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Stack #123035

a MCPHS- Provider I- Ch 25 Respiratory Care Modalities

Oxygen concentration in room air 21%
Hypoxemia vs. Hypoxia Emia:decreased oxygen in blood, Oxia:decreased oxygen supply to tissues
Manifestation r/t Hypoxemia Changes in mental status, Dyspnea, Increased BP, Changes in HR, Dysrhythmias
Late sign r/t Hypoxemia Central cyanosis
Oxygen toxicity occurs when Too high O concentration for an extended period of time
Hypoxemic vs. Circulatory vs. Anemic vs. Histotoxic Hypoxias Hyp:decreased O in blood, C:inadequate capillary circulation, A:ineffective hemoglobin concentration, Histo:caused by toxic substance
Stimulus for respiration r/t COPD Decrease in blood O
Normal stimulus r/t Respiration Elevated CO2
Cannula vs. Partial rebreather vs. Non-rebreather vs. Venturi r/t O flow rate C:1-6 L/min, P:8-11 L/min, N:12 L/min, V:4-8 L/min
Low-flow vs. High-flow oxygen delivery systems LF:combines O w/Pt's inspiration & inspired O changes, HF:Pt's that require constant and precise amount of O
Reservoir bags must remain inflated during Inspiration and expiration
Non-rebreathing masks prevent Room air from entering mask during inhalation
Noninvasive mask that provides most reliable/accurate O concentration Venturi mask
Venturi mask r/t COPD Accurate O supplementation avoid suppressing hypoxic drive
Amount of O dissolved in plasma r/t Hyperbaric O therapy O level in plasma increases, O levels in tissues increases
Humidity r/t O therapy Counteracts dry, irritating effects of compressed O, Moistens secretions
Method of deep breathing encouraging Pt to inhale slowly and deeply Incentive spirometry
Incentive spirometry functions Maximize lung inflation, Prevent/reduce atelectasis
Volume vs. Flow spirometers V:increases volume of inhaled air gradully & volume is pre-set, F:same function but volume is not pre-set
Proper breathing/Incentive spirometer positioning At least semi-Fowlers
Breathing technique to prepare for nebulizer use Diaphragmatic breathing
Area of body r/t Diaphragmatic breathing Abd protrudes as far as possible
Time r/t Postural drainage 2-4x a day, Before meals, Bedtime
Intervention d/t Pt inability to cough Sunction secretions
Percussion technique r/t Secretion loosening Cup hands and lightly strike chest wall, Wrists are alternately flexed
Technique that applies compression to chest wall Vibration
Vibration is done while Pt is Exhaling
Breathing retraining are exercises and practices to achieve more efficient and controlled Ventilation & decrease work of breathing
Pt's in which breathing retraining is indicated COPD and dyspnea
Examples r/t breathing retraining exercises Diaphragmatic breathing, Pursed-lip breathing
Pt's w/altered level of consciousness are at risk for ________ d/t _______ Upper airway obstructions, Loss of protective reflexes and tone of pharyngeal muscles
Endotracheal intubation Pt indications Cannot maintain adequate airway, Need mechanical ventilation, Secretion suctioning of pulmonary tree
Cuff pressures are checked Every 6-8 hours
Intubation is used no longer than 3 weeks
Disadvantages r/t Endotracheal/Tracheostomy tubes Depressed cough reflex, Thicker secretions, Depressed swallowing reflex
Preventing tube removal by Pt Explain purpose of tube, Distract Pt w/one-to-one interaction, Maintain comfort
Tracheostomy incision location B/w 2nd and 3rd tracheal rings
Inflated portion of tracheostomy tube Cuff
Long-term complication r/t Tracheostomy tube Airway obstruction, Infection, Innominate artery rupture, Dysphagia, Tracheoesophageal fistula, Ischemia, Necrosis
May develop after tracheostomy tube is removed Tracheal stenosis
Tracheostomy tube is kept patent by Sunctioning
Semi-fowler's position r/t Tracheostomy tube Facilitate ventilation, Promote drainage, Minimize edema, Prevent strain on sutures
Sterility r/t Tracheostomy tubes Prevent pulmonary and systemic infections
Cuff pressure limits > 15 mm Hg, <25 mm Hg
Preventing complications r/t Tracheostomy tubes Maintain skin integrity, Maintain adequate hydration
Cotton applicators moistened w/__________ during wound cleansing Hydrogen peroxide
Turned on before opening suction catheter kit Suction source
Suction catheter insertion depth Just far enough to stimulate cough reflex
Suction is applied while Withdrawing
Mechanical ventilation indications Continuous decrease in PaO(hypoxemia), Increase in PaCO2(hypercapnia), Persistent acidosis
Most commonly used Positive-pressure ventilator Volume-cycled ventilator
Volume-cycled ventilator r/t O delivery Volume of air delivered is relatively constant
Examples r/t Noninvasive Positive-pressure Ventilators Nasal cannula and all masks
Bucking the ventilator Pt is out of sync w/ventilator
Humidifier levels are checked 3x a day
Continuous positive-pressure ventilation r/t Secretions Secretion production is always increased
Method to assess for secretions Lung ascultation at least every 2-4 hours
Prevent atelectasis and retention of secretions r/t Ventilators Periodic sighs
Permits talking r/t Mechanical ventilation Passy-Muir valve
Order r/t Respiratory weaning Gradual removal of ventilator, Tube, Oxygen
Indications r/t Tube weaning Pt can breathe spontaneously, Maintain patent airway, Effectively cough, Swallow, Move jaw
Supplemental O recommended when, PaO < 70 mm Hg on room air (blank)
PaO level r/t Medicare/Medicaid reimbursement < 55 mm Hg
Metabolism of fat vs. Metabolism of carbohydrates r/t CO2 production Fat metabolism produces less CO2
Postoperative risk factors r/t Surgery-related Atelectasis/Pneumonia Immobilization, Supine, Decreased consciousness, Prolonged intubation/mechanical ventilation
Re-expands lungs and Removes excess air/fluid/blood from pleural spaces Chest tubes, Closed drainage systems
Fluid fluctuations stop when Lung has reexpanded, Tubing is obstructed, Suction is not properly working
Constant bubbling r/t Water seal chamber Air leak in drainage system
Drainage system r/t Pt chest level System is kept below Pt chest level
Water level r/t Inspiration Water level increase
Normal bubbling Intermittent
Created by: rpclothier
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