Respiratory System2

RESPIRATORY SYSTEM Billy Ray A. Marcelo, RN Faculty Bataan Peninsula State University

OVERVIEW 

Basic Process of Oxygenation  Ventilation- degree of compliance, airway resistance, accessory muscles (Respiratory System)  Diffusion- thickness of membranes (Hematologic System)  Perfusion- integrity of transport system (CV and Hematologic System)

OVERVIEW 

Function: Respiratory System  Obtains O2, removes CO2  Filters particles from incoming air  Control T and water content  Role in sense of smell  Regulates blood pH

OVERVIEW

OVERVIEW

Upper Respiratory Tract  Filtering of air, warming, moistening  Humidification A. Nose  Framework of cartilage  2 septum/nostril  Anastomosis of capillaries (Keisselbach) B. Pharynx (Throat)- organ of GI and RT  Muscular pasageway for food and air  Nasopharynx  Oropharynx  Laryngopharynx 

OVERVIEW C. Larynx (Voicebox)  Phonation (speech production)  Cough reflex  Frameworks  Arythenoid and cricoid cartilage  Thyroid gland  Hyoid bone  Glottis  Epiglottis  Opens: passage of air  Closes: passage of food

Upper Respiratory Tract

OVERVIEW

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Lower Respiratory System  Gas exchange A. Trachea (windpipe)  Cartilaginous rings, ‘U’ shape  Site of permanent artificial airway (tracheostomy) B. Carina- area of bifurcation of brochi C. Bronchi  R main bronchus- wider straighter  L main bronchus

OVERVIEW

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Lower Respiratory System D. Lungs- covered by serous membrane  R- 3 lobes  L- 2 lobes  Pleural cavity  Parietal- with 20 cc of fluid to prevent friction, with nerve endings  Visceral- without nerve endings  Pleural

OVERVIEW 

Lower Respiratory System D. Lungs  Terminal bronchioles Alveoli (Acinar cells)- site of gas exchange (CO2 and O2) Type II cells- secretes SURFACTANT (phospholipid lipoprotein) → ↓ surface tension

PNEUMONIA 

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Inflammation of lung parenchyma → pulmonary consolidation as the alveoli are filled with exudates Causative Agents  Streptococcus pneumoniae (Pneumococcal pneumonia)  Hemophilus influenzae (Bronchopneumonia)  E. Coli  Klebsiella  Pseudomonas aeruginosa

PNEUMONIA

Predisposing Factors:    

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PNEUMONIA Excessive smoking Air pollution Over fatigue Prolonged immobility → hypostatic pneumonia Aspiration Immunocompromised state  AIDS- Pneumocystis carinii (taking Zidovudine or AZT)  Bronchogenic CA

Signs and Symptoms: PNEUMONIA        

Productive cough (greenish to rusty sputum) Dyspnea with prolonged expiratory grunt Fever, chills, anorexia, N/V, weight loss Pleuritic friction rub Rales, crackles, Bronchial wheezing Cyanosis Chest pain Abdominal distension → paralytic ileus (most feared Cx)

Diagnostic Procedures: PNEUMONIA

Sputum C/S  Gram-staining C/S  Chest X-Ray- reveals pulmonary consolidation  ABG- ↓ pO2  CBC- ↑ WBC, ↑ ESR 

Nursing Management: PNEUMONIA

CBR  Place pt. on semi-fowler’s  Low flow O2 as ordered 

Give comfortable and humid environment  Diet: ↑ CHON, ↑ CHO, ↑ Vit C 

Force fluids to liquefy secretions  Importance of receiving immunization as recommended 

Nursing Management: PNEUMONIA 

Administer meds as ordered Broad spectrum antibiotics Penicillin, Tetracycline, Macrolides Antipyretics Mucolytics/ Expectorants (Guiafenesin, Glycerine, Guiacolate)

Nursing Management: PNEUMONIA Institute pulmonary toilet  DBE  Coughing  Chest physiotherapy (CPT)  Turning and repositioning  Nebulize and suction prn 

Chest Physiotherapy

Nursing Management: PNEUMONIA 

Institute postural drainage as ordered  Pt is placed on various positions to promote drainage of secretions, stay for 20-30 minutes  Best done before breakfast, or 2-3 hrs p.c.  Pt. should be well hydrated, knows how to cough  Prone with pillow on abdomen- drains lower part of the lungs  Supine with buttocks up- drains upper part of the lungs

