Mod 9 suction Flashcards
When not to use NPPV?
- Apnea
- Pt. can’t get it on
- others lol
What are predictors of NIPPV success in the acute setting?
improvement can be seen within 30-120 mins
- improved RR and HR
- just guidelines.
Criteria for terminating NPPV
Worsening pH and CO2
-RR > 30bpm
-hemodynamics instability
-inabiltiy to clear secretions
-decreased LOC
Are big (A-a) gradients good or bad?
Bad, you wan’t them low.
Reflect the offloading of O2 to tissues.
NPPV modes
CPAP
NPPV
EPAP
IPAP
Does PEEP or CPAP increased FRC?
Yes, both do.
what increases FRC? How does do they increase FRC?
PEEP and CPAP (they both do the same thing)
it opens up the alveoli increasing the bed for gas exchange.
It can be over distended though if too much pressure is going (think babies)
what are the benefits and primary function of: EPAP
Increases FRC
-recruits alveoli (improve v/q)
-reverses atelectasis
-improves compliance
reducing intrinsic PEEP
-Causes mech. bronchodilation, decreasing airway resistance
What is intrinsic PEEP?
intrinsic PEEP is air trapping?
IPAP function
Pressure supports patients own spontaneous breath.
- decrease WOB
-used as a CSV (pressure support device)
What is the critical component of NIVM?
Pt compliance.
What does pinky frothy sputum indicate?
heart failure or a pulmonary edema
W/pneumonia which mask would you use?
A nasal mask so they can continue to clear secretions.
-if possible; try to avoid a full face mask so they don’t need to remove it to clear secretions
Normal airway clearance is defined by the which traits?
-An effective cough
-a functional mucociliary escalator
Airway mucus is the secretory product of which glands/cells?
Goblet cells
Submucosal glands
Clara cells
What makes up mucus?
mucin + water
What is mucus?
A superficial “gel” or mucous layer compromised of 95% water and 5% mucin (glycoproteins)
What are 3 types of secretions found in the respiratory tract?
-Mucus
-Surfactant
-Periciliary fluid
What is the function of mucus?
Protect airways by trapping foreign bodies
Surfactant function
A thin layer of fluid that lubricates and reduces surface tension (prevents alveolar collapse)
Periciliary fluid function
Covers and keeps the cilia from sticking together and helps them return to form/position.
-cilia help move mucus/foreign bodies out so it helps keep everything moving
What is the “sol” layer between the mucous layer and epithelium?
Periciliary fluid
What is the mucous blanket made up of?
A Gel layer and a Sol layer
Why are the elements of the mucous blanket important
They work together to not only protect airways, but to transport fluids (mucus layer) from the sol layer.
Where are the Gel layer and Sol layer located within the realm of the respiratory tract?
Gel layer = present @ luminal surface
Sol layer = makes contact w/cilia
Function of mucus
Protect resp. tract including;
-humidification & warming of insp. gas
-mucociliary transport of debris
-waterproofing
-insulation
-antibacterial activity
How is mucus transported from the lower resp. tract into the pharynx?
Airflow and mucociliary clearance
why is clearance of mucus important?
If not cleared, the risk of infection increases
What is the main characteristic of a partial airway obstruction caused by retention of secretions?
over-distention and ventilation/perfusion imblanaces
Explanation:
Restricts airflow; increasing WOB and air trapping.
What is the main characteristic of a full airway obstruction caused by retention of secretions?
Mucus plugging, leading to to atelectasis and impaired oxygenation due to shunting
Retention of secretions if pathogens are present lead to what?
Infection.
-could be derived from failed cough reflex.
What are problems/symptoms that are derived from retained secretions?
What can they cause as a result?
Increased airway resistance and WOB
Leads to:
-Atelectasis
-hypoxemia
-infection
Left off at slide 20
