Oxygen Treatment - Equipment And Scenarios
I must admit that it is pretty hard to cover this material in a multiple-choice test, so a lot of the questions may seem awkward and will end up being easier than if you had to write in the answers. Be sure to read the explanations as there might be some good info in there; I try to go through everything fairly thoroughly.
- 1.
Okay, let's start with some basic equipment. You have a regulator containing a Bourdon gauge flowmeter. What type of reducing valve is employed in this regulator?
- A.
Preset Reducing Valve
- B.
Flow Restrictor Valve
- C.
Adjustable Reducing Valve
- D.
Multi-Stage Reducing Valve
Correct Answer
C. Adjustable Reducing ValveExplanation
A Bourdon gauge is found only with adjustable reducing valves since the adjustable pressure is what causes the flow changes in this device.
Flow restrictor valve does not exist, but a flow restrictor is actually a type of flowmeter itself. Both other option are other types of reducing valves.Rate this question:
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- 2.
Sticking with the bourdon (maybe I like it because it looks like bourbon), some idiot has crimped the patients air line. What might be an outcome of this?
- A.
Watch out for the pulmonary embolus!
- B.
Pressure could read falsely high or still show flow even though air was not flowing.
- C.
After un-kinking the line, tank has to be flipped over.
- D.
AOTA
Correct Answer
B. Pressure could read falsely high or still show flow even though air was not flowing.Explanation
Yeah, kind of a stupid question, but also a good reinforcement to show the major "con" of this device.
Oh, and the bourdon is gravity-independent, so even if "flipping a tank" would ever do anything (it won't), it wouldn't need to be done anyway. This may be good to know if you ever have to have a tank upside down.Rate this question:
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- 3.
One more flowmeter question and then we are on to bigger and better things. What exactly is the difference between pressure compensated and non-compensated thorpe tubes?
- A.
Needle valve location in respect to thorpe tube
- B.
Made to handle different pressures
- C.
Non-compensated will false-read low with added downstream backpressure
- D.
More than 1 answer is correct
Correct Answer
D. More than 1 answer is correctExplanation
Both the 1st and 3rd options are correct. Because of the distal placement of the needle valve on a pressure compensated thorpe tube, backpressure is prevented from messing with the reading in the tube and will not affect the reading.
Oh, and all thorpe tubes are made to be connected to 50psi wall outlets.Rate this question:
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- 4.
Let's start off with a quick question about Z-man's favorite apparatus: nasal cannula. What is the approximate (max) fiO2 of a nasal cannula at 2 L/min?
- A.
20-21%
- B.
40-41%
- C.
24-25%
- D.
28-29%
- E.
None of the above options are anywhere near correct
Correct Answer
D. 28-29%Explanation
Based on the "Rule of Thumb" shared by Rose and featured in all of it's glory on page 877 (Egan's). In class we were given the 20+ 4 for each additional liter, and in the book it has 21, so hopefully somewhere in there is good enough.Rate this question:
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- 5.
Okay, let's take it all the way to the top. No more dinking around. Your patient has a tidal volume of .600L and is inspiring over a period of 1 seconds. Currently he is receiving oxygen at an fiO2 of 40% by way of venti-mask. The white nozzle with the venti-mask specifies 8 L/min but he is currently at 10L/min (O2). What is wrong with this scenario and what can be done to rectify it?
- A.
Huh?????
- B.
Running venti-mask at 10L will decrease fiO2
- C.
Not enough flow to meet demands,
- D.
There is nothing wrong with this scenario
Correct Answer
D. There is nothing wrong with this scenarioExplanation
This question uses a number of different things to spin your head around, but if you go through the steps of calculating the inspiratory flow rate (.600/1)*60 = 36L/min.
Now that we know the patient's flow rate, we can calculate what we are giving him with the current setup. At 40% the air:oxygen ration turns out to be 3:1
(100-40)/(40-20) = 60/20 = 3/1
Knowing that we can figure out that at 10L/min the patient is receiving 10L/min O2 + 30L/min entrained room air = 40L/min at fiO2 of 40%.
Since the patient is receiving 40L/min and only requires 36L/min everything addressed in this scenario should be fine.
Interestingly enough, whoever didn't follow the guidelines on the nozzle knew that at 8L/min the patient would only be receiving 32L/min and would not get the full inspiratory requirement.
Strangely enough, I thought I was pulling these numbers somewhat out of the air but then noticed earlier that Sibberson's uses the same sort of example (p.52).Rate this question:
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- 6.
Now for some scenarios that are admittedly very similar to Rose's. Hopefully also very similar to what is on the test.Patient is on a 40% air-entrainment mask setup and the Dr. orders 65% fiO2. Whatcha gonna do?
- A.
Crank it up!!
- B.
Transfer the patient to partial rebreather mask
- C.
Transfer the patient to non-rebreather mask
- D.
Transfer the patient to another floor and let them deal with it
- E.
Transfer the patient to a nebulizer mask
Correct Answer
E. Transfer the patient to a nebulizer maskExplanation
The venti-mask (air-entrainment mask) can only go up to 50% (and according to the book it is shaky even above 40% but I digress) and so another solution is needed.
