NURS3055 Professional Practice 5 Lecture 1 - Week 4 PDF

NURS3055 – Professional Practice 5 Lecture 1 - Week 4 Acute Deterioration Requiring Complex Respiratory/Airway Support School of Nursing and Midwifery ACK NOWLE DGEM ENT OF COUNTR Y The University of Notre Dame Australia is proud to acknowledge the traditional owners and custodians of this land u...

NURS3055 – Professional Practice 5 Lecture 1 - Week 4 Acute Deterioration Requiring Complex Respiratory/Airway Support School of Nursing and Midwifery ACK NOWLE DGEM ENT OF COUNTR Y The University of Notre Dame Australia is proud to acknowledge the traditional owners and custodians of this land upon which our University sits. The University acknowledges that the Fremantle Campus is located on Wadjuk Country, the Broome Campus on Yawuru Country and the Sydney Campus on Cadigal Country. Week Four Learning Objectives On completion of this week, students will demonstrate ability to:  Differentiate between disorders of ventilation and perfusion  Identify the indications of ineffective Non-Invasive Ventilation (NIV)  Explore the roles and responsibilities of practitioners relating to intubation  Recognise the indications, considerations, and complications associated with intubation  Understand the role and mechanism for common pharmacological agents used in Rapid Sequence Induction (RSI) Section 1: Revision – Anatomy and Physiology Revision: What is ventilation? The process of allowing fresh air into the lungs and exhaling carbon dioxide Image 1. Mech ani cs o f bre athin g. R etrieve d fro m https://i.make agi f.com/med ia/1-01-20 22/Vhn TXi.g if Image 2. Airw ay passa ges. Retrie ved from https://med ical interp reterbl og.com/wp-con te nt/u plo ads/20 20/08 /ten or.gif?w =4 34 Section 1: Revision – Anatomy and Physiology Revision: Respiratory Mechanics of Inspiration Diaphragm flattens and ribs elevate → ↑ volume of the thoracic cavity Increased intrathoracic volume → ↓intrathoracic pressure Intrathoracic volume falls below atmospheric pressure and because of this pressure difference, air flows into the lungs Image 3-4. Mecha nics of brea th ing. Re tri eved from https://ba sicmed ical key.com/respi ratory-di sorde rs- 2/ Air flows from high to low pressure Section 1: Revision – Anatomy and Physiology Revision: Respiratory Mechanics Expiration Inspiratory muscles relax Natural elastic recoil of the lungs reduces the volume of the thoracic cavity ↓ volume of the thoracic cavity → ↑intrapulmonary pressure. Air moves out of lungs because the pressure in the alveolus is greater than atmospheric pressure. Image 3-4. Mecha nics of brea th ing. Re tri eved from https://ba sicmed ical key.com/respi ratory-di sorde rs- 2/ Air flows from high to low pressure Section 1: Revision – Anatomy and Physiology Revision: Lung characteristics - Resistance Airway resistance refers to the forces that oppose airflow within the respiratory passageways Increased airway resistance increased work of breathing: Bronchoconstriction/dilation Patency of ETT Size of ETT Image 5. Airw ay resistan ce in asthma. Re tri eved from https://ww w.shal by.org/wp-con te nt/u plo ads/20 17/10 /a sth ma.png Section 1: Revision – Anatomy and Physiology Revision: Lung characteristics - Compliance The ease at which the lungs can be expanded e.g. a balloon that is easy to inflate is very compliant. Conditions that will affect compliance: Pulmonary oedema Adult Respiratory Distress Syndrome (ARDS) Pulmonary fibrosis Volume is also dependent on chest wall compliance Section 1: Revision – Anatomy and Physiology Lung volume Functional residual capacity (FRC) is the amount of air in lungs at the end of a normal expiration FRC will impact: Gas exchange Lung compliance Atelectasis The greater the lungs are inflated, the more Image 7. Ana to mical d ead sp ace. Retrie ved from https://i0.w p.com/don tforg etth ebu bbl es.com/wp- con te nt/u plo ads/20 23/01 /D ead space.p ng? resize =1 024 %2C 768 &ssl=1 / surface area for gas exchange. Anatomical dead space is the volume of air that takes no part in gas exchange: the nose, pharynx, larynx, trachea, where no units of gas exchange (alveoli) are present Section 2: Exploring Oxygenation, Ventilation, and Perfusion In Section 2 we will delve deeper into oxygenation, ventilation, and perfusion through the respiratory system. Section 2: Exploring Oxygenation, Ventilation, and Perfusion O2 does not dissolve readily in water, & therefore very little O2 (3%) is carried in a dissolved state in blood. This results in the need for adequate red blood cells and haemogloblin to facilitate gas exchange CO2 readily dissolves in water and there