Oxygen Therapy Delivery Systems Study Guide

Structures and Functions of the Thoracic Cage

An examination of the bony structures, functional movements, and deformities associated with the human thoracic cage.

• Anatomy of the sternum
• Thoracic vertebrae and rib articulation
• Functions of the thoracic cage
• Pump handle motion
• Bucket handle motion
• Pectus carinatum deformity
• Kyphosis and kyphoscoliosis
• Scoliosis

Muscles of Ventilation

An examination of the primary and accessory muscles used during normal, deep, or forced breathing and the impact of pathologies on their function.

• primary and accessory muscles of ventilation
• diaphragm contraction and relaxation
• external intercostal muscle function
• thoracic volume changes during inhalation
• accessory muscles of the chest
• phrenic nerve innervation
• pathological impairments of ventilatory muscles
• mechanics of forced inhalation and exhalation

• Muscles of Ventilation: Mechanics and Pathologies

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Organs of the Thorax

An anatomical study of the structures within the thoracic cavity, including the pleurae, lungs, hilum, and mediastinum.

• visceral and parietal pleurae
• pleural cavity and serous fluid
• pneumothorax and hemothorax
• the lung hilum and pulmonary ligament
• hilar structures including bronchi and pulmonary vessels
• mediastinum divisions and contents
• thoracic organs and nerves

Lung Lobes and Segments

An anatomical overview of the human lungs, including the bronchial tree, lobes, fissures, and specific pulmonary segments.

• branching of the bronchial tree
• exchange of oxygen and carbon dioxide
• differences between right and left lungs
• lung lobes and fissures
• pulmonary circulation and alveoli
• structure of the hilum
• pleural cavity

Lung Volumes and Capacities

An overview of various pulmonary volumes and capacities, their definitions, and the clinical importance of measuring them.

• Tidal Volume (Vt)
• Inspiratory Reserve Volume (IRV)
• Expiratory Reserve Volume (ERV)
• Residual Volume (RV)
• Inspiratory Capacity (IC)
• Functional Residual Capacity (FRC)
• Vital Capacity (VC)
• Total Lung Capacity (TLC)
• Direct measurement with a spirometer
• Clinical application for lung conditions

Clinical Measurements of Ventilation

An overview of clinical pulmonary measurements including tidal volume, minute ventilation, deadspace ventilation, and alveolar ventilation.

• Tidal Volume (Vt)
• Vital Capacity (VC)
• Minute Ventilation (Ve)
• Respiratory Rate (RR)
• Anatomic Deadspace
• Alveolar Deadspace
• Physiologic Deadspace
• Alveolar Ventilation (Va)
• Ventilation without Perfusion

Gas Composition and Atmospheric Pressure

An examination of atmospheric gas composition and the relationship between partial pressures and total atmospheric pressure.

• Atmospheric composition percentages
• Nitrogen, oxygen, and argon levels
• Trace gases in air
• Sum of partial pressures
• Total atmospheric pressure
• Partial pressure of a dry gas
• Atmospheric pressure changes at higher altitudes

Breathing Mechanics and Airway Resistance

An examination of lung-thorax interaction, gas flow patterns, and the factors influencing airway resistance.

• Lung-thorax interaction
• Transpulmonary and intrapleural pressure
• Laminar and turbulent gas flow
• Airway resistance factors
• Inelastic resistance
• Obstructive airway problems

Resistance to Ventilation and Elastic Resistance

This material examines elastic resistance to ventilation, including internal, external within the thorax, and external to the chest, and its relation to restrictive problems.

• Elastic resistance to ventilation
• Internal lung tissue resistance
• External resistance within the thorax
• External resistance outside the chest
• Restrictive lung problems
• Interstitial fibrosis
• Alveolar hyaline membrane formation
• Impairment of diaphragmatic movement
• Skeletal deformities
• Pulmonary fibrosis

Lung-Thorax Interaction and Breathing Mechanics

An examination of pulmonary mechanics including airway resistance, lung compliance, and pressure relationships within the respiratory system.

• breathing mechanics
• airway resistance
• pulmonary compliance
• transpulmonary pressure
• intrapleural pressure
• dynamic vs static compliance
• peak inspiratory pressure
• plateau pressure
• obstructive air movement

Oxygen Therapy Delivery Systems

This content covers the administration and monitoring of oxygen therapy using low flow and high flow delivery systems.

