- low volume, not enough fluid for heart to pump
2.) hypervolemic- too much fluid to push around. Increase in volume EX. CHF |
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What can cause inadequate Cardiac output
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Myocardial Infraction, pulmonary vasoconstriction, cor Pulmonale
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What is Histotoxic
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tissue and cells that can't utilize O2.
Example: cyanide poisoning, blocks tissue utilization @ cellular level. STARVE TISSUES OF O2 |
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What is the Tx for Histotoxic
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Sodium Thiosulafte
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What is the Evaluation of Therapy
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Basline- with ANG's or Oximetry ABG=best
Physical- HR, skin color, WOB Subjective- how they feel |
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Contraindications Of Oxygen Therapy
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When pt's levels don't indicate a need
If Pt requires a certain amount and a > amount is given Oxygen is a safe drug |
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What is hypoventilation?
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Respiratory rate and volume decrease. Controlled by CO2
Happens to Everyone |
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What happens when Atelectasis occurs?
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Denitrogenation or O2 washout of nitrogen
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Reasons why Atelectasis can occur
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A complication due to rapid absorption of O2 & tendency of N2.
An increase in O2 the faster N2 gets washed out & alveolar collapse |
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What are the 2 phases under Pulmonary Toxicity?
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Pulmonary Toxicity
- exodative- lungs become consolidated, have and fluid filled,beefy or liver like. (lots of serous fluid) - Proliferative- alevolar hypertrophy & thickening |
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What are 2 types of oxygen toxicity that affect lungs?
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Pulmonary
Systemic |
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What is Systemic Toxicity?
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A toxicity that causes certain circulatory affects occurs when PaO2 of 240 or higher (normal =80)
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what are 2 test to measure O2 levels in the blood?
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PaO2- partial pressure of O2 in blood invasive -ABG
Pulse Oximetry- saturation of O2 (how much O2 is in the blood) invasive POX SaO2 = 97% |
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What is normal hemoglobin
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12-15 gms
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What are signs of central cyanosis
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eyelid, lips,tongue= appear blue
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What are the signs of Peripheral cyanosis
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toes,finger nail beds = blue
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What is a normal persons drive to breathe
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CO2 we need to get in out
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What is a COPD patients drive to breathe
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drive to breathe is O2-- need to maintain levels of CO2 inlungs in order to breath.
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In Pulmonary Toxicity how much O2 is a patient given (%)
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70-100 %
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What does the FDA regulate O2 to be
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99% pure for medical gas
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What does USP stand for
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United States Pharmacopeia
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Describe the Characteristics of Oxygen
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colorless, transparent, odorless and tasteless
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What it the atomic wt and molecular wt of oxygen
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16= atomic wt
32- molecular wt |
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Explain what the physical state of O2 in a cylinder is... psi..Critical temp... critical pres..boiling pt...freezing pt
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PSI 1650-2000 psi @ 70 F
Critical Temp= -181.9 F Critical Press 715.3 psi Boiling pt -297.4 F Freezing pt -361.8F |
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What is a law
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approval of a legislative body-federal,state, or local. describes something for common or public good
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What is a regulation
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it specifies laws, monitors laws and specifics how the law is carried out
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What is a standard?
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It established an acceptable procedure for common purposes.
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What does CGA stand for
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Compressed Gas Association
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What does the CGA do?
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organization that sets up gas manuf. by promoting safe practices in the manuf, handling and use of governing standards
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What are the 3 types of valve safety systems?
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ASSS
PISS DISS |
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What does ASSS stand for? What does it do?
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American Standard Safety Systems
sets standards covering connections to larger cylinder valves. |
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There is 2 kinds of threads right and left what do they mean?
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R= medical
L= industrial |
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What does PISS stand for? What is it?
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Pin Index Safety System
Sets standards governing small cylinders A _E or flush cylinder valves to regulators. |
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What does DISS Stand for?
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Diameter Indexed Safety System
It utlizies different thread pitch connection diameter and internal and external threading to prevent the valves, incorporated into station outlets to prevent gas loss when not in use. |
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What are quick connect fittings
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they are designed to be rapidly connected or disconnected.
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What does NFPA stand for and what is it?
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National Fire Protection
sets standards for storage, handling, and safety measures |
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How do you properly store a cylinder?
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upright with protective cap on, chained, temp not to exceed 125 F
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What is a must for a storage room?
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They must be vented to the outside.
Total change of air every 120 min Protective lighting, explosive proof fixtures and switches Nothing Flammable in area No oil or grease on cylinders |
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What does ANSI stand for? What do they regulate?
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American National Standards Institute
Sets the standards for RT and anesthesia equipment. |
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What does AAMI stand for? What do they regulate?
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American Association of Medical Instrumentation
Sets standards in relation to Biomedical engineering |
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What does DOT regulate?
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shipping and transport of gas & cylinder, filling, labeling,markings periodic testing and spec of what criteria the cylinder must be maunf under.
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What does the FDA regulate
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the quality and purity of gases, some regulations concerning shipping and labeling of gases.
