Intro to Mechanical Ventilation - Respiratory Care - PDF

Intro to Mechanical Ventilation Chapter 1 Part 1 Objectives 1. Define respiratory care and critical care. 2. Summarize the disease states or conditions which often require ICU admission and mechanical ventilatory support. 3. Contrast the types of patients seen in the medical intensive...

Intro to Mechanical Ventilation Chapter 1 Part 1 Objectives 1. Define respiratory care and critical care. 2. Summarize the disease states or conditions which often require ICU admission and mechanical ventilatory support. 3. Contrast the types of patients seen in the medical intensive care unit (MICU), surgical intensive care unit (SICU), coronary care unit (CCU), pediatric intensive care unit (PICU), and neonatal intensive care unit (NICU). 4. Explain the difference between a Level I and Level III NICU. 5. Describe the types of services provided in a Level I Trauma Center. 6. Explain the types of personnel and their qualifications needed to staff the ICU. 7. Explain the importance of interprofessional practice (IPP) in the ICU. 8. Contrast the design and activities associated with each of the four zones or areas found in the ICU. 9. Explain the differences between an acute care hospital ward, step-down unit, and ICU. 10. Explain the term “long-term term acute care” (LTAC) to include the types of patients seen in an LTAC facility. 11. Explain the difference between a specialty hospital and a skilled nursing facility (SNF). Objectives 12. Explain the importance of assessment of the respiratory care patient in the ICU to include types of assessment procedures and methods used. 13. Identify common admitting diagnoses seen in the ICU. 14. Explain the significance of specific physician’s orders in the ICU to include medication orders, orders for respiratory care ,laboratory testing, imaging and special procedures. 15. Describe the elements of the history and physical examination performed in the ICU. 16. Recognize and contrast the signs and symptoms of hypoxia, hypercapnea, respiratory failure, and ventilatory failure. 17. Describe the importance of specific laboratory tests and imaging procedures performed in the ICU. 18. Explain the purpose of bronchoscopy and thoracentesis performed in the intensive care unit. 19. Describe the types of cardiac and hemodynamic monitoring performed in the ICU. 20. Contrast the terms acute respiratory failure and acute ventilatory failure. 21. Recognize the indications for mechanical ventilatory support. 22. Describe the use of airway clearance therapies (ACT) in the ICU. 23. Summarize the types of care often provided by respiratory therapists in the ICU.  Key Terms Acute respiratory Coma Exudate distress syndrome Congestive heart Intensive care unit (ARDS) Acute respiratory failure (CHF) (ICU) failure (ARF) Chronic obstructive Interprofessional Acute ventilatory pulmonary disease education (IPE) failure (AVF) Arrhythmia (COPD) Interprofessional Atelectasis Coronary artery practice Bronchoscopy disease (CAD) Cerebral infarction Critical care Key Terms Long-term acute care Renal failure (LTAC) Respiratory care Mechanical ventilation Respiratory therapist Mechanical ventilatory Sepsis support Shock Step-down unit Musculoskeletal disease Thoracentesis Myocardial infarction (MI) Tracheostomy Neonatal intensive care Transudate unit (NICU) Trauma center Neuromuscular disease Pneumonia Pulmonary edema  Critical Respiratory care Respiratory therapists are trained in cardiopulmonary physiology and pathophysiology, the principles of biomedical engineering, and the application of technology to assist in the care of patient care services. Respiratory care may be provided by physicians, nurses, physician assistants, or other healthcare providers They apply scientific principles to prevent, identify, and treat acute or chronic dysfunction of the cardiopulmonary system.  Critical Respiratory Care Critical care refers to the care and management of critically ill patients who require sophisticated support, careful and constant monitoring, and complex decision- making to ensure that therapy is adjusted as patient needs change Examples shock, trauma, cardiac disease, hemodynamic instability, renal failure, neurologic disease, liver failure, and acute pulmonary disease May be provided in prehospital setting, emergency department, or other acute care settings  Critical Respiratory care Respiratory care provided in the ICU includes: Diagnostic and monitoring procedures (e.g., blood gases, respiratory monitoring) Maintenance and management of artificial airways (e.g., suctioning and airway care) Basic respiratory care techniques (e.g., oxygen therapy, aerosolized medication delivery). An essential respiratory care function is the provision of mechanical ventilatory support (aka mechanical ventilation) to patients suffering from respiratory failure  Critical Respiratory Care The role of the respiratory therapist in the ICU includes: Patient assessment and monitoring Performing basic and advanced respiratory care procedures and techniques Providing care to patients receiving mechanical ventilatory support. Table 1-1 pg 3-4  Types of Intensive Care Units Common types of ICUs include: Medical intensive care units (MICU) Respiratory Intensive General ICU Care Unit RICU) Surgical intensive care units (SICU) COPD, ARDS, severe Post-op pneumonia Coronary care units (CCU) Less common in US Acute myocardial infarction (MI) Neonatal intensive care Cardiovascular Intensive Care Unit units (NICU) (CVICU) RDS, TTN, PPHN, ECMO, ECMO, VADs, heart failure, and iNO, Premature infants cardiac dysrhythmias Pediatric intensive care units Postanesthesia Care (PICU) Unit (PACU) Infants to teen AKA Recovery room Mobile Intensive Care Unit (Mobile ICU)  Types of Intensive Care Units ICU’s may be described by the level of care provided: Level I - found in teaching hospitals with an academic mission and provide comprehensive care for patients with a wide variety of disorders Level II - may not have the resources to care for specific types of patients (e.g., multiple trauma) Level III - are able to stabilize critically ill patients and typically have transfer arrangements with more comprehensive units  Types of Intensive Care Units Level I Trauma Level V Center Trauma Provides total care for every aspect of injury and is Center Provides basic emergency characterized by: department services and 24-hour in-house coverage by may only perform: general surgeons Initial patient Rapid availability of specialists evaluation (e.g., anesthesiology, radiology, Stabilization orthopedics, neurosurgery) Transfer patients to Serves as a comprehensive facilities providing regional resource more comprehensive care, as needed.  Types of Intensive Care Units Neonatal intensive care unit (NICU) Unlike adult critical care units and trauma centers, where Level I indicates the most comprehensive care newborn infant care complexity goes from Level I, basic newborn care to Level IV, the highest level of regional neonatal intensive care unit (NICU)  Types of Intensive Care Units Level I (well newborn nursery) - care for healthy babies Level II - provide advanced newborn care (special care nursery) and may provide mechanical ventilatory support Neonatal intensive care units (NICU) (cont’d) Level III- provide comprehensive intensive care for very premature infants (i.e.,