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positive end-expiratory pressure (ventilatory support)
in ventilatory support, applies positive pressure to keep the alveoli from collapsing between breaths
assist/control mode (ventilatory support)
responds to each breathing attempt by administering a breath, or delivers preset breath
synchronized intermittent mandatory ventilation [SIMV] (ventilatory support)
delivers preset breaths but also allows pt to take unassisted breaths
controlled mandatory ventilation (ventilatory support)
delivers preset breaths without regards to pts attempt to breathe
rarely used except in paralyzed or anesthetized pts b/c of problems w/ synchrony
continuous positive airway pressure [cpap]
+ pressure applied throughout respiratory cycle to a spontaneously breathing pt to promote alveolar & airway stability. helps prevent alveolar collapse
infants: may be applied nasal prongs, nasopharyngeal tubes, or endotracheal tube
criterion: must be able to breathe spontaneously w/ assistance to relieve respiratory distress in infants
chronic obstructive pulmonary disease [copd]
when on 02 therapy, closely monitor for bradypnea b/c it could indicate impending problem. breath sounds are often diminished, but if still diminished following cpt it should be noted
monitor pulse oximetry & ABGs to ensure proper oxygenationadequate hydration is one of the simple, effective ways to achieve clear breath sounds. hypoxemia helps stimulate pts respiratory effortsprovide incentive spirometry & encourage deep breathingprovide high calorie, protein rich foods to promote healingpt should receive o2 at 1-2Lmin to prevent respiratory depressionwhen prolonged disease or injury has made lungs less capable of meeting body's o2 needs
"good lung down" & tripod positionex: chronic bronchitis, emphysema & asthmarisk factors: tobacco smoke, passive smoking, occupational exposure to dust & chemicals, ambient air pollution, genetic abnormalitiesactivity intolerance: estab. regular exercise routine
pursed-lip breathing (purpose)
good to teach w/ emphysema pt.
*prolongs exhalation & builds pts ability to control rate & depth of respirations (increase airway pressure) & ease sob. allows airways to not collapse between breaths. strengthens respiratory muscles
pneumonia
key indicators of development: fever, tachypnea, cough, & crackles
productive cough, rhonchi, wheezing & pleural friction rub
lobar pneumonia: exudate infiltrates & fills alveoli which leads to ventilation-perfusion mismatch & altered ABGs
bronchiectasis
chronic dilation of bronchus or bronchis/s: chronic cough, purulent secretions, hemoptysis, & clubbing
lung abcess (s/s)
dyspnea, fatigue, anorexia & wt loss
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