is a greater abundance carried in a dissolved state in the blood, in the form of carbonic acid and bicarbonate, which then offloads carbon dioxide at the alveoli Movement of oxygen and CO2. Retrieved from https://qph.cf2.quoracdn.net/main- qimg-807202e3616ebe7687f52ff0ab3c3aee-pjlq Section 2: Exploring Oxygenation, Ventilation, and Perfusion The movement of gases, into and out of the bloodstream and alveoli, is dependent on the law of diffusion. Molecules will diffuse across a semi-permeable membrane from an area of high to low concentration Alve ola r g as excha nge. Re tri eved from https://ba sicmed ical key.com/respi ratory-di sorde rs-2/ Section 2: Exploring Oxygenation, Ventilation, and Perfusion Hydrostatic pressure is the force exerted by a fluid against the wall of its container, in this case, the capillary walls. In the cardiovascular system, it's primarily generated by the pumping action of the heart. Hydrostatic pressure is balanced by oncotic pressure (osmotic pressure exerted by plasma proteins, notably Image 1 0. H ydrostatic pre ssure. Retrie ved from https://s3-us-we st-2.ama zona ws.com/course s-ima ges-arch ive-rea d-on ly/wp- con te nt/u plo ads/sites/40 3/201 5/04/21 031 434 /2 108 _Ca pil lary_ Exchan geN.j pg albumin, in the plasma and interstitial fluid), which tends to pull water into the capillary. Section 2: Exploring Oxygenation, Ventilation, and Perfusion Oxygen diffuses from alveoli to the bloodstream Oxygen then attaches to available haem-sites of red blood cells Oxygen then diffuses toward cells as the bloodstream has a higher concentration than the cells Image 1 0. C ell ula r g as excha nge. Re tri eved from https://med ictests.co m/u nits/th e-mech ani cs-of-resp iratio n / Section 3: Ventilation and Perfusion Disorders In Section 3 we will explore the specific presentations that result in disorders of ventilation and perfusion Section 3: Ventilation and Perfusion Disorders Ventilation and perfusion disorders relate to: Ventilation disorders where air has trouble Constricted reaching alveoli, as seen in constricted Airways airways. Perfusion disorders where air reaching the alveoli experiences a lack of adequate blood flow beside it. Section 3: Ventilation and Perfusion Disorders Ventilation Disorders: Obstructive Lung Diseases Conditions like chronic obstructive pulmonary disease (COPD), asthma, and bronchiectasis lead to narrowed airways, making it difficult to exhale all the air from the lungs, causing ventilation issues. Image 1 1. C OPD a nd ven ti latio n. R etrieve d fro m https://med ia.spri nge rnature.co m/ful l/sprin ger-static/imag e/art%3A1 0.103 8%2 Fn rdp.20 15.76 /Me dia Ob jects/415 72_ 201 5_Articl e_BFnrd p201 576 _Fig1 _HTML.jp g Section 3: Ventilation and Perfusion Disorders Ventilation Disorders: Restrictive Lung Diseases Diseases like pulmonary fibrosis, sarcoidosis, and neuromuscular disorders restrict lung expansion, limiting the volume of air that can be inhaled, hence decreasing ventilation. Image 1 2. Pu lmon ary fi brosi s a nd ven ti latio n. R etrieve d fro m https://med ia.spri nge rnature.co m/ful l/sprin ger-static/imag e/art%3A1 0.103 8%2 Fn rdp.20 17.74 /Me dia Ob jects/415 72_ 201 7_Articl e_BFnrd p201 774 _Fig1 _HTML.jp g Section 3: Ventilation and Perfusion Disorders Ventilation Disorders: Airway Obstruction Foreign bodies, tumors, or inflammation can physically block the airways, preventing adequate air movement. Image 1 3. Obstructive tumo urs and ve ntila ti on. Retrie ved from https://my.cleve lan dcli nic.org /-/scassets/Ima ges/org /h eal th /a rti cles/62 02-smal l-cel l-lu ng-can cer Section 3: Ventilation and Perfusion Disorders Ventilation Disorders: Chest Wall Abnormalities and Neuromuscular Disease Conditions like scoliosis or severe obesity restrict the expansion of the chest wall, limiting lung inflation. Diseases such as amyotrophic lateral sclerosis (ALS) or Guillain-Barré syndrome weaken the muscles that support breathing, leading to reduced Image 1 4. Insp iratio n gif. R etrieve d fro m https://ww w.visib leb ody.com/hu bfs/l earn /a ssets/g lossa ry/re spira to ry/re spira to ry-system-pu lmon ary-ven ti latio n-gi f.gi f ventilation. Section 3: Ventilation and Perfusion Disorders Perfusion Disorders: Pulmonary emboli Ventilation and Perfusion mismatch occurs A blood clot lodged in the pulmonary vasaculature This clot occludes normal blood flow beyond this occlusion site Abnormal blood flow occurs and reduces alveoli ventilation Alveoli may be ventilated appropriately Blood flow is obstructed, and gas exchange is reduced Image 1 4. Insp iratio n gif. R etrieve d fro m https://ww