Lecture 22: Pulmonary Medical and Surgical Management Flashcards
possible medical management options for pulmonary dysfunction
medications
supplemental O2
monitor vitals/diagnostics
adjustments to PA
why can certain O2 delivery devices only be used in a medical setting
portable tanks have upper limit of flow rate (<12-15L/min)
if device requires >12-15L/min of flow, that device will be seen in a medical setting with centralized O2
some devices used in high acuity settings for acute support can be used at home for maintenance therapy, at different levels of supplementation
some exceptions (i.e. home vents)
general rule = higher flow devices in hospital, lower flow devices can be used anywhere
what is non-invasive ventilation
method of breathing support that delivers pressure and volume wo the use of advanced airway (ETT or trach)
NIV used at first line therapy in 4 main acute conditions
- COPD exacerbation with hypercapnia
- cardiogenic pulm edema
- pulm infiltrates for immunocompromised pts
- weaning O2 in extubated COPD pts with hypercapnia
how does NIV help with COPD exacerbation with hypercapnia
helps pull off excess CO2
how does NIV help with cardiogenic pulmonary edema
pressure on inhalation helps “push” excess fluid out of alveoli
how does NIV help with pulmonary infiltrates for immunocompromised pts
risk of infection is higher with mechanical ventilation (MV)
how does NIV help with weaning O2 in extubated COPD patients with hypercapnia
used as a transition from MV to other supplemental O2
describe heated high flow nasal cannula as a non-invasive ventilation option and how it helps
up to 60 L/min and 100% FiO2
heated humidification helps protect airways and keep secretions thin
provides some pressure on inhalation and exhalation
most beneficial pressure on exhalation (device helps keep alveoli inflated at end of exhalation)
describe continuous positive airway pressure (CPAP) as a NIV
gives pressure on inhalation only
used for obstructive breathing patterns that cause sleep apnea
not effective enough to breathe off excess CO2 but is able to keep CO2 levels from climbing
describe BiLevel Positive Airway Pressure (BIPAP) as a NIV
gives one pressure on inhalation and one pressure on exhalation (may be different pressures)
used to help rid body of excess CO2 build up
can be used for protecting the airway in an attempt to avoid mechanical ventilation
indications for lung sx
remove tumor
remove part of lobe, entire lobe, or entire lung due to disease
remove lymph nodes
remove/repair unhealthy tissue
remove fluid in chest cavity
remove device or drain
to reduce lung volume
removal of blood clot
transplant donor lungs
what is a thoracotomy
incision along borders of ribs or mm to access thoracic cavity or lungs
posterolateral = more common; exposes most space
anterolateral = used if anterior structures involved; access heart or esophagus
clamshell = lung transplant
what is a video assisted thoracic sx (VATS)
minimally invasive
doesn’t require rib separation
may have mini thoracotomy or other small incision somewhere
benefits of VATS instead of open thoracotomy
more delicate handling and precision of instruments
decreased blood loss in sx
less incisional pain
less negatively affected pulmonary functions
decreased inflammatory cytokine reaction to sx
earlier post op mobility
reduced hospital LOS
thoracotomy precautions
usually 6-8 weeks
no lifting > 5 lbs
no twisting or rotational mvmts
no strenuous activity with surgical side
ROM encouraged as tolerated below 90-90
splinted coughing