O2 RESPIRATORY

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O2 RESPIRATORY

• TO BREATHE OR NOT TO BREATHE, THAT IS OUR
  QUESTION!
• Hope Knight BSN, RN

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Fig 25-1 structures of respiratory tract
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STRUCTURE OF LUNGS

• Upper Respiratory Tract
• Lower Respiratory Tract
• Chest Wall
• Structures of Lower Airways

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Fig 25-3 structure of lower airway
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Fig 25-5 total thickness is less than 1/5000 inch
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Fig 25-7
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ARTERIAL BLOOD GASES

• Normal Values
• PH 7.35 7.45
• PaO2 80-100mm Hg
• PaCO2 35-45 mm Hg
• HCO3 22-26 mEq/L
• SaO2 gt95

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INTERPRETATION OF ABG
ACID BASE Ph PaCO2 HCO3
NORMAL 7.35 35-45 22-26
RESP. ACIDOSIS NORMAL
RESP. ALKALOSIS NORMAL
METABOLIC ACIDOSIS NORMAL
METABOLIC ALKALOSIS NORMAL
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Table 25-2 S/S inadequate oxygenation
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Swan Ganz catheter used to measure Pulmonary
Artery Pressure. Elevation seen in Pulmonary
disease, pulmonary embolism, pulmonary
hypertension, left ventricular failure, MI.
Decrease noted in hypovolemia.
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GERENTOLIGIC DIFFERENCES IN ASSESSMENT
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CUES TO RESPIRATORY PROBLEMS
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Pulmonary Function Test measures lung volumes and
air flow.
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Obstructive Sleep Apnea fig 26-4
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Collaborative Management and Nursing Care for
Obstructive Sleep Apnea
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BIPAP/CPAP MACHINES
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CLINICAL APPLICATION FOR BIPAP

• BiPAP is essentially pressure support ventilation
  with CPAP. The flow of gas switches between a
  high inspiratory positive airway pressure (IPAP)
  and a low expiratory positive airway pressure
  (EPAP). The difference between IPAP and EPAP is
  the pressure support level and contributes to the
  total ventilation.

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CONTRAINDICATIONS FOR BIPAP

• Need for immediate intubation.
• Hemodynamic instability.
• Uncooperative patient.
• Facial burns or trauma.
• Need for airway protection.

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PULMONARY EMBOLI

• Thrombi in venous circulation or right side of
  the heart occlude pulmonary arterial blood flow
  to parts of lung

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CLASSIFICATION OF RESPIRATORY FAILURE
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ACUTE RESPIRATORY FAILURE

• Hypoxemic Respiratory
• Ventilation Perfusion (V/Q mismatch)
• Shunt
• Diffusion Limitation
• Alveolar Hypoventilation
• Hypercapnic Respiratory Failure
• Airway and alveoli
• Central nervous system
• Chest Wall
• Neuromuscular Condition

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VENTILATION TO PERSUSION RELATIONSHIPS (V/Q
mismatch)
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DIFFUSION LIMITATION
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ACUTE RESPIRATORY FAILURE MANIFESTATIONS

• Develops suddenly or gradually
• Compensatory mechanisms
• Mental status changes
• Tachycardia
• Mild hypertension
• Severe morning headache
• Cyanosis (late sign)

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NURSING AND COLLABORATIVE MANAGEMENT

• Respiratory therapy
• Nasal cannula, simple face mask, venturi mask,
  positive pressure ventilation, mechanical
  ventilation
• Mobilization of secretions
• Positive Pressure Ventilation
• Nutrition
• Diet Drug interactions

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ARDS

• Sudden and Progressive form of acute respiratory
  failure
• Mortality is 50
• Injury or Exudative phase
• Reparative or Proliferative Phase
• Fibrotic Phase
• Complications

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STAGES OF EDEMA FORMATION IN ARDS
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PHYSIOLOGY OF ARDS
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PREDISPOSING FACTORS OF ARDS
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DIAGNOSTIC FINDINGS IN ARDS
TABLE 66-8
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MECHANICAL VENTILATORS
Servo type ventilator
7200 type ventilator
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Care Standards for the Ventilator Patient

• Normal Saline as a lavage is NOT used routinely
  during suctioning.
• Perform vigorous oral care Q2 hours and PRN.
• Position patient in a semi-upright position with
  head of bed elevated 30 to 45 to reduce the
  possibility of aspiration.
• ALARMS!!! Check the patient! Bag the patient if
  Sats (Sa02) are low and then check the machine.
  Always remember, patient first!!

