Week 5 Respiratory Care Flashcards
Respiratory has two main functions
Brings oxygen into the lungs -inspiration
CO2 goes out- exhalation
Breathe through mouth and nose- nose preferred
Oro
Mouth
Phreno-
Diagram
Pleuro-, Pulmono
Lung
Pneumo, Pheumono-
Air or Lung
Air filled spaces in the skull
Sinuses
Structure that warms and moistens and filters air as it enters the respiratory tract
Nose
Has olfactory receptors for smell
Roof of the mouth, portion between the oral and nasal cavities two parts
palate
Hard Palate
Bony anterior front portion of roof of mouth 3/4ths
Soft Palate
Muscular posterior back of palate last 1/4th portion of your mouth
Oval Lymphatic tissue on each side of the pharynx that filter air to protect the body from bacterial invasion also called palatine tonsils
Tonsils
Adenoid
Lymphatic tissue on each side of the pharynx behind the nose, also called the pharyngeal tonsil
Small projection hanging from the back middle edge of the soft palate, name for grape like shape
Uvula
Pharynx
Throat
Passage for food to the esophagus and for air to the larynx
Nasopharynx
Part of the pharynx directly behind the nasal passage
Oropharynx
Central portion of the pharynx between the roof of the mouth and the upper edge of the epiglottis
Lower portion of the pharynx, just below the oropharyngeal opening in to the larynx and esophagus
Laryngopharynx
Voice box, passage for air moving from the pharynx to the trachea, contains vocal cords
Larynx
Glottis
Opening between the vocal cords in the larynx
Lid like structure that covers the larynx during swallowing to prevent food from entering the airway
Epiglottis
Windpipe, passage for air from the pharynx to the area of the carina, where it splits into the R and L bronchi
Trachea
Anatomical Dead Space
Portion of inspired air that does not take part of gas exchange
Nose to terminal bronchiole
Value 150 ml
Advantage of anatomical dead space- Conditioning of inspired air- warming, humidification, and filtration
Tidal Volume
Amount of air that moves in and out of lung with each cycle
500ml Males
400ml Females
Physiological Dead Space
Equal anatomic dead space plus alveolar dead space is volume of air in respiratory zone that does not take place for gas exchange
Resp. Zone= resp. bronchioles, alveolar duct, alveolar sac, and alveoli
Alveolar dead space is negligible, physological=anatomical
Branched airways that lead from the trachea to the microscopic air sacs called alveoli
Bronchial Tree
Increase in physiological dead space is in
Disease state where diffusion of membrane of alveoli does not function
Right and Left Bronchus
Two primary airways branching from the area of the Corina into the lungs
Bronchioles
Progressively smaller tubular branches of the airway
Thin walled, microscopic air sacs that exchange gases
Alveoli
Alveoli are like …
Leaves of a tree upside down
Two spongy organs in the thoracic cavity enclosed by the diaphragm and rib cage, responsible for respiration
Lungs
Lobes
Subdivisions of the lung, two on the left and three on the right
Membrane enclosing the lung (visceral pleura) and lining the thoracic cavity (parietal pleura)
Pleura
Pleura Cavity
Potential Space between the visceral and parietal layers
Muscular portion that separates the thoracic cavity and the abdominal cavity which moves upward and downward to aid in respiration
Diaphragm
Mediastinum
Partition that separates the thorax into to compartments containing the right and left lung. Encloses the heart, esophagus, trachea, and thymus gland.
