Advanced Respiratory: Oxygenation/Ventilation
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| show | Sedated...
In a severe amount of pain.
Changed LOC.
Respirator and Cardiac status are compromised
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| Although we have technology | show 🗑
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| Be prepared-What can potentially go wrong | show 🗑
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| With a higher acuity patient | show 🗑
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| If an alarm goes off or a number looks abnormal | show 🗑
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| show | Oxygen therapy
Reposition - move up in bed if slumped
Cough/deep breath
suction
Medications- look at standing orders or current orders
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| show | Smoking-how long? Smokers tend to do much worse d/t damage to lungs and mucosa, don't have as good responses, especially older smokers
Young smokers in traumas harder to manage
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| Cardiopulmonary history | show 🗑
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| show | Listen for crackles, assess urine output,
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| Sleep/Rest history | show 🗑
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| show | At rest or upon exertion?
Postop pts can have dyspnea upon exertion-are they tolerating it? Sats still ok?
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| Chest pain assessment | show 🗑
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| show | listen to cough, productive?, thick?, wheezy sounding? how does sputum look
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| show | More hoarse, dry sounding with distress
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| show | Overwhelming tiredness even when person is resting
Could be another issue
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| show | Disease processes (past and current)
Flu season? Immunizations current?
Environmental exposures/Behaviors (past and current)
Medical/surgical hospitalizations
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| cardinal s/sx of respiratory distress | show 🗑
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| show | Dyspnea, wheezing, cough, sputum, palpitations, swollen feet
Don't rely on monitor-s/sx can be masked ie., tachycardia masked by beta blockers
Fatigue
Chest pain
Anxiety-anxiety is big
Dizziness
Bradycardia
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| Key Factors that cause hypoxia or impede pts breathing | show 🗑
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| Observing the chest | show 🗑
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| show | Pursed lip breathing
Pallor, clammy, cool skin
↓ cap refill
Clubbing-long-term sign
Barrel chest
Respiratory rate (12-20)
However, all pts are different
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| A pt with COPD expiratory time? | show 🗑
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| show | Respirations gradually increase in depth, then become more shallow, followed by a period of apnea.
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| show | Highly irregular breathing pattern with abrupt pauses between efforts
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| show | Respiration faster and deeper without pauses
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| show | Respirations prolonged, gasping, followed by extremely short, inefficient expiration
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| Factors that alter a good wave form on a monitor | show 🗑
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| Respiratory Assessment | show 🗑
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| show | bronchial
bronchovesicular
Vesicular
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| bronchial | show 🗑
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| show | bronchovesicular
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| Vesicular | show 🗑
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| Adventitious breath sounds include: | show 🗑
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| show | Fluid or mucous moving through the smaller airways
Crackles can't be cleared with coughing, need loop diuretics, ↓ fluids
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| show | High-pitched musical sounds
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| Rhonchi | show 🗑
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| Pleural friction rub | show 🗑
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| Stridor | show 🗑
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| show | Look at the pulse ox, what is the pt restlessness and agitated for, it there something else going on? Could it be a pain situation?
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| Decreased LOC | show 🗑
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| show | Reposition. Did it help?
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| show | Usually a late sign - can happen quickly sometimes
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| Accessory muscles | show 🗑
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| Dyspnea or orthopnea | show 🗑
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| show | Changes from assessment to the next things are moving around
Be prepared for issues that might arise
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| Onset of S/S distress Early s/sx | show 🗑
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| Onset of S/S distress Late s/sx | show 🗑
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| show | early or late
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| SV02 | show 🗑
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| show | At what rate is the body using oxygen, is the body demanding more oxygen to perfuse the tissues than what we're giving them?
Manytimes used with pts w/ resp and cardiac problems
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| Don't start ? before Sputum tests | show 🗑
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| Pulmonary angiograms | show 🗑
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| ETCO2 monitoring (end tidal) | show 🗑
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| V/Q scans | show 🗑
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| Balance and Imbalance in Ventilation Perfusion (VQ) | show 🗑
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| Alterations in Ventilation: | show 🗑
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| Alterations in Perfusion: | show 🗑
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| show | Relationship between_the alveoli to _the flow of blood of the lungs__
-ventilation to flow of blood
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| Emphysema and COPD | show 🗑
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| show | V/Q is greatest in __base of the lungs because that where the majority of our gas exchange takes place
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| Possible VQ States | show 🗑
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| show | Amount of inhaled and exhaled air in mL, normally 6 - 10 mL/kg
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| show | Measured with incentive spirometer
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| show | Endo-tracheal - about 4 cm above the carina
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| show | Bilateral breath sounds
O2 sats come up nicely
End-tidal CO2 within normal limits
Then, look at chest x-ray for final confirmation
Note and chart ET tube depth measurement at lips
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| Improper Placement | show 🗑
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| show | Assess pt-need more O2? Bag, non-rebreather?
Call for physican
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| show | Need in room! Need bag and valve!
Need O2 wall or cylinder.
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| MECHANICAL Ventilation Indications: | show 🗑
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| show | Decreases system & MVO2 requirements
Helps L ventricle, decreases O2 requirements of the L ventricle
Permit sedation
Reduce ICP
Hyperventilation reduces ICP
Prevent atelectasis
Secure airway
Too much sedation causes respiratory depression
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| Goals of MV | show 🗑
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Created by:
mgyger
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