Podcast
Questions and Answers
What medication specifically targets inflammation and is typically administered for its effects on mucus?
What medication specifically targets inflammation and is typically administered for its effects on mucus?
Which of these interventions directly helps open the alveoli, potentially aiding in improved ventilation and oxygenation?
Which of these interventions directly helps open the alveoli, potentially aiding in improved ventilation and oxygenation?
Which of these is a direct indicator of a patient's ventilation status, typically assessed with a blood test?
Which of these is a direct indicator of a patient's ventilation status, typically assessed with a blood test?
Which of the following is NOT a direct indication of the respiratory system's ability to move air in and out of the lungs?
Which of the following is NOT a direct indication of the respiratory system's ability to move air in and out of the lungs?
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Which of the following techniques primarily assess the overall function of the respiratory system, including lung volumes and airflow?
Which of the following techniques primarily assess the overall function of the respiratory system, including lung volumes and airflow?
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Which of the following interventions directly targets the muscles responsible for breathing, aiding in relaxation and potentially promoting better ventilation?
Which of the following interventions directly targets the muscles responsible for breathing, aiding in relaxation and potentially promoting better ventilation?
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Which of the following interventions is PRIMARILY used to investigate the underlying cause of respiratory issues, NOT specifically to address ventilation or oxygenation?
Which of the following interventions is PRIMARILY used to investigate the underlying cause of respiratory issues, NOT specifically to address ventilation or oxygenation?
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What is the effect of increasing the positive end-expiratory pressure (PEEP) on the cardiovascular system?
What is the effect of increasing the positive end-expiratory pressure (PEEP) on the cardiovascular system?
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Which of the following ventilator settings are typically adjusted to manage low tidal volume (VT)?
Which of the following ventilator settings are typically adjusted to manage low tidal volume (VT)?
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What is the primary goal of adjusting PEEP in a mechanically ventilated patient?
What is the primary goal of adjusting PEEP in a mechanically ventilated patient?
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According to the content, what is the recommended minimum PEEP setting during mechanical ventilation?
According to the content, what is the recommended minimum PEEP setting during mechanical ventilation?
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Which of the following is a potential negative consequence of excessive PEEP?
Which of the following is a potential negative consequence of excessive PEEP?
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What is the primary reason for monitoring the peak inspiratory pressure (PIP) during mechanical ventilation?
What is the primary reason for monitoring the peak inspiratory pressure (PIP) during mechanical ventilation?
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What is the primary purpose of sedation during mechanical ventilation?
What is the primary purpose of sedation during mechanical ventilation?
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Which of the following is NOT a common ventilator setting that is typically adjusted during mechanical ventilation?
Which of the following is NOT a common ventilator setting that is typically adjusted during mechanical ventilation?
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What is the significance of monitoring the FiO2 during mechanical ventilation?
What is the significance of monitoring the FiO2 during mechanical ventilation?
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Based on the provided information, which intervention is considered contraindicated due to its potential impact on thyroid hormone levels?
Based on the provided information, which intervention is considered contraindicated due to its potential impact on thyroid hormone levels?
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Which intervention might be considered nonessential, but could provide additional support for the client's overall well-being?
Which intervention might be considered nonessential, but could provide additional support for the client's overall well-being?
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Which intervention is indicated and primarily aims to regulate the client's heart rate and rhythm?
Which intervention is indicated and primarily aims to regulate the client's heart rate and rhythm?
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Based on the information provided, which intervention is considered contraindicated due to its potential to worsen thyrotoxicosis?
Based on the information provided, which intervention is considered contraindicated due to its potential to worsen thyrotoxicosis?
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Which intervention aims to promote physical comfort and potentially reduce anxiety commonly associated with thyroid disorders?
Which intervention aims to promote physical comfort and potentially reduce anxiety commonly associated with thyroid disorders?
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Which of the following is NOT a reason for recommending a transfer to a higher level of care?
Which of the following is NOT a reason for recommending a transfer to a higher level of care?
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Which of the following vital signs is NOT listed as an early indicator of clinical deterioration?
