Pulmonary Management Flashcards
Simple Mask
used for short-term O2 therapy
contraindicated for those w/ CO2 retention
Difficult to talk/eat w/ mask in place
Low Flow: 6-10L/min = 35-60%
Need a MINIMUM OF 5L FLOW to flush out the CO2
CAN NOT wean to lower than 5L
Partial Rebreather Mask
contains reservoir bag allowing pt to rebreathe some of own exhaled air mixed w/ 100% O2
Low Flow: 6-10L/min = 40-70%
Non-rebreather Mask
Provides highest concentration of O2 with a mask to a spontaneously breathing patient. HAS TWO ONE-WAY VALVES preventing rebreathing of exhaled air.
Low Flow: 6-15L/min = 60-80%
Venturi Mask
delivers the most precise concentrations of O2 via a large tube w/ an O2 inlet
High flow: 4-10L/min = 24-55%
Ideal for patients with mod hypercarbia, hypoxemia, COPDr’s. No need to humidify
Air Entrainment Mask
high humidity mask or face tent provides excellent humidification and oxygen from 28-100%, if kept in place
Optiflow
Hi flow device
special N/C prongs
delivers 5-60L/min of O2 21-80% O2
Pharngeal Airways
stop tongue from obstructing upper airway
- oropharyngeal airway
- nasopharyngeal airway (nasal trumpet)
Oropharyngeal airway
creates an air passage way between the mouth and the posterior pharyngeal wall
useful when the tongue and/or epiglottis fall back against posterior pharynx in anesthetized or unconscious patients obstructing the flow of air
insert the oral airway upside down until the soft palate is reached. Rotate the device 180 degrees and slip it over the tongue.
Nasopharyngeal Airway
tube inserted through a nostril, across the floor of the nose and through the nasopharynx so that the tongue doesn’t block air flow in an unconscious person.
Purpose of the flared end is to prevent the device from becoming lost inside the patient’s head
Lubricate on insertion; used for suctioning; never leave in place can lead to sinusitis
Volume controlled ventilation
pre-set tidal volume (approx 10ml/kg); VT is constant for every breath delivered
assist controlled (AC) Synchronized intermittent mandatory ventilation (SIMV)
Pressure controlled ventilation
preset inspiratory and expiratory pressures
inspiratory pressures are constant for each breath
CPAP, pressure support, pressure control
continuous mandatory ventilation
CMV or AC (assist control)
we set vent to deliver a preset amount of tidal volume for each breath
pre-set: FIO2/VT/RR/PEEP
patient may over breathe, but they will get the preset VT
Intermittent mandatory ventilation
IMV or SIMV
preset VT and RR on vent; pt may take own breaths at their own VT
PS is added to this to support the breaths the patient takes on their own
Pressure Support
preset pressure to assist with patient’s inspiratory
- inspiratory pressure is added to spontaneous breaths to overcome the resistance of the endotracheal tube or to increase the volume of spontaneous breaths (overcomes the “dead space” of the ventilator)
Pt takes own RR/VT
typically weaning mode
pressure controlled ventilation
delivers preset pressure during a preset inspiratory time at a preset respiratory rate
used in stiff noncompliant lungs
High frequency oscillatory ventilation
does not require breaths therefore prevention “stretch injury” delivers a small volume of gas at a rapid rate
high frequency ventilation
delivers small volume of gas at a rapid rate
high frequency positive pressure ventilation (HFPPV) delivers 60-100 breaths/min
high frequency jet ventilation (HFJV) delivers 100-600 cycles/min
high frequency oscillatory ventilation (HFO) delivers 900-3000 cycles/min
volumetric diffuse respirator (VDR)
intrapulmonary percussive ventilation IPV with sub tidal volume deliveries
frequency of 50-900 cycles/min
PIP-Peak Inspiratory Pressure
highest level of pressure applied to the lungs during inhalation
positive end-expiratory pressure (PEEP)
positive pressure is applied to the airway during exhalation
3-20cm H2O (usual setting)
normally with exhalation airway pressure drops to 0, with PEEP the pressure drops to the PEEP set level
Volume alarms
patient doesn’t receive preset VT
- inadequate spontaneous VT
- disconnection of circuit from ETT or other break in the circuit
- leak in cuff of ETT
- tube out of position
Pressure Alarms
high pressure alarm will sound if preset pressure limit is exceeded
- secretions and mucus plugs
- kinks in ETT tube or tubing; pt isn’t laying on tube
- talking
- dysynchrony
- barotrauma - stiff lungs
signs of distress
rapid shallow breathing, use of accessory muscles, restlessness, tachycardia, PVCs, increased/decreased BP, change in LOC, decreased PO2, increased PCO2