• Low flow oxygen delivery
• High flow oxygen delivery
• Simple mask
• Partial rebreather mask
• Non-rebreather mask
• Air entrainment nebulizer
• Venturi masks
• FiO2 estimation
• Oxygen reservoir devices
• Inspiratory flow demand

• Oxygen Therapy Delivery Systems

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Oxygen Therapy and Medical Gas Therapies

This content covers high flow nasal cannula devices, oxygen blenders, heliox therapy, and carbogen therapy.

• High flow nasal cannula
• Oxygen blenders
• FiO2
• Heliox therapy
• Airway obstruction
• Carbogen therapy
• Ventilation stimulant and depressant

Introduction to Oxygen Therapy

An introduction to oxygen therapy including terminology, clinical objectives, and indications for treating or preventing hypoxia and hypoxemia.

• Hypoxia
• Hypoxemia
• Cyanosis
• Digital clubbing
• Cardiopulmonary system
• Acute myocardial infarction

Oxygen Therapy Precautions and Complications

Clinical practice guidelines regarding precautions and complications of oxygen therapy including ventilatory depression, absorption atelectasis, hyperoxic acute lung injury, and retinopathy of prematurity.

• Ventilatory Depression
• Absorption Atelectasis
• Hyperoxic Acute Lung Injury
• Oxygen Toxicity
• Retinopathy of Prematurity
• Hypoxic Drive Suppression
• Nitrogen Washout
• Combustion Risks

Clinical Signs and Assessment of Hypoxemia

Clinical signs of hypoxemia include increased ventilation, increased work of breathing, increased cardiac output, cyanosis, dyspnea, neurologic changes, and abdominal discomfort.

• Increased ventilation
• Increased work of breathing
• Increased cardiac output
• Cyanosis
• Neurologic symptoms
• Abdominal discomfort
• Hypoxemia
• Hypoxia
• ABG (SaO2, PaO2)
• Pulse oximeter (SpO2)
• Carbon monoxide poisoning
• Gas exchange

Medical Asepsis and Infection Control

An overview of medical asepsis and common disease-causing microorganisms found in healthcare settings.

• Medical asepsis
• Nosocomial infections
• Antibiotic resistance

Precautions and Isolation Procedures

This material covers medical asepsis precautions, personal protective equipment, and specific isolation procedures used to prevent the spread of infectious diseases.

• Medical asepsis in healthcare
• Standard precautions
• Airborne precautions
• Droplet precautions
• Contact precautions
• Reverse isolation
• Personal protective equipment
• Hand washing for infection control
• Transmission of communicable diseases

Hand Washing and Personal Protective Equipment

Instructional material regarding hand hygiene techniques and the proper use of gloves, masks, and eye protection to prevent the transmission of micro-organisms.

• preventing transmission of micro-organisms
• hand washing techniques
• proper use of hand sanitizer
• wearing gloves for body fluid contact
• sterile gloves usage
• mask and eye protection for droplet protection
• protecting mucous membranes

Infection Control and Sterilization Procedures

This material covers infection control protocols including personal protective equipment, sharps disposal, and methods of sterilization.

• Use of PPE gowns
• Nosocomial infection protection
• Sharps disposal in red containers
• Safe needle handling protocols
• Double bagging for isolation rooms
• Physical sterilization using an autoclave
• Chemical sterilization with liquid agents
• Steam under pressure sterilization

Safety Data Sheets and Chemical Hazards

Information regarding Safety Data Sheets (SDS), including their contents, departmental responsibilities, and specific chemical hazard identification and emergency procedures.

• Safety Data Sheets (SDS) contents
• Departmental and employee responsibilities for SDS
• Hazardous ingredients and physical characteristics
• Emergency and first aid procedures
• Spill and leak procedures
• Chemical handling and storage requirements
• Exposure controls and personal protection
• Health, fire, and reactivity hazards

Lifting and Moving Patients Safely

Instructional guidance on using body mechanics, gravity principles, and safety precautions to lift and move patients while monitoring levels of consciousness.