Which of the following vital signs is NOT listed as an early indicator of clinical deterioration?
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The SBAR format is used to improve communication between healthcare professionals. What does the 'R' in SBAR stand for?
The SBAR format is used to improve communication between healthcare professionals. What does the 'R' in SBAR stand for?
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The content emphasizes the importance of timely documentation of vital signs. Which of these scenarios would be considered a delay in charting?
The content emphasizes the importance of timely documentation of vital signs. Which of these scenarios would be considered a delay in charting?
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According to the content, what is the main benefit of using the SBAR format for communication?
According to the content, what is the main benefit of using the SBAR format for communication?
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The content mentions the National Patient Safety Goals. What are the two goals specifically mentioned in the context of the provided information?
The content mentions the National Patient Safety Goals. What are the two goals specifically mentioned in the context of the provided information?
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The content suggests several tests and consultations that might be ordered in an urgent situation. Which of the following is NOT explicitly mentioned?
The content suggests several tests and consultations that might be ordered in an urgent situation. Which of the following is NOT explicitly mentioned?
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In the provided text, what is the main reason for recommending a respiratory therapy consultation?
In the provided text, what is the main reason for recommending a respiratory therapy consultation?
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The content mentions the importance of aligning with National Patient Safety Goals. What is the primary reason for early warning systems (EWS) to be effective?
The content mentions the importance of aligning with National Patient Safety Goals. What is the primary reason for early warning systems (EWS) to be effective?
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The content mentions a provider needing to be notified if there is no improvement in the patient's condition. What does this suggest is crucial for the provider to do?
The content mentions a provider needing to be notified if there is no improvement in the patient's condition. What does this suggest is crucial for the provider to do?
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Which of the following conditions would be a contraindication for Non-Invasive Positive Pressure Ventilation (NIPPV)?
Which of the following conditions would be a contraindication for Non-Invasive Positive Pressure Ventilation (NIPPV)?
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Which of these statements about Pressure Support (PS) ventilation is false?
Which of these statements about Pressure Support (PS) ventilation is false?
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In the context of the provided text, what does the term "hypoventilation" refer to?
In the context of the provided text, what does the term "hypoventilation" refer to?
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Which of the following is NOT a potential benefit of CPAP (Continuous Positive Airway Pressure)?
Which of the following is NOT a potential benefit of CPAP (Continuous Positive Airway Pressure)?
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In the context of the provided text, what does the term "atelectasis" refer to?
In the context of the provided text, what does the term "atelectasis" refer to?
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Pressure Cycled Ventilation is best described as a mode of ventilation where the exhalation is triggered by:
Pressure Cycled Ventilation is best described as a mode of ventilation where the exhalation is triggered by:
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Which of the following statements accurately describes the difference between Pressure Support (PS) and CPAP (Continuous Positive Airway Pressure)?
Which of the following statements accurately describes the difference between Pressure Support (PS) and CPAP (Continuous Positive Airway Pressure)?
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Why might a patient with COPD and pneumonia be a suitable candidate for NIPPV (Non-Invasive Positive Pressure Ventilation)?
Why might a patient with COPD and pneumonia be a suitable candidate for NIPPV (Non-Invasive Positive Pressure Ventilation)?
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Which of the following statements correctly describes the mechanism of action of Pressure Cycled Ventilation?
Which of the following statements correctly describes the mechanism of action of Pressure Cycled Ventilation?
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Which of the following is NOT a mode of ventilation discussed in the provided text?
Which of the following is NOT a mode of ventilation discussed in the provided text?
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Study Notes
Respiratory Failure & Advanced Airways
- Topic is respiratory failure and advanced airway management
- Covers airway overview, endotracheal intubation, and tracheostomy tubes.
