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189 Cards in this Set

  • Front
  • Back
Respiratory
I. Assessment
A. Subjective Data
1. Past Health History--______, ________, _________, ________, previous hospitalizations, allergies, COPD, pneumonia, bronchitis, TB, weight loss (early lung cancer, TB, and COPD), sleep apnea, recent travel, flu vaccination
2. Symptoms--SOB (when, etc.), # of pillows for sleep, DOE (how far can they walk), associated symptoms (cough, changes, sputum, loose/dry, color, odor, blood), pain (what relieves it)
3. Medications--prescription and over the counter 169.254.115.213
Respiratory
I. Assessment
A. Subjective Data
1. Past Health History--smoking, asthma, occupation, recent illnesses, previous hospitalizations, allergies, COPD, pneumonia, bronchitis, TB, weight loss (early lung cancer, TB, and COPD), sleep apnea, recent travel, flu vaccination
2. Symptoms--SOB (when, etc.), # of pillows for sleep, DOE (how far can they walk), associated symptoms (cough, changes, sputum, loose/dry, color, odor, blood), pain (what relieves it)
3. Medications--prescription and over the counter
Respiratory
I. Assessment
A. Subjective Data
1. Past Health History--smoking, asthma, occupation, recent illnesses, ________, _________, _________, ________, bronchitis, TB, weight loss (early lung cancer, TB, and COPD), sleep apnea, recent travel, flu vaccination
2. Symptoms--SOB (when, etc.), # of pillows for sleep, DOE (how far can they walk), associated symptoms (cough, changes, sputum, loose/dry, color, odor, blood), pain (what relieves it)
3. Medications--prescription and over the counter
Respiratory
I. Assessment
A. Subjective Data
1. Past Health History--smoking, asthma, occupation, recent illnesses, previous hospitalizations, allergies, COPD, pneumonia, bronchitis, TB, weight loss (early lung cancer, TB, and COPD), sleep apnea, recent travel, flu vaccination
2. Symptoms--SOB (when, etc.), # of pillows for sleep, DOE (how far can they walk), associated symptoms (cough, changes, sputum, loose/dry, color, odor, blood), pain (what relieves it)
3. Medications--prescription and over the counter
Respiratory
I. Assessment
A. Subjective Data
1. Past Health History--smoking, asthma, occupation, recent illnesses, previous hospitalizations, allergies, COPD, pneumonia, _____, ______, _______ (early lung cancer, TB, and COPD), _______, recent travel, flu vaccination
2. Symptoms--SOB (when, etc.), # of pillows for sleep, DOE (how far can they walk), associated symptoms (cough, changes, sputum, loose/dry, color, odor, blood), pain (what relieves it)
3. Medications--prescription and over the counter
Respiratory
I. Assessment
A. Subjective Data
1. Past Health History--smoking, asthma, occupation, recent illnesses, previous hospitalizations, allergies, COPD, pneumonia, bronchitis, TB, weight loss (early lung cancer, TB, and COPD), sleep apnea, recent travel, flu vaccination
2. Symptoms--SOB (when, etc.), # of pillows for sleep, DOE (how far can they walk), associated symptoms (cough, changes, sputum, loose/dry, color, odor, blood), pain (what relieves it)
3. Medications--prescription and over the counter
Respiratory
I. Assessment
A. Subjective Data
1. Past Health History--smoking, asthma, occupation, recent illnesses, previous hospitalizations, allergies, COPD, pneumonia, bronchitis, TB, weight loss (early lung cancer, TB, and COPD), sleep apnea, ____,________
2. Symptoms--SOB (when, etc.), # of pillows for sleep, DOE (how far can they walk), associated symptoms (cough, changes, sputum, loose/dry, color, odor, blood), pain (what relieves it)
3. Medications--prescription and over the counter
Respiratory
I. Assessment
A. Subjective Data
1. Past Health History--smoking, asthma, occupation, recent illnesses, previous hospitalizations, allergies, COPD, pneumonia, bronchitis, TB, weight loss (early lung cancer, TB, and COPD), sleep apnea, recent travel, flu vaccination
2. Symptoms--SOB (when, etc.), # of pillows for sleep, DOE (how far can they walk), associated symptoms (cough, changes, sputum, loose/dry, color, odor, blood), pain (what relieves it)
3. Medications--prescription and over the counter
Respiratory
I. Assessment
A. Subjective Data
1. Past Health History--smoking, asthma, occupation, recent illnesses, previous hospitalizations, allergies, COPD, pneumonia, bronchitis, TB, weight loss (early lung cancer, TB, and COPD), sleep apnea, recent travel, flu vaccination
2. Symptoms--SOB (when, etc.), # of _______ for sleep, _____ (how far can they walk), associated symptoms (____, ______, sputum, loose/dry, color, odor, blood), pain (what relieves it)
3. Medications--prescription and over the counter
Respiratory
I. Assessment
A. Subjective Data
1. Past Health History--smoking, asthma, occupation, recent illnesses, previous hospitalizations, allergies, COPD, pneumonia, bronchitis, TB, weight loss (early lung cancer, TB, and COPD), sleep apnea, recent travel, flu vaccination
2. Symptoms--SOB (when, etc.), # of pillows for sleep, DOE (how far can they walk), associated symptoms (cough, changes, sputum, loose/dry, color, odor, blood), pain (what relieves it)
3. Medications--prescription and over the counter
Respiratory
I. Assessment
A. Subjective Data
1. Past Health History--smoking, asthma, occupation, recent illnesses, previous hospitalizations, allergies, COPD, pneumonia, bronchitis, TB, weight loss (early lung cancer, TB, and COPD), sleep apnea, recent travel, flu vaccination
2. Symptoms--SOB (when, etc.), # of pillows for sleep, DOE (how far can they walk), associated symptoms (cough, changes, _____, ______, ______, ______, blood), pain (what relieves it)
3. Medications--prescription and over the counter
Respiratory
I. Assessment
A. Subjective Data
1. Past Health History--smoking, asthma, occupation, recent illnesses, previous hospitalizations, allergies, COPD, pneumonia, bronchitis, TB, weight loss (early lung cancer, TB, and COPD), sleep apnea, recent travel, flu vaccination
2. Symptoms--SOB (when, etc.), # of pillows for sleep, DOE (how far can they walk), associated symptoms (cough, changes, sputum, loose/dry, color, odor, blood), pain (what relieves it)
3. Medications--prescription and over the counter
Respiratory
I. Assessment
A. Subjective Data
1. Past Health History--smoking, asthma, occupation, recent illnesses, previous hospitalizations, allergies, COPD, pneumonia, bronchitis, TB, weight loss (early lung cancer, TB, and COPD), sleep apnea, recent travel, flu vaccination
2. Symptoms--SOB (when, etc.), # of pillows for sleep, DOE (how far can they walk), associated symptoms (cough, changes, sputum, loose/dry, color, odor, ______), ______ (what relieves it)
3. Medications--prescription and over the counter
Respiratory
I. Assessment
A. Subjective Data
1. Past Health History--smoking, asthma, occupation, recent illnesses, previous hospitalizations, allergies, COPD, pneumonia, bronchitis, TB, weight loss (early lung cancer, TB, and COPD), sleep apnea, recent travel, flu vaccination
2. Symptoms--SOB (when, etc.), # of pillows for sleep, DOE (how far can they walk), associated symptoms (cough, changes, sputum, loose/dry, color, odor, blood), pain (what relieves it)
3. Medications--prescription and over the counter
Respiratory
I. Assessment
A. Subjective Data
1. Past Health History--smoking, asthma, occupation, recent illnesses, previous hospitalizations, allergies, COPD, pneumonia, bronchitis, TB, weight loss (early lung cancer, TB, and COPD), sleep apnea, recent travel, flu vaccination
2. Symptoms--SOB (when, etc.), # of pillows for sleep, DOE (how far can they walk), associated symptoms (cough, changes, sputum, loose/dry, color, odor, blood), pain (what relieves it)
3. Medications--________ and _______
Respiratory
I. Assessment
A. Subjective Data
1. Past Health History--smoking, asthma, occupation, recent illnesses, previous hospitalizations, allergies, COPD, pneumonia, bronchitis, TB, weight loss (early lung cancer, TB, and COPD), sleep apnea, recent travel, flu vaccination
2. Symptoms--SOB (when, etc.), # of pillows for sleep, DOE (how far can they walk), associated symptoms (cough, changes, sputum, loose/dry, color, odor, blood), pain (what relieves it)
3. Medications--prescription and over the counter
Respiratory
I. Assessment
B. Objective Data
1. Inspection
a. Signs of respiratory distress--_____, _______, ----------, ----------, ↑HR, accessory muscle use, pursed lip breathing, tracheal deviation
b. Shape and symmetry of chest--bilaterally unequal, anterior-posterior diameter (ex. COPD-barrel), kyphosis, scoliosis, pectis exctavatum
c. Ventilatory patterns--kussmals, chayne-stokes, rate, depth, etc.
d. Evidence of clubbing--chronic hypoxia from COPD, lung cancer, and CF
Respiratory
I. Assessment
B. Objective Data
1. Inspection
a. Signs of respiratory distress--cyanosis, diff breathing, anxiety, diaphoretic, ↑HR, accessory muscle use, pursed lip breathing, tracheal deviation
b. Shape and symmetry of chest--bilaterally unequal, anterior-posterior diameter (ex. COPD-barrel), kyphosis, scoliosis, pectis exctavatum
c. Ventilatory patterns--kussmals, chayne-stokes, rate, depth, etc.
d. Evidence of clubbing--chronic hypoxia from COPD, lung cancer, and CF
Respiratory
I. Assessment
B. Objective Data
1. Inspection
a. Signs of respiratory distress--cyanosis, diff breathing, anxiety, diaphoretic, ↑-----, -------------, -----------, ---------
b. Shape and symmetry of chest--bilaterally unequal, anterior-posterior diameter (ex. COPD-barrel), kyphosis, scoliosis, pectis exctavatum
c. Ventilatory patterns--kussmals, chayne-stokes, rate, depth, etc.