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MODES OF VENTILATION - CMV

• Volume Control Ventilation (CMV, A/C, VC)
• The clinician sets the tidal volume (Vt) to be
  delivered at a preset minimum rate.
• Each time the patient initiates a breath with a
  negative inspiratory effort or flow reaching or
  exceeding a set threshold, the ventilator
  delivers an additional breath at the preset Vt.
• The patient can increase the ventilator rate, and
  therefore ventilatory support, on demand.

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MODES OF VENTILATION SIMV

• Synchronized Intermittent Mandatory Ventilation
  (SIMV)
• The clinician sets a Vt for a preset number of
  breaths each minute.
• Additional breaths initiated by the patient are
  spontaneous patient controls Vt and RR.
• The synchronization allows the ventilator to
  deliver the preset machine breaths between the
  patients spontaneous inspiratory efforts.

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Modes of ventilation --

• SIMV with PS (Pressure Support)
• Pressure Support is added to the spontaneous
  breaths in order to boost the patients Vt.
• Advantages
• Allows the patient to assume a portion of their
  ventilatory requirement.
• The negative inspiratory pressure generated by
  spontaneous breathing leads to increased venous
  return to the right side of the heart, which may
  improve cardiac output and cardiovascular
  function.

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MODES OF VENTILATION - PCV

• Pressure Control Ventilation (PCV)
• PCV is a time-cycled mode of ventilation that
  allows limitation of peak inspiratory pressures
  (PIP).
• The PIP is set by the clinician and the Vt (tidal
  volume) and VE (minute ventilation) are a result
  of changes in the lung compliance or airway
  resistance.

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MODES OF VENTILATION P/S

• Spontaneous - Pressure Support (PSV or PS)
• This mode is completely patient controlled --
  Patient controls/sets their own respiratory rate,
  duration of inspiration, gas flow rate, and Vt.
• The machine delivers a preset pressure -- Vt
  will vary depending on the patients lung
  compliance.
• The inspiratory assist is used to overcome the
  increased resistance and WOB imposed by the
  disease process, the endotracheal tube (ET),
  inspiratory valves, and other mechanical aspects
  of ventilatory support.

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MODES OF VENTILATION P/S CONT.

• Spontaneous - Pressure Support continued
• The delivered Vt is affected by pulmonary
  compliance and resistance.
• The amount of pressure support set during
  mechanical ventilation is titrated according to
  the RR and the Vt of the patient.
• Advantage comfort and tolerance the mode offers
  patients. Reducing the WOB.

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MODES OF VENTILATION - CPAP

• CPAP (Continuous Positive Airway Pressure)
• All breaths are controlled by the patient.
• This mode simply delivers FiO2 and a variable
  flow with or without a preset inspiratory and/or
  expiratory pressure.

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MODES OF VENTILATION - PEEP

• Positive End Expiratory Pressure- the application
  and maintenance of pressure above atmospheric at
  the airway throughout the expiratory phase of
  positive pressure mechanical ventilation.

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Physiologic Effects of CPAP PEEP

• PEEP/CPAP will reduce sub-atmospheric
  intrathoracic pressure seen at end-expiration or
  even change it to positive values.
• This may exert profound effects on the
  circulation by increasing CVP and decreasing
  venous return to the heart (preload), thereby
  decreasing cardiac output.

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Weaning from Mechanical Ventilation

• Assessing for weaning readiness
• Weaning techniques
• Causes of weaning failure
• Weaning protocols

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