Complex Med/Surg Exam 1

Drugs

100

Albuterol: SABA reliever or rescue

1. 
   
   • Drug Class: Beta2-adrenergic agonist.
   • MOA: Stimulates beta2 receptors in bronchial smooth muscle, causing bronchodilation.
   • Indication: Used for relief of bronchospasm in asthma and COPD.
   • Major & Serious Adverse Effects: Tremors, nervousness, tachycardia, palpitations.
   • Contraindications: Hypersensitivity to albuterol, caution in patients with cardiovascular disorders.
   • Nursing Implications: Monitor for relief of bronchospasm, instruct proper use of inhaler

200

Salmeterol LABA – control /Fluticasone CORTICOSTEROID. – inhaled and po

1. 
   
   • Drug Class: Long-acting beta2-adrenergic agonist (LABA) and corticosteroid.
   • MOA: Salmeterol provides prolonged bronchodilation; fluticasone reduces airway inflammation.
   • Indication: Maintenance treatment of asthma and COPD.
   • Major & Serious Adverse Effects: Oral candidiasis (thrush), dysphonia, increased risk of pneumonia.
   • Contraindications: Not for acute asthma attacks, hypersensitivity to components.
   • Nursing Implications: Educate on rinsing mouth after use to prevent thrush, monitor lung function

300

Oseltamivir (Tamiflu):

1. 
   
   • Drug Class: Neuraminidase inhibitor.
   • MOA: Inhibits neuraminidase enzyme, preventing viral release from infected cells.
   • Indication: Treatment and prevention of influenza A and B.
   • Major & Serious Adverse Effects: Nausea, vomiting, headache, neuropsychiatric events.
   • Contraindications: Hypersensitivity to oseltamivir.
   • Nursing Implications: Must be taken within 48 hours of symptom onset for effectiveness, monitor for unusual behavior

400

Isoniazid (INH):

1. 
   
   • Drug Class: Antitubercular agent.
   • MOA: Inhibits synthesis of mycolic acids, essential components of bacterial cell walls.
   • Indication: Treatment and prevention of tuberculosis.
   • Major & Serious Adverse Effects: Hepatotoxicity, peripheral neuropathy.
   • Contraindications: Acute liver disease, previous severe reaction to isoniazid.
   • Nursing Implications: Monitor liver function tests, educate on avoiding alcohol, administer with vitamin B6 to prevent neuropathy

500

Hypokalemia Treatment:

• Potassium supplements (oral or IV), potassium-sparing diuretics.
• Nursing Implications: Monitor serum potassium levels, ECG for changes, administer potassium cautiously to avoid hyperkalemia

600

Hyperkalemia Treatment:

• Kayexalate, insulin with glucose, diuretics (e.g., furosemide).
• Nursing Implications: Monitor ECG for peaked T-waves, assess serum potassium levels, educate on low potassium diet

Fluids/Electrolytes, Acid/Base Imbalances

100

• Metabolic versus respiratory

• pH:       A          7.38 – 7.44       B
• PaCO2  B          38 – 42             A
• HCO3:  A          23 – 26             B

200

• Uncompensated versus compensated

• Uncompensated: body hasn’t responded to acid base disturbance, and only one system is abnormal
• Partially compensated: pH abnormal, both Paco2 and HCO3 are abnormal
• Compensated: pH is normal and both PaCO2 and HCO3 are abnormal

300

Identify common causes of respiratory acidosis or alkalosis and metabolic acidosis or alkalosis

• Metabolic acidosis: low pH and low HCO3
• DKA, renal failure, diarrhea
• Metabolic alkalosis: high pH High HCO3:
• vomiting, antacids, diuretics
• Respiratory acidosis: low pH, high PaCO2
• COPD, asthma, hypoventilation, decreased respiratory drive
• Respiratory alkalosis: high pH, Low PaCO2
• Hyperventilation, anxiety, pulmonary embolism, fever

• Respiratory acidosis: hypoventilation, CO2 retention
• Respiratory alkalosis: hyperventilation, CO2 loss
• Metabolic alkalosis: excess bicarb
• Metabolic acidosis: bicarb deficit

400

• What are the clinical signs of respiratory compensation? (respiration rate/depth and corresponding ABG values like PaCO2 levels)

• Metabolic acidosis:
• Tachypnea
• Kussmaul breathing

• Metabolic alkalosis
• Bradypnea
• Shallow breathing
• Hypoventilation
• cyanosis

500

• What are the effects of hypoventilation or hyperventilation?

