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O 2 RESPIRATORY

O 2 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. Upper Respiratory Tract Lower Respiratory Tract Chest Wall Structures of Lower Airways. Fig 25-3 structure of lower airway.

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O 2 RESPIRATORY

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  1. O2 RESPIRATORY TO BREATHE OR NOT TO BREATHE, THAT IS OUR QUESTION! Hope Knight BSN, RN

  2. Fig 25-1 structures of respiratory tract

  3. STRUCTURE OF LUNGS • Upper Respiratory Tract • Lower Respiratory Tract • Chest Wall • Structures of Lower Airways

  4. Fig 25-3 structure of lower airway

  5. Fig 25-5 total thickness is less than 1/5000 inch

  6. Fig 25-7

  7. 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 >95%

  8. INTERPRETATION OF ABG

  9. Table 25-2 S/S inadequate oxygenation

  10. 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.

  11. GERENTOLIGIC DIFFERENCES IN ASSESSMENT

  12. CUES TO RESPIRATORY PROBLEMS

  13. Pulmonary Function Test measures lung volumes and air flow.

  14. Obstructive Sleep Apnea fig 26-4

  15. Collaborative Management and Nursing Care for Obstructive Sleep Apnea

  16. BIPAP/CPAP MACHINES

  17. 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.

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

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

  20. CLASSIFICATION OF RESPIRATORY FAILURE

  21. 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

  22. VENTILATION TO PERSUSION RELATIONSHIPS (V/Q mismatch)

  23. DIFFUSION LIMITATION

  24. ACUTE RESPIRATORY FAILURE MANIFESTATIONS • Develops suddenly or gradually • Compensatory mechanisms • Mental status changes • Tachycardia • Mild hypertension • Severe morning headache • Cyanosis (late sign)

  25. 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

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

  27. STAGES OF EDEMA FORMATION IN ARDS

  28. PHYSIOLOGY OF ARDS

  29. PREDISPOSING FACTORS OF ARDS

  30. DIAGNOSTIC FINDINGS IN ARDS TABLE 66-8

  31. MECHANICAL VENTILATORS Servo type ventilator 7200 type ventilator

  32. 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!!

  33. 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.

  34. 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 patient’s spontaneous inspiratory efforts.

  35. Modes of ventilation -- SIMV with PS (Pressure Support) • Pressure Support is added to the spontaneous breaths in order to “boost” the patient’s 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.

  36. 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.

  37. 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 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.

  38. 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.

  39. 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.

  40. 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.

  41. 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.

  42. Weaning from Mechanical Ventilation • Assessing for weaning readiness • Weaning techniques • Causes of weaning failure • Weaning protocols

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