Postural Drainage

Postural Drainage

Nursing Management: PNEUMONIA 

Institute postural drainage as ordered  Monitor VS, breath sounds  Administer bronchodilators 15-30 minutes prior  Encourage DBE  Stop if pt can’t tolerate the procedure  Give oral care post procedure  No to pt with: hemoptysis, unstable VS, ↑ ICP, ↑ IOP

Nursing Management: PNEUMONIA  Discharge Health Teaching Stop smoking Regular adherence to meds Dietary modification Follow-up care Prevent Cx: atelectasis and meningitis

PULMONARY TUBERCULOSIS   

Or Koch’s Disease Causative agent: MTB- acid-fast, non-motile Predisposing Factors  Malnutrition  Overcrowding  Alcoholism  Ingestion of affected cattle (with M. bovis)  Virulence of the microorganism

PULMONARY TUBERCULOSIS

Signs and Symptoms: PTB Productive cough- yellowish secretions > 2 wks  Dyspnea  Low grade afternoon fever- Pathognomonic Sign  Night sweats- Classical Sign  Anorexia, general body malaise  Weight loss  Chest pain  Hemoptysis 

Diagnostic Procedures: PTB 

Mantoux Test- skin test, injection of PPD  Reading: after 48-72 hrs  (+) exposure to PTB:  DOH: 8-10 mm induration  WHO: 10-14 mm induration

Diagnostic Procedures: PTB Sputum AFB(+) MTB  Chest X-raypulmonary infiltrates (caseous necrosis)  CBC- ↑ WBC 

PULMONARY TUBERCULOSIS 

Nursing Management  CBR  Comfortable environment  O2 inhalation as ordered  Force fluids to liquefy secretions  NO CPT, only DBE and coughing  Nebulize and suction prn  Place on semi-fowler’s  Diet: ↑ CHON, ↑ CHO, ↑ Vit C

PULMONARY TUBERCULOSIS 

Short Course Chemotherapy  I. Intensive Phase  INH- given for 4 mos., taken a.c.  S/E: peripheral neuritis- give Vit B6  Rifampicin- given for 4 mos., taken a.c.  S/E: all body secretions turned red-orange  PZA- given for 2 mos., taken p.c.  S/E: skin rashes, nephro and hepatotoxicity  PZA is replaced by Ethambutol  S/E: optic neuritis (visual disturbance)

PULMONARY TUBERCULOSIS 

Short Course Chemotherapy  II. Standard Regimen  Streptomycin IM (Aminoglycoside)  S/E: Ototoxicity due to damage to CN VIII→ temporary hearing loss  Nephrotoxicity- monitor BUN and Crea levels

PULMONARY TUBERCULOSIS 

Discharge Health Teaching  Avoid precipitating factors  Take meds religiously  If missed 1 day’s meds, NEVER ↑ the dose on the next day, simply let the pt continue taking the meds  Prevent Cx: Atelectasis and Miliary TB  Follow-up care

HISTOPLASMOSIS 

Acute fungal infection characterized by inhalation of contaminated dust with Histoplasma capsulatum from bird’s manure

HISTOPLASMOSIS 

S/Sx: PTB, Pneumonia-like  Productive cough  Dyspnea  Cyanosis  Hemoptysis  Fever, chills, anorexia, general body malaise  Chest and joint pain

HISTOPLASMOSIS Diagnostic Procedure  (+) Histoplasmin skin test  (+) agglutination test  ↑ WBC  ABG- ↓ pO2  CXR- (+) infiltrates 

HISTOPLASMOSIS 

Nursing Management  CBR, semi Fowler’s position  O2 inhalation as ordered  Force fluids  Encourage coughing & DBE  Nebulize and suction prn

HISTOPLASMOSIS 

Nursing Management  Administer meds as ordered  Antifungal agent: Amphotericin B (Fungizone)  S/E: nephrotoxicity and hypoK+  Corticosteroids  Antipyretics  Antihistamines  Mucolytics/expectorants

HISTOPLASMOSIS 

Nursing Management  Spraying of breeding places  Prevent Cx: Atelectasis and Bronchietasis

SEVERE ACUTE RESPIRATORY SYNDROME (SARS)  

