RT210: Introduction to & Applied Respiratory Theraputics ( study guide ) Flashcards
SMI- Sustained maximal inhalation ( Incentive spirometry ) INDICATION
Improve atelectasis
Prevent atelectasis
Mobilize secretion
INCENTIVE SPIROMETRY CONTRAINDICATIONS
patient unable to cooperate
patient unable to follow instruction
patient unconscious
patient unable to take deep breath
INCENTIVE SPIROMETRY HAZARDS
ineffective unless preformed correctly
hyperventilation
barotrauma
discomfort secondary to pain
fatigue
INCENTIVE SPIROMETRY PROCEDURE
slow deep inspiration
inspiratory hold
relaxed exhalation
volume of gas move should be IC
coaching
frequency
INCENTIVE SPIROMETRY PATIENT EVALUATION
patient must be ALERT
COOPERATIVE
Physically able to increase IC greater than Vt
Should be 3 times predicted Vt
IPPB- PRIMARY INDICATIONS
If patient has inadequate VC to facilitate a cough
VC less than 3 times predicted VT
VC less than 15ml/kg of ideal body weight
IPPB-SECONDARY INDICATIONS
Deliver medication
improve I:E ratio
improve cough and mobilize secretions
alter V/Q
improve or prevent atelectasis
decrease CO2 temporarily
CONTRAINDICATIONS OF IPPB
untreated closed pneumothorax
( below are considerations )
hemodynamic instability
TB, can increase air trapping
Widespread blebs or bulla
may cause or worsen hemoptysis
may cause pneumothorax
tachypnea
decreased cardiac output
IPPB HAZARDS
barotrauma, increase ICP
nosocomial infection
hypocarbia, hyperventilation
tachypnea, decrease CO
gastric distention, Cause or worsen hemoptysis
impedance of venous return
air trapping, O2 induced hypoventilation
IPPB PHYSIOLOGIC EFFECTS
increase intrapulmonary pressure
decrease venous return, decrease CO
mechanical bronchodilation, alter I:E ratio
alter V/Q, mobilization of secretion
increase PaO2 and decrease PaCO2
decrease WOB
CLASSIFICATION OF BIRD MARK 7
positive pressure ventilator, pneumatically powered, pneumatically driven, single circuited
CLASSIFICATION BIRD MARK 7
Modes ( assist, assist control, control ) pressure cycled, flow limited, flow pattern, pressure pattern
CLASSIFICATION BIRD MARK 7
internal resistance, principle of operation
SPECIFICATION; flow is variable and adjustable, venturi/venturi gate, air mix controller, nebulizer, pressure, sensitivity, expiratory timer, circuit
HUMIDITY
water in a gaseous state, water vapor, molecular water in gas, potential humidity, saturated, Absolute Humidity, Relative Humidity
HUMIDIFICATION INDICATIONS ( primary )
humidifying dry medical gases
overcoming humidity deficit created when the upper airway is bypassed
HUMIDIFICATION INDICATIONS ( secondary )
treating bronchospasm caused by cold air, thick copious or bloody secretions, with expired tidal volume less than 70% of the delivered tidal volume, receiving in-line drugs etc….
HAZARDS AND COMPLICATIONS OF HUMIDIFICATIONS
potential electrical shock, potential for burns to caregivers, underhydration and mucous impaction
SIGNS AND SYMPTOMS OF INADEQUATE HUMIDIFICATION
atelectasis, dry nonproductive cough, increase airway resistance, increased work of breathing, patient complaint of substernal pain and airway dryness, thick dehydrated secretions
PRINCIPLES GOVERNING HUMIDIFIER FUNCTIONS
Temperature, surface area, contact time, thermal mass
BLAND AEROSOL THERAPY INDICATIONS
treat upper airway edema, overcome heat and humidity deficits in patients with tracheal airways, help obtain sputum specimens
AEROSOL
water particles suspended in air, particulate water in a gas, mist, fog
AEROSOL HAZARDS
adverse effect of aerosol drug therapy, infection, airway reactivity, Systemic effects of bland aerosols, Drug concentration changes during nebulization
FACTORS AFFECTING AEROSOL
Deposition
Inertia
Gravity
Diffusion
POSTURAL DRAINAGE INDICATIONS
mobilize accumulate secretions due to ( COPD, Dehydration, Acute pulmonary disease )
Prophylactically( history of pulmonary problems )
POSTURAL DRAINAGE CONTRAINDICATION
empysema, flail chest, wounds, spinal injuries, pneumothorax, head injuries, unstable cardiac status, COPD, obesity, pregnancy, recent meals or tube feeding, PE
HAZARDS CPT
hypoxemia, increase ICP, acute hypotension, pulmonary hemorrage, pain or injury to muscle, vomiting and aspiration, dysrhythmias
Right Upper Lobe
apical
anterior
posterior
Right Middle Lobe
medial