d. Evidence of clubbing--chronic hypoxia from COPD, lung cancer, and CF
Respiratory
I. Assessment
B. Objective Data
1. Inspection
a. Signs of respiratory distress--cyanosis, diff breathing, anxiety, diaphoretic, ↑HR, accessory muscle use, pursed lip breathing, tracheal deviation
b. Shape and symmetry of chest--bilaterally unequal, anterior-posterior diameter (ex. COPD-barrel), kyphosis, scoliosis, pectis exctavatum
c. Ventilatory patterns--kussmals, chayne-stokes, rate, depth, etc.
d. Evidence of clubbing--chronic hypoxia from COPD, lung cancer, and CF
Respiratory
I. Assessment
B. Objective Data
1. Inspection
a. Signs of respiratory distress--cyanosis, diff breathing, anxiety, diaphoretic, ↑HR, accessory muscle use, pursed lip breathing, tracheal deviation
b. Shape and symmetry of chest: --------, ------------------ (ex. COPD-barrel), ------------, scoliosis, pectis exctavatum
c. Ventilatory patterns--kussmals, chayne-stokes, rate, depth, etc.
d. Evidence of clubbing--chronic hypoxia from COPD, lung cancer, and CF
Respiratory
I. Assessment
B. Objective Data
1. Inspection
a. Signs of respiratory distress--cyanosis, diff breathing, anxiety, diaphoretic, ↑HR, accessory muscle use, pursed lip breathing, tracheal deviation
b. Shape and symmetry of chest--bilaterally unequal, anterior-posterior diameter (ex. COPD-barrel), kyphosis, scoliosis, pectis exctavatum
c. Ventilatory patterns--kussmals, chayne-stokes, rate, depth, etc.
d. Evidence of clubbing--chronic hypoxia from COPD, lung cancer, and CF
Respiratory
I. Assessment
B. Objective Data
1. Inspection
a. Signs of respiratory distress--cyanosis, diff breathing, anxiety, diaphoretic, ↑HR, accessory muscle use, pursed lip breathing, tracheal deviation
b. Shape and symmetry of chest--bilaterally unequal, anterior-posterior diameter (ex. COPD-barrel), kyphosis, ----------, ----------------
c. Ventilatory patterns--kussmals, chayne-stokes, rate, depth, etc.
d. Evidence of clubbing--chronic hypoxia from COPD, lung cancer, and CF
Respiratory
I. Assessment
B. Objective Data
1. Inspection
a. Signs of respiratory distress--cyanosis, diff breathing, anxiety, diaphoretic, ↑HR, accessory muscle use, pursed lip breathing, tracheal deviation
b. Shape and symmetry of chest--bilaterally unequal, anterior-posterior diameter (ex. COPD-barrel), kyphosis, scoliosis, pectis exctavatum
c. Ventilatory patterns--kussmals, chayne-stokes, rate, depth, etc.
d. Evidence of clubbing--chronic hypoxia from COPD, lung cancer, and CF
Respiratory
I. Assessment
B. Objective Data
1. Inspection
a. Signs of respiratory distress--cyanosis, diff breathing, anxiety, diaphoretic, ↑HR, accessory muscle use, pursed lip breathing, tracheal deviation
b. Shape and symmetry of chest--bilaterally unequal, anterior-posterior diameter (ex. COPD-barrel), kyphosis, scoliosis, pectis exctavatum
c. Ventilatory patterns: ------------, ----------, --------, ---------, etc.
d. Evidence of clubbing--chronic hypoxia from COPD, lung cancer, and CF
Respiratory
I. Assessment
B. Objective Data
1. Inspection
a. Signs of respiratory distress--cyanosis, diff breathing, anxiety, diaphoretic, ↑HR, accessory muscle use, pursed lip breathing, tracheal deviation
b. Shape and symmetry of chest--bilaterally unequal, anterior-posterior diameter (ex. COPD-barrel), kyphosis, scoliosis, pectis exctavatum
c. Ventilatory patterns--kussmals, chayne-stokes, rate, depth, etc.
d. Evidence of clubbing--chronic hypoxia from COPD, lung cancer, and CF
Respiratory
I. Assessment
B. Objective Data
1. Inspection
a. Signs of respiratory distress--cyanosis, diff breathing, anxiety, diaphoretic, ↑HR, accessory muscle use, pursed lip breathing, tracheal deviation
b. Shape and symmetry of chest--bilaterally unequal, anterior-posterior diameter (ex. COPD-barrel), kyphosis, scoliosis, pectis exctavatum
c. Ventilatory patterns--kussmals, chayne-stokes, rate, depth, etc.
d. Evidence of clubbing: --------------- from --------, ---------, and -----
Respiratory
I. Assessment
B. Objective Data
1. Inspection
a. Signs of respiratory distress--cyanosis, diff breathing, anxiety, diaphoretic, ↑HR, accessory muscle use, pursed lip breathing, tracheal deviation
b. Shape and symmetry of chest--bilaterally unequal, anterior-posterior diameter (ex. COPD-barrel), kyphosis, scoliosis, pectis exctavatum
c. Ventilatory patterns--kussmals, chayne-stokes, rate, depth, etc.
d. Evidence of clubbing--chronic hypoxia from COPD, lung cancer, and CF
Respiratory
I. Assessment
B. Objective Data
2. Palpitation
a. Assess trachea is -------, tracheal deviation indicated---------
b. Assess thoracic excursion/chest expansion--normally equal bilaterally
i. Decreased bilaterally for emphysema
ii. Decreased on effected side for pleural effusion and pneumothorax
Respiratory
I. Assessment
B. Objective Data
2. Palpitation
a. Assess trachea is midline--tracheal deviation indicated tension pneumothorax
b. Assess thoracic excursion/chest expansion--normally equal bilaterally
i. Decreased bilaterally for emphysema
ii. Decreased on effected side for pleural effusion and pneumothorax
Respiratory
I. Assessment
B. Objective Data
2. Palpitation
a. Assess trachea is midline--tracheal deviation indicated tension pneumothorax
b. Assess ---------/chest expansion--normally equal ---------
i. Decreased bilaterally for emphysema
ii. Decreased on effected side for pleural effusion and pneumothorax
Respiratory
I. Assessment
B. Objective Data
2. Palpitation
a. Assess trachea is midline--tracheal deviation indicated tension pneumothorax
b. Assess thoracic excursion/chest expansion--normally equal bilaterally
i. Decreased bilaterally for emphysema
ii. Decreased on effected side for pleural effusion and pneumothorax
Respiratory
I. Assessment
B. Objective Data
2. Palpitation
a. Assess trachea is midline--tracheal deviation indicated tension pneumothorax
b. Assess thoracic excursion/chest expansion--normally equal bilaterally
i. Decreased --------- for ---------
ii. Decreased on effected side for pleural effusion and pneumothorax
Respiratory
I. Assessment
B. Objective Data
2. Palpitation
a. Assess trachea is midline--tracheal deviation indicated tension pneumothorax
b. Assess thoracic excursion/chest expansion--normally equal bilaterally
i. Decreased bilaterally for emphysema
ii. Decreased on effected side for pleural effusion and pneumothorax
Respiratory
I. Assessment
B. Objective Data
2. Palpitation
a. Assess trachea is midline--tracheal deviation indicated tension pneumothorax
b. Assess thoracic excursion/chest expansion--normally equal bilaterally
i. Decreased bilaterally for emphysema
ii. Decreased on effected side for --------- and ---------
Respiratory
I. Assessment
B. Objective Data
2. Palpitation
a. Assess trachea is midline--tracheal deviation indicated tension pneumothorax
b. Assess thoracic excursion/chest expansion--normally equal bilaterally
i. Decreased bilaterally for emphysema
ii. Decreased on effected side for pleural effusion and pneumothorax
Respiratory
I. Assessment
B. Objective Data
2. Palpitation
c. -----------: vibration of chest wall produced by vocalization (“Say 99” feel upper back)
i. Decreased if lung is further away (pleural effusion, emphysema)
ii. Increased if pneumonia, tumors, and fibrosis
iii. Nothing felt if pneumothorax or severe atelectasis
Respiratory
I. Assessment
B. Objective Data
2. Palpitation
c. Fremitis--vibration of chest wall produced by vocalization (“Say 99” feel upper back)
i. Decreased if lung is further away (pleural effusion, emphysema)
ii. Increased if pneumonia, tumors, and fibrosis
iii. Nothing felt if pneumothorax or severe atelectasis
Respiratory
I. Assessment
B. Objective Data
2. Palpitation
c. Fremitis--vibration of chest wall produced by vocalization (“Say ----” feel upper back)
i. Decreased if lung is ---------- (------------,------------)
ii. Increased if pneumonia, tumors, and fibrosis
iii. Nothing felt if pneumothorax or severe atelectasis
Respiratory
I. Assessment
B. Objective Data
2. Palpitation
c. Fremitis--vibration of chest wall produced by vocalization (“Say 99” feel upper back)
i. Decreased if lung is further away (pleural effusion, emphysema)
ii. Increased if pneumonia, tumors, and fibrosis
iii. Nothing felt if pneumothorax or severe atelectasis
Respiratory
I. Assessment
B. Objective Data
2. Palpitation
c. Fremitis--vibration of chest wall produced by vocalization (“Say 99” feel upper back)
i. Decreased if lung is further away (pleural effusion, emphysema)
ii. Increased if -------, -----------, and --------------
iii. Nothing felt if pneumothorax or severe atelectasis
Respiratory
I. Assessment
B. Objective Data
2. Palpitation
c. Fremitis--vibration of chest wall produced by vocalization (“Say 99” feel upper back)
i. Decreased if lung is further away (pleural effusion, emphysema)
ii. Increased if pneumonia, tumors, and fibrosis
iii. Nothing felt if pneumothorax or severe atelectasis
Respiratory
I. Assessment
B. Objective Data
2. Palpitation
c. Fremitis--vibration of chest wall produced by vocalization (“Say 99” feel upper back)
i. Decreased if lung is further away (pleural effusion, emphysema)
ii. Increased if pneumonia, tumors, and fibrosis
iii. Nothing felt if ---------- or -----------
Respiratory
I. Assessment
B. Objective Data
2. Palpitation
c. Fremitis--vibration of chest wall produced by vocalization (“Say 99” feel upper back)
i. Decreased if lung is further away (pleural effusion, emphysema)
ii. Increased if pneumonia, tumors, and fibrosis
iii. Nothing felt if pneumothorax or severe atelectasis
Respiratory
I. Assessment
B. Objective Data
2. Palpitation
d. ---------- (subcutaneous emphysema): crackling, crinkling, or grating feeling/sound under skin, around lungs, or in joints caused by escape of air (like bubble wrap)
i. Common causes: chest tube leak, mechanical ventilation
Respiratory
I. Assessment
B. Objective Data
2. Palpitation
d. Crepitus (subcutaneous emphysema)--crackling, crinkling, or grating feeling/sound under skin, around lungs, or in joints caused by escape of air (like bubble wrap)
i. Common causes: chest tube leak, mechanical ventilation
Respiratory
I. Assessment
B. Objective Data
2. Palpitation
d. Crepitus (subcutaneous emphysema): ---------, -----------, or ------------------, around lungs, or in joints caused by escape of air (like bubble wrap)
i. Common causes: chest tube leak, mechanical ventilation
Respiratory
I. Assessment
B. Objective Data
2. Palpitation
d. Crepitus (subcutaneous emphysema)--crackling, crinkling, or grating feeling/sound under skin, around lungs, or in joints caused by escape of air (like bubble wrap)
i. Common causes: chest tube leak, mechanical ventilation
Respiratory
I. Assessment
B. Objective Data
2. Palpitation
d. Crepitus (subcutaneous emphysema)--crackling, crinkling, or grating feeling/sound under skin, ---------, or in---------- caused by escape of air (like bubble wrap)
i. Common causes: chest tube leak, mechanical ventilation
Respiratory
I. Assessment
B. Objective Data
2. Palpitation
d. Crepitus (subcutaneous emphysema)--crackling, crinkling, or grating feeling/sound under skin, around lungs, or in joints caused by escape of air (like bubble wrap)
i. Common causes: chest tube leak, mechanical ventilation
Respiratory
I. Assessment
B. Objective Data
2. Palpitation
d. Crepitus (subcutaneous emphysema)--crackling, crinkling, or grating feeling/sound under skin, around lungs, or in joints caused by escape of air (like bubble wrap)
i. Common causes: ------------, ------------
Respiratory
I. Assessment
B. Objective Data
2. Palpitation