Partial and nonrebreathing masks are variable and therefore won't fulfill the Dr.'s orders of "65%". Transferring them to another floor might be a good idea, but a nebulizer mask will allow a fairly easy method of delivering fixed oxygen all the way up to 100% along with the ability to provide temperature and humidity control of the inspired gas.Rate this question:
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- 7.
Patient on simple O2 mask at 3L/min. Dr.'s order states O2 at 3L/min. So.....
- A.
So what, is this some kind of trick question?
- B.
Switch the patient to a nasal cannula
- C.
Switch the patient to a partial rebreather mask
- D.
Switch the patient to a nebulizer
Correct Answer
B. Switch the patient to a nasal cannulaExplanation
No, it's not a trick question. The simple mask needs to be operated at a minimum of 5L/min in order to facilitate the removal of carbon dioxide. Switching to either of the two other options would be even worse, as you need about 10L to begin to do anything with them.Rate this question:
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- 8.
Trauma patient just arrived cyanotic, severe dyspnea, and is providing copious amounts of frothy pink sputum, Dr. has noted likely pulmonary edema and ordered 60% O2 while the patient is being stabilized and further assessed. What device are you going to want to use here?
- A.
Nonrebreathing mask
- B.
Nebulizer
- C.
Air-entrainment mask
- D.
Nasal cannula
Correct Answer
A. Nonrebreathing maskExplanation
The non-rebreathing mask is the best bet here due to the patient's pulmonary edema. Although the non-rebreathing mask is a variable O2 device, the bottom of its range just happens to fall at 60 (memorize those ranges!). A nebulizer might be a fine choice other than it would add additional moisture to the airways. Air-entrainment mask only goes up to 50%, and the cannula only goes up to 40% and is also variable.Rate this question:
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- 9.
Patient is in respiratory distress with BP 160/100 resp. rate 32bpm, O2sat is 84%. Doctor orders O2 to maintain saturation over 90%. What now?
- A.
Nasal cannula at 4L
- B.
Partial rebreather mask
- C.
Non rebreather mask
- D.
Venti-mask
Correct Answer
C. Non rebreather maskExplanation
Although nothing specific was ordered and any of these might accomplish the goal, the way I understood it was to go for the biggest bang for your buck, which in this case happens to be the nonrebreather which provides 60-80% variable fiO2.Rate this question:
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- 10.
Patient is on 28% fixed via venti mask, but is eating and talking with his family with the mask removed. After a couple hours the patient starts to act irritated and slightly disoriented. As you stop in to tell him that he needs his mask on, he tells you that he is "going to shove the mask up your *** if you don't quit bothering me about it". What should you do?
- A.
Try to persuade the patient to use a cannula at 2-3L while he wants to talk and eat
- B.
Quit -- you don't need this aggravation.
- C.
Make him put the mask on -- don't take no for an answer.
- D.
Paralyze him, and then see how he feels.
- E.
Wait for him to either comply or pass out, at which point you can put it on him without resistance
Correct Answer
A. Try to persuade the patient to use a cannula at 2-3L while he wants to talk and eatExplanation
Although all of these answers may seem like fine choices at certain times. The BEST route to take would be to try to get the patient to use a cannula at 2-3L, as this will put the flow somewhere in the ballpark of 28+% and he will still be able to talk and eat freely.Rate this question:
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- 11.
Let's try something different. Select the approximate range of fiO2 for a nasal catheter by checking the box next to the low number, and the box next to the high number.
- A.
21%
- B.
22%
- C.
24%
- D.
28%
- E.
35%
- F.
40%
- G.
45%
- H.
50%
Correct Answer(s)
B. 22%
G. 45%Explanation
Nasal catheter has an FiO2 range of 22-45% and is variable.Rate this question:
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- 12.
That was fun! Now let's do the same thing for a simple mask. Remember to click on 2 boxes, both the low and the high of the range.FiO2 range of simple mask ____ to _____.
- A.
21%
- B.
24%
- C.
28%
- D.
32%
- E.
35%
- F.
40%
- G.
50%
- H.
60%
- I.
70%
- J.
80%
Correct Answer(s)
E. 35%
G. 50%Explanation
Simple mask has FiO2 range of just 35-50%.Rate this question:
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- 13.
All of this variability is getting me restless. Mediate with me a moment on what the differences are between a variable and fixed oxygen device.......ah, isn't that enlightening? Now what is it exactly that makes a difference between a variable and fixed device. Remember to check any that are correct.
- A.
A fixed device provides for all patient demands (with adequate flow) at that fiO2.
- B.
A variable device allows you to change fiO2 on the fly.
- C.
A fixed device is only able to provide one fiO2 value.
- D.
A variable device's fiO2 will be largely determined by the patient's O2 demands.
- E.
Increased tidal volume and respiratory rate will cause fiO2 to drop with a variable device
- F.
Increased tidal volume and respiratory rate will cause fiO2 to rise with a variable device
- G.