• Body mechanics for injury prevention
• Principles of gravity and center of gravity
• Base of support and balance
• Ten commandments of body mechanics
• Using leg and thigh muscles for lifting
• Patient level of consciousness and AVPU scale
• Bed to wheelchair transfer techniques
• Use of draw sheets and slide boards

Physiology and Treatment of Atelectasis

This material covers the physiological effects of limited pulmonary expansion, the consequences of atelectasis, and lung expansion therapies such as incentive spirometry.

• Limited pulmonary expansion
• Alveolar collapse and atelectasis
• Effects of atelectasis on gas exchange
• Lung expansion therapy
• Incentive spirometry techniques
• Sustained maximal inspiration
• Flow dependent spirometers
• Volume dependent spirometers

Humidity Management and Condensation Risks

Medical circuits utilize heated humidifiers and heat moisture exchangers to manage humidity and prevent condensation risks.

• Heated Humidifier
• Condensation
• Heat Moisture Exchanger (HME)
• Passive Humidifier
• Bland Aerosol Therapy
• Large Volume Jet Nebulizer
• Ultrasonic Nebulizer

Aerosol Therapy, Delivery Mechanisms, and Particle Deposition

A study of aerosol therapy goals, delivery through various airway appliances and generators, and the mechanisms of aerosol particle deposition.

• Aerosol suspension
• Bland aerosol therapy
• Large-volume jet nebulizers
• Ultrasonic nebulizers
• Venturi effect
• Tonicity (Isotonic, Hypotonic, Hypertonic)
• Mass median aerodynamic diameter (MMAD)
• Aerosol deposition mechanisms
• Inertial impaction
• Sedimentation
• Brownian motion
• Airway appliances
• Patient circuit components
• Aerosol therapy
• Particle deposition
• Aerodynamic diameter
• Humidify inspired gases
• Bypassed upper airways
• Sputum induction
• Bronchodilators

Aerosol Delivery and Jet Nebulizer Mechanisms

Aerosol delivery systems include various devices such as jet nebulizers, which utilize breath-enhanced or breath-actuated designs to manage medication deposition and residual drug volume.

• Aerosol delivery systems
• Jet nebulizer with reservoir tube
• Venturi small volume nebulizer
• Jet nebulizer with collection bag
• Medication deposition
• Pneumatically powered nebulizers
• One-way valve
• Breath-enhanced nebulizer
• Breath-actuated nebulizer
• Aerosol deposition
• Inspiratory vent and one-way valves
• Baffles
• Residual drug volume
• Dead volume
• Venturi jet nebulizers
• Small volume nebulizers
• Large volume nebulizers
• Ultrasonic nebulizer
• Piezoelectric transducer
• Continuous drug administration

Metered Dose Inhaler Aerosol Therapy

Information regarding metered dose inhaler design, propellant use, and administration of aerosol drug therapies.

• Metered Dose Inhaler (MDI)
• HFA propellant
• Aerosol drug administration
• MMAD
• Breath-actuated MDI
• Inspiratory flow rate
• Lung deposition
• Beta agonists
• Anticholinergic agents
• Inhaled corticosteroids

MDI Administration and Accessory Devices

Techniques for administration of metered-dose inhalers using non-spacer, spacer, and valved holding chamber methods.

• Metered-dose inhaler (MDI) administration techniques
• Open mouth vs. closed mouth technique
• Non-spacer techniques
• Oropharyngeal impaction
• Spacer valve-less extension
• Valved holding chamber (VHC)
• Pulmonary deposition
• Hand-breath coordination
• Electrostatic charge in chambers
• Dose counters
• Soft mist inhaler

Metered Dose and Dry Powder Inhalers

A review of metered dose inhaler and dry powder inhaler advantages, disadvantages, and patient delivery considerations.

• Metered dose inhaler
• Dry powder inhaler
• Unit dose DPI
• Multiple unit dose DPI
• Multiple dose DPI
• Inspiratory flow rate
• Breath-actuated dosing system
• Inhalation coordination
• Aerosol drug delivery system
• Nebulizer

Gas Laws and Diffusion Principles

• Partial pressure
• Gas solubility
• Solubility Coefficient
• Diffusion
• Arterial vs. Venous Blood
• FiO2

Ideal Gas Laws and Diffusion

• Ideal Gas Law
• Pressure and Volume relationship
• Volume and Temperature relationship
• Pressure and Temperature relationship
• Gas Diffusion

Gas Diffusion in the Lungs

Gas diffusion involves gas phase, membrane phase, and blood phase processes for respiratory gas exchange.