d. Crepitus (subcutaneous emphysema)--crackling, crinkling, or grating feeling/sound under skin, around lungs, or in joints caused by escape of air (like bubble wrap)
i. Common causes: chest tube leak, mechanical ventilation
Respiratory
I. Assessment
B. Objective Data
3. Percussion--assessment of --------- or ----------- of the lungs
a. Resonance--air filled lung (normal)
b. Hyperresonance--loud, lower pitched sound from increased air volume (ex. COPD)
c. Tympany--drum like (ex. gastric air bubble)
d. Dullness--consolidation in lung (ex. heart, top of liver, or pneumonia, hemothorax)
e. Flat--soft, high pitched sound from large fluid mass (ex. thigh)
Respiratory
I. Assessment
B. Objective Data
3. Percussion--assessment of density or aeration of the lungs
a. Resonance--air filled lung (normal)
b. Hyperresonance--loud, lower pitched sound from increased air volume (ex. COPD)
c. Tympany--drum like (ex. gastric air bubble)
d. Dullness--consolidation in lung (ex. heart, top of liver, or pneumonia, hemothorax)
e. Flat--soft, high pitched sound from large fluid mass (ex. thigh)
Respiratory
I. Assessment
B. Objective Data
3. Percussion--assessment of density or aeration of the lungs
a. Resonance: ---------- (normal)
b. Hyperresonance: -----, lower pitched sound from --------------- (ex. COPD)
c. Tympany--drum like (ex. gastric air bubble)
d. Dullness--consolidation in lung (ex. heart, top of liver, or pneumonia, hemothorax)
e. Flat--soft, high pitched sound from large fluid mass (ex. thigh)
Respiratory
I. Assessment
B. Objective Data
3. Percussion--assessment of density or aeration of the lungs
a. Resonance--air filled lung (normal)
b. Hyperresonance--loud, lower pitched sound from increased air volume (ex. COPD)
c. Tympany--drum like (ex. gastric air bubble)
d. Dullness--consolidation in lung (ex. heart, top of liver, or pneumonia, hemothorax)
e. Flat--soft, high pitched sound from large fluid mass (ex. thigh)
Respiratory
I. Assessment
B. Objective Data
3. Percussion--assessment of density or aeration of the lungs
a. Resonance--air filled lung (normal)
b. Hyperresonance--loud, lower pitched sound from increased air volume (ex. COPD)
c. ----------: drum like (ex. gastric air bubble)
d. Dullness--consolidation in ----------- (ex. heart, top of ---------, or pneumonia, ----------)
e. Flat--soft, high pitched sound from large fluid mass (ex. thigh)
Respiratory
I. Assessment
B. Objective Data
3. Percussion--assessment of density or aeration of the lungs
a. Resonance--air filled lung (normal)
b. Hyperresonance--loud, lower pitched sound from increased air volume (ex. COPD)
c. Tympany--drum like (ex. gastric air bubble)
d. Dullness--consolidation in lung (ex. heart, top of liver, or pneumonia, hemothorax)
e. Flat--soft, high pitched sound from large fluid mass (ex. thigh)
Respiratory
I. Assessment
B. Objective Data
3. Percussion--assessment of density or aeration of the lungs
a. Resonance--air filled lung (normal)
b. Hyperresonance--loud, lower pitched sound from increased air volume (ex. COPD)
c. Tympany--drum like (ex. gastric air bubble)
d. Dullness--consolidation in lung (ex. heart, top of liver, or pneumonia, hemothorax)
e. Flat--soft, high pitched sound from --------------- (ex. thigh)
Respiratory
I. Assessment
B. Objective Data
3. Percussion--assessment of density or aeration of the lungs
a. Resonance--air filled lung (normal)
b. Hyperresonance--loud, lower pitched sound from increased air volume (ex. COPD)
c. Tympany--drum like (ex. gastric air bubble)
d. Dullness--consolidation in lung (ex. heart, top of liver, or pneumonia, hemothorax)
e. Flat--soft, high pitched sound from large fluid mass (ex. thigh)
Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for ---------- and --------- sounds
Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sounds
a. Adventitious Sounds
i. Fine crackles--short lasting, high pitched at end of inspiration
Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sounds
a. Adventitious Sounds
i. Fine crackles--short lasting, ---------- at --------------
Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sounds
a. Adventitious Sounds
i. Fine crackles--short lasting, high pitched at end of inspiration
Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sounds
• Due to ---------- snapping open or movement of ---------- through a lot of ----------
• Post-op atelectasis, pulmonary edema
ii. Course crackles--low pitched on inspiration and expiration that is not eliminated by cough (will not go away until disease process ends/gets better)
• Due to air passing through airway intermittently occluded with mucus
• Pulmonary edema, pneumonia, CHF
• Do fluid assessment, I/Os, and O2Sat
Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sounds
• Due to alveoli snapping open or movement of air through a lot of liquid
• Post-op atelectasis, pulmonary edema
ii. Course crackles--low pitched on inspiration and expiration that is not eliminated by cough (will not go away until disease process ends/gets better)
• Due to air passing through airway intermittently occluded with mucus
• Pulmonary edema, pneumonia, CHF
• Do fluid assessment, I/Os, and O2Sat
Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sounds
• Due to alveoli snapping open or movement of air through a lot of liquid
• Post-op -----------, pulmonary--------
ii. Course crackles--low pitched on inspiration and expiration that is not eliminated by cough (will not go away until disease process ends/gets better)
• Due to air passing through airway intermittently occluded with mucus
• Pulmonary edema, pneumonia, CHF
• Do fluid assessment, I/Os, and O2Sat
Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sounds
• Due to alveoli snapping open or movement of air through a lot of liquid
• Post-op atelectasis, pulmonary edema
ii. Course crackles--low pitched on inspiration and expiration that is not eliminated by cough (will not go away until disease process ends/gets better)
• Due to air passing through airway intermittently occluded with mucus
• Pulmonary edema, pneumonia, CHF
• Do fluid assessment, I/Os, and O2Sat
Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sounds
• Due to alveoli snapping open or movement of air through a lot of liquid
• Post-op atelectasis, pulmonary edema
ii. Course crackles--low pitched on --------- and ----------- that is not eliminated by---------- (will not go away until disease process ends/gets better)
• Due to air passing through airway intermittently occluded with mucus
• Pulmonary edema, pneumonia, CHF
• Do fluid assessment, I/Os, and O2Sat
Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sounds
• Due to alveoli snapping open or movement of air through a lot of liquid
• Post-op atelectasis, pulmonary edema
ii. Course crackles--low pitched on inspiration and expiration that is not eliminated by cough (will not go away until disease process ends/gets better)
• Due to air passing through airway intermittently occluded with mucus
• Pulmonary edema, pneumonia, CHF
• Do fluid assessment, I/Os, and O2Sat
Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sounds
• Due to alveoli snapping open or movement of air through a lot of liquid
• Post-op atelectasis, pulmonary edema
ii. Course crackles--low pitched on inspiration and expiration that is not eliminated by cough (will not go away until disease process ends/gets better)
• Due to air passing through --------- intermittently occluded with---------
• Pulmonary ------, pneumonia, CHF
• Do fluid assessment, I/Os, and O2Sat
Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sounds
• Due to alveoli snapping open or movement of air through a lot of liquid
• Post-op atelectasis, pulmonary edema
ii. Course crackles--low pitched on inspiration and expiration that is not eliminated by cough (will not go away until disease process ends/gets better)
• Due to air passing through airway intermittently occluded with mucus
• Pulmonary edema, pneumonia, CHF
• Do fluid assessment, I/Os, and O2Sat
Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sounds
• Due to alveoli snapping open or movement of air through a lot of liquid
• Post-op atelectasis, pulmonary edema
ii. Course crackles--low pitched on inspiration and expiration that is not eliminated by cough (will not go away until disease process ends/gets better)
• Due to air passing through airway intermittently occluded with mucus
• Pulmonary edema, pneumonia, CHF
• Do -------- assessment, ------, and -------
Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sounds
• Due to alveoli snapping open or movement of air through a lot of liquid
• Post-op atelectasis, pulmonary edema
ii. Course crackles--low pitched on inspiration and expiration that is not eliminated by cough (will not go away until disease process ends/gets better)
• Due to air passing through airway intermittently occluded with mucus
• Pulmonary edema, pneumonia, CHF
• Do fluid assessment, I/Os, and O2Sat
Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
iii. Rhonchi--harsh/----------, from large airway obstruction by --------
• Pneumonia
• Can be cleared--have pt cough or suction if vented and listen for changes
iv. Wheezes--mostly on inspiration (can also be expiration)
• Asthma
Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
iii. Rhonchi--harsh/course rattling, from large airway obstruction by mucus
• Pneumonia
• Can be cleared--have pt cough or suction if vented and listen for changes
iv. Wheezes--mostly on inspiration (can also be expiration)
• Asthma
Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
iii. Rhonchi--harsh/course rattling, from large airway obstruction by mucus
• Pneumonia
• Can be cleared--have pt ------- or --------- if vented and listen for ----------
iv. Wheezes--mostly on inspiration (can also be expiration)
• Asthma
Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
iii. Rhonchi--harsh/course rattling, from large airway obstruction by mucus
• Pneumonia
• Can be cleared--have pt cough or suction if vented and listen for changes
iv. Wheezes--mostly on inspiration (can also be expiration)
• Asthma
Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
• If stops w/out intervention could be diminished due to ------------ (bad)
v. --------------: grating/leather rubbing sound stops when pt holds breath
Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
• If stops w/out intervention could be diminished due to tightness (bad)
v. Pleural friction rub--grating/leather rubbing sound stops when pt holds breath
Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
• If stops w/out intervention could be diminished due to tightness (bad)
v. Pleural friction rub--grating/leather rubbing sound stops when pt -----------
Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
• If stops w/out intervention could be diminished due to tightness (bad)
v. Pleural friction rub--grating/leather rubbing sound stops when pt holds breath
Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
• Diff from ----------- rub (continuous rub while holding breath)
b. Normal--: ------------ breath sounds throughout (Moving down, sounds high to low pitch)
i. Bronchial--heard over trachea; “wind through tube” (louder and higher pitch)
ii. Bronchovesicular--heard over main bronchi (medium pitch)
iii. Vesicular--heard over lobes (softer and lower pitched)
iv. Patients can open mouth to breath deeper
Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
• Diff from pericardial rub (continuous rub while holding breath)
b. Normal--vesicular breath sounds throughout (Moving down, sounds high to low pitch)