lateral
Right Lower Lobe
superior
anterior basal
lateral basal
posterior basal
Left Upper Lobe
anterior
apical - posterior
superior lingula
inferior lingula
Left Lower Lobe
superior
anterior medial
lateral basal
posterior basal
PERCUSSION INDICATIONS
When difficult to mobilize secretions, when postural drainage alone may not be effective
PERCUSSION CONTRAINDICATIONS
empysema, flail chest, wounds, frank hemoptysis, anticoagulant therapy, pain or patient intolerance, TB, metastasized cancer
VIBRATIONS(used with percussion or alone) INDICATIONS
after each segment with percussion to move secretions in large airways, alone when percussion is not tolerated
INDICATIONS FOR OXYGEN THERAPY
treat hypoxemia, decrease the work of breathing, decrease myocardial work
HAZARDS OF OXYGEN THERAPY
oxygen toxicity, absorption atelectasis, oxygen induced hypoventilation, Retrolental Fibroplasia-RLF-ROP-retinopathy of prematurity
INDICATIONS FOR LOW FLOW DEVICES
Patients Vt 300-700ml, Respiratory rate lower than 25 BPM, Consistent regular ventilator patterns
FACTORS INFLUENCING FIO2
patients venilatory pattern, flow of gas, reservoir
FIO2 IS
unpredictable
immeasurable
may vary from minute to minute
LOW FLOW DEVICES
nasal cannula, nasal catheter, simple O2 mask, partial rebreather mask, non rebreather mask
HIGH FLOW SYSTEMS
meets all patients demands for gas delivered, total system output must be at least 3 times patients minute volume, consistent predictable measurable FIO2
USE OF ANALYZERS
to analyze high flow systems, patients may not receive FIO2 analyzed if flow is not adequate, used in measuring mechanical ventilation
CALIBRATION
Greater than 60% - Calibrate last to 100%
Less than 60% - Calibrate last to 21%
Should be calibrated once per shift
CALIBRATION Possible sources of error:
Weak batteries
Torn, wet, or leaky membranes
Positive pressure (PEEP or IPPB)
Altitude
Avogadro’s Law
1 gram of any substance has 6.02 x 1023 known as a mole
1 mole of a gas at STP = 22.4 Liters
PRESSURE
PB = Barometric Pressure
760 mmhg
14.7 PSI
1034 cmH2O
Water vapor (or humidity) exerts pressure
PH2O at 100% humidity at body temperature = 47 mmhg
Dalton’s Law
Individual partial pressures = Total
Pb = PN2 + PO2 + P trace gases
Concentrations of Gases in the Air
Oxygen 20.95%
Nitrogen 78.08%
Argon 0.93%
Carbon Dioxide 0.03%
Trace Gases 0.01%
Ideal Gas Law
If mass is constant then
P1V1 = P2 V2
T1 T2
Boyle’s Law
If temperature and mass are constant, volume and pressure are inversely proportional.
P1V1 = P2 V2
Charles’ Law
If pressure and mass are constant, temperature and volume are directly proportional.
V1 = V2
T1 T2
Gay-Lussac’s Law
If volume and mass remain constant, pressure and temperature are directly proportional.
P1 = P2
T1 T2
Tank duration
Tank Pressure x tank Factor/Liter Flow= min
Tank Factors:
E Cylinder = 0.28
G Cylinder = 2.41
H Cylinder = 3.14
EX: E cylinder has 2200 PSI and your pt. is on 5L NC. How long will this cylinder last.
Always round down
To determine hour divide min/60
Cylinder testing
every 5- 10 years
water displacement measured to check for expansion with 5/3 maximum pressure
Henry and Graham Law
Henry Law
(0.003 x PaO2)
Graham Law
(1.34 x Hgb x SaO2)
Total O2 Content
CaO2 = (0.003xPaO2) + ( 1.34 x Hgb x SaO2)
Oxygen Carried Two Ways
Dissolved
Combined with hemoglobin
Hypoxemia
Deficiency of oxygen in the arterial blood.
Causes of Hypoxemia:
Decreased alveolar oxygen tension:
Alveolar air equation, Intrapulmonary shunting
Responses to Hypoxemia
Increased ventilation
Increased cardiac output
Hypoxia
Decreased oxygen to the tissues.
Hypoxia TYPES
Hypoxemic Hypoxia or Ambient Hypoxia
Anemic Hypoxia or Hemic
Stagnant Hypoxia or Circulatory Hypoxia
Histotoxic Hypoxia
CO2 IS TRANSPORTED IN THE BLOOD BY
dissolved gas, (2) bicarbonate, and (3) carbaminohemoglobin bound to hemoglobin
Ventilation
air movement in and out of the lungs to allow external respiration to occur.
Respiration
gas exchange across a permeable cellular membrane
External respiration
gas exchange between alveolar gas (AIR) and capillaries (BLOOD)
Internal respiration
gas exchange between capillaries and the tissues.
Normal Ventilation Pressures
Inspiration
Intrapleural= (-9 cmH2O)
Intrapulmonary= (-3 cmH2O)
Expiration-
Intrapleural= (-5cmH2O)
Intrapulmonary= (+3 cmH2O)