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What does OSHA regulate?
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matters affecring the safety , health of employees in all industries with the manuf storage and handling and usage.
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What are the 2 types of cylinders
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flammable
non-flammable |
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What are the 6 sizes of O2 tanks
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D
E M G H T |
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Why are labels impt and who requires them?
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DOT and FDA
absolute indicator of contents in tank describes all hazards of gas yellow diamond=supports combustion |
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What color code is oxygen on a cylinder
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green in the US
White internationally |
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What color code is Carbon dioxide
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Gray
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What color code is Nitrous Oxide
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light
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What color code is helium
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brown
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carbon dioxide-oxygen
CO2>7% |
green stripe on a gray tank
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carbon dioxide-oxygen CO2 <7 %
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gray stripe of a green tank
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Color code for a helium-oxygen tank
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green tank with a brown or gold stripe
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What is the color code for compressed air
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yellow tanks
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what color is the tank for nitrogen
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black
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what is the color of the tank for carbon monoxide
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light blue, black or white. Typically not a straight gas.
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What are the 2 types of valves on a cylinder?
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diaphragm
direct acting needle valve |
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How many liters are in 1 cubic foot
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28.316
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Factor to calc. duration of a cylinder flow for an E tank
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0.28
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Factor to calc. duration of a cylinder flow for an D tank
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0.16
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Factor to calc. duration of a cylinder flow for an H & K tank
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3.14
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In Bulk systems there is 2 types of systems what are they?
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cylinder banks
liquid systems |
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Standard cylinders in cylinder banks connect to all tanks at what psi
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2200-2400 pis
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Where are liquid systems used
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they are used to supply large amounts of medical gas to hospitals or other institutions
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What does LOX stand for
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Liquid Oxygen
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in liquid oxygen tanks the release of pressure as the gas expands, cools the reservoir. Who's law?
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Gay Lussacs
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1 cu ft of liquid = ________ cu ft of gas O2
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860
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what type of system is thus when O2 is supplied form a manifold-2 or more cylinders connected together using high pressure steel or copper tubing, a bulk sys., or both
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Piping System
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A reserve supply is required to provide up to _______hrs of O2 in the vent that the main supply become depleted
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24
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What is a piped distribution system
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system which consists of a central supple system with control equip and a sus of piping extending to the points where non-flammable medical gases are req. with suitable station outlet valves at each pt of use.
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What are shut off valves?
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part of a piping system that allows you to control different areas.
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What are the steps to take in the event of a fire?
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Remove pts form immediate area, extinguish if on fire.
Sound alarm-manual, phone Close zone valves to affected area Remove other pts in area or from hospital close doors extinguish or contain fire |
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What are the two types of regulators
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high and low pressure
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What characteristics does a high pressure regulator have?
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Preset- takes tank pressure down,
Adjustable- adjust on a lower range Multistage- 2 stage drops from 2200 to 700 to 50 psi |
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What does the Bourdon gauge measure?
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Its a low pressure or flow regulator it measures pressure not flow
**Gauge shows higher flow than what is actually delivered this is b/c of back pressure. |
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Is the flow rate of a bourdon gauge direct or indirectly related to the error of recorded pressure
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directly
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The Thorpe gauge has 2 types what are they?
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uncompensated and compensated
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What "effect" does the Thorpe gauge follow?
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Bernoulli effect
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What is an uncompensated Thorpe Regulator?
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its affected by back pressure and show lower flow than what is actually delivered.
Needle valve proximal to meter |
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What is a compensated Thorpe?
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needle valve distal to meter back pressure doesn't affect actual reading
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What is a Thorpe tube
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it fxns as a flow avriable orficie constant pressure flow meter device
Always attached to a 50 pis source Used to measure true flow The pressure compensated in the preferred version. |
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The FiO2 range on a simple mask is?
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0.35-0.50
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Which oxygen device should be used to deliver carbogen and heliox therapy?
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Nonrebreathing mask
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What is the min liter floe of oxygen needed for a pt. on a simple mask to prevent rebreathing of exhaled gases
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8 L/min
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What is the purpose of using a Moustache-style reservoir cannula
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to conserve oxygen
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What is the FiO2 range for a partial rebreather mask
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0.35-0.60
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Where are open-closed systems used?
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administration of anesthesia agents
Pulmonary fxn lab Ventilation/profusion scans |
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What is a high flow system
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When gas flow is adequate to meet all the patients. Inspiratory demands (flow rate and volume)
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what is a low flow system
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where the gas flow is insufficient to meet inspiratory requirement therefore, R/A is entrained and provides part of the inspired gas causing variations in FiO2.
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Low flow systems can deliver from 21 to 90 +% there is 3 variables that influence this what are they
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Capacity or Reservoir
LPM O2 flow rate pt ventilatory pattern |
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A nasal Cather is an example of what type of lflow system
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Low Flow system
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With a nasal catheter what is the FiO2?
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25-45 % +-5% optimum flows 4-6 lpm with a max of 8 lpm
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What is the step process to insert a nasal catheter?
