Respiratory Flashcards
What is the timed cycle ventilator
Pushes air into the lungs until a preset time has elapsed
Peds or neonate unit
What is the volume cycled ventilator
Pushes air into the lungs until a preset volume is delivered
Constant tidal volume is delivered regardless of the changing compliance of the lungs and chest wall or airway resistance in the client or ventilator
What is the microprocessor ventilator
Computer or microprocessor is built into the ventilator to allow continuous monitoring of ventilatory functions alarms and client parameters
Type of ventilator is more responsive to clients who have severe lung disease or require prolonged weaning
Noninvasive positive pressure ventilation or bilevel positive airway pressure (bipap) - what is it and in what situations
Support given without using invasive airway (trach)
Orofacial masks and nasal masks are used
Situations of COPD distress, heart failure, asthma, pulmonary edema, hypercapnic respiratory failure
Controlled ventilation what is it
Receives a set tidal volume at a set rate
Clients- who cannot initiate respiratory effort
Least used - client initiates a breath the ventilator locks out the clients inspiratory effort
Assist control ventilation what is it
Most common
Tidal volume and ventilatory rate are preset
Takes over the work of breathing for the client
Programmed to respond to the clients inspiratory effort if they do initiate a breath
What happens when a client initiates a breath on assist control
Ventilator delivers the preset tidal volume while allowing the client to control their rate of breathing
However if the clients spontaneous ventilatory rate increases - wants to deliver a preset tidal volume with each breath - may cause hyperventilation and respiratory alkalosis
What is synchronized intermittent mandatory ventilation
Similar to assist control
Tidal volume and ventilator rate are preset
Can breath spontaneously at own rate and tidal volume between the ventilator breaths
Can be used on primary mode or weaning
Complications of mechanical ventilation
Hypotension caused by the application of positive pressure which increases intrathoracic pressure and inhibits blood return to the heart
Respiratory complication - pneumothorax or emphysema as a result of the positive pressure
GI alterations such as stress ulcers
Malnutrition if nutrition is not maintained
Infectious
Muscular deconditioning
Ventilator dependence or inability to wean
What are the three ways to wean off of mechanical ventilation
SIMV
T PIECE
PRESSURE SUPPORT
How to wean with SIMV
client breaths between the preset breaths per minute rate of the ventilator
The SIMV rate is decreased gradually until the client is breathing on his or her own without the use of the ventilator
How to wean with the t piece
Client is taken off of the ventilator and the ventilator is replaced with a t piece of continuous positive airway pressure - which delivers humidified oxygen
Client is taken off of the ventilator for short periods initially and is allowed to breathe spontaneously
Need to tolerate longer periods off of the ventilator
How to wean with positive pressure
Pressure support is predetermined pressure set on the ventilator to assist the client in respiratory effort
As weaning continues the amt of pressure is decreased gradually
Pressure may be maintained while the preset breaths per minute of the ventilator gradually are decreased
Define tidal volume
The volume of air that the client receives with each breath
Define rate
The number of ventilator breaths delivered per minute
Define fraction of inspired oxygen
The oxygen concentration delivered to the client
Determined by the clients condition and ABG levels
Define peak airway inspiratory pressure
The pressure needed by the ventilator to deliver a set tidal volume at a given compliance
Monitoring peak airway inspiratory pressure reflects changes in compliance of the lungs and resistance in the ventilator or client
What is continuous positive airway pressure Pi
Positive airway pressure through the entire respiratory cycle for spontaneously breathing clients
Keeps alveoli open - prevents alveolar collapse
No ventilator breaths are delivered but the ventilator delivers oxygen and provides monitoring alarm system - pattern is determined by the clients efforts
What is PEEP
Exerted during the expiratory phase of ventilation which improves oxygenation by enhancing gas exchange and preventing atelectasis
Means that there is severe gas exchange disturbance in the client to need Peep
Higher levels of PEEP increase the chances of complications such as barotrauma and tension pneumothorax
What is pressure support option on the machine
Application of positive pressure on inspiration that eases the workload of breathing
May be used in combo with PEEP to wean for breathing
As the weaning process continues the amt of pressure applied to inspiration is gradually decreased
What is acute respiratory distress syndrome
As a complication of some other condition
Diffuse lung injury and leads to extra vascular lung fluid
In ARDS where is the major site of injury
Alveolar capillary membrane
What does the interstitial edema cause in ARDS
Compression and obliteration of terminal airways and leads to reduced lung volume and compliance
InARDS what do the ABGs say
Identify respiratory acidosis and hypoxemia that do not respond to increased oxygen
What does the CXR show in ARDS
Bilateral interstitial and alveolar infiltrates
Interstitial Edema may not be noted until 30% increase in fluid content
Assessment of ARDS
Tachypena Dyspnea Decreased breath sounds Deteriorating ABG levels Hypoxemia despite high concentrations of delivered oxygen Decrease pulmonary compliance Pulmonary infiltrates
Assessment of tonsillitis
Persistent or recurrent sore throat
Enlarged bright red tonsils that may be covered with white exudate
Difficulty in swallowing
Mouth breathing and an unpleasant mouth odour
Fever
Cough
Enlarged adenoids may cause nasal quality of speech mouth breathing hearing difficulty snoring or obstructive sleep apnea
Things to check preop before a tonsillectomy
Assess bleeding and clotting studies because the throat is vascular
Assess for loose teeth as aspiration might be likely
Prepare for sore throat post op and they will need to drink liquids
Post op instructions for tonsillectomy
Position child prone or side lying to promote drainage
Only suction if there is a airway obstruction
Monitor for signs of bleeding - frequent sign is swallowing - turn to side
Provide an ice collar
Avoid red purple or brown foods incase the child vomits as it appears as blood
What foods should PTS avoid post op tonsillectomy
Milk ice cream and pudding as they coat the throat and encourage the client to cough which will increase bleeding
Soft food will be prescribed 1 to 2 days post op
Normal signs post op from a tonsillectomy
Mouth odour
Slight ear pain
Low grade fever
Notify the physician - tonsillectomy
Bleeding
Persistent earache
Fever occurs
May take 1-2 weeks of recovery
What is the pressured cycled ventilator
Ventilator pushes air into the lungs until a specific airway pressure is reached
Used for short periods -PACU