Thin sheets of tissue that line the respiratory passages and secrete mucous, a viscid fluid that affects artificial airways
Mucous Membranes
Cilia
Hair like processes from the surface of the epithelial cells, such as those of the bronchi, to move the mucous cell secretions upward( affected by artificial airways)
Parenchyma
Functional Tissues of any organ such as tissues of the bronchioles, alveoli, ducts, and sacs, that perform respirations
Pooping sounds heard on auscultation of the lung when air enters diseased airways and alveoli
Crackles/ Rales
Wheezes/ Rhonchi
High pitched musical sound heard on auscultation of the lungs as air flows through narrowed airways
Stridor
High pitched sound that occurs with an obstruction or swelling in the upper airway
Gradual increase in depth and sometimes rate to max level followed by a decrease resulting in apnea
Cheyne Stokes Pattern
Normal Breathing
Eupnea
Slow Breathing
Bradypnea
Tachypnea
Fast Breathing
Shallow Breathing
Hypopnea
Deep Breathing
Hyperpnea
Dyspnea
Difficult Breathing
Apnea
Inability to breath
Orthopnea
Ability to breathe only in upright position
Respiratory Assessment
Inspection
-Chest Shape
Flail- Due to trauma
-Funnel or Barrel chested
Respiratory rate and pattern
Skin Color- mucous membranes and nail beds
Patient Position
-Tripoding, orthopnea, dyspnea with exertion
Signs of Respiratory Distress
- Accessory muscle use
-Retractions
-Supraclavicular, sternal
-Nasal Flaring
Ability to Speak
- Full Sentences, short phrases, single words
Fremitus
Assessment- Examiner feels changes in intensity of fremitus by palpating the chest wall
Vibration of the chest wall
- sound transmitting through the lung tissue
Causes decreased Fremitus - Excess Air in the lung
- Increased thickness of chest wall
Causes of Increased Fremitus
-Lung consolidation
Air in healthy lung replaced with something else
Diaphragmatic Excursion
Movement of the thoracic diaphragm during breathing. Measures contraction of the diaphragm.
Normal is is 3-5cm but can be 7-8 cm in well conditioned people
less than 3-5 cm patient may have pneumonia or pneumothorax in which need a chest xray for either
Auscultation
Lung Sounds
Right Lung
Upper lobe
Middle lobe
Lower lobe
Left Lung
Upper lobe
Lower Lobe
Non Invasive way of estimating oxygen in the blood
Pulse Oximetry
Radiology
Department that studies/ performs radiographic tests
Chest Xray
Film of entire chest
PA- Back to front
AP- Front to back
Lateral toward the side
Cyanosis
Bluish coloration of skin caused by deficient amount of oxygen
Hoariness
Dysphonia
Nosebleed
Epistaxis
Thin watery discharge from the nose
Rhinorrhea
Expectorant
Sputum- Material expelled from the lungs by coughing
Hemoptysis- Coughing up or spitting out blood that originates from the lungs
Excessive Level of CO2
Hypercapnia
Deficient level of CO2
Hypocapnia
Either of these will disrupt the pH of the blood either causing what?
Acidosis or Alkalosis
Both are driven by excessive or severely decreased breathing
Excessive Movement of air into and out of the lungs causing hypocapnia
Hyperventilation
Deficient amount of oxygen in the blood
Hypoxemia
Deficient movement of air into and out of the lungs
Hypoventilation
Deficient amount of oxygen in the tissue cells
Causes Anaerobic Cellular Metabolism
Causes lactic acid production= death
Build up in the muscles and you feel the burn
Condition blocking flow of air moving out of the lungs
Obstructive Lung disorder - COPDP
Pulmonary Fibrosis
Restrictive Lung disorder conditioning restricting the intake of air into the lungs
Reactive Airway
Asthma
Reversible narrowing of the airways in response to a stimulus
Fluid filling the spaces around the alveoli and eventually flooding the alveoli
Pulmonary Edema
Pulmonary Infiltrate
Density on an x-ray image representing the consolidation of matter within the air spaces of the lungs, usually resulting from inflammatory
RAD
Reactive airways disease - Asthma
Caused by spasm of the bronchial tubes or by swelling of the mucous membrane
Collapse of the lung tissue at the alveolar level
Atelectasis
Abnormal dilation of the bronchi with accumulation of mucous
Bronchiectasis
Inflammation of the bronchi