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Coat end with water soluble jelly
Place in nose Catheter sits behind uvula on soft palate Tragus to tip of nose |
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A nasal cannul is an type of what flow system
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Low flow system
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With a Nasal Cannula what is the FiO2
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25-44% +/- 5% flow range less tha 2 up to 4-6 lpm with a max of 8 lpm
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With a nasal cannula what does 1 L = in % of FiO2
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20+4=24%
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What is a trantracheal catheter
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a catheter that is surgically placed in the trachea through the neck by a physicain
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What type pf flow system is a transtracheal catheter
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Low flow system
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What are the flow rate of a nasal catheter?
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1/4 to 4 L/Min
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What are the 3 types of reservoir masks used
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simple, partial and nonrebreathing
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What type of concetration does the simple mask allow?
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low to medium concetration via nose and mouth up to 65%
40-60% Concentated O2 |
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What is the flow rate of a simple mask?
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6-10 LPM or flush
***8 LPM*** |
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When using a siple oxygen mask you want to never fo less than ___ LPM otherwise t will inc their CO2 levels
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6
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Simple mask is what type of flow system
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low flow
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What type of low flow system increases the concentration but decrease the volume device
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Partial rebreathing
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When using a partial rebreathing nasal mask why is it impt to keep the bag inflated
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this gives up to 95%, dependent upon how tight the mask fits
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What is a non-rebreathing mask
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its a mask that allows no nixing of exhaled gas due to 1 way valves 95 % to 100%
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what type of sytem:
supplys a given O2 [ ] at a flow = or exceeding the patients peak inspiratory glow |
HIgh flow system
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What type of high flow system used entarined room air to mix with 100% O2, is sued when a specfic [] of O2 is desired in a low to med range
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Venturi
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Someone with a hypoic drive needs this type of mask
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venturi HaFoe
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what type of system adds humidity to pt. delivery
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Aersol systems
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In an aerosol system total flow rate and entrainemnt are directly or indirectly related
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directly
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You can connect 2 serosols together or tandem bu use of what?
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Wye adapter
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what type of system ensures that patient only gets O2 from the reservoir and not dorm room air. It can provide a range of FiO2 form 21-100% in both intubated and non intubated patients
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Non-Rebreathing Systems
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How do you determine what equip types to use
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based pn pt. diagnosis-pathology where its going type of oxygentaion problems
Your assesment of patient their oxygenation. Blood gas results |
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What is an example of environmental chamber flushes out Co2
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oxihood heated aerosol it flushes out CO2
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what type of environment chamber provides a neutral thermal environment for newborns and premies
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Incubator
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what type of system does the incubator have with protects the infant
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An O2 limiter system
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How much O2 does an oxygen tent deliver and what is it used for?
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30-60 % its used for temperature control and humidity
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what are the cons of an oxygen tent
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if a pt. requires hands on care its hard to kepp up [] high FiO2
Fire hazard On;y approved item are allowed in tent No electrical call bells in tent Optimal flow rate is 10LPM |
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what does a hyperbaric chamber do
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it increase availb O2 by increasing partial pressure since Hb is already saturated more dissolved into plama
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What are hyperbaric chambers used to treat
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air or gas embolisom, decompression sickness
co poisioning anaerobic infections sickle cell crisis cyanotic cyandie poising burns, skin grafts |
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What are the hazards of a hyperbaric chamber
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rapid decompression _bring a pt up to fast
O2 toxicity Fire Hazard Barotrauma-taruma in the lung |
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What are the contraindications of a hyperbaric chamber
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absolute -pneumothorx
realtive COPD with CO2 retention |
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what type of therapy can decreae the WOB for pateints with airway obstructions (ex asthma or croup)
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helium oxygen therapy
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how is a heliox treatment delivered
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via a tight fitting nonrebrething mask with a high flow
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how is helium delivered to a pt
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close system rebreathing system with a CO2 absorber tight fitting mask
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What type of gas is approved for term and near term neonates with hypoxic resp failure with assoc pulmonary hypertension
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Nitrous Oxide
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What gas is used in adults to tx bronchospasms and pulmonary hypertension
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Nitrous Oxide
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What is meant by an electochemical oxygen analyzer
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electri effects that accompany chemcial actions and the chemical actively produced by electrical influence.
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What are the 2 most common types of electrochemical O2 analyzers
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Polargraphic
Galvanic |
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What is a polargraphic O2 analyzer
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increase in O2 Pp speed up rxn
increase in the # of lectrons Battery polarized electnodes sets up a current |
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What is a Galvanic Cell
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it produces its own electrical current through rxn its slower than the polargraphic
membranes are semi-permable it uses positive pressure |
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What do air oxygen analyzers do
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dial in cocnetration in most models
low pressure glow meter high pressure -50 psi |
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how does an air compressor work
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the psiton has intake and output used fr moderate needs the diaphragm is fixed to wall pulls less air in
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how can up increase O2 []?
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Increase liter flow
change to a nonrebreather mask or partial rebreather mask use a venturi mask |