Normal Respiratory System
- Oxygen saturation should be appropriate
- Skin color should be pink
- Chest expansion should be appropriate
- Breath sounds should be clear
- ABG's (Arterial Blood Gases) are relevant in monitoring
- CXR and PFT may also be helpful
- Hgb levels are important
Acute Respiratory Failure (ARF)
- Failure of oxygenation or ventilation or both
- Altered gas exchange
- PaO2 < 60 mm Hg leads to hypoxemia
- PaCO2 > 50 mm Hg leads to hypercapnia
- pH ≤ 7.30
- SaO2 < 90%
Failure of Oxygenation
- Hypoventilation
- Intrapulmonary shunting
- Ventilation-perfusion mismatch
- Diffusion defects
- Decreased barometric pressure (high altitude)
- Non-pulmonary hypoxemia
- Low cardiac output
- Low hemoglobin
Tissue Hypoxia
- Some conditions prevent tissues from using oxygen, despite it being available
- Cardiovascular related: shock, altered perfusion
- Pulmonary related: carbon monoxide poisoning
- Tissue hypoxia results in anaerobic metabolism and lactic acidosis
Failure of Ventilation
- Results in hypercapnia
- Related to increased CO2 production
- Decreased alveolar ventilation
- Airway and alveoli abnormalities
- Chest wall abnormalities
- Neuromuscular conditions
Case Study: Ms. Emmi Physema
- 62-year-old presenting to the ER with increasing shortness of breath (SOB)
- New onset confusion and restlessness
- Medical History: COPD and hypertension
- Medications: Budesonide/Formoterol and amlodipine
- Assessment Data:
- Disoriented
- Bilateral wheezes with rales in right middle and lower lobes -Peripheral pulses 2+/2+ -Edema of ankles
- Capillary refill <3 seconds
- Skin pale
- Vital Signs: T 98.5 (oral), HR 115 (sinus tachycardia), RR 28, BP 135/90, SpO2 88%
- CXR: Right middle lobe pneumonia
- EKG: sinus tachycardia
- WBC 15,000/mL
- Hgb 16 g/dL
- Hct 48% -ABG: pH 7.30, PaCO2 60, PaO2 65, HCO3- 35
- Partially compensated respiratory acidosis
Form and Prioritize Hypotheses
- Possible COPD exacerbation
- Pulmonary infection (pneumonia)
- Tachycardia, tachypnea, and low SpO2 indicate potential respiratory distress
- Assess for other potential needs
- Develop potential solution: elevate HOB, apply oxygen, keep NPO, BiPap, meds, etc.
Case Study Progresses
- Vital signs show increased HR, increased RR, accessory muscles, and decreased SpO2.
- ABG: pH 7.42, PaCO2 58, PaO2 60, HCO3- 30
- Fully compensated respiratory acidosis
- Decision is made to intubate and place her on a ventilator.
Airway Adjuncts
- Oropharyngeal airway
- Nasopharyngeal airway
Indications for Intubated Ventilation
- Hypoxemia (PaO2 ≤ 55 mm Hg on FiO2 > 0.5)
- Hypercapnia (PaCO2 ≥ 50 mm Hg with pH < 7.32)
- Progressive deterioration (tachypnea, bradypnea, or apnea)
- Decreasing tidal volume
- Increased work of breathing
- Inability to maintain airway
- Neurological dysfunction
Endotracheal Intubation
- Insertion of an endotracheal tube (ETT)
- Orotracheal route preferred to reduce infections
- Nasal route if oral trauma or surgery
- Used for maintaining airway, removing secretions, providing mechanical ventilation preventing aspiration
Intubation Equipment
- Stylet (disposable)
- Endotracheal tube with 10 ml syringe for cuff inflation
- Laryngoscope handle with attached blade
- Water-soluble lubricant
- Colorimetric CO2 detector to check tube placement
- Tape or commercial device to secure tube
- Yankauer disposable pharyngeal suction device
- Magill forceps
- Suction source and stethoscope
Endotracheal Intubation (by RT or provider)
- Explain procedure to client
- Remove dentures
- Ensure patent IV
- Hyperoxygenate client with 100% NRB
- Continuous SpO2
- Gather supplies
- Endotracheal tube/ Stylet / Lubricant for tube/ BVM, Ambu, CO2 detector/ Laryngoscope/ Blade/ to see airway
- Sniffing position (next slide) - pt head back
- Suction oropharynx
- Pre-medicate - RSI sedation (plus pain meds) then paralytic if prescribed
- Intubate within 30 seconds
- Inflate balloon
- Ventilate with 100% O2 via BVM
- Verify placement (capnography, then CXR)
- Connect to ventilator
Airway and Breathing
- Rescue breathing with bag-mask device
- Bag-valve-mask should have reservoir and be connected to O2 with regulator dialed to 15L
- Capnography (aka ETCO2)
- End-tidal carbon dioxide detector connected to an ETT
- Waveform
- Normal waveform: adequate ventilation (ETCO2 35 to 40 mm Hg)
- Abnormal waveform: airway obstruction
- Check ETT for placement and then check for carotid pulse (CO2 delivery to the lungs)
- Client is no longer perfusing with adequate CO
- If CO2 drops.