• Hypoventilation: respiratory acidosis
• Hyperventilation: respiratory alkalosis

600

• What are the clinical signs/symptoms of dehydration?

• Mental status
• Tight shoe or ring
• Skin turgor
• Orthostatic hypotension
• Tachycardia
• Flat neck veins
• Tachypnea
• Skin changes/oral mucosa/tongue
• Low grade fever
• Concentrated, amber urine
• Less than 500 ml/day
• hemoconcentration

700

• What are risk factors for developing dehydration?

• Too little intake: nausea, mental statues, illness
• Too much output: exercise, heat, diarrhea, vomiting
• Hypovolemia = inadequate perfusion
• Nutritional hx
• Decreased wight
• Diarrhea, insensible losses
• Misuse of laxative and diuretics
• Hot environments or high altitudes

800

• What are insensible losses?

• Losses not able to measure sweat

900

• What are clinical signs/symptoms of fluid overload?

• Pitting edema
• Bounding pulse
• Elevated BP
• Distended neck veins
• Weight gain
• Dyspnea
• Crackles
• Rings are tight
• Headache
• Visual disturbances
• Increased GI mobility
• More than 3 lbs a week or 2 lbs in 24 hours

1000

• What are common causes of electrolyte losses?

• Vomiting, diarrhea, ng suctioning, fistulas: abnormal connections between organs that leak fluid rick in electrolytes
• Renal losses (kidney)
• Diuretics
• Chronic kidney disease, polyuria
• Sweating, burns
• Endocrine disorders
• Addison’s diseas: deficiency in adreanal hormones, particularly aldosterone, can lead to sodium and fluid loss and potassium retention
• Diabetes: increased urination
• Laxatives
• Corticosteroids
• Chemo
• hyperventilation

1100

• How is hypo/hyperkalemia treated (including pharmacological and nonpharmacological treatments)?

• Hyperkalemia:
• Tx: assess cardiac complications
• Kayexalate, glucose and insulin therapy/dextrose, furosemide
• Cardiac monitoring
• Health teaching
• Notify if HR below 60
• Hypokalemia:
• Adequate o2
• Pt safety for fall prevention
• Prevent injury form k+ administration
• Monitor
• Potassium IV or PO
• 10 meq/hr peripheral and 20 meq/hr centrally
• Slow and never push
• Replace diuretics w/ potassium sparing
• Mix po k+ w/ flavored drinks
• Bananas, veggies green, fruit

Respiratory Infections

100

• Tuberculosis
• Causes:
• How it's transferred
• Stages

• Caused by mycobacterium tuberculosis
• Airborne
• Initial infections: three stages ---- secondary infection: one stage of reactivation after 12 to 24 months.  Sx = highly active TB and contagious

200

• What is considered a positive PPD skin test?

• Immune compromised: _> 5 but skin test could be negative in old or immunocompromised
• 10 mm: drugs, other countries, lab workers, high risk, metabolic disorders, young
• 15mm no known risk factors

300

• How do we determine if a patient has latent or active TB?

• Latent
• Tb skin test indicating infection
• has normal CXR and negative sputum test
• tb in body but isn’t active and doesn’t feel sick
• can’t spread to others
• 
  
•  active
• Tb skin test indicating infection
• has abnormal XCR w/ positive sputum spear
• abnormal xray or positive sputum smear or culture
• may spread to others w/ sxs

400

• How do we determine if a TB patient is contagious?

if they feel sick

• Strict adherence for 6-12 months as no not develop drug resistant tb
• Three sputum cultures indicative of gone infection
• Rifampin – liver damage, red urine, skin , secretions
• Isoniazide – causes liver failure, take on empty stomach
• Pyrazinamide – liver damage, photo sensitive
• Ethambutol – can lead to blindness
• Direct observation for multidrug resistant tb
• Treatment 26 weeks to 3 years.
• Negative when 3 consecutive sputum cultures negative
• Negative pressure room

500

• What are interventions to prevent spread of infectious respiratory disease?