Bronchitis
Lung cancer originating in the bronchi
Bronchogenic Carcinoma
Constriction of the bronchi caused by spasm
Bronchospasm
Obstructive pulmonary disease characterized by overexpansion of the alveoli with air and destructive changes to their walls, resulting in loss of elasticity and gas exchange
Emphysema
COPD
Permanent destructive pulmonary disorder that is a combination of chronic bronchitis and emphysema
Inherited condition of exocrine gland malfunction causing abnormally thick mucous that obstructs passageways within the body, commonly affecting the lungs and digestive tract
Cystic Fibrosis
These obstruction of mucous in the lung/ airways lead to inflammation, infection, and damage to lung tissue
Can either be passed from both parents or long term exposure to certain substances such as silica dust, asbestos fibers, hard metals, coal dust, grain dust, and prolonged animal and bird droppings
Cystic Fibrosis
Accumulation of fluid in the pleural cavity
Pleural Effusion
Accumulation of pus in the pleural cavity
Empyema
Blood in the pleural cavity
Hemothorax
Air in the pleural cavity
Pneumothorax
- Can be due to trauma
Left side trachial deviation
Both blood and air you have…
Pneumohemothorax
Mycobacterium Tuberculosis
In the lungs. Called Pulmonary tuberculosis
Characterized by the formation of tubercles, inflammation, and necrotizing( cellular death) caseous lesions
ABG
Arterial Blood Gas
Used to determine the adequacy of lung function and gas exchange
pH
Level of acidity
Procedure using a scope to look inside the body either down the throat to the stomach or up to the rectum
Endoscopy
Procedure using a scope examine the airway and bronchus
Bronchoscopy
Procedure using a scope to go into the nose and down to the pharynx
Nasopharyngoscopy
Bronchoscopy Procedure can detect …
Area of carina
Blood Clot
Mucous Plug
Foreign Body
Occlusion in the pulmonary circulation caused by an embolism
PE
Periods of breathing cessation of 10 seconds or more that occur during sleep, often resulting in snoring
Sleep Apnea
URI
Upper Respiratory Infection
Infectious disease of the upper respiratory tract involving the nasal passages, pharynx, and bronchi.
X ray image of the blood vessels of the lungs after injection of contrast
Pulmonary Angiogram
Detect PE
VQ Scan
Ventilation/ Perfusion scan used to look at both air and blood movement through the lungs - uses radiopaque dye
Detect PE
Also used for COPD, Pneumonia, Post Lobectomy
Pulmonary Angiogram
VQ Scan
Ability for air to reach all parts of the lungs
Ventilation
How well blood circulates within the lungs
Q= Perfusion
V/Q mismatch when either one is altered
Nasal Polypectomy
Removal of nasal polyp
Operative Terms
Adenoidectomy
Lobectomy
Pneumonectomy
Nasal Polypectomy
Puncture through the chest wall for aspiration of fluid in the chest wall
Thoracentesis
Repair of the chest wall involving the fixation of the ribs
Thoracoplasty
Creating a whole in the chest wall for a tube insertion
Thoracostomy
Incision into the chest through all layers to access lungs
Thoracotomy
Incision into the trachea
Tracheotomy
Creation of an opening in the trachea, usually to insert a tube
Tracheostomy
CPR
Artificial respiration and chest compressions to move oxygenated blood through out the body when breathing and the heart has stopped
CPAP
Use of a device with a mask that pumps constant pressurized flow of air through the nasal passages, commonly used when sleeping (sleep apnea)
BIPAP
Similar to CPAP
For more acutely ill patients
COPD exacerbation
CHF exacerbation
CPAP
Constant positive airway pressure
CPAP used by paramedics and used for sleep apnea
BiPAP
Needs constant monitoring of the different pressures
Used to treat severely ill patients with respiratory problems ( COPD and CHF)
May be used prior to intubation if patient can maintain airway
Common postoperative breathing using a specially designed spirometer to encourage the patient to inhale and hold an inspiratory volume to exercise the lungs and prevent pulmonary complications
Incentive Spirometer
Endotracheal Intubation
Passage of a tube into the trachea via nose or mouth to open the airway for delivering gas mixtures into the lung