Immediately after Intubation: Verify Placement
- Visible bilateral chest rise
- Auscultate bilateral breath sounds
- Auscultate epigastric area
- ETCO2 detector
- Secure tube
- CXR (confirmatory)-2 to 6 cm above carina
- Record position of ETT in cm at the teeth/ lip
- Follow up ABG in 30-60 minutes
Critical Thinking Challenge
- How to tell if the ET tube is in the right mainstem bronchus
- What to do if you suspect the ETT tube is in the esophagus
Tracheostomy
- Indications: long-term mechanical ventilation or recovery, frequent suctioning, protecting the airway, bypassing airway obstruction, reduce work of breathing, sometimes in morbid obesity
- Placed in OR or bedside in the ICU
- Cuffed tube for mechanical ventilation to prevent air leaks
- Keep obturator at bedside
- Replacement trach tube at the bedside (same size = bedside, hold retention sutures, stay open for airway access)
Tracheostomy Nursing Management
- Post-procedure care
- Obturator removed, kept
- Cuff (balloon) is inflated if using vent
- Auscultate for air entry
- Connect client to ventilator w/cuff inflated
- Deflate cuff when on tracheostomy collar
- Secure with velcro strap/ ties
- Mouthcare
- Skin care around neck
- Trach care (replace ties – one side first – then other – side then place in other side places)
NCLEX Readiness: Trach Care
- Explain procedure, position semi-fowler
- Cleansing inner cannula
- Gather equipment, position client, don PPE, and set up equipment
- Don sterile gloves
- Unlock and remove inner cannula; place in sterile saline, cleanse, rinse, and reinsert
- If disposable, replace Clean stoma
- Change ties (if needed 24 hours after placement of trach)
- Remove old ties after new ones applied
Advanced Airway Suctioning
- Suction only as indicated by assessment, visible secretions, coughing, rhonchi
- High pressure alarm on ventilator, decreasing O2 sats
- Explain procedure to client
- Only suction while withdrawing the catheter, no longer than 10 seconds
- Allow for rest between suctioning
- Avoid normal saline instillation
- Monitor SpO2 and heart rate before, during, and after suctioning
- Closed tracheal suction device
Mechanical Ventilation
- Provides supportive care until underlying disease is treated
- Specifically supports gas exchange, which includes both alveolar ventilation and arterial oxygenation
- Invasive positive pressure ventilation delivery includes ETT or tracheostomy tube
- Ventilators assist in movement of gas into the lungs, while the expiration remains passive
- Positive pressure ventilators are common in critical care
- Mechanical ventilation settings
Ventilator Settings
- Respiratory rate
- FiO2 “Oxygen” Tidal Volume (VT)
- Peak inspiratory pressure (PIP)
- Positive end-expiratory pressure (PEEP) 5-20cm H20
- Decreases CO and venous return to heart
- Pressue support
- Mode of ventilation
- Alarm settings
Effect of Positive End-Expiratory Pressure (PEEP) on Alveoli
- Prevents alveolar collapse
- Improves oxygenation
Modes of Mechanical Ventilation
- Describes how breaths are delivered
- Method by which the client and ventilator interact to perform the respiratory cycle
- Full or partial support
- Client triggered or ventilator triggered breaths
- Spontaneous or mandatory breaths
Volume-Cycled Ventilation
