click below
click below
Normal Size Small Size show me how
375 Exam 1
Obstructive Sleep Apnea, NPPV
Term | Definition |
---|---|
obstructive sleep apnea | episodes of partial or complete upper airway obstruction during sleep |
apnea | cessation of respiratory airflow; 90% or greater decrease in airflow lasts longer than 10 seconds, may experience hypoxia |
hypopnea | caused by shallow respirations, decrease in airflow limitation 30 - 90% can last 10 - 90 seconds |
airflow obstruction in OSA can occur due to | narrowing of air passages with relaxation of muscle tone during sleep, the tongue and soft palate falling backward and partially or completely obstructing the pharynx |
3 major signs of OSA | sleepiness, excessive daytime sleepiness, sleep apnea, snoring |
OSA signs | insomnia, dry mouth, fatigue and nocturia, attention deficit, morning headache from buildup of CO2 |
OSA complications | over activation of the SNS, increased vascular resistance and reduced oxygenation of the heart muscle; hypertension, diabetes, coronary disease, heart failure, depression |
diagnosis OSA | sleep and medical history; berlin questionnaire (snoring, severity, history of hypertension, obesity), STOP BANG (eight yes/no items) |
sleep study | polysomnography, monitors sleep cycles and stages, patterns, chest and abdominal movement, oral and nasal airflow, oxygen and ocular movement |
apnea hypopnea index | apnea + hypopnea/ hour of sleep |
noninvasie positive pressure ventilation (CPAP/ BiPAP) | prevent airway collapse with air pressure |
continuous positive airway pressure (CPAP) | air pressure (5 - 15) during inspiration and expiration can be delivered via nasal or facial mask; highly effective if 4 hours a night |
bilevel positive airway pressure (BiPAP) | set to deliver a set amount of pressure during the inspiratory phase of each breath (IPAP) and then maintains a low positive pressure at the end of the expiratory phase (PEEP) |
IPAP | 5 - 10 cm H2O, higher pressure, enhances oxygenation and ventilation |
EPAP | 3 - 5 cm H2O, lower pressure |
UPPP | removes obstructing tissue from tonsillar pillars, uvula and posterior soft palate |
GAHM | places the pharyngeal muscles and base of tongue of tension |
major concerns post op | airway and breathing, monitor for swelling, decreased oxygen levels, agitation (hypoxemia), respiratory distress, stridor (airway closing) |
noninvasive positive pressure ventilation | ventilatory support without an invasive artificial airway, uses a mask; reduce intubation rates and ICU admissions |
NPPV use | reduce respiratory rate, reduce CO2 levels, increase oxygen levels, correct pH, increase volume of each breath |
NPPV indications | acute respiratory failure, heart failure, COPD exacerbation, OSA, acidosis or hypercapnia |
CPAP | used for clients with obstructive sleep apnea, delivers continuous positive airway pressure above atmospheric pressure keeping the airway patent |
nasal mask advantages | best suited for cooperative clients, causes less claustrophobia, allows for speaking, drinking, coughing, decreased aspiration risk |
nasal mask disadvantages | increased risk of air leaks from the mouth, limited effectiveness in clients with nasal deformities |
orofacial mask advantages | less cooperative clients, better for clients with mouth breathing or pursed lip breathing, more effective ventilation |
complications for invasive ventilation | skin irritation, mouth dryness, sinus pain, barotrauma, gastric distention |
indication for mechanical ventilation | failure to generate spontaneous ventilations, hypoxia or hypercarbia |
goal of mechanical ventilation | maintain alveolar ventilation appropriate for client's metabolic needs, correct hypoxemia and maximize oxygen transport, rest respiratory muscle |
volume ventilation | predetermined tidal volume is delivered with each inspiration |
pressure ventilation | tidal volume varies based on several factors; pressure, compliance and resistance |
PEEP | positive end expiratory pressure; exerts pressure to oppose passive emptying of the lung and keep airway pressure above atmospheric pressure; limits risk of O2 toxicity |
alarm fatigue | sensory overload from excessive alarming, can cause delayed response or dismissal of the alarm |
high pressure limit | secretions and coughing, excess water in tubing, tubing kinked, decreased compliance, client or ventilator asynchrony |
low pressure limit | disconnect, loose secretions, self extubation, trach cuff leak |
ventilator mode | way the ventilator delivers effective ventilation; setting determines on ABG, weight, LOC, respiratory muscle strength |
assist control | every breath is supported by the ventilator, delivers a preset tidal volume with a preset rate (6 - 8); indicated for critically ill with no or weak spontaneous drive to breath, max amount of support |
advantage assist control | guaranteed respiratory rate, guaranteed minute volume, better for CO2 removal |
disadvantages assist control | less comfortable, may lead to deconditioning |
pressure support | no set tidal volume or RR, set pressure level, PEEP and sensitivity, patient must be able to initiate spontaneous breaths and control overall rate and volume of each breath; used for weaning from mechanical ventilation, increased client comfort |
synchronized intermittent mandatory ventilation (SIMV) | set tidal volume, set RR; allows spontaneous breaths, improved synchrony with the ventilator, prevents muscle atrophy |
disadvantages of SIMV | need to have respiratory drive, can cause increase work of breathing |
barotrauma | increase airway pressure distends the lungs and ruptures over distended alveoli |
pneumothorax | complication of mechanical ventilation; air in the pleural space becomes trapped and increases pleural pressure that collapses the lung |
pneumomediastinum | rupture of alveoli into the lung interstitium |
alveolar hypoventilation | caused by inappropriate ventilator settings, leakage of air or obstruction; caused by a low tidal volume or respiratory rate, can lead to atelectasis, hypoventilation and respiratory acidosis |
alveolar hyperventilation | overventilation; respiratory rate or tidal volume is too high, leads to respiratory alkalosis; caused by fear pain or anxiety |
sodium and water imbalance | fluid retention can occur 48 - 72 hours after starting mechanical ventilation, lead to decrease urine output and increased sodium retention |
ventilator associated pneumonia | contaminated respiratory equipment, inadequate hand hygiene, client's inability to cough or clear secretions |
weaning on mechanical ventilation | reducing ventilator support, respiratory therapy will complete a spontaneous breathing trial, assess client's tolerance |