Respiratory - Ch 21 Flashcards
Hypoxemic hypoxia
Decreased O2 level in blood due to decreased oxygen perfusion
Hypoxemic hypoxia
Causes
Hypoventilation, high altitude, ventilation-perfusion mismatch, atelactasis
Hypoxemic hypoxia
Treatment
Increase alveolar ventilation by providing supplemental oxygen
Circulatory hypoxia
Results from inadequate capillary circulation
Circulatory hypoxia
Causes
Decreased CO, local vascular obstruction, low-flow states (shock, cardiac arrest)
Anemic hypoxia
Result of decreased effective hgb concentration —> decrease in oxygen-carrying capacity of blood
Anemic hypoxia
Causes
Carbon monoxide poisoning
Histotoxic hypoxia
Occurs when toxic substance (cyanide) interferes w/ability of tissues to use available O2 —> reduction in ATP production
Oxygen toxicity
Cause
Too high concentration of O2 (50% or higher) for extended period of time
Oxygen toxicity
S/S
Substernal discomfort, paresthesias, dyspnea, restlessness, fatigue, malaise, progressive respiratory difficulty, refractory hypoxemia, alveolar atelactasis, alveolar infiltrates on XR
Nasal cannula
Flow rates
1-6 L/min
Nasal cannula
O2 % settings
24-44%
Nasal catheter
Flow rate
1-6 L/min
Nasal catheter
O2 % setting
24-44
Mask, simple
Flow rate
5-8 L/min
Mask, simple
O2 % setting
40-60
Mask, partial rebreathing
Flow rate
8-11
Mask, partial rebreathing
O2 % setting
50-75%
Mask, non-rebreathing
Flow rate
10-15
Mask, non-rebreathing
O2 % settings
80-95
Mask, Venturi
Flow rate
4-8
Mask, Venturi
O2 % setting
24, 26, 28, 30, 35, 40
Tracheal catheter
Flow rate
1/4-4
Tracheal catheter
O2 % setting
60-100
How to use IS
- Semi-Fowler’s position
- Diaphragmatic breathing
- Place mouthpiece firmly in mouth, breathing in slowly through mouth, hold breath for 3 sec, exhale slowly through mouthpiece
- Cough during & after each session, splint incision if coughing postop
- Perform procedure 10x/hr while awake
Mini-nebulizer therapy
Indication
Difficulty clearing secretions, reduced vital capacity, unsuccessful with simpler methods
Postural drainage position
Anterior lower lobes, basal segments
Right side lying w/2 pillows under hip
Postural drainage position
Anterior upper lobes
On back w/2 pillows under butt
Postural drainage position
Anterior lower lobes w/lateral basal segments
L side lying on 2 pillows under hip
Postural drainage position
Anterior upper lobes, apical segments
Semi-Fowler’s w/pillows behind back
Postural drainage position
Posterior lower lobes, superior segments
Prone w/2 pillows under hips
Postural drainage position
Posterior upper lobes, posterior segments
Sitting up, leaning slightly forward, holding pillow against stomach
HFCWO
High-frequency chest wall oscillation
Type of percussion/vibration to break up secretions
ET intubation
Nursing interventions
- Check symmetry of chest expansion, auscultate breath sounds
- Obtain capnography & end-tital CO2
- CXR to ensure proper tube placement
- Check cuff Q6-8 hrs
- Monitor for S/S of aspiration
- Ensure high-humidity (visible mist should appear in T piece)
- Admin O2 as RX’d
- Oral hygiene & oropharynx suction
Indications for mechanical ventilation
Labs: PaO2 <55, PaCO2 >50, pH <7.32, vital capacity <10, negative inspiratory force <25, FEV1 <10
S/S: apnea/bradypnea, respiratory distress w/confusion, increased work of breathing not relieved by other interventions, circulatory shock, controlled hyperventilation (patient w/TBI)
Positive-pressure ventilators
Inflate lungs by exerting positive pressure on airway, pushing air in, and forcing alveoli to expand during inspiration
Volume-cycled ventilators, pressure-cycled ventilators, high-frequency oscillatory ventilators, noninvasive positive-pressure ventilation
Volume-cycled ventilator
Deliver a preset vol of air w/each inspiration
Pressure-cycled ventilator
Delivers a flow of air (inspiration) until it reaches a preset pressure and then cycles off, expiration occurs
High-frequency oscillatory support ventilators
Deliver very high respiratory rates (180-900 breaths/min) that are accompanied by low tidal volumes & high airway pressures
Used to open alveoli in situations with closed airways —> atelectasis & ARDS
Non-invasive positive-pressure ventilation
Given via facial mask/cannula/oral airway device
For patients that can breathe on their own but need a little help, provides backup care for pts with periods of apnea
CPAP, BiPAP, PEEP
Interventions to prevent VAP
- Elevation of bed 30-45
- Daily “sedation vacations” and assessment of readiness to extubate
- Peptic ulcer disease prophylaxis
- DVT prophylaxis
- Daily oral care with chlorhexidine (0.12% oral rinses)
Controlled mechanical ventilation (CMV)
Provides full ventilatory support by delivering preset tidal vol and respiratory rate
Intermittent mechanical ventilation (IMV)
Combination of mechanically assisted breaths and spontaneous breaths
Synchronized intermittent mandatory vent (SIMV)
Delivers a preset tidal vol and # of breaths per min. B/t ventilator-delivered breaths, patient can breathe spontaneously w/no assistance from vent on those extra breaths
Gas exchange
Nursing interventions
- Use of analgesics to relieve pain w/o suppressing respiratory drive
- Frequent repositioning
- Monitor fluid balance: peripheral edema, I&O, daily weight
- Admin meds to control primary disease
Effective airway clearance
Nursing interventions
- Assess lung sounds Q2-4 hrs
- Measures to clear airway: suction, CPT, positioning, promote increased mobility
- Humidification of airway
- Admin meds
Trauma & infection
Nursing interventions
- Infection control measures
- Tube care
- Cuff management
- Oral care
- Elevation of head of bed
Potential complications for mechanical vent
- Alterations in cardiac function
- Barotrauma, pneumothorax
- Pulmonary infection
- Delirium
Weaning criteria
- Vital capacity 10-15
- Maximum inspiratory pressure (MIP) at least -20
- Tidal volume 7-9
- Minute ventilation 6L/min
- Rapid/shallow breathing index: below 100 breaths/min, PaO2 >60, FiO2 <40%
Criteria to terminate weaning process
- HR increase of 20 bpm, systolic BP increase of 20
- Decrease in SpO2 <90%, RR <8 or >20
- Ventricular dysrhythmias
- Fatigue, panic, cyanosis, erratic/labored breathing, paradoxical chest movement
How often should nurse monitor chest tube drainage? What should be documented?
-Q2hrs, document amt & character
When to notify HCP of chest tube drainage
> 150 mL/hr