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Cause: Coronavirus Begins with fever, body aches, mild respiratory Sxs After 2-7 days, dry cough & dyspnea develops MOT: close person-to-person contact (direct contact with infectious secretions and soiled articles) Prevention: avoiding contact with those suspected of having SARS, avoiding travel to countries with SARS outbreak, frequent hand washing

INHALATION INJURIES: CO poisoning 

CO: colorless, Blood odorless, tasteless, Level with affinity for Hgb 1-10% 200X greater than 11-20% O2, forming carboxyHgb→ tissue 21-30% hypoxia

Assessment Impaired visual acuity Flushing, HA N/, impaired dexterity

31-40% Vom,dizziness,syncope 41-50% ↑HR, ↑RR >50%

Coma, death

INHALATION INJURIES: CO poisoning 

Interventions  Remove victim from exposure  Administer 100% O2  Assess need for CPR  Monitor VS and CO levels

OCCUPATIONAL LUNG DISEASE: SILICOSIS  Or Asbestosis or Coal Workers’ Pneumoconiosis  Fibrotic lung disease caused by inhalation or organic dusts over long periods of time  Common among miners & sandblasters

OCCUPATIONAL LUNG DISEASE: SILICOSIS 

S/Sx Uncomplicated or simple: asymptomatic with evidence of fibrosis on CXR  Chronic complicated: malaise, A/, wt loss, severe dyspnea on exertion, massive fibrosis on CXR 

OCCUPATIONAL LUNG DISEASE: SILICOSIS  Interventions Eliminate the toxic substance  O2 as ordered  Coughing and DBE  Administer antitussives for cough & anti-TB meds as ordered (Cx: PTB) 

COPD

Types  Chronic Bronchitis  Bronchial Asthma  Bronchiectasis  Pulmonary Emphysema

COPD-Chronic Bronchitis 

Inflammation of bronchi→ hyperplasia of goblet mucusproducing cells → narrowing of smaller airways

COPD-Chronic Bronchitis 

Predisposing Factors  Excessive, chronic smoking  Air pollution

COPD-Chronic Bronchitis 

S/Sx  Productive cough  Dyspnea at exertion  Prolonged expiratory grunt  Scattered rales, rhonchi  Anorexia, general body malaise  Cyanosis- Blue Bloaters  Feeling of breathlessness  Pulmonary HTN leading to peripheral edema and Cor Pulmonale (most feared Cx)

Cor Pulmonale

COPD-Bronchial Asthma Reversible inflammatory disorder of lung tissue due to hypersensitivity to allergens → narrowing of smaller airways  Predisposing Factors (based on 3 types)  Extrinsic (Atopic/Allergic)  Pollen, dust, furs, fumes, gases, smoke, danders, lints 

COPD-Bronchial Asthma 

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Intrinsic (Non-Atopic/Non-Allergic)  Hereditary  Drugs: ASA, Pen, Phenylbutazone, Beta blockers  Foods: seafoods, eggs, chicken, chocolate, milk and its products  Food additives- nitrates (also can cause CA)  Sudden change in T, air pressure and humidity  Extreme emotion  Physical stress Mixed- combination of the 2  Most common type (90% of cases)

Pathophysiology Allergens Release of IgE by B-lymphocytes IgE + mast cells (respiratory tract) Damage to mast cells Release of chemical mediators (histamine, bradykinin, serotonin, prostaglandin)

vasodilatation Hypotension blood congestion shock increased capillary permeability escape of colloids edema decreased blood vol.

COPD-Bronchial Asthma

COPD-Bronchial Asthma 

S/Sx  Non-productive cough  Dyspnea  Wheezing on expiration  Slight cyanosis  Mild restlessness and apprehension  Tachycardia and palpitation  Diaphoresis

COPD-Bronchial Asthma 

Diagnostic Procedures  ABG- ↓pO2  PFT- ↓ vital lung capacity (max. vol. of air that can be exhaled with the deepest breath possible)

COPD-Bronchial Asthma 

Nursing Management  Administer meds as ordered Bronchodilators- inhalation or metered dose inhaler (pump) Corticosteroids Mucolytics/Expectorants Anti-histamine  O2 as ordered

COPD-Bronchial Asthma

COPD-Bronchial Asthma 

Nursing Management  Force fluids  Nebulize and suction prn  Comfortable and humid environment

