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resp pt management
respiratory system parient management
| Question | Answer |
|---|---|
| ventilatory pump failure (V) | hypercapnia, inadequate alveolar ventilation, elevation in carbon dioxide |
| gas exchange failure (Q) | hypoxemia |
| disorders of the CNS associated with a reduced drive to breathe | depressant drugs, brain stem lesions, head tauma, CVA |
| disorders associated with neuromuscular function | polio, myasthenia gravis, gulliain-Barre, SCI, paralytic drugs, electrolyte imbalance |
| disorders associated with musculoskeletal and pleural functions | pleural effusion, flail chest |
| dissorders of the conducting airways | laryngeal edema, asthma, bronchospasm |
| disorders of the gas exchanging units | pneumonia, pulmonary edema, ARDS |
| acute respiratory failure interventions | establish and maintain an airway, oxygenation, promote secretion clearance, optimize cardiac function |
| Nasal cannula | 2 liters to max of 6 liters of O2 |
| At what level of liters do you need to start humidifying the oxygen | 4 liters |
| Simple face mask gives up to how much % of O2 | 60% O2 |
| the partial rebreathing mask gives up to what % of O2 | 85% O2 |
| the non-rebreather mask gives up to what % of O2 | 85% o2 |
| This type of O2 deliverig system gives a very specific amount of O2 to the patient | venturi mask |
| how to measure for an oropharyngeal airway | size by measuring device from lips to angle of the jaw |
| how to measure for a nasophharyngeal airway | size by placing device from ear lobe to corner of mouth |
| endotracheal tube ariway | use uncuffed tubes for children younger than 10 years of age |
| oropharyngeal artifical airway | not for use on concious patients |
| a high low endotrach tube | has an extra lumen to use for suction to continusosly aspirate fluid around the trach and the balloon |
| Post intubation what are the most important nursing actions to initiate in reguard to the artificial airway | secure the tube, order a CXR to assess placement, note com marking at front teeth and document, prevent self-extubation |
| how to prevent ventilator acquired pneumonia | elevate head of bed to 35 degrees |
| suction should not be set greater than | 150mm |
| position to improve diaphragm function and lung volume. What sequence of events should be used | supine, sitting, sitting with feet dangling to standing |
| When a patient is on continuous lateral rotation therapy how many hours a day of rotation is necessary | 18 hours |
| When a patient is on continuous lateral rotation therapy how many hours of rotation are necessary per shift | 9 hours |
| When positioning a patient that has respiratory failure it is best to | put the good lung down it gives the best oxygenation |
| beta 2 agonist | albuterol |
| anticholinergics | blocks vagas nerve |
| bronchodilators | albuterol, anticholinergics, methylaxanthines |
| used to open an airway | anti-inflamatory, steroids |
| breaks the protien bonds in mucus | mucomyst |
| light to deep sedation | sedative/hypnotic |
| sedative/hypnotic | benzodiazepines(versed, valum, ativan), propofol, precedex |
| analgesics | morphine, fentanyl |
| negative pressure ventilation | for longterm or homehealth care not used in the acute care setting |
| forcing gas into lungs | positive pressure ventilation |
| positive pressure ventilation | could cause pneumothorax, barro trauma and low preload with low cardiac output |
| Why do you not want to use normal saline to moisten mucous build up or secretions | causes decreased sats and puts bacteria into the lungs |
| monitor FiO2 changes with | pulse oximetry |
| Goal for vent settings PaO2 | greater than 60 |
| Goal for vent settings SaO2 | greater than 90 |
| Goal for vent settings FiO2 | less than or equal to 0.5 |
| keep peak inspiratory pressure less than 40cm H2O | if greater causes injury to lungs |
| a smaller tidal volume is needed when | the lungs are less compliant |
| on the vent resp rate should be set around | 12-20 |
| PEEP | hold avoli open to improve oxygenation |
| Positive end expiratiory pressure | PEEP |
| keep less than 40 cm H2O | PIP (pressure inspiratory pressure) |
| compare to set tidal volume | exhaled tidal volume |
| methods y which the patient and ventilator interact to perform the respiratory cycle | Mechanical ventilation MODES |
| Assist control | set number of breaths at a set Vt, patient can take spontanious breaths, assisted breaths at a set Vt, minimal work for the patient |
| SIMV (synchronized Intermittent Mandatory Ventilation) | set number of breaths at a set tidal volume, patient can take spontaneous breaths at their own tidal volume, allows patient to contribute to the work of breathing, also known as the weaning mode |
| volume control vent modes | Assist control and SIMV |
| Pressure control (PC) | patient receives a set number of breaths of a set inspiratory pressure, patient can take spontaneous breaths at a set pressure, minimal work for the patient, guaranteed number of breaths with inspiratory support, used for fullsupport and noncompliant lung |
| Pressure Support (PS) | Patients spontaneous breaths are augmented by the delivery of a preset amount of positive inspiratory pressure patient has to iniciate every breath no rate is set |
| CPAP (continuous positive airway pressure | spontaneous breating with pressure applied at end expiration, weaning mode, for patient that needs to maintain oxygenation |
| Airway Pressure Release Ventilation (APRV) | provides two levels of CPAP, spontaneous breaths at anypoint in resp, starts at an elevated pressure followed by a release pressure, time on high pressure is longer than low pressure time, holds airway open |
| keeps alveoli open at all times and is for patients wit hvery incompliant lungs | APRV (airway pressure release ventilation) |
| Pressure control vent modes | PC, PS, CPAP, APRV |
| highest priority in the ICU | vent alarm |
| never turn off | an alarm |
| when a patient does not breathe for 20 sec. | apnea |
| what would cause a low inspiratory pressure | a break in the circuit |
| what would cause a high pressure limit | coughing secretions kinked tube or biting |
| pressure injurt to the lungs | barotrauma |
| how to prevent vent pneumonia | washing hands, keep head of bed at 30degrees, use sterile procedures, and good oral care |
| if patient has a decreased cardiac output | give volume, dopamine or dobutamine (inotrope) |
Created by:
dnoyes
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