Requires mechanical breathing with a ventilator
Drug that kills or inhibits the growth of microbes
Antibiotic
Drug that dissolves or prevents the formation of thrombi or emboli in the blood vessels
Anticoagulant
- Heparin
Antihistamine
Drug that neutralizes or inhibits histamine
Histamine is released by injured cells during an allergic reaction , inflammation, causing constriction of bronchial smooth muscles and dilation of blood vessels
ex: Diphenhydramine
Cetitizine- Zyrtex
Antiinflammatory examples
Corticosteroids
Leukotriene Antagonists- Montelukast
Bronchodilator
Drug that dilates the muscular wall
Beta 2 agonist- Albuterol
Cholinergic antagonist- Atrovent
Methylxanthines- Theophylline, Aminophylline
Pumps air or oxygen through the liquid medication to turn into vapor
Commonly used with albuterol and atrovent
Expectorant and Antitussives
Anti Cough
Drug that breaks up mucous and promotes coughing
Dextromethorphan= Robitussin
Guaifenesin- Robitussin
G+D= Mucinex
Mucolytics
Acetylcysteine- Mucomyst
Methods of Oxygenation/ Ventilation
Breathing Room air
Supplemental Oxygen
O2 Delivery devices
CPAP
BIPAP
Mechanical Ventilation
FiO2
Fraction of Inspired Oxygen
Breathing room air is 21%
Each liter plus 4%
HFNC
Bridge between the conventional oxygen therapy and the mechanical ventilation
Up to 60lpm
Bridge between oxygen therapy and mechanical ventilation
Reactive Airway disease caused by a spasm of the bronchial tubes or by swelling of the mucous membrane
Asthma
Caused by triggers; allergens example
Atrovent
Bronchdilator
Anticholinergic
Inhaled
Beta 2 Agonist
Albuterol
Bronchodilator
Inhaled
Spiriva
Anticholinergic
Bronchodilator
Inhaled
Singulair
Montelukast
PO
Block Leukotrienes
Corticosteroids
PO
Prednisone
Prednisolone
Inhaled Steroids
Budesonide
Pulmicort
Qvar
Fluticasone
Collapse or airless condition of alveoli caused by hypoventilation, obstruction to airways or compression
Atelectasis
Causes of Atelectasis
Bronchial obstruction by secretions due to impaired cough mechanism or conditions that restrict normal lung expansion on inspiration
What Pt at high risk for Atelectasis?
Post Op
Insidious, cough, sputum production, lo grade fever, crackles
Symptoms of Atelectasis
Respiratory distress, anxiety, symptoms of hypoxia occur if large areas of lung are affected with …
Atelectasis
Nursing Management Prevention for Atelectasis
Prevention
Frequent Turning, early ambulation
Strategies to improve ventilation, deep breathing exercises at least every two hours, incentive spirometer, chest/ Abd pain- splint chest/ ABD with inspiration
Strategies to remove secretions : coughing exercises, suctioning, aerosol therapy, chest physiotherapy
Cough and deep breathing
Always think basic nursing interventions first
Tx for Atelectasis
Strategies to improve ventilation, remove secretions
May include PEEP
IPPB
Bronchoscopy may be used to remove obstruction
Patient Teaching and Home Care Considerations for Atelectasis
Breathing and coughing techniques
Positioning
Addressing pain and discomfort
Promoting mobility and arm shoulder exercises
Diet
Prevention of infection
Signs and Symptoms to report
Acute event in which the heart’s left ventricle can not handle an overload of blood volume
Pulmonary Edema
Pressure increases in the pulmonary vasculature, causing fluid movement out of the pulmonary capillaries and into the intestinal space of lungs and alveoli
Results in hypoxemia
Clinical Manifestations of Pulmonary Edema
Restlessness, anxiety, dyspnea, cool and clammy skin, cyanosis, weak and rapid pulse, cough, lung congestion ( moist or wet), course or crackles,
Increased sputum production- May be frothy and blood tinged or pink frothy sputum
Decreased Level of LOC
Early recognition of Pulmonary Edema
Monitor lung sounds and for signs of decreased activity tolerance and increased fluid retention
Place Pt upright and dangle legs
Minimize exertion and stress
Oxygen
Medications and Emergency Tx
Vasodilators- Nitroglycerin
Diuretics- Furosemide
Addition with BIPAP
Dilate pulmonary vessels, pull fluid from tissue into the vascular system and urinate out and positive pressure to force fluid back into the vascular system
What is ARDS?
