Airway Disorders
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| show | To lungs for gas exchange
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| Bronchial Blood Supply | show 🗑
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| Conducting Airway | show 🗑
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| What is Acinus | show 🗑
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| Respiratory Functions | show 🗑
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| show | *Neurochemical= Medulla @ base of brain-brain stem (pattern) & Pons (rate & debth) *Mechanical= Irritant, stretch & pressure receptors *Hering-Breuer= Keeps us from over stretching
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| Mechanisms Of Breathing-Ventilation | show 🗑
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| Examples Of Respiratory Passageway Resistance | show 🗑
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| This Happens In Non-Lung Compliance | show 🗑
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| This Improves Aveolar Surface Tension | show 🗑
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| Example Of Diffusion | show 🗑
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| Accessory Muscles | show 🗑
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| Pulmonary Blood Flow And Gravity | show 🗑
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| show | SOB, wheezing, pleuritic chest pain, cough, sputum production, hemoptysis , voice change, fatigue
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| show | Predominant complaints, family hx, health hx, smoking hx, occupational exposure
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| Patterns Of Breathing | show 🗑
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| show | Constriction (vagus nerve) Histamine release= >mucus/prostoglandin= more constriction
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| show | NSAID, ASA, -olol, ACE, some inhalers
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| Symptoms Of Bronchospasm | show 🗑
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| show | #1 Inspection #2 Palpation #3 Percussion #4 Auscultation
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| show | *Lying=mild distress *Sitting=moderate *Upright=severe *Tripod=increases A&P diameter *Orthopnea="one,two,three pillow"
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| Finger Clubbing | show 🗑
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| show | Sentence= mild/moderate dyspnea *Phrase= moderate *Words= severe "1-2-3 word dyspnea"
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| show | With pads of fingers, crepitus-crackles, nodes-if swollen should move, mediastinal shift- trachea shifts to opposite side of lung injury.
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| show | Vibration, ask pt. to say 99, decreased in atelectasis, emphysema, asthma, pleural effusion & pneumothorax, increased in pneumonia, tumor, secretions
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| Sounds Of Percussion | show 🗑
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| How To Auscultation Pt. | show 🗑
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| show | *Bronchial= loud, high pitched, over large airways, expiratory * Bronchiovesicular= medium pitch, R&L bronchus, i=e *Vesicular= soft/low pitch, i>e *E-I-E-I-I
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| show | Rales, not cleared by coughing, fluid scruntching down on aveoli, ex. pulmonary edema
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| Sonorous Wheezes | show 🗑
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| show | High pitched, harsh, inspiratory ex. laryngeal spasms due to tetany w/ low calcium, croup
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| show | Loud, dry, creaking, loss of lubricant, most often heard laterally ex. pleurisy, pleuritis, effusion, poss pneumonia
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| show | Ex. atelectasis, pleural effusion, pneumonia, worsening bronchonconstriction
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| show | SaO2= saturation of oxygen on hemoglobin**Does not determine acid-base status
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| Inaccurate Pulse Ox Reading | show 🗑
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| show | **<90-91% (12 hrs)= Report & corrective nursing action **<80% (4 hrs)= Hurry **<70% (1 hr)= You better run!
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| show | 0.8-0.9, Perfect= 1mL O2 per 1mL of blood, Abnormal VQ= hypoxia, most often done for pulmonary embolism or baseline for someone with ARDS
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| Shunt | show 🗑
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| Silent Unit | show 🗑
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| show | Poor perfusion=horrible blood flow to pick up O2, nothing wrong w/ lungs, ex. PE, decreased CO
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| show | Based on age, height, wt, sex, monitor the course of pulmonary disease, evaluate meds, determine need for mechanical ventilation
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| show | No..tobacco,bronchiodilators,heavy meal,sedatives,narcotics,distended abdomen. Instruct pt how to breathe for test= nose clip,tight seal
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| PFT Results | show 🗑
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| show | Maintain airway, prevent injury-may be dizzy
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| Sputum Specimines | show 🗑
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| Pre Bronchoscopy procedure | show 🗑
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| Post Bronchoscopy Procedure | show 🗑
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| Bronchoalveolar Lavage (BAL) | show 🗑
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| Mediastinoscopy | show 🗑
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| Methemo-Globinemia | show 🗑
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| show | Lg bore needle through chest wall, position client in supine or sitting postion, affected lung accessible
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| Low Flow O2 systems | show 🗑
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| High Flow O2 systems | show 🗑
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| show | Flow= Force (# of liters) Concentration= Percent
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| Oral Airway | show 🗑
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| show | Advantages=easy to insert, preserves airway. Disadvantages=easy to dislodge,unconscious pts,no use in facial/oral surgery
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| show | Mechanical ventilation up to 100% O2, can be inserted oral or nasal
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| Oral vs. Nasal ET | show 🗑
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| Indications for ETT & Mechanical Ventilation | show 🗑
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| show | Only nurses with training can perform, RN-sets up equpiment, verify placement, check cuff leaks, monitoring location, care vent. settings, teach conscious pt. about gagging/feelings of suffocation
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| Function Of Cuff On ET Tube | show 🗑
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| Rapid Sequence Intubation (RSI) | show 🗑
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| Procedure for RSI | show 🗑
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| Correct ET location | show 🗑
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| Verifying Placement Of ET | show 🗑
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| show | "Lip Line" Q-24 hrs, women 21cm, men 23cm, move side to side but not up and down, x-ray is absolute look!
