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