Acute Lung Injury
Syndrome characterized by sudden, progressive pulmonary edema, increasing bilateral lung infiltrates on CXR, hypoxemia refractory to oxygen therapy, decreased lung compliance
36-44 mortality rate
Patho of ARDS
Develops from variety of direct or indirect lung injuries
- Most common cause is sepsis
Exact cause for damage to alveolar capillary membrane not known
Pathophysiological changes of ARDS thought to be due to stimulation of inflammatory and immune systems
TRUE
Stages of Edema Formation in ARDS
Normal Alveolus and Pulmonary Capillary
Interstitial edema occurs with increased flow of fluid into the interstitials space
Alveolar edema occurs when the fluid crosses the blood gas barrier
Early Clinical Manifestations of RDS
Dyspnea, tachypnea, cough, restlessness
Chest Auscultation may be normal or reveal fine scattered crackles
For ARDS use …. what tools?
ABGs
Chest X Ray
ABG- Mild hypoxemia respiratory alkalosis caused by hyperventilation
Chest X-Ray- May be normal or show minimal scattered interstitial infiltrates
Edema may not show until 30% of lungs are filled with fluid
Name Causes of ARDS
Pneumonia
Near drowning
Massive Blood transfusions
Pancreatitis
Trauma
Sepsis
S/S of ARDS
Dyspnea
Tachypnea
Anxiety and Restlessness
Decrease in o2 sat.
Tachycardia
Cyanosis
Late Clinical Manifestations of ARDS
Symptoms worsen with progression of fluid accumulation and decreased lung compliance
Pulmonary Function Tests reveal decreased compliance and lung volume
Suprasternal Retractions
Tachycardia, Diaphoresis, changes in sensorium with decreased mentation, cyanosis, and pallor
Hypoxemia despite increased FIO2
Diagnostics of ARDS
“White Out” - CXR
Decreased PFTs
Resp. Alkalosis- Resp. Acidosis
Increased pulmonary artery pressure
Management of ARDS
Intubation, mechanical ventilation with PEEP to treat progressive hypoxemia
Positioning- Frequent Position changes
Nutritional Support
General Supportive Care
ARDS complications of Tx
Hospital Acquired Pneumonia
Barotrauma - Duet to mechanical ventilation
- Positive Pressure
High risk for stress ulcers
Renal Failure
Nursing Dx for ARDS
Ineffective Airway Clearance
Ineffective Breathing Pattern
Impaired Gas Exchange
Impaired Tissue Perfusion
Activity Intolerance
Risk for Infection
Imbalanced nutrition, less than
Sudden Life threatening decrease of gas exchange function of lung and indicates failure of lungs to provide oxygenation or ventilation for blood
Results from inadequate gas exchange
- Insufficient O2 transferred to the blood
- Hypoxemia
Inadequate CO2 removal
- Hypercapnia
ARF
ARF is not a _____________ but a ________
disease, condition
Results of one or more diseases involving th elungs or other body systems
Increased PaCO2 greater than 50mm Hg is
Hypercapnia , pH less 7.35
Decreased in PaO2 less than 50mmHg is
Hypoxemia,
Ventilatory Failure and Oxygenation Failure is what pathos?