COPD-Bronchial Asthma 

Discharge Health Teaching  Avoid precipitating factors  Regular adherence to meds  Sudden withdrawal to corticosteroids→ status asthmaticus  Prevent Complications  Emphysema  Status asthmaticus- Drug of Choice: Epinephrine

COPD-Bronchiectasis 

Permanent dilatation of bronchus → destruction of elastic and muscular tissues of the alveolar walls

COPD-Bronchiectasis 

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Predisposing Factors  Recurrent URTI and LRTI  Congenital anomalies  Lung tumor Signs and Symptoms  Productive cough  Dyspnea  Anorexia, general body malaise  Cyanosis  Hemoptysis

COPD-Bronchiectasis  Diagnostic Procedures  ABG- ↓ pO2  Bronchoscopy

COPD-Bronchiectasis 

Bronchoscopy: Nursing Management  Pre-op: informed consent, maintain on NPO, monitor VS  Post-op  Feed when gag reflex returns  Avoid talking, coughing, smoking → chronic irritation  Monitor for S/ of gross/frank bleeding  WOF laryngospasm and edema → DOB, SOB → prepare trache set at bedside

COPD-Bronchiectasis 

Nursing Management  Same as in pulmonary emphysema  Assist in surgical procedure  Pneumonectomy  Position post-op: lie on affected side  Segmental wedge lobectomy  Position post-op: lie on unaffected side

Pneumonectomy vs. Lobectomy

COPD-Pulmonary Emphysema 

Irreversible, end-stage stage of COPD characterized by inelasticity of alveolar wall → air trapping → maldistribution of gases → over distension of thoracic cavity → ↑ A:P diameter (Barrel-chest)

COPD-Pulmonary Emphysema

COPD-Pulmonary Emphysema 

Predisposing Factors  Excessive, chronic smoking  Allergy  Air pollution  Hereditary- deficiency of alpha-1 antitrypsin → elastase/elastin → alveolar recoil (Northern European origin)  Elderly- high risk group

COPD-Pulmonary Emphysema 

Types  Centrilobular/Panlobular  Blue Bloaters  pCO2 ↑, pO2 ↓, resp. acidosis with hypoxemia  Centriacinar/Panacinar  Pink Puffers  pCO2 ↓, pO2 ↑, resp. alkalosis with hyperoxemia

Blue Bloater vs. Pink Puffer

The Blue Bloater

COPD-Pulmonary Emphysema 

Signs and Symptoms  Productive cough  Dyspnea at rest  Anorexia, general body malaise  On lung percussion- resonance to hyperresonance

COPD-Pulmonary Emphysema 

Signs and Symptoms  (+) nasal flaring  rales, rhonchi  ↓ breath sounds, vocal fremiti  Barrel chest- Pathognomonic Sign  (+) pursed-lip breathing

COPD-Pulmonary Emphysema 

Nursing Management  CBR  Administer meds as ordered Bronchodilator Corticosteroid Antibiotics Mucolytics/expectorants

COPD-Pulmonary Emphysema 

Nursing Management  Low flow, Fixed concentration O2 inhalation as ordered not to remove the Hypoxic Drive

COPD-Pulmonary Emphysema 

Nursing Management  Force fluids  Diet: ↑ CHON, ↑ Vit & min., ↓ CHO  DBE- pursed-lip, cascade coughing, CPT  Nebulize and suction secretions prn

COPD-Pulmonary Emphysema 

Discharge Health Teaching  Stop smoking  Regular adherence to meds  Prevent Complications  Atelectasis  Cor Pulmonale  CO2 narcosis- severe disorientation/confusion → coma  Pneumothorax  Follow-up care

Restrictive Lung Disorders Pneumothorax  Partial/complete collapse of the lungs due to accumulation of air in the pleural space

Pneumothorax 

3 types  Spontaneous- without obvious cause  e.g. rupture of bleb (alveolar fluid sac) in recurrent lung inflammation and infection  Open- thru chest opening  e.g. stab, gunshot wounds  Tension- from blunt chest injury or from mech. vent. With PEEP air enters pleural space with each inspiration and cannot escape →↑ thoracic cavity → mediastinal shift  E.g. flail chest (with paradoxical breathing)

Pneumothorax 

Predisposing Factors  Chest trauma  Recurrent inflammatory lung condition  Lung tumors