i. Bronchial--heard over trachea; “wind through tube” (louder and higher pitch)
ii. Bronchovesicular--heard over main bronchi (medium pitch)
iii. Vesicular--heard over lobes (softer and lower pitched)
iv. Patients can open mouth to breath deeper
Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
• Diff from pericardial rub (continuous rub while holding breath)
b. Normal--vesicular breath sounds throughout (Moving down, sounds high to low pitch)
i. Bronchial--heard over -----------; “wind through ---------” (louder and higher pitch)
ii. Bronchovesicular--heard over main bronchi (medium pitch)
iii. Vesicular--heard over lobes (softer and lower pitched)
iv. Patients can open mouth to breath deeper
Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
• Diff from pericardial rub (continuous rub while holding breath)
b. Normal--vesicular breath sounds throughout (Moving down, sounds high to low pitch)
i. Bronchial--heard over trachea; “wind through tube” (louder and higher pitch)
ii. Bronchovesicular--heard over main bronchi (medium pitch)
iii. Vesicular--heard over lobes (softer and lower pitched)
iv. Patients can open mouth to breath deeper
Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
• Diff from pericardial rub (continuous rub while holding breath)
b. Normal--vesicular breath sounds throughout (Moving down, sounds high to low pitch)
i. Bronchial--heard over trachea; “wind through tube” (louder and higher pitch)
ii. Bronchovesicular--heard over ---------- (medium pitch)
iii. Vesicular--heard over -------- (softer and ------- pitched)
iv. Patients can open mouth to breath deeper
Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
• Diff from pericardial rub (continuous rub while holding breath)
b. Normal--vesicular breath sounds throughout (Moving down, sounds high to low pitch)
i. Bronchial--heard over trachea; “wind through tube” (louder and higher pitch)
ii. Bronchovesicular--heard over main bronchi (medium pitch)
iii. Vesicular--heard over lobes (softer and lower pitched)
iv. Patients can open mouth to breath deeper
Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
• Diff from pericardial rub (continuous rub while holding breath)
b. Normal--vesicular breath sounds throughout (Moving down, sounds high to low pitch)
i. Bronchial--heard over trachea; “wind through tube” (louder and higher pitch)
ii. Bronchovesicular--heard over main bronchi (medium pitch)
iii. Vesicular--heard over lobes (softer and lower pitched)
iv. Patients can open ------- to breath deeper
Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
• Diff from pericardial rub (continuous rub while holding breath)
b. Normal--vesicular breath sounds throughout (Moving down, sounds high to low pitch)
i. Bronchial--heard over trachea; “wind through tube” (louder and higher pitch)
ii. Bronchovesicular--heard over main bronchi (medium pitch)
iii. Vesicular--heard over lobes (softer and lower pitched)
iv. Patients can open mouth to breath deeper
Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
• Diff from pericardial rub (continuous rub while holding breath)
c. Abnormal--sound other than what is supposed to be there (diff from --------)
d. Voice Sounds--can indicate need for ---------
i. Whispered Pectoriloquy--the way words come across as the whisper “1, 2, 3”
Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
• Diff from pericardial rub (continuous rub while holding breath)
c. Abnormal--sound other than what is supposed to be there (diff from adventitious)
d. Voice Sounds--can indicate need for CXR
i. Whispered Pectoriloquy--the way words come across as the whisper “1, 2, 3”
Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
• Diff from pericardial rub (continuous rub while holding breath)
c. Abnormal--sound other than what is supposed to be there (diff from adventitious)
d. Voice Sounds--can indicate need for CXR
i. -----------------: the way words come across as the whisper “1, 2, 3”
Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
• Diff from pericardial rub (continuous rub while holding breath)
c. Abnormal--sound other than what is supposed to be there (diff from adventitious)
d. Voice Sounds--can indicate need for CXR
i. Whispered Pectoriloquy--the way words come across as the whisper “1, 2, 3”
Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
i. Whispered Pectoriloquy-the ways come across as the whisper "1-2-3"
• Normal to hear it muffled when listening to ----------------
• Abnormal to hear it clearly (---------,-----------)
ii. Bronchophony--say “99” in louder tone (should sound muffled)
iii. Egophony--say “E” abnormal if it sounds like “A” (should sound muffled)
Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
• Normal to hear it muffled when listening to posterior chest wall
• Abnormal to hear it clearly (pneumonia, atelectasis)
ii. Bronchophony--say “99” in louder tone (should sound muffled)
iii. Egophony--say “E” abnormal if it sounds like “A” (should sound muffled)
Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
• Normal to hear it muffled when listening to posterior chest wall
• Abnormal to hear it clearly (pneumonia, atelectasis)
ii. -------------: say “99” in louder tone (should sound muffled)
iii. ------------: say “E” abnormal if it sounds like “A” (should sound muffled)
Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
• Normal to hear it muffled when listening to posterior chest wall
• Abnormal to hear it clearly (pneumonia, atelectasis)
ii. Bronchophony--say “99” in louder tone (should sound muffled)
iii. Egophony--say “E” --> abnormal if it sounds like “A” (should sound muffled)
Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
• Normal to hear it muffled when listening to posterior chest wall
• Abnormal to hear it clearly (pneumonia, atelectasis)
ii. Bronchophony--say “-----” in louder tone (should sound muffled)
iii. Egophony--say “-----” abnormal if it sounds like “------” (should sound muffled)
Respiratory
I. Assessment
B. Objective Data
4. Auscultation--to assess for quality and adventitious sound
• Normal to hear it muffled when listening to posterior chest wall
• Abnormal to hear it clearly (pneumonia, atelectasis)
ii. Bronchophony--say “99” in louder tone (should sound muffled)
iii. Egophony--say “E” abnormal if it sounds like “A” (should sound muffled)
Respiratory
II. Artificial Airways
A. ------------- Airway--used to keep tongue from occluding airway in unconscious pts (protection)
1. Techniques of Insertion
a. Clear mouth of secretions and maintain head position
b. Measure from corner of mouth to tragus
2. Precautions--cannot use with oral trauma or if patient has gag reflex
Respiratory
II. Artificial Airways
A. Oropharyngeal Airway--used to keep tongue from occluding airway in unconscious pts (protection)
1. Techniques of Insertion
a. Clear mouth of secretions and maintain head position
b. Measure from corner of mouth to tragus
2. Precautions--cannot use with oral trauma or if patient has gag reflex
Respiratory
II. Artificial Airways
A. Oropharyngeal Airway--used to keep tongue from occluding airway in unconscious pts (protection)
1. Techniques of Insertion
a. Clear mouth of ------ and maintain -------
b. Measure from corner of mouth to ------
2. Precautions--cannot use with oral trauma or if patient has gag reflex
Respiratory
II. Artificial Airways
A. Oropharyngeal Airway--used to keep tongue from occluding airway in unconscious pts (protection)
1. Techniques of Insertion
a. Clear mouth of secretions and maintain head position
b. Measure from corner of mouth to tragus
2. Precautions--cannot use with oral trauma or if patient has gag reflex
Respiratory
II. Artificial Airways
A. Oropharyngeal Airway--used to keep tongue from occluding airway in unconscious pts (protection)
1. Techniques of Insertion
a. Clear mouth of secretions and maintain head position
b. Measure from corner of mouth to tragus
2. Precautions--cannot use with -------- or if patient has -------
Respiratory
II. Artificial Airways
A. Oropharyngeal Airway--used to keep tongue from occluding airway in unconscious pts (protection)
1. Techniques of Insertion
a. Clear mouth of secretions and maintain head position
b. Measure from corner of mouth to tragus
2. Precautions--cannot use with oral trauma or if patient has gag reflex
Respiratory
II. Artificial Airways
B. ----------------- airway--provides patent airway without stimulating gag reflex (needs lubrication)
1. Precautions--cannot be used for facial trauma (basal skull fracture)
Respiratory
II. Artificial Airways
B. Nasopharyngeal Airway--provides patent airway without stimulating gag reflex (needs lubrication)
1. Precautions--cannot be used for facial trauma (basal skull fracture)
Respiratory
II. Artificial Airways
B. Nasopharyngeal Airway--provides patent airway without stimulating -------- (needs lubrication)
1. Precautions--cannot be used for ----------- (basal skull fracture)
Respiratory
II. Artificial Airways
B. Nasopharyngeal Airway--provides patent airway without stimulating gag reflex (needs lubrication)
1. Precautions--cannot be used for facial trauma (basal skull fracture)
Respiratory
II. Artificial Airways
C. ------------- Intubation--can be placed for 2 weeks, than tracheotomy or extubation
1. Oral--larger tube therefore less air resistance (preferred form)
a. Disadvantage--pt can bit tube (need to use a bite block)
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
1. Oral--larger tube therefore less air resistance (preferred form)
a. Disadvantage--pt can bit tube (need to use a bite block)
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for ------ weeks, than tracheotomy or ------------
1. Oral--larger tube therefore less air resistance (preferred form)
a. Disadvantage--pt can bit tube (need to use a bite block)
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
1. Oral--larger tube therefore less air resistance (preferred form)
a. Disadvantage--pt can bit tube (need to use a bite block)
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
1. Oral--larger tube therefore less ------------- (preferred form)
a. Disadvantage--pt can ---------- (need to use a ---------- block)
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
1. Oral--larger tube therefore less air resistance (preferred form)
a. Disadvantage--pt can bit tube (need to use a bite block)
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
2. Nasal--used if ------------ prevents moving neck for --------- intubation (more comfortable)
a. Disadvantages--hard to suction (smaller tube diameter)
b. Contraindicated in pts with facial trauma
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
2. Nasal--used if spinal cord injury prevents moving neck for oral intubation (more comfortable)
a. Disadvantages--hard to suction (smaller tube diameter)
b. Contraindicated in pts with facial trauma
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
2. Nasal--used if spinal cord injury prevents moving neck for oral intubation (more comfortable)
a. Disadvantages--hard to -------- (smaller tube --------)
b. Contraindicated in pts with --------- trauma
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
2. Nasal--used if spinal cord injury prevents moving neck for oral intubation (more comfortable)
a. Disadvantages--hard to suction (smaller tube diameter)
b. Contraindicated in pts with facial trauma
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
3. Indications
a. Inadequate -------------- (↓arterial --------, etc.) that is not corrected by supplemental O2
i. Causes--barbiturate overdose, anesthesia, etc.