WASH HANDS

yearly vaccines for a and b

• Antiviral w/in 24 to 48 hours of sxs.  (oseltamivir and zanamivir)

600

• Pneumonia: Excessive amount of fluid in lungs resulting from inflammation process

• Caused by inhaling irritants or infectious organisms
• CAP, HAP, or VAP
• Impaired gas exchange and hypoxemia d/t fluid collecting around the alveolar
• Can turn into empyema: bacteria in pleural cavity
• SX: fever, dyspnea, tachypnea, copious secretions
• LABS: sputum: color, amount consistency, odor and send for culture
• crackles
• CBC for elevated WBC
• blood cultures
• ABGs
• Chest xray
• INTERVENTIONS:
• Antibiotics PO or IV, bronchodilators like B2 agonists
• Aspiration can lead to ARDS
• ENCOURAGE PT TO DRINK AT LEAST 2 LITERS DAILY TO PREVENT DEHYDRATIONS AND TO THIN SECRETIONS
• Smoking cessation

700

• Atelectasis: complication of pneumonia

• Complete or partial collapse of a lung or section of a lung
• Common after surgery
• Incentive spirometry
• Cough and deep breathe
• Absorption atelectasis: with high supplemental o2, o2 diffuses from alveoli, alveoli collapses d/t lack of nitrogen

800

• Plural Effusion: Collection of fluid in pleural space

• Causes:
• CHF
• TB
• Pneumonia
• Pulmonary infections
• Nephrotic syndrome
• SX:
• SOB
• Pain
• Decresed chest wall excursion
• Diminished lung sounds in affected side
• LABS:
• CXR
• CT
• US
• Thoracentesis – to remove fluid to obtain a specimen, and to relieve dyspnea and respiratory compromise
• Pt may need a chest tube

900

• Pneumothorax: injury that allows air to enter the pleural space

• Causes a rise in chest pressure and reduction in vital capacity of lung
• SX
• Reduces breath sounds
• Hyperresonance on percussion
• Decreased chest movement on affected side
• Deviated trachea
• Pleuritic pain
• Tachypnea
• Subq air
• Suprasternal retractions from accessory muscle use
• Require chest tube

1000

• What is empyema and what are common treatment interventions?

• Collection of puss in space between the lung and the inner surface of the chest wall (pleural space).
• Caused by an infection spreading from lungs
• TX:
• Antibiotics, drainage, chest tube, surgery

Respiratory Critical

100

What are the basic parts of a chest tube

• Chamber one: collects fluid draining from patient.  Collection. 
• Chamber 2: water seal that prevents air from entering patients pleural space.  Intermittent bubbling
• Chamber three: suction control system.  Gentle bubbling

200

• What are the two reasons that can cause bubbling in the water seal chamber?

• Intermittent is okay – when lung is reexpanding
• Continuous is bad – there is a leak

300

• What are important assessments?

• Chest tube below patient’s chest
• Assess for kinks
• No milking or stripping the tubing
• Only clamp tubing with orders
• Monitor
• Color
• Amount (no more than 100 ml/hour)
• Leaks
• Suction
• Valsalva maneuver during extubation

400

• Tracheostomy: surgical incision into the trachea

• Is the stoma or opening that results from the procedure of a tracheotomy
• May be temporary or permanent

500

• What are indications for tracheostomies?

• ventilator weaning for patients with acute respiratory failure who are unable to be liberated from mechanical ventilation in the intensive care unit. Prolonged ventilator dependence.
• Prophylactic tracheostomy prior to head and neck cancer treatment.
• Obstructive sleep apnea refractory to other treatments.
• Chronic aspiration.
• Neuromuscular disease.
• Subglottic stenosis.

600

• What are important care considerations for a new tracheostomy?

1. Airway Management and Patency

• Suctioning: Frequent suctioning may be required initially to remove secretions and prevent airway obstruction. Use sterile technique and limit each suction pass to 10-15 seconds to prevent hypoxia.
• Humidification: The air bypasses the upper respiratory tract in a tracheostomy, so humidification is necessary to prevent drying and thickening of secretions. Use humidified oxygen or a heat moisture exchanger (HME) filter.
• Cuff Management: If the tracheostomy tube has a cuff, ensure it is inflated according to orders to prevent aspiration but avoid overinflation, which can damage the trachea. Check cuff pressure regularly.

2. Tracheostomy Site Care

• Stoma Cleaning: Clean the area around the tracheostomy stoma with sterile saline and replace dressing frequently to prevent infection and irritation. Avoid using gauze with loose fibers that may enter the stoma.
• Assess for Infection: Monitor for signs of infection such as redness, swelling, warmth, drainage, or foul odor. Report any abnormalities to the healthcare provider.
• Skin Integrity: Ensure the area around the stoma and under the securing ties is clean and dry. Rotate the tracheostomy ties or straps regularly to avoid skin breakdown.