ARF
Ventilatory Failure includes
Impaired CNS
Neuromuscular
Musculoskeletal
Pulmonary
Oxygenation Failure
PNA
ARDS
HF
COPD
PE
Restrictive Lung Disease
Asthma
Early Manifestations of ARDS include
Early
Restlessness, Fatigue, Headache, Dyspnea, Air hunger, tachycardia, HTN
ARF manifestations of hypoxemia progresses include
Confusion
Lethargy
Tachycardia, tachypnea
Central cyanosis
Diaphoresis
Resp. Arrest
Medical Management of ARF include
Correct Cause
Restore adequate gas exchange in lung
Intubation/ Mechanical Ventilation
ARF Nursing Management
Maintaining mech. ventilation
Monitoring responsiveness
ABGs
Vital Signs
Turning, skin care, SCDs, DVT prophylaxis, oral care, hygiene, nutrition- all preventative measures
Address etiology of ARF
Placement of a tube to provide a patient airway for mechanical ventilation and for removal of secretions
Endotracheal Tube
Endotracheal Tube
Purpose and complications related to the tube cuff
Assessment of cuff pressure
Pt assessment
Risk for injury/ airway compromise related to tube removal
Pt and family teaching
RSI
Rapid Sequence Intubation
Rapid concurrent administration of a paralytic agent and a sedative agent during emergency airway management
Increased risk for aspiration, combativeness, and injury to the patient
- Not indicated for comatose or cardiac arrest patients
Name Muscle Paralytics
Succinylcholine
Pancuronium
Vercuronium
NAme Sedation Drugs
Etomidate
Ketamine
Versed
Fentanyl
Propofol
Exhaled CO2 will change CO2 detector from what to what
Purple to yellow
Following intubation
Inflate cuff and confirm placement of ET tube while manually ventilating patient with 100% O2
End- Tidal CO2 detector measures amount of
Exhaled CO2 from the lungs
Place between BVM and ET tube
Observe the color change
If no CO2 is detected then
Endotracheal tube is in the esophagus
Auscultate lung bases and apices for bilateral breath sounds
Yellow color change is good
Following ET intubation
Observe chest for symmetric wall movement
Obtain portable chest xray to confirm placement
Connect ET tube to either humidified air, O2, or mechanical ventilator
Obtain ABGs with 25 min after intubation to determine oxygenation and ventilation status
Continue monitor pulse oximetry as estimate of arterial oxygenation
Nursing Management Artificial Airway
Maintaining correct tube placement
- Monitor ET tube every 2-4 hours
Confirm exit mark on ET tube remains constant while
- at rest
- during pt care
- repositioning
- transporting patient
Maintaining proper cuff inflation
Incorrect tube placement is an emergency
- Stay with the patient and maintain airway
Support Ventilation
Nursing Management Artificial Airway
Maintain tube patency
- Assess pt. routinely to determine need for suctioning, but do not suction routinely
Indication for suction
-Visible Secretions
- Sudden onset of respiratory distress
- Suspected aspiration of secretions
Nursing Management Artificial Airway
Providing oral care and maintaining skin integrity
- Brush teeth BID
Oral care every 2-4 hours
Suction oral/ pharyngeal cavity
Reposition and re tape ET tube
If Pt is anxious or uncooperative, two caregivers needed for reposition
Nursing management Artificial Airway
Fostering comfor and communication
- Anxiety due to inability to communicate requires emotional support
- Physical discomfort associated with ET intubation and mechanical ventilation necessitates sedation and analgesia
Consider alternative therapies to compliment drug therapy
What are some complications of ET intubation?
