Wk3 Flashcards
Hypoxaemia
Lack of o2 rich blood results in less efficient anaerobic metabolism and compromised cellular function
Signs of hypoxia
Confusion, headaches, reduced consciousness, tachyarrhthymias, chest pain
Initial responses: increased RR and depth of breathing
Raised HR and vasoconstriction
Inflammation and oedema
Pulmonary oedema: occurs from inadequate left ventricular function, limited lymphatic drainage in distal lung areas
Inflammatory processes: inhalation injury, aspiration or resp infections, sepsis, trauma,
Pulmonary oedema: shunts blood past alveoli, results in left ventricular failure increased preload and after load
LMA
Rapidly easily inserted
Variety of sizes
More efficient than face mask
Avoids need of laryngoscopes and full intubation
Types: supreme, iGel, Unique, fastrack iLMA
Endoctracheal intubation
Patients has reduced LOC
Respiratory failure that requires additional o2 therapy, positive pressure ventilatory support and active remove of sputum
Cricoid pressure
Technique to stop aspiration during intubation
BURP
Occluded oesophagus
Tracheal intubation advantages and limitation
Ad: allows ventilation up to 100%, isolates airway preventing aspiration, allows suctioning, alternative route for drug administration
Lim: training and experiences essential, potential to worsen cervical cord or head injury, damage to airway
Nursing priorities for intubate patient
Ensure tube is secure Monitor RR, depth , effort, sats, ABG Prevent accidental extubation Monitoring Medication Mouth care Suctioning Positioning Communication
Tracheostomy
Surgical opening in anterior wall of the trachea to facilitate ventilation
Surgical or percutaneous
Indication: upper airway obstruction, oedema, tumour, burns, neuromuscular disorders
Types of tubes: cuffed, uncuffed, fenestrated
Changing inner cannula of tracheostomy and wound care
Check every 4hrs if copious secretions
Remove and clean using sterile water
Aseptic technique
Use protective, absorbent, non adhesive dressing around stoma to keep it dry
Communication
Speaking tubes
Speaking valves - passymuir
Info and reassurance
Details to patient and fam
Negative pressure ventilation
Iron lungs
Non invasive ventilation first used in Bostons children hospital 1928
Pump draws out air and creates a suction pressure
Positive pressure ventilation
First used in Massachusetts General hospital 1955
Allows air to flow into airway until the ventilator breath is terminated
Exhalation occurs due to elastic recoil of lungs
Non invasive ventilation/ non invasive positive pressure ventilation
Provides adjunct between simple oxygen delivery systems and ETT
Reduces day in hospital without reducing quality of care
Reduces trauma do infection risks associated with intubation
CPAP - continuous positive airway pressure
Splints airway open Increased pressure within airway Gas exchange is maintained Decreases work of breathing Clinical applications: acute pulmonary oedema, COPD, anaesthesia, weaning from mechanical ventilation
BiPAP bilevel positive airway pressure NIV
Cycles between two levels of pressure and provides continuous positive airway pressure (IPAP and EPAP)
Rest respiratory muscles
Increases o2 delivery
Reduces WOB
Patient selection criteria for NIPPV and COAP
Spontaneously breathing Ability to protect and maintain airway Ability to clear secretion Co-operate Tolerate mask Not retain co2 Contraindications: facial surgery or trauma, base skull fractures, pneumothorax, upper airway obstruction, decreased conscious level, high risk of aspiration or vomiting.
CPAP vs intubation
CPAP: NIV, easily discontinued, adjusted, doesn’t require sedation, comfortable
Intubation: invasive, potential for infection, requires high skill level, requires sedation, traumatic
Commencing CPAP BiPAP clinical obs
Explain procedure, prescription
15 min obs the first hour then hourly, temperature every 4 hours
Abdominal distension (may require NG tube insertion ie swallowing a lot of gas can cause aspiration)
Have planned breaks
Diets and fluid
Pressure area care
Common complication with CPAP and BiPAP
Pressure sores, gastric distension, reduced CO therefore drop in BP, hyperventilation, fluid retention
Mechanical ventilation
Critically ill patients who have persistent respiratory insufficiency and don’t respond to other interventions
Can’t protect airway
Inadequate breathing pattern
Inability to sustain adequate oxygenation
Hypercarbia
Mechanical ventilators
Invasive can be short term or long term
Enable synchrony to patients own respiratory efforts
Basic ventilation
Delivers gas to lungs using positive a certain rate
Volume and pressure settings
High frequency ventilation
Lungs that are extremely inflamed, can be made worse if lungs are constantly inflating and deflating hence given fats breaths that endure lungs don’t have to work, 900 bpm,
Nitric oxide
Smooth muscle relaxant working on pulmonary arteries, causes vasodilation so shunting does not occur
Prone positioning:
Air goes up and they get good gas exchange
Extracorporeal membrane oxygenation
Blood removed from the body via a lump system and oxygenated via an external membrane
Future ventilation strategy
Liquid ventilation: breathe an oxygen rich liquid (per fluorocarbon) rather than breathing air, less stress on lungs
Weaning from ventilation
Patients have increased WOB and reduced muscle strength
Assess patient
Increase strength and stamina
Extubation when ready
Nursing care of ventilated patient
ABCDE Regular monitoring Position patient: 45 degrees to reduce VAP, prevent secretion build up, pressure area care Mouth and eye care Wound dressings and drains Nutrition and hydration Medication and drugs Infection control Investigations Other therapies / inotropes Transfer
Common acute and critical respiratory states
Respiratory failures Acute lung injury Asthma Pneumothorax PE Infection/pneumonia