3. Tube Security and Position

• Securing the Tube: Ensure the tracheostomy tube is securely fastened to prevent accidental dislodgement, which is a serious risk in the early stages. Use tracheostomy ties or securement devices that are not too tight to avoid pressure injuries but tight enough to keep the tube in place.
• Emergency Care: Always keep a tracheostomy tube of the same size and one size smaller, an obturator, a suction catheter, and resuscitation equipment at the bedside in case of accidental dislodgement or obstruction. Know the facility’s protocol for managing accidental decannulation.

4. Ventilation and Oxygenation

• Monitor Oxygen Levels: Monitor oxygen saturation levels using pulse oximetry. Provide oxygen as ordered, ensuring it is humidified if going directly through the tracheostomy.
• Respiratory Assessment: Regularly assess breath sounds, respiratory rate, and effort. Be alert for signs of respiratory distress, including use of accessory muscles, increased respiratory rate, and cyanosis.

5. Prevention of Complications

• Tracheostomy Tube Dislodgement: The risk of accidental decannulation is high in the early days after a tracheostomy. Ensure secure tube fixation, and avoid excessive movement or pulling on the tracheostomy tube.
• Aspiration: If the tracheostomy tube is cuffed, maintain proper inflation to prevent aspiration of secretions. Assess the patient’s ability to swallow and protect the airway, particularly if oral feeding is initiated.
• Bleeding: A small amount of bleeding may occur after the procedure, but excessive bleeding should be reported immediately.

6. Patient Communication

• Non-verbal Communication: A new tracheostomy limits the patient's ability to speak. Provide communication tools such as a writing board, communication app, or picture board to help them communicate effectively.
• Speech Therapy: If appropriate, refer the patient to speech therapy for teaching about speaking valves, which can be used to allow speech as the tracheostomy heals.

7. Nutritional Support

• Swallowing Assessment: Patients with new tracheostomies are at risk for aspiration, so an evaluation by a speech-language pathologist is often needed to assess the patient’s ability to swallow safely.
• Enteral Nutrition: Many patients with new tracheostomies will initially receive enteral nutrition (via a feeding tube) until it is determined that they can safely eat by mouth.

8. Education and Psychosocial Support

• Patient and Family Education: Educate the patient and family on tracheostomy care, including cleaning the site, suctioning, recognizing complications, and managing the tracheostomy at home.
• Psychosocial Support: A new tracheostomy can be emotionally challenging for patients, leading to feelings of anxiety, fear, or depression. Offer emotional support, and provide reassurance about the healing process and long-term management options.

9. Pain Management

• Pain Control: Assess and manage pain appropriately, as patients with new tracheostomies may experience discomfort at the stoma site or from coughing and suctioning.

700

• What are interventions if a new tracheostomy accidentally comes out?

• Ventilate the patient using an ambu bag and facemask while another nurse calls rrt
• w/in 72 hours a medical emergency
• make sure tube is at bedside at all times with insertion tray

800

• How are speaking valves used? Can this be used with both a cuffed and uncuffed tracheostomy tube?

Speaking valves, such as the Passy-Muir valve, are devices designed to enable speech in patients with tracheostomies by allowing air to flow into the lungs through the tracheostomy tube during inhalation but closing during exhalation. This forces exhaled air through the vocal cords, allowing the patient to speak.

How Speaking Valves Work:

• Inhalation: Air is drawn through the tracheostomy tube into the lungs as the valve remains open.
• Exhalation: The valve closes, directing exhaled air upward through the vocal cords and out the mouth and nose, allowing phonation (speech).

Benefits of Speaking Valves:

• Restores Speech: Allows patients with tracheostomies to speak by forcing air past the vocal cords during exhalation.
• Improved Swallowing: It may also improve swallowing by restoring more normal airflow through the upper airway, which aids in sensation.
• Promotes Lung Health: Speaking valves encourage the patient to exhale through the upper airway, which can help improve lung strength and reduce secretions by promoting more effective coughing.

Use with Cuffed vs. Uncuffed Tracheostomy Tubes:

1. Uncuffed Tracheostomy Tube:

• Direct Use: Speaking valves can easily be used with uncuffed tracheostomy tubes because there is no inflated cuff blocking airflow. When the valve closes on exhalation, air can pass around the tube and up through the vocal cords, enabling speech.

2. Cuffed Tracheostomy Tube:

• Cuff Deflation is Required: Speaking valves can be used with cuffed tracheostomy tubes, but the cuff must be deflated before the valve is placed. This is because an inflated cuff completely blocks airflow past the tracheostomy tube, which would prevent air from reaching the vocal cords and create a dangerous situation where the patient cannot exhale effectively.
• Safety Considerations: If the cuff is not deflated before attaching the speaking valve, the patient would be unable to exhale through the tracheostomy tube or the upper airway, leading to increased airway pressure and potential respiratory distress.