Unplanned extubating
- Patient vocalization
Activation low- pressure ventilator alarm
Diminished or absent breath sounds
Respiratory Distress
Gastric Distention
Aspiration RF of Artificial Airway
Improper Cuff Inflation
Patient positioning
Tracheoesophageal Fistula
Suction oral cavity frequently
- Insert orogastric or nasogastric tube and connect to low intermittent suction
If receiving enteral feedings, elevate HOB 30-45 degrees
Provide continuous suction of secretions above cuff
Risk for Pressure Ulcer
Lowering HOB decreases pressure on coccyx but increases risk for aspiration
Continual monitoring of HOB
Complications of tracheostomy
Bleeding
Pneumothorax
Aspiration
Emphysema; subcutaneous or mediastinal, laryngeal nerve damage, posterior tracheal wall penetration
Long term complications include airways obstruction, infection, rupture of the innominate artery, dysphagia, fistula formation, tracheal dilation, and tracheal ischemia, and necrosis
Tracheostomy Long term complications
Tracheostomy
Bypasses the upper airway to bypass an obstruction, allow removal of secretions, permit long term ventilation, prevent aspirations and secretions, or to replace endotracheal tube
Purpose of Cuff in Tracheostomy
Maintain air delivered in mechanical ventilation to the lungs
Important to keep inflated so air can go to lungs and back to ventilator and can be measured
If the patient does not require air from vent be monitored then…
Tolerate cuff deflation without respiratory distress; then CUFFLESS tracheostomy tube may be placed
Pediatric and neonatal pt have cuffless to prevent mucosal injury
Cuffless Trach air may
Leak out
Some speech is possible depending ho much space is around the trach for airflow through the upper airway
Nursing Dx for Pt with endotracheal intubation or tracheostomy
Ineffective communication
Anxiety
Knowledge Deficit
Ineffective airway clearance
Potential for Infection
NIPPV
Non invasive positive pressure ventilation
Use of mask or other device to maintain seal and permit ventilation
Indications
CPAP
BIPAP
Positive or negative pressures breathing device to maintain ventilation or oxygenation
Mechanical Ventilation
-Negative Pressure
-Iron Lung - rare
Positive Pressure
- Pressure cycled
- Timed cycle
- Volume- Cycled
Mechanical Ventilation
Process by which fraction inspired oxygen at > 21% room air is moved into and out of lungs by mechanical ventilator
Indications for mechanical ventilation
Apnea or inability to breathe
ARF
Severe hypoxia
Respiratory muscle fatigue
Settings of mechanical ventilators
Regulate rate, depth, and other characteristics
Based on Pt status ( ABGs, body weight, LOC, muscle strength)
Ventilator is tuned to match pt. ventilatory pattern
Mechanical Ventilation
PPV- Positive Pressure Ventilation
Used primarily in acutely ill patients
Pushes air into lungs under positive pressure during inspiration
Expiration occurs passively
IMV
Intermittent mandatory vent
Preset tidal volume at preset rate
ACV
Assist Control Vent
Preset volume for every breath set and taken by client
CMV
Controlled Mandatory Vent
Preset volume at preset rate for pt. with no ventilatory effort
SIMV
Synchronized Intermittent Mandatory Vent
Preset mandatory volume that syncs with client inspiratory effort - most common
APRV
Volume of gas to preset insp. pressure and allows exhalation to a second preset pressure
Vent Settings
Rate- breaths per minute
FiO2- amount of O2 in inhaled air
Tidal Volume- Amount of air delivered with each breath ( ml or L)
PEEP
Positive end respiratory expiratory pressure
Amount of positive pressure at the end of exhalation
- Keeps the alveoli open
Typical if 5mmhg- higher levels increase risk for pneumothorax
IPAP
Inspiratory positive airway pressure: controls the peak inspiratory pressure during inspiration
EPAP
Expiratory positive airway pressure, controls the end expiratory pressure
Bipap or mechanical ventilator is used as CPAP when
IPAP=EPAP
Enhancing AGs Exchange
Monitor ABGs and other indicators of hypoxia. Note trends
Auscultate lung sounds frequently
Judicious use of analgesics
Monitor fluid balance
Complex Dx that requires a collaborative approach
Promoting Effective Airway Clearance
Assess Lung sounds at least every 2-4 hours
Measures to clear airway: suction, position changes, promote mobility, also CPT
- Chest physical therapy may include percussion, vibration, deep breathing, huffing or coughing.
