Transcript O2 RESPIRATORY

O2 RESPIRATORY
TO BREATHE OR NOT TO
BREATHE, THAT IS OUR
QUESTION!
Hope Knight BSN, RN
Fig 25-1 structures of respiratory tract
STRUCTURE OF LUNGS
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Upper Respiratory Tract
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Lower Respiratory Tract
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Chest Wall
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Structures of Lower Airways
Fig 25-3 structure of lower airway
Fig 25-5 total thickness is less than 1/5000 inch
Fig 25-7
ARTERIAL BLOOD GASES
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Normal Values
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PH
7.35 – 7.45
PaO2
80-100mm Hg
PaCO2 35-45 mm Hg
HCO3
22-26 mEq/L
SaO2
>95%
INTERPRETATION OF ABG
ACID BASE
NORMAL
Ph
PaCO2
7.35
35-45
HCO3
22-26
RESP.
ACIDOSIS
NORMAL
RESP.
ALKALOSIS
NORMAL
METABOLIC
ACIDOSIS
NORMAL
METABOLIC
ALKALOSIS
NORMAL
Table 25-2
S/S inadequate oxygenation
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.
GERENTOLIGIC DIFFERENCES IN
ASSESSMENT
CUES TO RESPIRATORY PROBLEMS
Pulmonary Function Test measures lung volumes
and air flow.
Obstructive Sleep Apnea
fig 26-4
Collaborative Management and Nursing Care for
Obstructive Sleep Apnea
BIPAP/CPAP MACHINES
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.
CONTRAINDICATIONS FOR BIPAP
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Need for immediate intubation.
Hemodynamic instability.
Uncooperative patient.
Facial burns or trauma.
Need for airway protection.
PULMONARY EMBOLI
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Thrombi in venous
circulation or right
side of the heart
occlude pulmonary
arterial blood flow to
parts of lung
CLASSIFICATION OF
RESPIRATORY FAILURE
ACUTE RESPIRATORY FAILURE
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Hypoxemic Respiratory
Ventilation Perfusion (V/Q mismatch)
 Shunt
 Diffusion Limitation
 Alveolar Hypoventilation
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Hypercapnic Respiratory Failure
Airway and alveoli
 Central nervous system
 Chest Wall
 Neuromuscular Condition
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VENTILATION TO PERSUSION
RELATIONSHIPS (V/Q mismatch)
DIFFUSION LIMITATION
ACUTE RESPIRATORY FAILURE
MANIFESTATIONS
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Develops suddenly or gradually
Compensatory mechanisms
Mental status changes
Tachycardia
Mild hypertension
Severe morning headache
Cyanosis (late sign)
NURSING AND
COLLABORATIVE MANAGEMENT
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Respiratory therapy
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Nasal cannula, simple face mask, venturi mask, positive
pressure ventilation, mechanical ventilation
Mobilization of secretions
Positive Pressure Ventilation
Nutrition
Diet – Drug interactions
ARDS
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Sudden and Progressive form of acute
respiratory failure
Mortality is 50%
Injury or Exudative phase
Reparative or Proliferative Phase
Fibrotic Phase
Complications
STAGES OF EDEMA FORMATION
IN ARDS
PHYSIOLOGY OF ARDS
PREDISPOSING FACTORS OF ARDS
DIAGNOSTIC FINDINGS IN ARDS
TABLE 66-8
MECHANICAL VENTILATORS
Servo type ventilator
7200 type ventilator
Care Standards for the
Ventilator Patient
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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!!
MODES OF VENTILATION - CMV
Volume Control Ventilation (CMV, A/C,
VC)
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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.
MODES OF VENTILATION SIMV
Synchronized Intermittent Mandatory
Ventilation (SIMV)
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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
patient’s spontaneous inspiratory efforts.
Modes of ventilation -SIMV with PS (Pressure Support)
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Pressure Support is added to the
spontaneous breaths in order to “boost”
the patient’s Vt.
Advantages:
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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.
MODES OF VENTILATION - PCV
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Pressure Control Ventilation (PCV):
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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.
MODES OF VENTILATION – P/S
Spontaneous - Pressure Support
(PSV or PS)
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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 patient’s 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.
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.
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.
MODES OF VENTILATION - PEEP
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Positive End Expiratory Pressure- the
application and maintenance of pressure
above atmospheric at the airway
throughout the expiratory phase of
positive pressure mechanical ventilation.
Physiologic Effects of CPAP & PEEP
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PEEP/CPAP will reduce sub-atmospheric
intrathoracic pressure seen at endexpiration or even change it to positive
values.
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This may exert profound effects on the
circulation by increasing CVP and decreasing
venous return to the heart (preload), thereby
decreasing cardiac output.
Weaning from Mechanical
Ventilation
Assessing for weaning readiness
 Weaning techniques
 Causes of weaning failure
 Weaning protocols
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