900

• Pulmonary embolisms: collection of matter in pulmonary vessel
• What are risk factors for developing pulmonary embolisms?

• Prolonged immobilization
• Central venous catheters
• Surgery
• Obesity
• Advancing age
• Conditions that increase blood clotting
• Hx of thromboembolism
• Smoking
• Pregnancy
• Estrogen therapy
• Oral contraceptives
• Heart failure
• Cancer
• Trauma
• Covid 19

1000

• Do PEs cause problems with ventilation (oxygen intake problem) or perfusion(blood flow problem)?

• perfusion

1100

• What are signs/symptoms of PE?

• Dyspnea
• Tachypnea
• Pleuritic chest pain
• Tachycardia
• Hypotension
• Decreased oxygen saturation
• anxiety

1200

• What are the diagnostic tests to evaluate for a PE?

• Stat ct if PE suspected
• 20 g IV AC
• Abg
• D dimer

1300

• What are nursing/medical interventions for an acute PE?

• STAT CT if PE suspected!!
• Obtain IV access at least 20g in AC preferably
•  ABGs
•  D-dimer
•  Pulse oximetry
•  Imaging assessment
•  Pulmonary angiography is gold standard, but is not available in all settings
•  V/Q Scan
•  Spiral CT Scan (angiogram with contrast)
•  Transesophageal echocardiography (TEE)
•  Doppler ultrasound of extremities

1400

• What are the clinical signs of flail chest?

• Sucking inward of loose chest and puffing out in same area

1500

• What are the clinical signs of pneumothorax?

• Reduced breath sounds
• Hyperresonance
• Decreased chest movement on affected side
• Deviated trachea
• Pain
• Tachypnea
• Subq air
• Suprasternal retractions from accessory muscle use

Respiratory Critical

100

• How do we manage tension pneumothorax?

• Call code
• Large bore needle
• Chest tube

• Think what supplies are needed for these interventions
• Large bore needle in 2nd intercostal space, midclavicular line

200

• What distinguishes ARDS from ARF?

• 
  
• mismatch between ventilation and blood perfusion
• ARDS:
• hypoxia even when o2 @ 100 percent
• Decreased pulmonary compliance
• White out
• Lower PaO2 value on arterial blood gas

300

• What are the clinical signs of ARDS?

• Hypoxia
• Hyperpnea, noisy respiration, cyanosis, pallor, retraction
• Decreased pulmonary compliance
• Dyspnea
• Bilateral pulmonary edema
• Infiltrates on xray
• Traumatic episode, pt otherwise healthy

400

• Intubation/mechanical ventilation

• Severe problem w/ gas exchange or airway problem
• Usually temporary
• Hypoxia
• Hypoventilation
• Ventilatory support after surgery
• General anesthesia or heavy sedation
• Airway protection

500

• What are the methods to confirm endotracheal tube (ETT) placement?

• Assess bilateral, symmetrical chest movement
• Air emerging from ET tube
• Color changing, signifies proper airway placement

600

• What are interventions to prevent ventilator associated pneumonia (VAP)?

• HOB, chlorhexidine, oral care, gastric feeding, repositioning, suctioning

700

• What are important nursing interventions during and following extubation?

• Hyper oxygenate
• Suction ET
• Deflate ET
• Remove tube at peak inspiration
• Instruct pt to cough
• STRIDOR IS OBSTRUCITON
• Clearing secretions
• Assess gag reflex

Other Respiratory

100

• What causes respiratory issues in patients with cystic fibrosis?

• Genetic disease affecting many organs, lethally impairing pulmonary function
• Present in birth, first seen in early childhood
• Locked chloride transport into the cell membrane, producing thick mucus with low water content
• Mucus plugs up glands, causing atrophy and organ dysfunction
• Chronic cough
• Recurrent uri
• Thick, sticky mucus
• Hypoxia
• ventilation
• Clubbing, barrel chest

200

• What are important preventative interventions with these patients?

• Positive expiratory pressure
• Breathing technique
• Nutritional management: up calcium and protein
• Drug therapy: antibiotics, supplements, bronchodilators, mucolytics
• Infection prevention
• Pulmonary hygiene

300

• What contagious bacterial infection can occur in these patients and appropriate interventions for infection prevention?