Humidification
Medications- Mucomyst
Preventing Trauma and Infection
Infection control measures
Tube Care
Cuff management
Oral Care
Elevation of HOB
PPV and hypermetabolism can contribute to
Inadequate nutrition
Pt is likely to be without food for
3-5 days, a nutritional program should be initiated
Poor nutrition and disuse of respiratory muscles
Contributes to decreased muscle strength
Inadequate Nutrition can
Delay warning
Decrease resistance to infection
Decrease speed of recovery
Enteral Feeding Via small bore feeding tube is preferred method to meet caloric needs on ventilated patients
TRUE
Mechanical Ventilation Complication
Machine disconnection or malfunction
- Most frequent site for disconnection is between tracheal tube and adapter
Pause alarms during suctioning or removal from ventilator
Reactivate alarms before leaving
Malfunction may be due to
Power failure, failure of O2 supply
If machine malfunctions
Disconnect pt from ventilator
Manually ventilate 100% O2
Process of withdrawal of dependence upon the ventilator
Weaning
Successful weaning is a collaborative process
TRUE
Methods of weaning
Process of
decreasing ventilator support
resuming spontaneous ventilation
Weaning Outcome Phase
Weaning stops and patient is extubated
Weaning is stopped because no further progress is made
After extubating
Encourage deep breathing and coughing
Pharynx should be suctioned as needed
Supplemental oxygen should be applied and naso oral care provided
Monitor VS, resp. status, and oxygenation immediately within 1 hour
After extubation
Other Interventions Respiratory
ROM mobility; get out of bed
Communication methods
Stress reduction techniques
Interventions to promote coping
Include in care: family teaching, and emotional and coping support of the family
Home ventilator care
CO2 is also converted to what in the blood
HCO3
Why is CO2 important?
Source of acid.
co2 and h2o- carbonic acid- then can become HCO3
pH measurement of free hydrogens
ABG
Monitor pt ability to oxygenate
Partial Pressures of CO2
PCO2 35-45
CO2- is produced from cellular respiration and eliminated through lungs ( respiratory function)
HCO3
Bicarbonate 22-26
Produced and reabsorbed in kidneys
Partial Pressure of O2
pO2- 80-100
BE
Base Excess
Amount of anions or cations needed to correct acid/ base imbalance (if present)
oxygen saturation above 94%
CO2 increase with
Hypoventilation
Infection (Pneumonia)
CNS depression
Ventilation Perfusion Conditions
ARF
COPD
PE
Rebreathing CO2
Trauma -pneumothorax
CO2 decreases with
Hyperventilation
Anxiety
Fat embolism
PE
Metabolic Acidosis
Aspirin Overdose
S/S of Hypocapnia
Cerebral vasoconstriction
Hypocalcemia
Carpal Pedal Spasms
Shift in O2-HgB dissociation curve
Decreased oxygenation
High HCO3 can be seen with
Gastric conditions
Vomiting
Dehydration
Gastric suctioning
Low HCO3 seen with
DKA
Diarrhea
Liver failure
Kidney Disease
Acidosis condition that resulted in the use of the body’s HCO3 reserves
Allen’s Test
Prior to an ABG, an Allen’s Test should be performed
Allens Test
You want positive Allens test
Means ulnar artery can sufficiently profuse the hand if the radial artery is altered in any way
