Term
| What factors affect the control of respiration? |
|
Definition
Pulmonary irritant reflexes
Major trauma
emotions/pain/body temp change
Voluntary control
changes in arterial levels of CO2, O2, H
Hypercarbia/hypocarbia
Hypoxaemia |
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Term
| Indications for assisted ventilation |
|
Definition
change in volume and capacity
change in air pressure
change in O2, CO2, H levels
Airway resistance, lung compliance & elasticity
Alveolar surface tension |
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Term
|
Definition
continuous positive airway pressure:
maintains open airway and decreases workload through continuous pressure. Done with ETT or face mask. |
|
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Term
|
Definition
Bi-level positive airway pressure:
inspiration positive pressure and a pressure that stays present on expiration |
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Term
| What are the complications of CPAP and BiPAP |
|
Definition
gastric dilation
aspiration
facial skin necrosis
drying of eyes
drying of mucosal membranes
stress
claustrophobia |
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Term
| Why mechanically ventilate? |
|
Definition
When alveolar ventilation not adequate in maintaining blood O2 and CO2 levels
-aponea
-acute ventilatory failure
-hypoxaemia unresponsive to O2 therapy
-Increased breathing workload with progressive fatigue |
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Term
| What is the nursing management of mechanical ventilation? |
|
Definition
Observations
-head to toe
-End tidal CO2
-Arterial BP
-Ventilation measures
-Regular arterial blood gas readings
Observe system/circuit
-patency and placement of ETT
-Ventilator settings, tubing and O2 supply
-regular suctioning
-subcutaneous emphysema
-elevate head of bed 30 degrees
-mounth care 4th hrly
deep oropharyngeal suctioning 12th hrly
-stress ulcer prophylaxis
-communication strategies |
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|
Term
| Complications of mechanical ventilation |
|
Definition
Baro-trauma
Volutrauma
decreased cardiac output and BP
Noscomal infection/ pneumonia
Oxygen toxicity
erosive gastritis
intestinal distension
facial pressure area
premature weaning
malnutrition
fluid imbalance
neurological compromis |
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Term
| Ventilator settings: Rate |
|
Definition
| Number of ventilator delivered breaths per min. Usually 10-15 using ACMV, may be lower in SIMV |
|
|
Term
| Ventilator settings: tidal volume (Vt) |
|
Definition
| Amount of gas delivered with each ventilator breath- usually between 8-10 mL/kg |
|
|
Term
| Ventilator settings: oxygen concentration (FiO2) |
|
Definition
| Percentage of O2 delivered with ventilator breaths- can be 21% (RA) and 100% |
|
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Term
| Ventilator settings: I:E ratio |
|
Definition
| duration of inspiration to expiration usually 1:2 or 1:1.5 |
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|
Term
| Ventilator settings: Flow rate |
|
Definition
| Speed at which air is delivered |
|
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Term
|
Definition
| Controlled or assisted breaths based on measured volume settings |
|
|
Term
|
Definition
| controlled or assisted ventilation based on measured pressures within the airway |
|
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Term
| What is PEEP, why and when is it used |
|
Definition
Peak end expiratory pressure:
+ve pressure to airway and alveoli to keep them open.
Used when pt has invasive artificial airway, when patients have decreased lung compliance
It increases lung volume, redistributes fluid, decreases O2 demand
High levels of PEEP can cause volutrauma by over distending airways and alveoli |
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|
Term
|
Definition
Acute respiratory distress syndrome:
Inflammatory syndrome
Direct or indirect injury
Fluid, blood and protein fill alveoli spaces
Surfactant production decreases thus contributing to decreased compliance
Hypoxemia respiratory failure
Most commonly seen in multiple trauma, sepsis, burns, smoke & noxious gas inhalation |
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|
Term
| ARDS clinical presentation |
|
Definition
Can mirror acute pulmonary oedema
Severe dysponea and rapid/shallow breathing
Respiratory alkalosis
Decreased lung compliance
Audible diffuse crackles
Hypoxemia non responsive to 100% O2
Diffuse alveolar infiltration on CXR
Altered mental status
Hypotention
Tachycardia
Decrease UO |
|
|
Term
|
Definition
Mechanical ventilation
PEEP
100% O2
Diuretics
Maintain cardiac output
Antibiotics
Prone positioning
Steroids |
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