- The Vt delivered by the ventilator is constant, regardless of compliance and resistance
- Air will flow into the lungs until the preset volume is reached
- Must monitor PIP, risk of hyperventilation, respiratory alkalosis, and ventilator-induced lung injury
Pressure-Cycled Ventilation
- Ventilator is set to allow airflow until preset pressure is reached
- Vt is variable-must watch exhaled tidal volume
- PIP can be better controlled
- Risk of hypoventilation, atelectasis, respiratory acidosis
Pressure Support (PS)
- Client's spontaneous inspiratory effort is assisted by preset amount of positive pressure during inspiration
- Decreases work of breathing with spontaneous breaths
- Useful in weaning, when vent rate is turned off
CPAP
- Continuous Positive Airway Pressure
- Administered throughout the respiratory cycle to a client who is spontaneously breathing
- Similar to PEEP
- Via ventilator or nasal or face mask (NIPPV)
- Option for clients with sleep apnea (OSA)
- May facilitate weaning
- Can also be used to prevent reintubation (NIPPV)
Critical Thinking Challenge
- Identifying clients not appropriate for NIPPV (Noninvasive Positive Pressure Ventilation)
Case Study Progresses...
• Vital signs show: T 99 (oral), HR 135 (sinus tachy), RR 34, increased use of accessory muscles, BP 165/105 (125 MAP), pulse oximetry 86% despite increased oxygen to 80% via BiPaP and ABG: pH 7.42, PaCO2 58, PaO2 60, HCO3– 30
Complications of Mechanical Ventilation
- ETT out of position
- Unplanned extubation
- Laryngeal/Tracheal injury
- Damage to Oral and Nasal Mucosa
- Routine monitoring of ETT cuff pressure
Types of Alarms and Potential Causes
- High pressure alarms (secretions, biting on tube, kinks in tube, bronchospasm, pneumothorax, pulmonary edema)
- Low pressure limit (disconnection, cuff leak, unplanned extubation)
- Apnea (only seen in weaning - sedation is a factor)
Case Study: ICU
- Client is continuously monitored in the ER while awaiting ICU bed
- Client is placed on BiPaP with oxygenation and appropriate inspiratory/expiratory pressure settings • The client is continuously monitored in the ER while awaiting a bed in the ICU
Acute Respiratory Failure Concerns and Actions
- Respiratory muscle fatigue
- Cerebral hypoxia and carbon dioxide narcosis
- Symptoms: Diaphoresis, Nasal flaring, Tachycardia, Abdominal paradox, Muscle retractions, Intercostal, Suprasternal, Supraclavicular, Central cyanosis, Lethargy, Somnolence, Coma, Respiratory acidosis
- Nursing Actions: Improve O2 delivery; Ensure adequate cardiac output and blood pressure; Correct low hemoglobin; Administer bronchodilators; Decrease O2 demand: Provide rest, reduce fever, relieve pain, and anxiety; Position patient for optimum gas exchange and perfusion; Prepare for possible intubation and mechanical ventilation
Treatment of Acute Respiratory Failure
- Maintain airway patency
- Prepare for intubation and mechanical ventilation
- Consider corticosteroids
ICU Liberation Bundle
- Includes aspects A, B, C, F of the ABCDEF bundle: Assess, Prevent, and Manage Pain, Both Spontaneous Awakening Trials (SAT) and Spontaneous Breathing Trials (SBT), Choice of Analgesia and Sedation, Family Engagement and Empowerment
- ICU Liberation Bundle protocolized care, involving all disciplines, for clients in the ICU.