Fixed devices shouldn't be used on COPD patients due to hypoxic drive in some patients.
Correct Answer(s)
A. A fixed device provides for all patient demands (with adequate flow) at that fiO2.
D. A variable device's fiO2 will be largely determined by the patient's O2 demands.
E. Increased tidal volume and respiratory rate will cause fiO2 to drop with a variable deviceExplanation
A fixed device provides for all patients demands, whereas a variable device depends on how hard and fast the patient is breathing (as well as things like mask fit, mouth breathing with nasal cannula, etc.). Decreased tidal volume and/or res. rate will tend to increase the delivered FiO2 whereas increases will cause the opposite (lower fiO2).Rate this question:
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- 14.
One more thing about fixed devices and we will move on. Which of the following fixed devices are able to provide a 100% FiO2? More than 1 answer may be correct.
- A.
Simple mask
- B.
Nonrebreathing mask
- C.
Nonrebreathing circuit
- D.
Air Entrainment mask (venti mask)
- E.
Air Entrainment Nebulizer
- F.
Blending system
- G.
Oxyhood enclosure
Correct Answer(s)
C. Nonrebreathing circuit
E. Air Entrainment Nebulizer
F. Blending system
G. Oxyhood enclosureExplanation
All but 2 (simple mask and nonrebreathing mask) are fixed devices, but the venti mask is only able to provide a max fiO2 of 50%. All of the correct selections provide a full range of fiO2 (21-100%) except the nebulizer which starts out at about 28%.Rate this question:
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- 15.
Question #15 (will we make it to 20?)You are preparing to transport a patient and the good doctor wants the patient to be on the highest fiO2 possible. What are you going to bring?
- A.
Nebulizer mask
- B.
Non-rebreathing mask
- C.
Blender system
- D.
Non-rebreathing circuit
Correct Answer
B. Non-rebreathing maskExplanation
This is an almost complete rip-off of Rose's example, but I think it is a good one to go over. I want to think - max fiO2 = 100%, the only problem is that 100% is not always practical (or possible) in situations like this where the patient is being transported. Blender systems and non-rebreathing circuits require extra equipment and multiple connections and a bunch of stuff you don't want to mess with on the go. The nebulizer mask might work, but if the patient is not able to hold the the nebulizer bottle it might make for a sloppy, wet trip. At least that's the way I overheard Rose explaining it.Rate this question:
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- 16.
Dr. orders O2 at 31%. What device do you want to use?
- A.
Nasal Cannula
- B.
Simple Mask
- C.
Partial Rebreather Mask
- D.
Venti Mask
Correct Answer
D. Venti MaskExplanation
Maybe kind of tricky because of the number I selected, but since you need a fixed device (dr.'s orders) the venti mask would be the best choice out of those given. In some situations you would maybe choose a nebulizer mask over the venti mask, but since there is usually a 31% nozzle and nothing specifying mentioned about needing added heat/humidity you would probably go with the venti.Rate this question:
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- 17.
Let's spend some time with the Non-Rebreather Mask.What is the fiO2 range of this mask? Remember to select the low and the high number of the range.
- A.
21%
- B.
25%
- C.
35%
- D.
50%
- E.
60%
- F.
70%
- G.
80%
- H.
90%
- I.
100%
Correct Answer(s)
E. 60%
G. 80%Explanation
If the mask was 100% non-leaking, had perfect valves, and was provided with enough flow to prevent bag collapse it would theoretically provide 100% fiO2, modern disposable (cheap) masks do not typically provide more than 70%. (Egan's p.860 sourcing Branson RD) On Egan's table 38-3 it specifies 60%-80% as the range.Rate this question:
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- 18.
The Non-Rebreather mask is a fixed device capable of providing high fiO2.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
Although it does provide a high fiO2 (60-80%), the fiO2 delivered will depend on how fast and deep the patient is breathing (variable).Rate this question:
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- 19.
The only difference between the Non-Rebreather and Partial Rebreather masks are that the Non-Rebreather does NOT have valves.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
I know it is worded funny, taking Jen's tests has taught me to be aware of these kind of things that lead you in the wrong direction. The Non-Rebreather actually DOES have 1-way valves which let exhaled air exit but close off the ports during the inhalation, providing for the higher fiO2 range of the device.Rate this question:
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- 20.
To finish up on this device, what is the flow range of the non-rebreather mask? May not be exact depending on what you are looking at, but the range will be close.
- A.
1-8 L/min
- B.
5-10 L/min
- C.
5-15 L/min
- D.
8-15L/min
- E.
12-15L/min
Correct Answer
E. 12-15L/minExplanation
Although Egan's says that 10LPM is what is needed to keep the bag from collapsing, I'm guessing that could be low in many cases.Rate this question:
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- 21.
What do you think this is?
- A.
A mask....duhhhh
- B.
Venti-mask
- C.
Non-Rebreather Mask
- D.
Simple mask
- E.
Nebulizer mask
Correct Answer
B. Venti-maskExplanation
The tubing and nozzle are the giveaways on this one.Rate this question:
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