Pneumothorax 

Signs and Symptoms  Cool, moist skin (beginning of shock)  Sharp, chest pain  Unexplained dyspnea  ↓ breath sounds → lung collapse  ↓ lung expansion  Cyanosis

Pneumothorax 

Signs and Symptoms  Mild restlessness/apprehension  On lung percussion- resonance to hyperresonance  SQ emphysema (crepitus on palpation)  Tracheal deviation to unaffected side

Pneumothorax 

Diagnostic Procedure  ABG- ↓ pO2  Chest X-ray- partial or complete lung collapse

Nursing Management: Pneumothorax  Assist in intubation  Administer meds as ordered Narcotic analgesic Antibiotics

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Nursing Management: Pneumothorax

Assist in thoracentesis/ chest tube thoracostomy  Remove air- insert at 2nd-3rd ICS  Remove fluid- insert laterally near base, posteriorly at 8th-9th ICS  Pt position: struggling to a chair, pt exhales and hold breath during insertion (under local anesthesia)

Thoracentesis

Nursing Management: Pneumothorax Attach tube to water-seal drainage Objectives: To reestablish (-) pressure in the lungs To promote lung expansion To drain air, fluid and blood and to prevent it reflux

Nursing Management: Water Seal Drainage  Monitor VS, I/O, breath sounds  DBE  Administer meds as ordered  Maintain strict asepsis

Nursing Management: Water Seal Drainage  Prepare at bedside: vaselinized gauze Hemostan clamp Extra bottle with water

Nursing Management: Water Seal Drainage 

Monitor for oscillation and fluctuation  N- (+) intermittent bubbling, ↑ with inspiration, ↓ expiration  Check for leakage  If (-) bubbling: check for kinks, obstructionmilk towards drainage bottle, or lungs are fully expanded

Water Seal Drainage

Nursing Management: Water Seal Drainage  3 parameters to remove chest tube  (-) bubbling/fluctuations  (+) symmetrical breath sounds  Chest X-ray confirms full lung expansion

Nursing Management: Water Seal Drainage 

Before, During and After Removal of Chest Tube  Encourage DBE  Monitor VS, breath sounds  Give analgesic prior to removal  Instruct pt to perform Valsalva maneuver for easy removal and to prevent air entry to pleural space  Apply vaselinized occlusive dressing, WOF bleeding

PLEURAL EFFUSION  

Collection of fluid in the pleural space S/Sx   

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Pleuritic pain that is sharp & ↑ with inspiration Dyspnea on exertion Dry, nonproductive cough caused by bronchial irritation or mediastinal shift ↑HR, ↑T ↓ breath sounds CXR: confirms the dx & shows mediastinal shift

PLEURAL EFFUSION 

Interventions  Identify & tx the underlying cause  Monitor breath sounds  High Fowler’s position  Coughing & DBE  Prepare the pt for thoracentesis

PLEURAL EFFUSION Interventions  If recurrent, prepare the pt for:  Pleurectomy: surgically stripping parietal away from visceral pleura to promote adhesion of the 2 layers during healing  Pleurodesis: instilling sclerosing substance into pleural space via thoracotomy tube 

EMPYEMA Collection of pus in the pleural cavity (thick, opaque, foul-smelling)  Causes: pulmonary infection, lung abscess due to thoracic surgery or chest trauma  Goal of tx: emptying empyema cavity, reexpanding the lung, controlling infection 

EMPYEMA S/Sx of infection + ↓ chest wall mov’t & pleural exudate on CXR  Interventions 

Semi or High Fowler’s position  Monitor breath sounds  Coughing and DBE  Splint the chest if in pain  Antibiotics as ordered 

EMPYEMA 

Interventions  Assist in chest tube insertion  If (+) marked pleural thickening, prepare the pt for Decortication: surgical removal of restrictive mass of fibrin & inflammatory cells

PLEURISY

Inflammation of the visceral & parietal pleura, rubbing together during breathing causing pain  May be caused by pulmonary infarction or pneumonia  Usually occurs on one side of the chest (lower lateral portion) 

PLEURISY 

S/Sx  Knifelike pain aggravated by deep breathing & coughing  Dyspnea  Pleural friction rub on auscultation  Apprehension

PLEURISY 

Interventions  Identify and tx the cause  Monitor breath sounds  Hot or cold applications as ordered  Encourage coughing & DBE  Lie on affected side to splint the chest  Analgesics as ordered