• Gas phase
• Membrane phase
• Blood phase
• Respiratory gas exchange
• Physiologic alterations
• Alveolar or interstitial fibrosis
• Capillary thickening
• Alveolar fluid (edema)
• Adult respiratory distress syndrome (ARDS)
• Diffuse alveolar damage (DAD)
• Pulmonary Function Test

Pulmonary Vessel Interstitial Pressures

Fluid movement between the capillary endothelium and interstitial space is influenced by hydrostatic and colloid osmotic pressures.

• Transmural Pressure
• Hydrostatic Pressure
• Colloid Osmotic Pressure
• Oncotic Pressure
• Pulmonary Capillary Hydrostatic Pressure
• Interstitial Hydrostatic Pressure
• Interstitial Oncotic Pressure
• Lymphatic Drainage System

Anatomy of the Upper Airway

An overview of the structures comprising the nasal cavity and the pharynx.

• nasal cavity structures
• nasal septum composition
• turbinates or nasal conchae
• nasopharynx and eustachian tubes
• oropharynx and palatine tonsils
• laryngopharynx and epiglottis
• pharyngeal tonsils

Alveolar Gas Equation and Respiratory Gas Exchange

This material explains how to account for water vapor and carbon dioxide when determining the partial pressure of oxygen in the alveolus.

• dry gas vs air entering respiratory tract
• accounting for added H2O
• subtracting CO2 from gas inside the body
• alveolar gas equation

Ventilatory Mechanics and Lung-Thorax Interaction

This material covers the mechanical forces, pressure differences, and physical laws that govern lung ventilation and the interaction between the lungs and thorax.

• Lung-thorax interaction
• Intrapleural pressure
• Intra-alveolar pressure
• Transpulmonary pressure
• Elastic recoil of lung and chest wall
• Functional residual capacity
• Pressure gradients in gas movement
• Hooke's Law
• Elastic resistance and compliance

Anatomy and Physiology of Pulmonary Circulation

This content reviews heart chambers, valves, vessels, and the pressure gradients driving pulmonary and systemic circulation.

• cardiac anatomy
• heart chambers
• heart valves
• pulmonary circulation
• systemic circulation
• driving pressure
• pressure gradient
• right atrial pressure
• right ventricular pressure
• pulmonary artery pressure
• pulmonary capillaries
• left atrial pressure
• left ventricular pressure

Pulmonary Artery Catheterization and Hemodynamics

This content covers Swan-Ganz catheterization, hemodynamic pressures, and measurements such as SvO₂, mixed venous blood samples, and C.O. (Q).

• Central venous access
• SvO₂
• Mixed venous blood sample
• C.O. (Q)
• Hemodynamic pressures
• Fluid resuscitation
• Lung and heart disease management
• Shock management
• Drug infusion therapy
• Pulmonary artery pressure (PAP)

Pulmonary Vascular Resistance and Circulation

This content examines pulmonary vascular resistance, mechanical and chemical factors, and pathological changes affecting pulmonary circulation.

• Pulmonary vascular resistance
• Pulmonary circulation
• Systemic circulation
• Mechanical factors
• Chemical factors
• Vasodilators
• Vasoconstrictors
• Hypoxia
• Acidemia
• Pathological changes
• Vascular obstruction
• Atelectasis
• Recruitment

Functions of Pulmonary Vessels

Pulmonary vessels perform six major functions including gas exchange, filtration, blood reservoir, providing nutrition, and fluid exchange.

• Gas exchange
• Respiratory membrane
• Filtration
• Saddle embolus
• Blood reservoir
• Nutrition for gas exchange airways
• Fluid exchange
• Interstitial area

Pulmonary Blood Distribution and Ventilation Perfusion

Pulmonary perfusion and ventilation depend on pressure gradients and gravity across different lung zones.

• Pulmonary blood distribution
• Perfusion
• Pressure gradient
• Arterial pressure
• Venous pressure
• Alveolar pressure
• Gravity
• Ventilation perfusion (V/Q)
• Lung zones
• Zone 1
• Zones 2 & 3
• Zone 4
• Hypoxemia
• Hypoxia

Vital Signs: Pulse, Respirations, and Blood Pressure

An instructional guide covering the measurement, normal ranges, and clinical patterns of pulse, respiration, and blood pressure.