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
3. Indications
a. Inadequate oxygenation (↓arterial PO2, etc.) that is not corrected by supplemental O2
i. Causes--barbiturate overdose, anesthesia, etc.
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
3. Indications
a. Inadequate oxygenation (↓arterial PO2, etc.) that is not corrected by supplemental -----------
i. Causes--: -------------, ------------, etc.
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
3. Indications
a. Inadequate oxygenation (↓arterial PO2, etc.) that is not corrected by supplemental O2
i. Causes--barbiturate overdose, anesthesia, etc.
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
3. Indications
b. Inadequate ---------- (increased arterial ----------)--can’t move gas inside
i. PCO2 >50 or pH <7.25
**Get ABG after to see if corrected
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
3. Indications
b. Inadequate ventilation (increased arterial PCO2)--can’t move gas inside
i. PCO2 >50 or pH <7.25
**Get ABG after to see if corrected
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
3. Indications
b. Inadequate ventilation (increased arterial PCO2)--can’t move gas inside
i. PCO2 >-------- or pH <--------------
**Get ------------ after to see if corrected
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
3. Indications
b. Inadequate ventilation (increased arterial PCO2)--can’t move gas inside
i. PCO2 >50 or pH <7.25
**Get ABG after to see if corrected
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
4. Procedure--need ----------- and --------- at bed side
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
4. Procedure--need suction and O2 at bed side
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
4. Procedure--need suction and O2 at bed side
a. Patient education
i. Won’t be able to --------- (reassure needs will be met)
ii. Assure that pt will be able to----------- better
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
4. Procedure--need suction and O2 at bed side
a. Patient education
i. Won’t be able to talk (reassure needs will be met)
ii. Assure that pt will be able to breathe better
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
4. Procedure--need suction and O2 at bed side
b. Preparation for intubation--: -----------, ----------, -------, and sedation -------- (Versed)
i. Assess for hypoxia (arrhythmias) and vomiting
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
4. Procedure--need suction and O2 at bed side
b. Preparation for intubation--supplies, ambu bag, code cart, and sedation meds (Versed)
i. Assess for hypoxia (arrhythmias) and vomiting
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
4. Procedure--need suction and O2 at bed side
b. Preparation for intubation--supplies, ambu bag, code cart, and sedation meds (Versed)
i. Assess for ------- (arrhythmias) and ----------
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
4. Procedure--need suction and O2 at bed side
b. Preparation for intubation--supplies, ambu bag, code cart, and sedation meds (Versed)
i. Assess for hypoxia (arrhythmias) and vomiting
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
4. Procedure--need suction and O2 at bed side
c. Hold breath to remember --------- of attempt (no more than ---------- to 1min)
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
4. Procedure--need suction and O2 at bed side
c. Hold breath to remember length of attempt (no more than 30sec-1min)
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
4. Procedure--need suction and O2 at bed side
d. Checking placement--tape tube at ------ and record --------
i. Check tidal CO2 monitor (color or number change)
ii. Listen for breath sounds
iii. Visualize chest expansion
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
4. Procedure--need suction and O2 at bed side
d. Checking placement--tape tube at lip and record line mark
i. Check tidal CO2 monitor (color or number change)
ii. Listen for breath sounds
iii. Visualize chest expansion
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
4. Procedure--need suction and O2 at bed side
d. Checking placement--tape tube at lip and record line mark
i. Check tidal -------- monitor (color or number change)
ii. Listen for --------
iii. Visualize ----------
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
4. Procedure--need suction and O2 at bed side
d. Checking placement--tape tube at lip and record line mark
i. Check tidal CO2 monitor (color or number change)
ii. Listen for breath sounds
iii. Visualize chest expansion
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
4. Procedure--need suction and O2 at bed side
5. Post Intubation Assessment
a. Assess end tidal ---------
b. Assess for -----------, equal breath sounds, and ----------
c. Auscultation of gastric area (to determine if esophageal intubation instead of tracheal)
d. Nurse, RT, or anesthetist stabilizes tube
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
4. Procedure--need suction and O2 at bed side
5. Post Intubation Assessment
a. Assess end tidal CO2
b. Assess for bilateral, equal breath sounds, and chest expansion
c. Auscultation of gastric area (to determine if esophageal intubation instead of tracheal)
d. Nurse, RT, or anesthetist stabilizes tube
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
4. Procedure--need suction and O2 at bed side
5. Post Intubation Assessment
a. Assess end tidal CO2
b. Assess for bilateral, equal breath sounds, and chest expansion
c. Auscultation of ----------- (to determine if esophageal intubation instead of ----------)
d. Nurse, RT, or anesthetist stabilizes --------
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
4. Procedure--need suction and O2 at bed side
5. Post Intubation Assessment
a. Assess end tidal CO2
b. Assess for bilateral, equal breath sounds, and chest expansion
c. Auscultation of gastric area (to determine if esophageal intubation instead of tracheal)
d. Nurse, RT, or anesthetist stabilizes tube
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
4. Procedure--need suction and O2 at bed side
5. Post Intubation Assessment
e. Oral ETT positioned ------ or ------- side of mouth and changed q24hrs (safer with 2 people)
i. Suction before deflating balloon so secretions do not flow into lungs
f. Oral airway may need bite block to prevent pt from biting tube
g. Stat CXR verifies correct placement (if it needs to move, deflate and reinflate balloon)
i. Should be 2 finger breadths above carina
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
4. Procedure--need suction and O2 at bed side
5. Post Intubation Assessment
e. Oral ETT positioned lf or rt side of mouth and changed q24hrs (safer with 2 people)
i. Suction before deflating balloon so secretions do not flow into lungs
f. Oral airway may need bite block to prevent pt from biting tube
g. Stat CXR verifies correct placement (if it needs to move, deflate and reinflate balloon)
i. Should be 2 finger breadths above carina
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
4. Procedure--need suction and O2 at bed side
5. Post Intubation Assessment
e. Oral ETT positioned lf or rt side of mouth and changed --------hrs (safer with 2 people)
i. Suction before deflating ------------ so secretions do not flow into lungs
f. Oral airway may need bite block to prevent pt from biting tube
g. Stat CXR verifies correct placement (if it needs to move, deflate and reinflate balloon)
i. Should be 2 finger breadths above carina
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
5. Post Intubation Assessment
e. Oral ETT positioned lf or rt side of mouth and changed q24hrs (safer with 2 people)
i. Suction before deflating balloon so secretions do not flow into lungs
f. Oral airway may need bite block to prevent pt from biting tube
g. Stat CXR verifies correct placement (if it needs to move, deflate and reinflate balloon)
i. Should be 2 finger breadths above carina
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
5. Post Intubation Assessment
e. Oral ETT positioned lf or rt side of mouth and changed q24hrs (safer with 2 people)
i. Suction before deflating balloon so secretions do not flow into lungs
f. Oral airway may need ---------- to prevent pt from biting tube
g. Stat ----------- verifies correct placement (if it needs to move, deflate and reinflate balloon)
i. Should be 2 finger breadths above carina
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
5. Post Intubation Assessment
e. Oral ETT positioned lf or rt side of mouth and changed q24hrs (safer with 2 people)
i. Suction before deflating balloon so secretions do not flow into lungs
f. Oral airway may need bite block to prevent pt from biting tube
g. Stat CXR verifies correct placement (if it needs to move, deflate and reinflate balloon)
i. Should be 2 finger breadths above carina
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
5. Post Intubation Assessment
e. Oral ETT positioned lf or rt side of mouth and changed q24hrs (safer with 2 people)
i. Suction before deflating balloon so secretions do not flow into lungs
f. Oral airway may need bite block to prevent pt from biting tube
g. Stat CXR verifies correct placement (if it needs to move, deflate and ------------ balloon)
i. Should be ------------ breadths above carina
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
5. Post Intubation Assessment
e. Oral ETT positioned lf or rt side of mouth and changed q24hrs (safer with 2 people)
i. Suction before deflating balloon so secretions do not flow into lungs
f. Oral airway may need bite block to prevent pt from biting tube
g. Stat CXR verifies correct placement (if it needs to move, deflate and reinflate balloon)
i. Should be 2 finger breadths above carina
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
a. Maintaining correct --------- placement (------- shift)
b. Monitoring proper cuff inflation (20-25mmHg q8hr)--should not be 100% occlusive
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
a. Maintaining correct tube placement (q shift)
b. Monitoring proper cuff inflation (20-25mmHg q8hr)--should not be 100% occlusive
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
a. Maintaining correct tube placement (q shift)
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
a. Maintaining correct tube placement (q shift)
b. Monitoring proper cuff inflation (20-25mmHg q8hr)--should not be 100% occlusive
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
a. Maintaining correct tube placement (q shift)
b. Monitoring proper cuff inflation (-------to ----------mmHg q-------hr)--should not be 100% occlusive
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
a. Maintaining correct tube placement (q shift)
b. Monitoring proper cuff inflation (20-25mmHg q8hr)--should not be 100% occlusive
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
a. Maintaining correct tube placement (q shift)
b. Monitoring proper cuff inflation (20-25mmHg q8hr)--should not be ----------% occlusive
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
a. Maintaining correct tube placement (q shift)
b. Monitoring proper cuff inflation (20-25mmHg q8hr)--should not be 100% occlusive
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
b. Monitoring proper -------- inflation (20-25mmHg q8hr)--should not be 100% occlusive

i. If <--------mmHg leak
ii. If >----------mmHg damage to tissue
iii. If able to talk air through vocal cords balloon deflated then ----------
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
b. Monitoring proper -------- inflation (20-25mmHg q8hr)--should not be 100% occlusive

i. If <20mmHg leak
ii. If >20mmHg damage to tissue
iii. If able to talk air through vocal cords balloon deflated reinflate