ACUTE RESPIRATORY DISTRESS SYNDROME 

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A form of acute respiratory failure as a complication of other condition, caused by diffuse lung injury→ extravascular lung fluid →compression of terminal airways → ↓ lung vol. & compliance ABG= resp. acidosis & hypoxemia not responding to ↑ O2 concentration CXR= interstitial edema

ACUTE RESPIRATORY DISTRESS SYNDROME 

Predisposing factors  Sepsis  Fluid overload  Shock  Trauma  Neuro injuries  Burns  DIC  Drug ingestion  Toxic substance inhalation

ACUTE RESPIRATORY DISTRESS SYNDROME 

S/Sx  ↑ HR  Dyspnea  ↓ breath sounds  Deteriorating blood gas levels  Hypoxemia despite high O2 concentration  ↓ pulm. compliance  Pulm. infiltrates

ACUTE RESPIRATORY DISTRESS SYNDROME 

Interventions  Identify & tx the cause  O2 as ordered  High Fowler’s position  Fluid restriction as ordered  Diurretics, anticoagulants, corticosteroids as ordered  Prepare for intubation and mechanical ventilation with PEEP

MECHANICAL VENTILATION  

TYPES 1. Pressure-cycled The ventilator pushes air into the lungs until an airway pressure is reached  Used for short periods (pt in PACU & for respiratory tx) 

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2. Time-cycled With preset time  Used for pedia & neonatal pt 

MECHANICAL VENTILATION 

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3. Volume-cycled  With preset tidal volume that is delivered regardless of the changing lung compliance or airway resistance (from the vent. or from the pt) 4. Microprocessor  Built into the vent. to allow continuous monitoring of the vent. functions, alarms & other parameters  For pt with severe lung disease or required prolonged weaning

MECHANICAL VENTILATION MODES  1. Controlled  With set TV & RR  For pt who cannot initiate respiratory effort  Least used bec. if the pt attempts to breathe, the vent. blocks the effort 

MECHANICAL VENTILATION  

MODES 2. Assist-control 

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With set TV while allowing the pt control the RR Most commonly used The vent. takes over the work of breathing for the pt Responds to pt’s inspiratory effort If the pt’s spontaneous RR ↑ the vent. continues to deliver preset TV→ hyperventilation & respiratory alkalosis

MECHANICAL VENTILATION  

MODES 3. Synchronized Intermittent Mandatory Ventilation (SIMV) 

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With set TV and RR while allowing the pt control own TV & RR in between the vent. breaths Used as a primary vent. mode or as a weaning mode The no. of SIMV breaths is ↓ gradually until the pt gradually resumes spont. breathing

MECHANICAL VENTILATION  

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CONTROLS & SETTINGS 1. TV: vol. of air that the pt receives with each breath 2. RR: no. of vent. breaths/min 3. Fraction of inspired O2 (FiO2): O2 concentration delivered to the pt; determined by pt’s condition & ABG 4. Sighs: vols. of air 1.5-2X the set TV, delivered 6-10X/hr, prevents atelectasis

MECHANICAL VENTILATION CONTROLS & SETTINGS  5. Peak airway inspiratory pressure (PIP)  Pressure needed by the vent. to deliver set TV at a given compliance  Reflects changes in compliance of the lungs & resistance in the vent. or the pt 

MECHANICAL VENTILATION  

CONTROLS & SETTINGS 6. Continuous positive airway pressure (CPAP)  Applied throughout the entire respiratory cycle for spont. breathing pt  Keeps the alveoli open during inspiration & prevents alveolar collapse  Used primarily as a weaning modality since no vent. breaths are delivered, only FiO2  RR is determined by the pt’s efforts

MECHANICAL VENTILATION  

CONTROLS & SETTINGS 7. Positive end-expiratory pressure (PEEP)  Exerted during the expiratory phase of ventilation  Improves oxygenation by enhancing gas exchange & preventing atelectasis  Used in pt with severe gas exchange disturbance  Higher amounts of PEEP (↑15) ↑ the chance of Cx: barotrauma tension pneumothorax

MECHANICAL VENTILATION  

CONTROLS & SETTINGS 8. Pressure Support  Application of positive pressure on inspiration  Eases workload of breathing  May be used in combo with PEEP as a weaning method

