Karteikarten
Advanced Methods of Respiratory Support
Karten in diesem Stapel (44)
- 1The Respiratory tractPulmonary functional unit
Ciliated mucous membrane - 2Goals of the respiratory system- transport oxygen from atmosphere to alveoli, where it is collected by HB and transported to active tissue
- O2 is used with mitochondria to support aerobic metabolism by-product is CO2
-CO2 is transported out of the body in blood, across alveolar membrance and expired - 3Non- Respiratory functions of the lungs- Filtration of micro-emboli
- Metabolic function of lungs:
- inactivation of damaging enzymes (Alpha 1 antitrypsin)
- alteration of hormonal levels (angiotensin 1 converted to angiotensin 2)
- involvement in lipid metabolism
- acts as a reservoir for blood
- storage of megakaryocytes - 4Oxygen Delivery - step by step process1 - atmosphere to alveoli (Ventilation)
2- Alveoli to blood (Diffusion)
3 - Transport to gases in blood (HB binding)
4 - Convection (Cardiovascular)
5 - Blood to tissues (Diffusion) - 5Tissue and cellular oxygenation relies on:Oxygen delivery
Pulmonary gas exchange
Oxygen consumption - 6Respiratory system consists of:- Ventilatory pump
(Pleura, peripheral nerve, bones, muscles, soft tissues)
- Gas exchanger
- Respiratoy controller (Automatic, behavioural, sensory) - 7RespirationProcess of supply and demand
Supplied oxygen and carbon dioxide are elimiinated - 8Oxygen delivery depends on:- Ventilation
- Diffusion of o2 into the blood
- Binding with hb
- Adequate cardiac output
- Diffusion into the cell
- DO2 = HB x 10 x sao2 x1.3 x co - 9Laryngospasm-Precipitating causes:
airway irritation and or obstruction
- failure of anaesthetic delivery
clinical signs:
- Inspiratory stridor/airway obstruction
- increased inspiratory efforts/ trachel tug - 10Laryngospasm management- 100% oxygen
- chin lift and jaw thrust
- positive pressure - 11Definition of respiratory failurePAO2 of 60mmhg or less when the pt is receiving is receiving an inspired oxygen concentration of 60% or greater
- 12Classification of respiratory failureHypoxaemic - oxygenation failure, less than 60mmhg
Hypercapnic - Ventilatory failure, greater than 50mmhg
acute - minutes to hours
chronic - several days or longer - 13Hypoxaemic respiratory failure- ventilation-perfusion VQ mismatch
- Shunt
- Diffusion limitation
- Alveolar hypoventilation - 14Hypercapnic respiratory failure- airways and alveoli
- central nervous system
- chest wall
- neuromuscular conditions
- tissue oxygen needs - 15Acute Respiratory Distress syndrome ARDS- injury or exudate phase
- clinical progression
- fibrotic phase - 16ARDSstages of oedema formation in ARDS,
- Alveoli oedema occurs when the fluid crosses then blood- gas barrier - 17Complications of ARDS-nosocomial pneumonia
- Barotrauma
- Volu-pressure trauma
- physiological stress ulcers
- renal failure - 18Respiration versus ventilationExternal respiration (Ventilation) - transfer of gas to enable the exchange of carbon dioxide and oxygen occurring in the alveoli
Internal Respiration (Respiration) - consumption of oxygen and production of carbon dioxide within the tissues - 19Principles of ventilationVentilation therapy is provided via non invasive or invasive means and usually with positive pressure breaths
- 20Non-invasive ventilation- NIV delivers positive pressure breaths to a spontaneous breathing patient by face or nasal mask within an airtight seal
- Positive end expiratory pressure (PEEP)
- Bilevel positive airway pressure (BiPAP)
- Continuous positive airway pressure (CPAP) - 21Optimising success:Initial application technique
- good tolerance without frequent intervention
- Titrate to achieve and maintain patient in a 'zone of comfort'
- Secure the mask and evaluate leak - 22Recognising failure of interventions- poor tolerance
- PaO2/FiO2 less than 175 after 1 hour
- Worsening PH and PACo2
-Haemodynamic instability
- reduction in loss of consciousness - 23Complications of NIPPV- Drying of eyes
- nasal bridge ulceration
- leaks leading to hypoventilation
- sleep disturbances - 24Invasive ventilation- inability to protect airway
- inadequate breathing pattern
- inability to sustain adequate oxygenation for metabolic demands
- hypercarbia - 25Gold standardETT
- 26Components of a ventilator- pneumatic system:
- inspiratory ventilator circuit
- expiratory valve closes or partially closes
- Electronic system:
- microprocessor: insp/exp valve
- Information/monitoring systems
- ventilator alarms - 27Modes of ventilation and breath delivery- breath type and breath delivery during mechanical ventilation constitute mode of ventilation
Factors to consider are:
- type of breath
- targeted control variable (volume or pressure)
- Timing of breath delivery (Mandatory or spontaneous) - 28mandatory breathsVentilator controls timing, patient triggered, volume targeted and volume cycled
- 29Spotaneous breathspatient controls timing and tidal volume, the volume and pressure of both delivered is based on patient characteristics not a set value
- 30Assisted breathCharacteritics of above, but all or part of breath is generated by ventilator, which does part of WOB for patient.
