Ch. 25: Management of Respiratory System Flashcards
Bronchial Hygiene Therapy (BHT)
AKA pulmonary toileting, includes:
Coughing and Deep Breathing
Airway Clearance Adjunct Therapies
Chest Physiotherapy
Airway clearance adjunct therapies
Includes:
Acapella and flutter valves; valves that induce natural vibrations to help loosen secretions
Vest therapy: chest wall oscillation device, like for cystic fibrosis
CPAP, BiPAP
Chest physiotherapies
Includes:
Postural drainage
Chest percussion and vibration
Patient positioning
Contraindications to postural drainage
Increased ICP After meals/during tube feeding inability to cough hypoxia hemodynamic instability decreased mental status recent eye surgery hiatal hernia obesity
Contraindications to percussion/vibration
fractured ribs/osteoporosis chest/abd trauma/surgery pulmonary hemorrhage/embolus pneumothorax SCI TB asthma Pleural effusion pulmonary edema
Oxygen Therapy
administration of O2 to a patient tis designed to correct hypoxemia.
Complications of O2 Therapy
Respiratory depression/arrest
Discomfort with skin breakdown from straps and masks
Dry mucous membranes, epistaxis, or infection in the nares
O2 toxicity: prolonged high levels seen in acute lung injury or ARDS
absorptive atelectasis
CO2 narcosis: AMS, confusion, HA, somnolence
Purpose of Artificial Airway
Establish an airway
Protection of the airway with the cuff inflated
Profusion of continuous ventilatory assistance with ETT and tracheostomy
Facilitation of airway clearance
Types of artificial airways
nasopharyngeal, oropharyngeal, endotracheal tube, tracheostomy tube, tracheostomy button
Equipment needed for ETT intubation
laryngoscope with curved/straight blades/working light, suction, correct size ETT, 10 mL syringe, pulse oximetry, oxygen, BVM, sedation/paralytic meds
Complications of intubation
Laryngospasm/bronchospasm Hypoxemia/hypercapnia during intubation Laryngeal edema Trauma Fractured teeth HAI Displacement of tube in wrong spot Aspiration Tracheal stenosis/trachomalacia Dysrhythmias, HTN, hypotension
Complications of suctioning
Hypoxemia Dysrhythmias Vagal stimulation (bradycardia, hypotension) Bronchospasm Elevated ICP Atelectasis Tracheal mucosal trauma Bleeding HAI
Absolute contraindications of suctioning without artificial airway
Epiglottitis or croup: suctioning will make condition worse, may result in an artificial airway
Indications for chest tube
Hemothorax: trauma, neoplasm, pleural tears, post-surgery, excessive anticoag
Pneumothorax: Bleb rupture, lung disease
Tension pneumo: mechanical vent, penetrating wound, prolonged clamping of chest tube, lack of seal in chest tube drainage system
Bronchopleural fistula: tissue damage, tumor, aspiration of toxic chemicals, Boerhaave syndrome
Pleural effusion: neoplasms, cardiopulmonary disease, CHF, inflammatory conditions, recurrent infections
Chylothorax: trauma/surgery, malignancy, congential abnormalities
Complications of chest tube
tension pneumothorax. Only clamp chest tube when to: located source of air leak, replace the chest tube drainage unit
accidental removal: if this happens cover insertion site with petroleum gauze, then dry gauze, then occlusive tape dressing