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
c. Monitor ---------- and ----------
i. End tidal CO2 monitor--indicates correct placement
ii. ABGs--SAO2 measures tissue oxygenation and gives info on CO
iii. Peak inspiratory pressure--if increased suction
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
c. Monitor oxygenation and ventilation
i. End tidal CO2 monitor--indicates correct placement
ii. ABGs--SAO2 measures tissue oxygenation and gives info on CO
iii. Peak inspiratory pressure--if increased suction
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
c. Monitor oxygenation and ventilation
i. End tidal CO2 monitor--indicates ------------
ii. ABGs: ------------ measures tissue oxygenation and gives info on CO
iii. Peak ---------- pressure--if increased suction
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
c. Monitor oxygenation and ventilation
i. End tidal CO2 monitor--indicates correct placement
ii. ABGs--SAO2 measures tissue oxygenation and gives info on CO
iii. Peak inspiratory pressure--if increased suction
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
c. Monitor oxygenation and ventilation
i. End tidal CO2 monitor--indicates correct placement
ii. ABGs--SAO2 measures tissue oxygenation and gives info on CO
iii. Peak inspiratory pressure--if increased -----------
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
c. Monitor oxygenation and ventilation
i. End tidal CO2 monitor--indicates correct placement
ii. ABGs--SAO2 measures tissue oxygenation and gives info on CO
iii. Peak inspiratory pressure--if increased suction
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
d. Provide --------- and maintaining skin ------: tube positioning and oral care
e. Comfort and communication--talk to pt/use meds (Versed, Propofol) to relieve anxiety
i. When pt starts to wake up watch for pt pulling tube out and assess for mental status (takes time to get used to tube often pts kept sedated for a while)
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
d. Provide oral care and maintaining skin integrity--: tube positioning and oral care
e. Comfort and communication--talk to pt/use meds (Versed, Propofol) to relieve anxiety
i. When pt starts to wake up watch for pt pulling tube out and assess for mental status (takes time to get used to tube often pts kept sedated for a while)
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
d. Provide oral care and maintaining skin integrity--: tube positioning and oral care
e. Comfort and communication--talk to pt/use meds (---------, ----------) to relieve anxiety
i. When pt starts to wake up watch for pt pulling ----------- and assess for ---------- (takes time to get used to tube often pts kept sedated for a while)
FIX
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
d. Provide oral care and maintaining skin integrity--: tube positioning and oral care
e. Comfort and communication--talk to pt/use meds (Versed, Propofol) to relieve anxiety
i. When pt starts to wake up watch for pt pulling tube out and assess for mental status (takes time to get used to tube often pts kept sedated for a while)
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
f. Assess for complications: --------, ----------, decreased ------, etc.
g. Maintain tube patency--suction as needed
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
f. Assess for complications--ALOC, arrhythmias, decreased O2, etc.
g. Maintain tube patency--suction as needed
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
f. Assess for complications--ALOC, arrhythmias, decreased O2, etc.
g. Maintain tube --------: --suction as needed
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
f. Assess for complications--ALOC, arrhythmias, decreased O2, etc.
g. Maintain tube patency--suction as needed
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
h. Pt needs --------- assessment within ------hrs of intubation
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
6. Nursing Management
h. Pt needs nutritional assessment within 72hrs of intubation
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
7. Potential Complications
a. Suctioning--suction for <--------sec and watch for ------------
i. Hypoxemia--preoxygenate (suctioning will drop O2Sats)
ii. Bronchospasm--give pt break in between
iii. Arrhythmias--stop if bradycardia (vaso-vagal response)--have atropine near by
iv. HTN/hypotension
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
7. Potential Complications
a. Suctioning--suction for <10sec and watch for arrhythmias
i. Hypoxemia--preoxygenate (suctioning will drop O2Sats)
ii. Bronchospasm--give pt break in between
iii. Arrhythmias--stop if bradycardia (vaso-vagal response)--have atropine near by
iv. HTN/hypotension
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
7. Potential Complications
a. Suctioning--suction for <10sec and watch for arrhythmias
i. --------------: preoxygenate (suctioning will drop O2Sats)
ii. B------------: give pt break in between
iii. A-----------: stop if bradycardia (vaso-vagal response)--have atropine near by
iv. HTN/-------------
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
7. Potential Complications
a. Suctioning--suction for <10sec and watch for arrhythmias
i. Hypoxemia--preoxygenate (suctioning will drop O2Sats)
ii. Bronchospasm--give pt break in between
iii. Arrhythmias--stop if bradycardia (vaso-vagal response)--have atropine near by
iv. HTN/hypotension
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
7. Potential Complications
a. Suctioning--suction for <10sec and watch for arrhythmias
i. Hypoxemia--preoxygenate (suctioning will drop O2Sats)
ii. Bronchospasm--give pt --------- in between
iii. Arrhythmias--stop if ------------- (vaso-vagal response)--have atropine near by
iv. HTN/hypotension
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
7. Potential Complications
a. Suctioning--suction for <10sec and watch for arrhythmias
i. Hypoxemia--preoxygenate (suctioning will drop O2Sats)
ii. Bronchospasm--give pt break in between
iii. Arrhythmias--stop if bradycardia (vaso-vagal response)--have atropine near by
iv. HTN/hypotension
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
7. Potential Complications
a. Suctioning--suction for <10sec and watch for arrhythmias
v. ---------: can be too much suction (should be <120mmHg)
vi. I------------
vii. Increase in ------------ pressure (in head trauma pts)--use minimal suctioning
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
7. Potential Complications
a. Suctioning--suction for <10sec and watch for arrhythmias
v. Pulmonary bleeding--can be too much suction (should be <120mmHg)
vi. Infections
vii. Increase in intracranial pressure (in head trauma pts)--use minimal suctioning
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
7. Potential Complications
a. Suctioning--suction for <10sec and watch for arrhythmias
v. Pulmonary bleeding--can be too much suction (should be <---------mmHg)
vi. Infections
vii. Increase in intracranial pressure (in --------- trauma pts)--use minimal suctioning
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
7. Potential Complications
a. Suctioning--suction for <10sec and watch for arrhythmias
v. Pulmonary bleeding--can be too much suction (should be <120mmHg)
vi. Infections
vii. Increase in intracranial pressure (in head trauma pts)--use minimal suctioning
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
7. Potential Complications
b. Self-extubation--most pts --------- or ----------- for prevention (explain need to family)
c. Aspiration--keep HOB >30° (likely tube fed--always check placement)
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
7. Potential Complications
b. Self-extubation--most pts restrained or sedated for prevention (explain need to family)
c. Aspiration--keep HOB >30° (likely tube fed--always check placement)
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
7. Potential Complications
b. Self-extubation--most pts restrained or sedated for prevention (explain need to family)
c. Aspiration--keep HOB >------° (likely tube fed--always check ----------)
Respiratory
II. Artificial Airways
C. Endotracheal Intubation--can be placed for 2 weeks, than tracheotomy or extubation
7. Potential Complications
b. Self-extubation--most pts restrained or sedated for prevention (explain need to family)
c. Aspiration--keep HOB >30° (likely tube fed--always check placement)
Respiratory
II. Artificial Airways
D. ---------: stoma that results from a surgical incision (in OR or at bedside) into the trachea
Respiratory
II. Artificial Airways
D. Tracheostomy--stoma that results from a surgical incision (in OR or at bedside) into the trachea
Respiratory
II. Artificial Airways
D. Tracheostomy--stoma that results from a surgical incision (in OR or at bedside) into the trachea
1. Indications
a. Bypass an ----------- obstruction
b. Facilitate removal of -----------
c. Permit long-term -------------- ventilation--after two weeks with ET tube
i. Easier to ween from trach than from ET tube
d. Permits oral ----------
Respiratory
II. Artificial Airways
D. Tracheostomy--stoma that results from a surgical incision (in OR or at bedside) into the trachea
1. Indications
a. Bypass an upper airway obstruction
b. Facilitate removal of secretions
c. Permit long-term mechanical ventilation--after two weeks with ET tube
i. Easier to ween from trach than from ET tube
d. Permits oral intake and speech
Respiratory
II. Artificial Airways
D. Tracheostomy--stoma that results from a surgical incision (in OR or at bedside) into the trachea
1. Indications
a. Bypass an upper airway obstruction
b. Facilitate removal of secretions
c. Permit long-term mechanical ventilation--after -------- weeks with--------tube
i. Easier to ween from --------- than from ET tube
Respiratory
II. Artificial Airways
D. Tracheostomy--stoma that results from a surgical incision (in OR or at bedside) into the trachea
1. Indications
a. Bypass an upper airway obstruction
b. Facilitate removal of secretions
c. Permit long-term mechanical ventilation--after two weeks with ET tube
i. Easier to ween from trach than from ET tube
d. Permits oral intake and speech
Respiratory
II. Artificial Airways
D. Tracheostomy--stoma that results from a surgical incision (in OR or at bedside) into the trachea
2. Care
a. Suctioning for ----------
b. ----------- care
c. Changing --------- ties
d. Inner cannula care (always have opterator at bed side to get it back in-then remove)
Respiratory
II. Artificial Airways
D. Tracheostomy--stoma that results from a surgical incision (in OR or at bedside) into the trachea
2. Care
a. Suctioning for secretions
b. Stoma care
c. Changing tracheostomy ties
d. Inner cannula care (always have opterator at bed side to get it back in-then remove)
Respiratory
II. Artificial Airways
D. Tracheostomy--stoma that results from a surgical incision (in OR or at bedside) into the trachea
2. Care
a. Suctioning for secretions
b. Stoma care
c. Changing tracheostomy ties
d. Inner -------- care (always have ------------ at bed side to get it back in-then remove)
Respiratory
II. Artificial Airways
D. Tracheostomy--stoma that results from a surgical incision (in OR or at bedside) into the trachea
2. Care
a. Suctioning for secretions
b. Stoma care
c. Changing tracheostomy ties
d. Inner cannula care (always have opterator at bed side to get it back in-then remove)
Respiratory
III. Mechanical Ventilation
A. Goals
1. Improve ------------
2. Improve -------------
3. Decrease work of ----------- (decreases oxygen consumption)
4. Permit sedation
5. Airway protection
Respiratory
III. Mechanical Ventilation
A. Goals
1. Improve oxygenation
2. Improve ventilation