Infection Prevention
- Normal protective mechanisms bypassed, aspiration risk, ventilator-associated pneumonia (VAP), oral flora
- VAP bundle: HOB 30° to 45°, sedation vacation daily, stress ulcer prophylaxis, DVT prophylaxis, oral care and oral suction (q2 hr)
Alveolar Hypo-ventilation
• Under ventilating→ low volume settings, lung secretions, mucous plugs • Results: atelectasis, hypoventilation, respiratory acidosis • Treatment: appropriate Vt setting, increase in PEEP, suction as needed
Alveolar Hyper-ventilation
• Over ventilating→ good settings, no pain/anxiety • Results: respiratory alkalosis • Treatment: appropriate settings If client is hyperventilating: sedation, pain medication, anti-anxiety medications
Barotrauma
- Due to lung inflation pressures
- Examples: Pneumothorax, Tension pneumothorax, High-pressure alarm
- Decreased breath sounds, tracheal shift
- Subcutaneous crepitus/emphysema, Hypoexemia
- Treat tension pneumothorax with needle decompression, Chest tube
Volutrauma
- Overdistension of alveoli causes tissue changes
- Damages the lung similar to early ARDS
- Monitor inspiratory pressures
Acid-Base Disturbances
- Respiratory acidosis/ alkalosis (abnormal pH, PaCO2, HCO3)
Cardiovascular System
- Hypotension
- Decreased cardiac output (CO)
- Decreased venous return to heart
- Decreased CO decreases renal blood flow
- Causes compensatory RAAS activation
- Possible decrease in atrial natriuretic peptide
- Stress response: ADH and cortisol → more sodium and water retention (RAAS = water retention)
GI System
- Complications: stress ulcers, GI bleeding, risk for aspiration, weakened swallowing, dysphagia
- Interventions: SUP (H2 or PPI), NGT or OGT, Provide nutritional, Keep HOB 30-45°, Oral care q2hr/prn, Speech Therapy consult post extubation
Nutritional Therapy
- Hypermetabolic
- Early enteral nutrition via gastric tube once intubated
- Preserves structure and function of gut mucosa (microvilli)
- Prevents translocation of gut bacteria
- Monitor albumin, prealbumin, total protein, electrolytes, and CBC
Musculoskeletal System
- Passive ROM
- Active ROM
- Consult PT/OT
- "E" on ICU liberation bundle: Early mobility and exercise
Neurological System
- Impaired blood flow to and from brain, detrimental in elevated ICP
- Treatment: lowest possible PEEP, tidal volume, keep head midline, daily sedation vacation
Communication with ET Tube
- Client cannot vocalize their needs
- Assess stressors: fear, frustration, isolation, anger, helplessness, anxiety, sleeplessness, delirium, and restraints
- Create a healing environment
- Focus on client and family
- Reduce noise
- Reduce light
- Provide reassurance
- Sleep-wake cycles
- Orientation measures (time, place, etc.)
- Complementary and alternative measures
- Therapeutic touch
- Guided imagery/relaxation
- Spirituality/prayer
- Individualize care
- Inform and involve client
- Involve family in the care delivery
Weaning from Ventilator (Liberating)
- Individualized and collaborative effort
- Inform client about expectations
- Use the "B" and "F" of the ABCDEF bundle
- Involve family, loved ones
Readiness to Wean
• Client's recovery (respiratory, hemodynamic, mental) • Resolution of underlying issues (underlying causes) • Adequate respiratory strength • Oxygen: SpO2 ≥90% and PEEP ≤5, FiO2 ≤50% • Mental readiness and neuro intact • Respiratory-suppressing drugs are minimal
Weaning Methods
- Ventilator settings, provide pressure support or CPAP
- No vent respiratory rate, T-piece trials
Stop the Weaning Process
- Evaluate clinical status (respiratory, cardiovascular, neurological)
- Respiratory: Rate, low spontaneous tidal volume, Increased work of breathing, abnormal breathing pattern, low oxygen saturation
- Cardiovascular: HR or BP changes, dysrhythmias, ST-segment elevation, diaphoresis
- Neurologic: decreased LOC, anxiety, agitation, restlessness, subjective discomfort
Extubation
- Determine need for secretion management
