Med-Surg Respiratory System, part 3: Oxygen Delivery Devices, Hypoxemia/Hypoxia, Sleep Apnea

by Cathy Parkes August 18, 2021 Updated: September 16, 2021

Full Transcript

Hi, I'm Cathy with Level Up RN. In this video, we are going to talk about oxygen delivery devices as well as hypoxemia and hypoxia. We're going to talk about oxygen toxicity, and then we'll start getting into our respiratory disorders, starting with sleep apnea. And at the end of the video, I'll give you guys a quiz and test your knowledge about some of the facts I'm going to be covering in this video.

 Let's first talk about our oxygen delivery devices. For each of these devices, I'll share a rough liters per minute that can be delivered using that device. Just know that depending on your textbook or the source online that you're using, those ranges will vary across sources.

So first of all, a nasal cannula is something you see being used all the time in the hospital. It delivers between 1 and 6 liters per minute. If your patient is getting over 4 liters per minute, then it can be rather drying in the nares. So you can provide the patient a water-based lubricant using their nares, and you can also attach some water to humidify the air that the patient is receiving.

Then we have a simple face mask which delivers between 6 to 10 liters per minute. A face mask, of course, kind of impairs the patient's ability to eat, drink, and makes it difficult for them to talk.

And then we have our partial rebreather and our non-rebreather masks.

So the difference between these is that with a non-rebreather, there is a one-way valve such that the patient is not rebreathing the air that they exhale.

So with either of these devices, we're going to want to inflate the bag that's attached to the mask about two-thirds full, and we're going to want to adjust the flow rate such that that bag stays inflated about two-thirds full. We do not want to let that bag deflate because then that places the patient at risk for suffocation.

In terms of the flow rate, with a non-rebreather, we're looking at about 10 to 15 liters per minute.

With a partial rebreather, we're looking at between 10 and 12 liters per minute.

Then we have our Venturi device, and our Venturi device provides the most precise oxygen delivery without intubation. It also provides high humidification. In terms of the flow rate, it will depend on what mask that Venturi device is applied to. So it usually varies between 4 and 12 liters per minute.

And then finally, we have our face tent, which is good for patients who have facial trauma. It provides high humidification, and the flow rate will be pretty high, usually over 15 liters per minute.

Next, let's talk about hypoxemia and hypoxia.

Hypoxemia is where we have insufficient oxygen in the arterial blood. So it will be less than 80 mmHg. And the way we would need to diagnose hypoxemia is through an ABG, or arterial blood gas.

Hypoxia is insufficient tissue oxygenation. And as a nurse, it's going to be important for you to know the early signs of hypoxia versus the late signs of hypoxia.

Early signs can include restlessness, irritability, abnormal breathing, such as the use of the accessory muscles, nasal flaring, or adventitious lung sounds. The patient may also have tachycardia, tachypnea, hypertension, as well as pallor.

Now, if hypoxia continues to the point where we have the late signs of hypoxia, these late signs can include a decreased level of consciousness, increased lactic acid levels, so lactic acidosis. The patient may also have dysrhythmias, bradypnea, bradycardia, hypotension, and cyanosis.

So when we're giving oxygen to a patient, we always want to use the lowest oxygen flow rate in order to manage the patient's hypoxia.

We don't want to give them too much oxygen, or else, they can have oxygen toxicity. Signs and symptoms of oxygen toxicity include a nonproductive cough, nasal congestion, substernal pain, headache, nausea and vomiting, fatigue, and a sore throat.

All right. Now, we're going to transition to talking about respiratory system disorders, starting with sleep apnea.

Sleep apnea is defined as a breathing disruption that occurs during sleep that last at least 10 seconds and occurs 5 or more times per hour.

So the causes of sleep apnea include obstructive causes and central causes.

With obstructive sleep apnea, the upper airways become blocked by overly relaxed airway muscles or by the tongue or soft palate.

With central sleep apnea, the brain doesn't send the proper signals to the muscles that control breathing.

So risk factors associated with sleep apnea include obesity, large tonsils, and neuromuscular or endocrine disorders.

Signs and symptoms may include persistent daytime sleepiness or irritability. So my daughter had huge tonsils, just massive, and she was very irritable during the day. We ended up taking them out, and as soon as she was recovered, she was a brand-new person. She was getting sleep, and it wasn't really impairing her airway during the night.

So in terms of how we diagnose sleep apnea, we would do so with a sleep study.

And then treatment options include a CPAP, which is continuous positive airway pressure, or BiPAP, which is bilevel positive airway pressure. In addition, the patient may need to get their adenoids out or their tonsils out through a tonsillectomy, which is what we had to do for my daughter.

Okay. Time for a quiz. I have three questions for you. First question. Which oxygen delivery system provides the most precise oxygen delivery without intubation? If you said a Venturi device, you're correct. Question number two is a fill-in-the-blank question. Restlessness and irritability are blank signs of hypoxia. The answer is early. These are early signs of hypoxia. Question number three. With sleep apnea, the patient has a disruption in sleep that last at least blank seconds and occurs more than blank times per hour. If you said 10 and 5, you're correct. I hope this video has been helpful. If so, be sure to like the video and leave me a comment. Take care.

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