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| show | PaCO2=best indicator of hypo/hyper ventilation
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| Complications of ET | show 🗑
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| Maintaining Tube Patency | show 🗑
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| show | Useful for PEEP >7-8cmH20,secretions,freq. suctioning need,unstable
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| show | Impaired gas exchange & Decreased cardiac output
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| Negative Pressure Vent | show 🗑
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| show | Inflates aveoli, must be intubated or trach, creates decreased cardiac output
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| Pressure Cycled Ventilators | show 🗑
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| show | Preset volume, tidal volume delivered regardless of resistance or compliance, more frequently used
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| Tidal Volume (TV or VT) | show 🗑
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| show | 21-100% ex. ARDS, Can have O2 toxicity (lost nitrogen) or absorbtion atelectasis (alveolar collapse)
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| show | Vent only delivers TV & breaths per min. that have been set, total control for pt. by decreasing work of breathing, but can cause muscle atrophy=harder to wean
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| Assist/Control Ventilation (ACV) | show 🗑
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| show | Least control=used for weaning, pt. can take own additional breaths @ own TV, vent. rate gradually decreased, will not breathe as pt. breaths on their own
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| show | + pressure applied via facemaskor ET helps maintain open airways and aveoli >5cm Used mostly for weaning and sleep apnea
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| show | 3-5cm, increases amt. of air remaining in the lungs during expiratory phase, allows for reduction of FiO2
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| show | Amt. of pressure required to deliver TV, Plateau pressure: 30cm H20 or less, if increased=bad, decreased=good
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| Low Pressure Alarm | show 🗑
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| show | Pre-set peak inspiratory pressure limit is reached b4 venthas delivered set TV, Fix the problem! Check for obstruction, placement..
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| If In Distress With An Alarming Vent.. | show 🗑
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| show | 5-10cm, pt. receives increased TV
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| Sighs | show 🗑
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| Hypoventilation | show 🗑
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| Hyperventilation | show 🗑
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| show | Uneven blood flow in lungs
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| Decreased CO | show 🗑
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| Volu or Barotrauma | show 🗑
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| O2 Toxicity | show 🗑
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| show | Reposition side to sidein mouth, release cuff pressures via protocol
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| show | May be caused by high vent pressure
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| When to draw ABGs | show 🗑
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| Nursing Assessments | show 🗑
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| show | Humidified/warmed air, HOB 30 degrees, position change, suction, ABGs, keep vent alarms on, correst bucking, decrease anxiety, respect sleep/wake cycles, high calorie need
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| Weaning Phase #1 Pre-Weaning | show 🗑
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| show | *Short term pt-linear *Long term pt. peaks & valleys *Psych support for pt. and family
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| Weaning Phase #3 Outcome | show 🗑
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| Ready To Wean? | show 🗑
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| Weaning Guidelines | show 🗑
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| show | 30 min-2 hrs, increasing time, stop before fatigue
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| show | Remove pt. from vent, place on t-piece which delivers specified FiO2 back on vent then gradually increase time (10 min or so) off until pt. breaths spontaneously for prolonged period
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| show | Gradually decrease # of breaths that machine delivers until pt. breathing totally on own. Vent is there for support, do not need to return to original vent settings
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| CPAP | show 🗑
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Created by:
tjcox50
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