• Burkholderia cepacia

400

• What are the signs/symptoms of COPD?

• Emphysema: loss of lung elasticity and hyperinflation of the lung
•  and chronic bronchitis: inflammation of the bronchi and bronchioles caused by chronic exposure to irritants
• Increases number of mucus glands that produce a large amount of thick mucus
• .  Tissue damage is not reversible and increases in severity, eventually leading to respiratory failure

SOB

Chronic Cough

Chronic Sputum Production

Wheezing

Chest Tightness

Frequent Respiratory Infections

Fatigue

Cyanosis: clubbing and barrel chest

Unintended Weight Loss

Pursed-lip breathing

Hypoxemia: low oxygen levels in blood

Hypercapnia: high carbon dioxide levels

500

• What are primary risk factors for developing COPD?

• Cigarette smoking – 20 pack year
• Second hand smoke
• Alpha 1 antitrypsin deficiency
• A protein that protects lungs/prevents inflammation

600

• What are priority nursing interventions for COPD?

• Abg values for abnormal oxygenation, gas exchange, and acid base status
• Sputum samples
• Cbc
• Hemoglobin and hematocrit blood tests
• Serum electrolyte levels
• Serum alpha 1 antitrypsin levels
• CXR
• Pulmonary function test

700

• What interventions can help prevent COPD exacerbations?

• Airway maintenance
• Breathing techniques
• Monitoring patient q 2 hours
• Effective coughing
• O2 therapy
• Exercise conditioning
• Suctioning
• Hydration
• Positive pressure device
• Tracheostomy
• Pursed lips
• Focus long term long-acting drugs
• Beta adrenergic agents
• Cholinergic antagonists
• Xanthine
• Corticosteroids
• Chromones
• mucolytics

800

• What else would you include in the patient education upon discharge?

• High calorie, high protein meals and snacks
• Minimize anxiety
• Energy conservation
• Avoid working with arms raised
• Supplemental oxygen therapy
• Avoid large crowds
• Pneumonias vaccination
• Flu vaccine

900

• What are nursing interventions following a bronchoscopy?

• Determine if lung infection present

1000

• Review oxygen delivery devices (nasal cannula, simple mask, partial rebreather, non-rebreather, oxymask) and appropriate oxygen flow for each device

Nasal Cannula (NC)

• Description: A nasal cannula consists of two small prongs that fit into the patient's nostrils. It is a low-flow oxygen delivery system.
• Flow rate:
  • 1 to 6 liters per minute (L/min).
• For patients with mild hypoxia or chronic lung conditions (like COPD).
• Can dry out nasal mucosa at higher flow rates, so humidification may be needed above 4 L/min.

Simple Face Mask

• Description: A face mask that covers the nose and mouth, providing higher oxygen flow than a nasal cannula but with less precise control over oxygen concentration.
• Flow rate:
  • 5 to 10 L/min.
• Considerations:
  • Minimum flow rate of 5 L/min is necessary to prevent rebreathing of exhaled CO₂.
  • Used for patients needing moderate oxygen support but who can still breathe effectively on their own.

3. Partial Rebreather Mask

• Description: This mask has a reservoir bag attached, which collects part of the patient’s exhaled air. The exhaled air mixes with fresh oxygen, providing a higher FiO₂ than a simple mask.
• Flow rate:
  • 8 to 15 L/min.
• Considerations:
  • The bag should remain partially inflated throughout inhalation; if the bag is collapsing, the flow rate may be too low.
  • Used for patients who require a higher concentration of oxygen but do not need complete non-rebreathing support.

4. Non-Rebreather Mask (NRB)

• Description: Similar to a partial rebreather but with one-way valves that prevent the patient from inhaling exhaled air, ensuring that only fresh oxygen is inhaled.
• Flow rate:
  • 10 to 15 L/min.
• Considerations:
  • The reservoir bag must stay fully inflated (or at least two-thirds inflated) during inspiration.
  • Used in emergency situations when the patient requires high-flow oxygen for severe hypoxemia or acute respiratory distress.

5. Oxymask

• Description: The oxymask is a newer design that delivers oxygen in a broader range, with an open design that allows for more patient comfort and less risk of CO₂ retention. It has an open face design with an adjustable oxygen delivery range.
• Flow rate:
  • 1 to 15 L/min.
• Considerations:
  • Provides flexibility for a wide range of oxygen needs.
  • Allows for better communication and patient comfort since it is less confining than traditional masks.
  • Useful in settings where the oxygen requirements fluctuate or need to be titrated.