w.visib leb ody.com/hu bfs/l earn /a ssets/g lossa ry/re spira to ry/re spira to ry-system-pu lmon ary-ven ti latio n-gi f.gi f The blockage caused by blood clot formation must be resolved Section 3: Ventilation and Perfusion Disorders Perfusion Disorders: Pulmonary arterial hypertension, pulmonary fibrosis, and left sided heart failure Elevated blood pressure in the pulmonary arteries can impede blood flow, affecting perfusion. Reduced perfusion may result in a decreased gas exchange at the site of alveoli Image 1 6. Pu lmon ary embo li. Retrie ved from https://ww w.svhhe arthea lth.com.au/Image s/U serUp loa ded Ima ges/96 5/6_SVH _Lu ng_ Hea lth_Pu lmon ary_H yperten sion _fina l_1 080 p.jpg Section 4: The Impact of NIV on Ventilation and Perfusion In Section 4 we consolidate your understanding of NIV modes and relate them to ventilation and perfusion Section 4: The Impact of NIV on Ventilation and Perfusion NIV: High Flow Oxygen Therapy Paediatric administration: 12kg: 2L/kg/minute for the first 12kg + 0.5L/kg/min for each additional kg thereafter (maximum flow 50L/min) Adult administration: 40L/min is the recommended minimum requirement to produce a positive intrathoracic pressure in the adult patient Section 4: The Impact of NIV on Ventilation and Perfusion NIV: CPAP and BiPAP Continuous Positive Airway Pressure: A preset, constant pressure of air is delivered to the patient throughout the entire breath cycle Indicated in presentations of failure to oxygenate (Hypoxic respiratory failure – Type 1) Bi-level Positive Airway Pressure: A preset, inspiratory pressure (IPAP) of air higher than expiratory pressure (EPAP) delivered throughout the breath cycle Indicated in presentations of failure to oxygenate and ventilate ( Hypercapnic respiratory failure – Type 2) Section 4: The Impact of NIV on Ventilation and Perfusion CPAP - Indications Acute exacerbations of COPD Asthma Acute cardiogenic pulmonary oedema Hypoxemic respiratory failure Post-op respiratory failure – atelectasis Obstructive sleep apnoea Section 4: The Impact of NIV on Ventilation and Perfusion BiPAP Indications Acute respiratory failure - Type 2 COPD Pneumonia Congestive cardiac failure Acute pulmonary oedema Atelectasis Neuromuscular disease Sleep apnoea Useful in patients who are poor candidates for mechanical ventilation. Section 5: Exploring Invasive Oxygenation and Ventilation Respiratory failure and Escalating care What happens when oxygen therapy and Non-Invasive Positive Pressure Ventilation is not enough? Respiratory failure Type 1 respiratory failure – Failure to oxygenate Type 2 hypercapnoeic respiratory failure – Failure to ventilate Section 5: Exploring Invasive Oxygenation and Ventilation Laryngeal Mask Airway (LMA) 1. Description and Types Various designs: Inflatable, soft-gel seal, and those with dual gastric access to facilitate nasogastric tube access. Selection is based on the specific needs and safety considerations of the patient. 2. Indications and Contraindications Preferred for less invasive procedures, ease of placement, and reduced trauma. Not suitable for patients at risk of aspiration or with severe airway obstruction. Section 5: Exploring Invasive Oxygenation and Ventilation 3. Advantages of LMA Minimally invasive, quick and easy to place. Causes less trauma to the airway, enhancing patient comfort and A person wearing a yellow glove holding a tube to a person's safety. mouth Description automatically generated 4. Procedure for Insertion Starts with patient preparation, including fasting to reduce aspiration risk. Insertion involves positioning the patient, lubricating the LMA, gentle insertion to the hypopharynx to create a seal around the glottic opening, inflation of the cuff, and checking for correct placement and adequate ventilation. Section 5: Exploring Invasive Oxygenation and Ventilation Intubation is a procedure to secure a patient's airway, facilitating ventilation and oxygenation. Anatomy relating to Intubation: - Oropharynx - Glottis and Epiglottis - Trachea - Nasopharynx - Bronchi - Larynx Section 5: Exploring Invasive Oxygenation and Ventilation Indications for Intubation: Any patient in cardiac or respiratory arrest Risk of airway obstruction (burns of upper airways, head & facial trauma, foreign body ingestion, increased swelling) Need to control and remove pulmonary secretions Inadequate oxygenation (decreased PaO2) Inadequate ventilation (increased PaCO2) Anticipated respiratory failure secondary to conditions that may rapidly lead to respiratory compromise, e.g. Asthma, COPD, Heart Failure, Respiratory Infections Patient with reduced consciousness GCS