Overview of Interventions Flashcards
Therapeutic Actions (Order of Importance)
- Ventilation
- Oxygenation
- Circulation and Perfusion
- Underlying disease/problem
Ventilation
moving oxygen molecules into the alveolar spaces and carbon dioxide out of those same spaces
Oxygenation
oxygen molecule passes through the alveolar capillary membrane into the blood stream
Circulation
must occur to deliver the oxygen molecule to the tissues, through contraction of the heart and the descending pressure gradient that exists in the vascular system
Perfusion
oxygen crosses from the blood into the tissues through pressure gradients; occurs due to difference in partial pressure of oxygen between blood stream and the tissue
Optimal Breathing Pattern
- Inspire slowly and deeply
- Pause at the top of inspiration for 1-3 seconds
- Exhale slowly and passively
- Totally relax between breaths
SMI
Sustained Maximal Inspiration
Incentive Spirometry
incentive spirometer - procedure
SMI - maneuver name
done every 1-2 hours, 8-10 breaths each time
Inspiratory Capacity
VT + IRV
Incentive Spirometry - Indications
- prevent atelectasis (only in conscious pts)
- Help post-operative patients achieve pre-operative values
- Most helpful at preventing post-operative pulmonary complications
Two Types of Incentive Spirometers
- Flow-oriented
2. Volume-oriented (easier)
IPPB
assist, pressure-limited device via mask, closed system
IPPB - Indications
decreases work of breathing, helpful post-operatively for unconscious patients or patients too sedated to perform IS, CORRECT AND/OR PREVENT ATELECTASIS, IMPROVE COUGH EFFECTIVENESS, provide bronchodilation (mechanical), mobilize secretions, delivery medications, treat/prevent pulmonary edema
IPPB - Contraindications
- untreated pneumothorax
- current pulmonary hemorrhage
- active tuberculosis
IPPB - Hazards
- pneumothorax
- /\ air trapping (COPD and severe asthma)
- \/ venous return and potentially decreased C.O.
- Excessive elimination of CO2 - light headedness, dizzy
- Gastric distention
NIV characteristics
- It is done by mask (pt NOT INTUBATED)
2. may be provided W/O a rate (pt must initiate all breaths)
NIV is ideal for:
- COPD, CHF
- Assisting ventilation temporarily
- DNR and DNI patients
NIV vs Mechanical Ventilation
Although a patient may have only slightly elevated CO2 and may benefit from NIV, if the patient is unable to protect his or her own airway, intubation and mechanical ventilation is preferable.
Patients should be intubated rather than use NIV
- unable to respond appropriately to commands
- unable to produce an effective cough
- evidence of aspiration
- obtunded
- unconscious and not arousable
IPAP
inspiratory positive airway pressure, primary control used to blow off CO2; pressure support, ventilation
EPAP
expiratory positive airway presure - like PEEP or CPAP - used primarily to address oxygenation
The amount of ventilation is NOT determined by the IPAP pressure setting alone. RATHER:
it is determined by the distance between the IPAP and EPAP pressure settings
Initial NIV Settings
IPAP 10-12 cm H2O
EPAP 4-6 cm H2O
FiO2 as low as possible to maintain SpO2 of 90% or >
Increasing IPAP does what to CO2?
decrease
Increasing EPAP does what to the change in pressure?
decrease
What results from decreasing the EPAP?
lower the resulting PaO2 AND will increase the distance between the IPAP and EPAP pressures
Indications for Full Ventilatory Support
Acute ventilatory failure; impending ventilatory failure - determined by serial ABGs, shows a degration of ventilation (/\ PaCO2, \/ pH), do not wait until absolute ventilatory failure - look for a downward trend; observed cessation of breathing (APNEA)