- A target pressure is set by clinician and ventilator delivers the set pressure above baseline pressure to assist breathing effort - 31Modes of ventilation- volumes modes: volume controlled (VC), Synchronised Intermittent Volume Controlled (SIMV)
- Pressure modes: Pressure controlled (PC), pressure support (PS)
- Others: PEEP, CPAP, BIPAP, high frequency - 32Ventilator setting for specific patient situationsCOPD: - maximise patient ventilator synchrony and decrease WOB and anxiety
- Asthma: most difficult to ventilate, secretions lead to oedema, tight airways make gas movement impossible in some areas
ARDS: Increase vascular permeability, lung water and protein, issues with oxygenation and ventilation - 33Sedated and critically ill patients with resp failure rely on nurse to:- correct circuit disconnections
- provide suction
- monitor ventilator effects
- observe for complications of ventilation
- optimise sedation level - 34Nursing care- check ventilation order against what is giving
- Check ETT length
- check pilot ballon
- check resp status
- check for leaks in system - 35Ventilator bundle- series of interventions that should be done on each mechanically ventilated patient to move this closer to removal of mechanical ventilation
purpose: to eliminate ventilator associated complications and reduce duration of ventilator, risk of death - 36Complications associated with ventilation- VAP, ALI
- na and h20 imbalance
- gastro bleeding
- resp muscle weakness
- PTS - 37Mutisystem effects of positive pressure ventilation- volutrauma/ barotrauma/ alectrauma= increase gas flow to nodependent lund, increase dead space
- resdistribution of pulmonary blood flow
- oxygen toxicity
- ventilator associated pneumonia , altered VQ mismatching - 38Effects of PPV cardiovasculardecrease CO, SV, Right ventricular preload
clinical manisfestations - decrease BP - 39Effects of PPV NeurovascularCPP = MAP - ICP (Difference b/w MAP and IP
clinical manisfestations: possible increase in ICP, altered LOC - 40Effects of PPV RenalRedistribution of blood flow to kidneys
clinical manisfestations:
decrease UO, increase NA and creatinine - 41Effects of ppv GastrointestinalDecrease blood flow to intestinal viscera
clinical manifestations - increase risk of ulcer, GI bleed - 42Ventilator bundle of care- DVT prophylaxis
TEDS
gastric bleeding prophylaxis
Head of bed elevation
sedation vacation
nutrition
Tight glycaemic control
'FASTHUG' - 43Pharmacology- Neuromuscular blocking agents (atracurium/rocuronium/vecuronium)
- Anaesthetic agents (Propofol/Thiopentone)
- Sedation agents (Midazolam)
- Opioid analgesics (Morphine/fentanyl) - 44Weaning- weaning methods:
T-Piece still around
SIMV
PSV
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- Beschreibung
- Der Nutzer hat seine Fachbereichs-Information gelöscht. Karteikarten am Advanced Methods of Respiratory Support, erstellt von Gelöschter Nutzer am 28/08/2018.
- Erstellt von
- Gelöschter Nutzer · Aug 2018
- Aktualisiert
- 28 Aug 2018
- Aufrufe
- 36
- Verlauf
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- Erstellt von Elizabeth Then · 28 Aug 2018
- Kopiert von Elizabeth Then · 28 Aug 2018
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