- Hyperoxygenate
- Assess (hoarseness, stridor, airway obstruction, change in vital signs, low oxygen saturation)
- NIPPV (optional, bridge 1-2 hrs)
- Monitor closely first hour (post extubation)
Review of Case Study #1: Thyroid Storm vs Myxedema Coma
- Client is presented with reported insomnia, heart fluttering, weight loss, and intolerance to heat
- Subjective: Nausea (1 week), diarrhea (2 days), increasingly irritable and restless (per family)
- Objective: Restless, mild diaphoresis, Eyes appear dry, slightly protruding (exophthalmos); lungs clear bilateral upper anterior lobes with bibasilar crackles; S1, S2 appreciated with audible S3, bounding peripheral pulses (3+), sinus tachycardia noted on cardiac monitor; enlarged bulging on neck (goiter), thyroid bruit
Review of Case Study #2: Recognizing Cues in elderly male client with possible infection and elevated blood glucose
• Initial brief assessment: Alert and oriented, productive cough, Serum blood glucose 486 mg/dL, Hemoglobin A1c 6.8%, Serum potassium 3.5 mEq/L, Rhinitis with pale yellow, thick drainage, Reports urinating multiple times every hour, Burning pain bilateral toes to mid-calves • Highlight the 4 assessment findings that require follow-up by nurse: • Serum blood glucose 486 mg/dL • Burning pain bilateral toes to mid-calves • Reports urinating multiple times every hour • Productive cough
Analyzing Laboratory Results for Acid-Base imbalances and potential causes
Types of Acid-Base & related imbalances
Principles for ABGs
- STEP 1: Look at each number and label
- Evaluate oxygenation
- Determine the pH
- Determine the primary cause of the acid-base status
- Determine the compensation (if occurring)
Quick Quiz - Interpreting ABG Results
Noninvasive Assessment of Oxygenation
- Pulse oximetry measures (Sp02 and PaO2)
- Ensure accurate readings
- Limit movement (in client)
Non-invasive Assessment of Ventilation
- End-tidal CO2 (ETCO2) capnography
- Compare with ABGs and use for trending
- Values tend to be 1 to 5 mm Hg less than PaCO2
- Calorimetric CO2 detector
- Disposable devices. Yellow CO2 present
- Use of other confirmatory measures for ETT placement
Oxygen Administration
- Oxygen to treat or prevent hypoxemia, keep SaO2 >60mmHg and SpO2 >90%
- Humidification
- Flow rates > 4 L/min
- Mechanical ventilation
- Delivery devices: (Low flow: nasal cannula 1-6L/Min, High flow: nasal cannula up to 15L/M, Salter)
- (High flow: optiflow up to 60L airflow and 100%, Simple face mask 5-12L usu 8L)
- (Reservoir systems (partial mask, Non-rebreathing mask), Venturi or air-entrainment mask)
Avoiding High Levels of Oxygen Therapy
- Nitrogen washout
- Promote atelectasis and fibrotic changes in lung tissue
- Risk for oxygen toxicity (ringing in ears or tingling extremities)
Noninvasive Positive Pressure Ventilation (NIPPV)
- Delivery of positive-pressure ventilation without artificial airway
- Via face mask, nasal pillow, Both inspiratory and expiratory support
- Reduces the need for intubation
- Useful in COPD clients, heart failure, palliative care
- Must have ability to maintain airway and respiratory drive
- Do not use in nauseated client
- Must have continuous cardiac/ SpO2 monitor
- Do not restrain the client with NIPPV!
Complications of ARDS
- Multiple organ dysfunction syndrome (primary cause of death)
- Renal failure and blood pressure decreases
- Barotrauma and volutrauma
- Stress ulcers and gastrointestinal bleeding
- Long-term pulmonary effects associated with high oxygen therapy
Oxygenation and Ventilation Overview
- Include acid-base imbalances and ABGs
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Description
Test your knowledge on various interventions and medications used for respiratory management. This quiz covers medication targeting inflammation, techniques for assessing ventilation, and more. Gain insights into how to improve respiratory function effectively.
