Managing Ventilation Flashcards
What controls and can reduce our respiratory rate?
Controlled by various groups in the brainstem
(head trauma leading to brain stem injury leads to decreased or absent respirations)
Spinal cord injuries that affect the phrenic nerves c3-c5 will also result in decreased/absent resp.
Some drugs can reduce resp. rate and tidal volumes
What reduces chest wall compliance and causes decreased ventilation?
Certain disorders can reduce movement between ribs and vertebral column. Stiffens chest wall and decrease in tidal volume.
Rib fractures is a reduction in ribcage expansion due to severe pain involved.
What reduces lung compliance and causes decreased ventilation?
The accum. of air or fluid in the pleural cavity reduces overall lung expansion and compliance (Accum of air= pneumothorax)
The accum. of fluid in the pleural cavity (pleural effusion)
pressure of effusion reduces lung expansion like a pneumothorax
Types of pleural effusion:
-watery effusion
-effusions from lung infections, pleuritis, lung cancers
-bleeding in pleural cavity
What reduces alveolar compliance and causes decreased ventilation?
Pulmonary edema
-accum. of fluid in the interstitial space between alveoli and pulmonary capillaries
-pressure of fluid makes it difficult for alveoli to expand enough to take in adequate tidal volume
-Can dilute surfactant on inside of alveoli which further reduced alveolar compliance
-pulm. edema can also collapse alveoli- atelectasis
Pulm Fibrosis:
-Causes severe reduction in alveolar compliance
How do you assess mechanical ventilation?
Inspection:
-Presentation of thoracic anatomy
-Respiratory effort:
-chest rise
-ease of breathing
-use of accessory muscles
-dyspnea
-cough
-color
Auscultation
How do you assess Neural Control?
Inspection:
-Cognitive function
-Breathing patterns
-tachypnea/bradypnea
-kussmaul
-Biot’s
-Cheyne-stokes
-Pain
How do you Assess Lung Volume?
Pulmonary function tests:
-Spirometry most common -measures amount of air breathed in and out and how quickly the air is inhaled and expelled from the lungs while breathing thru mouthpiece (generally repeated 3 times/bronchodilator will be administered sometimes)
-Diffusion tests (how well inspired air moves into the blood)
-Plethysmography: looks at total and reserve volume
-Chest X-ray: acute/chronic lung conditions such as pneumothorax, pulmonary edema, pneumonia
How do you assess oxygen saturation?
-SaO2 is the percentage of hemoglobin molecules carrying oxygen (95-100%)
-PO2 is that partial pressure of O2 or the amount of oxygen dissolved in the blood and available for binding (75-100 mm Hg)
-Small changes in SaO2 often indicate large changes in PO2
How do you assess oxygen saturation?
-SaO2 is the percentage of hemoglobin molecules carrying oxygen (95-100%)
-PO2 is that partial pressure of O2 or the amount of oxygen dissolved in the blood and available for binding (75-100 mm Hg)
(Small changes in SaO2 often indicate large changes in PO2)
-Pulse Oximetry (factors: nail polish, poor circ., very dark skin, swollen)
How do you assess CO2 Levels?
90% of CO2 in arterial blood is carried as HCO3- (bicarbonate)
Venuous blood only 60% is bicarbonate as larger portions are bound to Hemoglobin or dissolved in blood
PCO2 is the partial pressure of CO2 or amount of CO2 dissolved in blood (norma 35-45 mm Hg)
Capnography: real time info about perfusion, ventilation, metabolism
How do you assess PO2 and PCO2 levels?
Arterial blood gas analysis is the gold standard (ABG)
How do you position patient for lung expansion?
Semi-fowler’s (HOB 30 degrees)
-facilitates lung expansion and prevents secretions
from entering airway in clients w/ atelectasis or
decreased resp. functioning
-maintain HOB >30 degrees
High-fowler’s (HOB 60-90 degrees)
-facilitates lung expansion in clients with dyspnea or
difficulty maintaining oxygen sautration
-as close to 90 degrees as possible
Tripod:
-client seated/ leaning forward
-allows for max use of accessory resp. muscles
Incentive Spirometry:
Prevents atelectasis
Help reestablish normal patterns of pulmonary hyperinflation
Device provides visual reference and positive feedback for patient
How to mobilize secretions in patients?
Cough, Deep Breath, Hydration:
-Deep breath promotes ventilation and gas exchange
-Coughing helps mobilize secretions keeping airways and alvooli open for gas exchange
-Hydration helps keep secretions thin and mobile
Chest physiotherapy:
-Includes postural drainage, chest percussion and vibration
-Postural drainage: use gravity to drain lungs helps drain secretions to major airways
(check chest xray to determine affected lung area)
-positioning to facilitate postural drainage (frequent
position changes- every 2 hours)
What is important to know about oxygen therapy?
-reactive substance
-normal byproducts of oxygen metabolism includes reactive species which result in free radicals including hydrogen peroxide, nitric oxide, ozone
-excess free radicals damage cells thru oxidative stress
-cumulative oxidative stress contributes to disorders such as atherosclerosis, DM, Parkinson’s
- as we age enzymatic action that processes free radicals works less efficiently
-Non hypoxic patient’s oxygen therapy has little to know value