3. Decrease work of breathing (decreases oxygen consumption)
4. Permit sedation
5. Airway protection
Respiratory
III. Mechanical Ventilation
A. Goals
1. Improve oxygenation
2. Improve ventilation
3. Decrease work of breathing (decreases oxygen consumption)
4. Permit ----------
5. Airway -------
Respiratory
III. Mechanical Ventilation
A. Goals
1. Improve oxygenation
2. Improve ventilation
3. Decrease work of breathing (decreases oxygen consumption)
4. Permit sedation
5. Airway protection
Respiratory
III. Mechanical Ventilation
B. Negative Pressure Ventilation--noninvasive --------- encase chest/body and provide intermittent negative pressure (ex. --------- wrap)
Respiratory
III. Mechanical Ventilation
B. Negative Pressure Ventilation--noninvasive chambers encase chest/body and provide intermittent negative pressure (ex. Pulmo-wrap)
Respiratory
III. Mechanical Ventilation
B. Negative Pressure Ventilation--noninvasive chambers encase chest/body and provide intermittent negative pressure (ex. Pulmo-wrap)
1. Patient must be able to cough up own ---------- and have adequate lung ------------
2. Indications--neuromuscular and ---------- disorders; severe COPD
Respiratory
III. Mechanical Ventilation
B. Negative Pressure Ventilation--noninvasive chambers encase chest/body and provide intermittent negative pressure (ex. Pulmo-wrap)
1. Patient must be able to cough up own secretions and have adequate lung elasticity
2. Indications--neuromuscular and spinal disorders; severe COPD
Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
1. ---------- Ventilation--predetermined tidal volume w/ varied pressure (most common)
a. Opposite of -------------- (passive exhalation)
Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
1. Volume Ventilation--predetermined tidal volume w/ varied pressure (most common)
a. Opposite of normal volume (passive exhailation)
Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
2. ------------ Ventilation--peak inspiratory pressure is predetermined w/ variable tidal volume
a. Prevents adding too much -----------
Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
2. Pressure Ventilation--peak inspiratory pressure is predetermined w/ variable tidal volume
a. Prevents adding too much volume
Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
3. Monitoring
a. V---------- settings--program settings
b. P-------: own rate, etc.
c. A-----: customized based on needed parameters
Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
3. Monitoring
a. Ventilator settings--program settings
b. Patient data--own rate, etc.
c. Alarms--customized based on needed parameters
Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
4. Settings
a. Rate--number of ------------ ventilations
Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
4. Settings
a. Rate--number of delivered ventilations
Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
4. Settings
b. Tidal Volume (VT)--volume of------ delivered; generally weight based (___-____mL/kg)
Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
4. Settings
b. Tidal Volume (VT)--volume of gas delivered; generally weight based (5-15mL/kg)
Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
4. Settings
c. FIO2--fraction of ------------- delivered (adjust for PAO2 to be at least >------)
i. Room air is 21%
Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
4. Settings
c. FIO2--fraction of inspired oxygen delivered (adjust for PAO2 to be at least >60)
i. Room air is 21%
Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
4. Settings
c. FIO2--fraction of inspired oxygen delivered (adjust for PAO2 to be at least >60)
i. Room air is ------%
Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
4. Settings
c. FIO2--fraction of inspired oxygen delivered (adjust for PAO2 to be at least >60)
i. Room air is 21%
Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
4. Settings
d. Flow Rate--speed ------ is delivered
Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
4. Settings
d. Flow Rate--speed VT is delivered
Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
4. Settings
e. I:E ratio--duration of--------- to ---------- (normal is 1:2)
Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
4. Settings
e. I:E ratio--duration of inspiration to expiration (normal is 1:2)
Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
4. Settings
e. I:E ratio--duration of inspiration to expiration (normal is ------:--------)
Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
4. Settings
e. I:E ratio--duration of inspiration to expiration (normal is 1:2)
Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
4. Settings
f. Sensitivity (---------- pressure)--effort pt must generate to initiate -------- breath
i. Higher sensitivity less work pt does
ii. Lower sensitivity increase in pt’s muscular use to initiate breath
Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
4. Settings
f. Sensitivity (trigger pressure)--effort pt must generate to initiate ventilator breath
i. Higher sensitivity less work pt does
ii. Lower sensitivity increase in pt’s muscular use to initiate breath
Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
4. Settings
f. Sensitivity (trigger pressure)--effort pt must generate to initiate ventilator breath
i. ----------- sensitivity less work pt does
ii. ---------- sensitivity increase in pt’s muscular use to initiate breath
Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
4. Settings
f. Sensitivity (trigger pressure)--effort pt must generate to initiate ventilator breath
i. Higher sensitivity less work pt does
ii. Lower sensitivity increase in pt’s muscular use to initiate breath
Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
4. Settings
g. Pressure Limit--regulates -------- pressure ventilator can generate to deliver ---------
Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
4. Settings
g. Pressure Limit--regulates maximal pressure ventilator can generate to deliver VT
Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
5. Modes--based on ---------- status and dependent on resp. drive and ---------
Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
5. Modes--based on ventilatory status and dependent on resp. drive and ABGs
Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
5. Modes--based on ventilatory status and dependent on resp. drive and ABGs
a. Controlled ----------- Ventilation (CMV)--not used often
i. Ventilator ----------
Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
5. Modes--based on ventilatory status and dependent on resp. drive and ABGs
a. Controlled Mandatory Ventilation (CMV)--not used often
i. Ventilator parameters
Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
• Set rate
• Set tidal --------- or pressure
ii. Indication--pt with no -------- (spinal cord, anesthesia, neuromuscular disease)
Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
• Set rate
• Set tidal volume or pressure
ii. Indication--pt with no drive (spinal cord, anesthesia, neuromuscular disease)
Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
• If pt has drive, ventilator can’t sense pt fight ventilator need sedation
b. Assist-Control Mechanical Ventilation (AC)
i. Ventilator parameters
FIX
Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
• If pt has drive, ventilator can’t sense pt fight ventilator need sedation
b. Assist-Control Mechanical Ventilation (AC)
i. Ventilator parameters
Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
• If pt has drive, ventilator can’t sense pt ----------- need sedation
b. Assist-Control ------------ Ventilation (AC)
i. Ventilator parameters
Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
• If pt has drive, ventilator can’t sense pt fight ventilator need sedation
b. Assist-Control Mechanical Ventilation (AC)
i. Ventilator parameters
Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
• Preset ------- volume/pressure--vent delivers breaths at preset --------- volume in response to pt’s own inspiratory drive (senses pt inspiration)
Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
• Preset tidal volume/pressure--vent delivers breaths at preset tidal volume in response to pt’s own inspiratory drive (senses pt inspiration)
Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
• Preset rate--minimal setting (if pt does not ------------ a breath, vent will breathe so that pt receives the ------------- rate)
Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
• Preset tidal volume/pressure--vent delivers breaths at preset tidal volume in response to pt’s own inspiratory drive (senses pt inspiration)
Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
ii. Potential disadvantages
• Hyperventilation if pt is anxious (resp --------------)
• Hypoventilation if monitor is set too ---------- (must monitor rate saturations)
Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
ii. Potential disadvantages
• Hyperventilation if pt is anxious (resp alkalosis)
• Hypoventilation if monitor is set too low (must monitor rate saturations)
Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
ii. Potential disadvantages
• Hypoventilation if monitor is set too low (must monitor rate saturations)
c. Synchronized ------------ ------------ Ventilation (SIMV)--most common
Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
ii. Potential disadvantages
• Hypoventilation if monitor is set too low (must monitor rate saturations)
c. Synchronized Intermittent Mandatory Ventilation (SIMV)--most common
i. Ventilator parameters
Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
c. Synchronized Intermittent Mandatory Ventilation (SIMV)--most common
i. Ventilator parameters
• Preset---------- volume/pressure
• Preset ---------
Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
c. Synchronized Intermittent Mandatory Ventilation (SIMV)--most common
i. Ventilator parameters
• Preset tidal volume/pressure
• Preset rate
Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
c. Synchronized Intermittent Mandatory Ventilation (SIMV)--most common
i. Ventilator parameters
• Pt can initiate ------------ breathing (in between vent breaths) with own tidal volume, but vent delivers full tidal volume for preset ---------- rate
ii. Used for -------: --preset gradually lowered (better synchrony-pt no fight vent)
Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
c. Synchronized Intermittent Mandatory Ventilation (SIMV)--most common
i. Ventilator parameters
• Preset tidal volume/pressure
• Preset rate
Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
c. Synchronized Intermittent Mandatory Ventilation (SIMV)--most common
i. Ventilator parameters
• Can lead to --------- fatigue
Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
c. Synchronized Intermittent Mandatory Ventilation (SIMV)--most common
i. Ventilator parameters
• Can lead to muscle fatigue
Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
d. Pressure ----------- Ventilation (PSV)--enhanced mode (can be used with SIMV)
Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
d. Pressure support Ventilation (PSV)--enhanced mode (can be used with SIMV)
Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
d. Pressure Support Ventilation (PSV)--enhanced mode (can be used with SIMV)
i. Positive pressure is applied to airway only during ------------ and is used in conjunction with pts spontaneous respirations
Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
d. Pressure Support Ventilation (PSV)--enhanced mode (can be used with SIMV)
i. Positive pressure is applied to airway only during inspiration and is used in conjunction with pts spontaneous respirations
Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