Nursing Interventions: MECHANICAL VENTILATION Assess the pt first before the ventilator  Assess for VS, breath sounds, respiratory status & breathing patterns  Monitor skin color, pulse oximetry, ABG  Suction secretions prn  Assess the ventilator settings 

Nursing Interventions: MECHANICAL VENTILATION Check level of water in humidifier & temp. or humidification system  Ensure that alarms are set  If cause of alarm cannot be determine, manually ventilate the pt  Empty ventilator tubing when moisture collects 

Nursing Interventions: MECHANICAL VENTILATION 

Weaning: the process of going from ventilator dependence to spont. Breathing SIMV mode  T-piece  Decreasing PS 

Nursing Interventions: MECHANICAL VENTILATION Causes of Alarms  High-Pressure Alarm 

↑ secretions  Wheezing, bronchospasm  Displaced, kinked, ET  Excess water in vent. Tubings  Pt. coughs, gags, bites ET  Pt is anxious, fighting the vent. 

Nursing Interventions: MECHANICAL VENTILATION Causes of Alarms  Low-Pressure Alarm 

Disconnection or leak in the ventilator  Busted airway cuff  Pt stops spontaneous breathing 

Nursing Interventions: MECHANICAL VENTILATION

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WOF Cx

Hupotension r/t (+) pressure increasing intrathoracic pressure  Pneumothorax  SQ emphysema  Stress ulcers  Malnutrition  Infection  Muscular atrophy  Ventilator dependence, inability to wean 

CGFNS/NCLEX Question 

A pt in the ER department has multiple fractured ribs and R-sided tension pneumothorax. The RN should expect to prepare the pt for which of the following procedures? A. Electrocardiography B. Urinary catheter placement C. Chest tube insertion D. Gastric lavage

CGFNS/NCLEX Question 

A pt with asthma is producing thick, white secretions. Which of the following nursing measures would be most appropriate for the RN to include in her plan of care? A. increase fluid intake B. promote exercise C. administer O2 D. encourage coughing

CGFNS/NCLEX Question 

A RN education a pt on the correct use of metered dose inhaler should instruct the pt to A. take several short shallow breaths before inhaling B. hold breath after inhaling the drug C. cough before inhaling the drug D. press the cartridge down before inhaling the drug

CGFNS/NCLEX Question 

The MD orders a corticosteroid inhaler 4 puffs BID for a pt with asthma. Which of the following actions by the pt should indicate to the RN that the pt needs further teaching? A. taking 4 puffs in rapid succession B. pausing for 1-2 mins. in between puffs C. rinsing the mouth with water after inhaling D. inhaling meds slowly

CGFNS/NCLEX Question 

A pt who has asthma is given instructions about the use of inhalant meds. Which of the following statements, if made by the pt, indicates that the pt understands the instructions?

CGFNS/NCLEX Question A. “I will use the steroid inhaler 1 hr before I use the brochodilator.” B. “I will use the bronchodilator before I use the steroid inhaler.” C. “I need to take these meds 1 hr after each meal.” D. “I need to alternate the sequence of inhaler administration.”

CGFNS/NCLEX Question 

An asthmatic pt has orders for all of the following meds. Which meds should a RN expect to prepare when the pt shows signs of status asthmaticus? A. Epinephrine (Adrenaline) B. Theophylline (Theo-Dur) C. Erythromycin (Robimycin) D. Cromolyn Sodium (Nasalcrom)

CGFNS/NCLEX Question 

Cromolyn Sodium (Intal) is ordered for a pt who has asthma. A RN would determine that the pt understands when to take the med if the pt makes which of the following statements? A. “I will use my inhaler after meals.” B. “I will use my inhaler prior to exercise.” C. “I will use my inhaler when I am having an attack.” D. “I will use my inhaler after being outside in cold weather.”

CGFNS/NCLEX Question 

Prior to discharging a pt who is asthmatic, a RN should include which of the following measures in the teaching plan? A. Discussing techniques for weight control while taking steroids B. Identifying specific environmental triggers C. Maintaining school performance using a home tutor D. Keeping a record of weekly sputum testing

CGFNS/NCLEX Question 

A RN teaches pursed-lip breathing to a pt who has COPD. Which of the following statements indicates the pt understands the instructions? A. “I will maintain a supine position during the exercise.” B. “I will alternate positions during the exercises.” C. “I will exhale for twice as long as I inhale.” D. “I will inhale and exhale thru my nose.”