• Pulse measurement and palpation sites
• Pulse rate and rhythm variations
• Bradycardia and tachycardia definitions
• Respiratory rate and patterns
• Blood pressure systolic and diastolic components
• Hypertension and hypotension classifications
• Pediatric blood pressure calculation
• Stethoscope diaphragm and bell uses
• Aneroid and mercury sphygmomanometer types
• Blood pressure measurement technique

Physical Exam Techniques and Purposes

This material covers the techniques and objectives used during a physical exam to assess patient information and detect pathologies.

• Auscultation using a stethoscope
• Palpation using hands to feel body parts
• Observation with the naked eye
• Percussion techniques
• Specimen collecting
• Detecting presence and extent of pathologies
• Vital signs and blood work
• Identifying risk factors through annual physical exams

Physical Exam Equipment and Tools

An overview of commonly used medical equipment and diagnostic tools required for physical examinations.

• Sphygmomanometer components
• Stethoscope anatomical parts
• Otoscope and ophthalmoscope usage
• Tuning fork applications
• Pen light observations
• Pupil dilation and constriction
• Tongue depressor use
• Examination gloves

Patient Lifting, Moving, and Positioning

This material covers techniques for lifting and moving patients using equipment and various medical body positions.

• Use of draw sheets and slider boards
• Supine position for comfort and weight relief
• Prone position for preventing pressure sores
• Lithotomy position for vaginal or rectal examinations
• Knee chest position for procto-sigmoidoscopic exams

Anatomy and Functions of the Larynx and Upper Airway

An overview of the cartilaginous structures of the larynx, the epithelial lining of the upper airway, and the physiological functions of the upper respiratory tract.

• Anatomy of the larynx and its cartilages
• Functions of the upper airway
• Air conduction and airway patency
• Protection of the lower airway
• Warming and humidifying inhaled air
• Role of the epiglottis during swallowing
• Cricothyroid membrane emergency access

Functional Anatomy of the Lower Airway

• tracheobronchial tree structure
• airway generations
• conducting airways vs gas exchange airways
• pseudostratified ciliated columnar epithelium
• goblet cells and mucus production
• bronchial cartilage and smooth muscle changes
• alveolar epithelium types
• alveolar-capillary membrane diffusion
• pulmonary circulation
• acinus definition

Pulmonary Defense Mechanisms

An overview of the clearance mechanisms used to remove foreign material from the respiratory tract.

• mucociliary clearance
• mucociliary escalator
• sol layer and gel layer
• ciliary movement
• alveolar clearance
• alveolar macrophages
• cough mechanism
• goblet cell hyperplasia
• lung parenchyma function

Anatomy of the Heart and Cardiac Conduction

An overview of the heart's anatomical structures, blood flow pathways, cardiac muscle, and coronary circulation.

• location and position of the heart
• structures and chambers of the heart
• pulmonary and systemic circulation
• electrical conduction system of the heart
• cardiac cycle and electrocardiogram waves
• myocardium and cardiac muscle characteristics
• coronary circulation and coronary arteries
• myocardial infarction and coronary artery occlusion

Coronary Electrical Conduction and Cardiac Anatomy

An examination of the heart's specialized electrical conduction system, the mechanisms of cellular depolarization and repolarization, and the components of an electrocardiogram.

• coronary electrical conduction system
• sino-atrial node function
• atrioventricular node delay
• Bundle of HIS and Purkinje fibers
• cellular depolarization and repolarization
• electrocardiogram wave components
• P wave atrial stimulation
• QRS complex ventricular depolarization
• T wave ventricular repolarization
• cardiac chamber anatomy
• systemic and pulmonary circulation

Pulmonary Tissue and Alveolar Surfactant

• attractive forces between liquid molecules
• La Place's Law
• relationship between radius and surface tension
• surfactant function
• Type II Pneumocyte
• atelectasis

Cardiac Arrest and Choking Relief

Distinctions between myocardial infarction and sudden cardiac arrest alongside emergency maneuvers for foreign-body airway obstruction in adults, children, and infants.

• Myocardial Infarction
• Sudden Cardiac Arrest
• Foreign-Body Airway Obstruction (FBAO)
• Universal Choking sign
• Chest thrusts
• Back blows
• Blind finger sweeps