d. Pressure Support Ventilation (PSV)--enhanced mode (can be used with SIMV)
ii. Pt must be able to----------- breath (only for spontaneous breathers)
Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
d. Pressure Support Ventilation (PSV)--enhanced mode (can be used with SIMV)
ii. Pt must be able to initiate breath (only for spontaneous breathers)
Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
d. Pressure Support Ventilation (PSV)--enhanced mode (can be used with SIMV)
iii. Pt completely controls inspiratory ----------, tidal volume, and RR
Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
d. Pressure Support Ventilation (PSV)--enhanced mode (can be used with SIMV)
iii. Pt completely controls inspiratory length, tidal volume, and RR
Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
d. Pressure Support Ventilation (PSV)--enhanced mode (can be used with SIMV
iv. Decreases pt work during ----------- (decreases effort)
Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
d. Pressure Support Ventilation (PSV)--enhanced mode (can be used with SIMV
iv. Decreases pt work during weaning (decreases effort)
Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
d. Pressure Support Ventilation (PSV)--enhanced mode (can be used with SIMV
v. Advantages--↑ pt comfort and ↓-------- consumption (↓work) and ↑ ----------
Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
d. Pressure Support Ventilation (PSV)--enhanced mode (can be used with SIMV
v. Advantages--↑ pt comfort and ↓O2 consumption (↓work) and ↑ endurance
Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
e. Pressure Controlled ------ ------- Ventilation (PC-IRV)
Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
e. Pressure Controlled Inverse Ratio Ventilation (PC-IRV)
Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
e. Pressure Controlled Inverse Ratio Ventilation (PC-IRV)
i. Prolonged (+)pressure applied↑--------------- time expands collapsed -----------
Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
e. Pressure Controlled Inverse Ratio Ventilation (PC-IRV)
i. Prolonged (+)pressure applied↑inspiratory time expands collapsed alveoli
Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
e. Pressure Controlled Inverse Ratio Ventilation (PC-IRV)
ii. Unnatural (causes anxiety paralyze/sedate) -------------- (2:1 4:1)
Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
e. Pressure Controlled Inverse Ratio Ventilation (PC-IRV)
ii. Unnatural (causes anxiety paralyze/sedate) nonphysiologic (2:1 4:1)
Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
e. Pressure Controlled Inverse Ratio Ventilation (PC-IRV)
ii. Unnatural (causes anxiety paralyze/sedate) nonphysiologic (-----:1 ------:1)
Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
e. Pressure Controlled Inverse Ratio Ventilation (PC-IRV)
ii. Unnatural (causes anxiety paralyze/sedate) nonphysiologic (2:1 4:1)
Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
e. Pressure Controlled Inverse Ratio Ventilation (PC-IRV)
iii. Used for pt still hypoxic after other measures (------ and --------)
Respiratory
III. Mechanical Ventilation
C. Positive Pressure Ventilation--push air into lungs w/ positive pressure in inspiration (most common)
e. Pressure Controlled Inverse Ratio Ventilation (PC-IRV)
iii. Used for pt still hypoxic after other measures (ARDS and neonates)
Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive _____-______ Pressure (PEEP)
Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
a. (+) pressure exerted during -------- allows for better saturation with ↓------
Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
a. (+) pressure exerted during expiration allows for better saturation with ↓FiO2
Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
a. (+) pressure exerted during expiration allows for better saturation with ↓FiO2
i. Airway P is ------ at expiration end w/ atmospheric P (PEEP prevents this)
Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
a. (+) pressure exerted during expiration allows for better saturation with ↓FiO2
i. Airway P is 0 at expiration end w/ atmospheric P (PEEP prevents this)
Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
a. (+) pressure exerted during expiration allows for better saturation with ↓FiO2
ii. Prevents ---------- and alveolar collapse
Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
a. (+) pressure exerted during expiration allows for better saturation with ↓FiO2
ii. Prevents atelectasis and alveolar collapse
Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
b. ↑functional -------- capacity (FRC-volume at end of normal cresp) ↑oxygenation
Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
b. ↑functional residual capacity (FRC-volume at end of normal cresp) ↑oxygenation
Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
b. ↑functional residual capacity (______-volume at end of normal cresp) ↑________
Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
b. ↑functional residual capacity (FRC-volume at end of normal cresp) ↑oxygenation
Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
c. Uses--severe hypoxia that does not improve w/ FiO2 between ____-____%
Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
c. Uses--severe hypoxia that does not improve w/ FiO2 between 50-70%
Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
c. Uses--severe hypoxia that does not improve w/ FiO2 between 50-70%
i. For hypoxia could breath faster, deeper, use PEEP or ↑____ (risk O2 toxicity)
Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
c. Uses--severe hypoxia that does not improve w/ FiO2 between 50-70%
i. For hypoxia could breath faster, deeper, use PEEP or ↑FiO2 (risk O2 toxicity)
Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
d. Indications
i. Acute lung injury and -------
ii. Cardiogenic ---------- edema
Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
d. Indications
i. Acute lung injury and ARDS
ii. Cardiogenic pulmonary edema
Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
d. Indications
iii. Atelectasis associated with severe ---------
iv. Diffuse pneumonia requiring --------- ventilation
Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
d. Indications
iii. Atelectasis associated with severe hypoxemia
iv. Diffuse pneumonia requiring mechanical ventilation
Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
e. Contraindications
i. Pneumothorax w/out --------- catheter (would worsen pneumo)
Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
e. Contraindications
i. Pneumothorax w/out pleural catheter (would worsen pneumo)
Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
e. Contraindications
ii. Increased --------- pressure
Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
e. Contraindications
ii. Increased intracranial pressure
Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
e. Contraindications
iii. Hypovolemia--↑---------- pressure ↓------- return ↓BP
Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
e. Contraindications
iii. Hypovolemia--↑intrathoracic pressure ↓venous return ↓BP
Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
e. Contraindications
iv. Low ------- output
Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
e. Contraindications
iv. Low cardiac output
Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
f. -------------- considerations--decreases venous return and CO
Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
f. Hemodynamic considerations--decreases venous return and CO
Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
g. Normal setting:____-____cm H2O
Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
1. Positive End-Expiratory Pressure (PEEP)
g. 5-15cm H2O
Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
2. Continuous ----------- ----------- Pressure (CPAP)
Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
2. Continuous Positive Airway Pressure (CPAP)
Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
2. Continuous Positive Airway Pressure (CPAP)
a. Continuous (+) pressure during entire ------- cycle--prevents airway P from reaching ----------
Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
2. Continuous Positive Airway Pressure (CPAP)
a. Continuous (+) pressure during entire resp. cycle--prevents airway P from reaching 0
Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
2. Continuous Positive Airway Pressure (CPAP)
b. No breaths by vent--must be ----------- breather (rate determined by pt own ----------)
Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
2. Continuous Positive Airway Pressure (CPAP)
b. No breaths by vent--must be spontaneous breather (rate determined by pt own RR)
Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
2. Continuous Positive Airway Pressure (CPAP)
b. No breaths by vent--must be spontaneous breather (rate determined by pt own RR)
i. Pt is doing all the work--increases -----------
Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
2. Continuous Positive Airway Pressure (CPAP)
b. No breaths by vent--must be spontaneous breather (rate determined by pt own RR)
i. Pt is doing all the work--increases WOB
Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
2. Continuous Positive Airway Pressure (CPAP)
c. Commonly used for ------------- and primarily in the weaning process (do CPAP trials)
Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
2. Continuous Positive Airway Pressure (CPAP)
c. Commonly used for sleep apnea and primarily in the weaning process (do CPAP trials)
Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
3. High ---------- Ventilation
Respiratory
III. Mechanical Ventilation
D. Other Ventilatory Maneuvers
3. High Frequency Ventilation
Respiratory
III. Mechanical Ventilation
E. Complications
1. Cardiovascular
a. Decreased venous return--from increased ------------ pressure
Respiratory
III. Mechanical Ventilation
E. Complications
1. Cardiovascular
a. Decreased venous return--from increased intrathoracic pressure
Respiratory
III. Mechanical Ventilation
E. Complications
1. Cardiovascular
b. Decreased ________--preload
c. Decreased _______ output
Respiratory
III. Mechanical Ventilation
E. Complications
1. Cardiovascular
b. Decreased LVEDV--preload
c. Decreased cardiac output
Respiratory
III. Mechanical Ventilation
E. Complications
1. Cardiovascular
d. Hypotension
**Further impairment with --------
Respiratory
III. Mechanical Ventilation
E. Complications
1. Cardiovascular
d. Hypotension
**Further impairment with PEEP
Respiratory
III. Mechanical Ventilation
E. Complications
2. Pulmonary--_____% of vented pts have some lung damage
Respiratory
III. Mechanical Ventilation
E. Complications
2. Pulmonary--65% of vented pts have some lung damage
Respiratory
III. Mechanical Ventilation
E. Complications
2. Pulmonary--65% of vented pts have some lung damage
a. ___________--damage to lungs by excessive pressure
Respiratory
III. Mechanical Ventilation
E. Complications
2. Pulmonary--65% of vented pts have some lung damage
a. Barotrauma--damage to lungs by excessive pressure
Respiratory
III. Mechanical Ventilation
E. Complications
2. Pulmonary--65% of vented pts have some lung damage
a. Barotrauma--damage to lungs by excessive pressure
i. Lungs can be over extended and rupture w/ high ----------- pressure
Respiratory
III. Mechanical Ventilation
E. Complications
2. Pulmonary--65% of vented pts have some lung damage
a. Barotrauma--damage to lungs by excessive pressure
i. Lungs can be over extended and rupture w/ high peak inspiratory pressure
Respiratory
III. Mechanical Ventilation
E. Complications
2. Pulmonary--65% of vented pts have some lung damage
a. Barotrauma--damage to lungs by excessive pressure
ii. Can cause pneumothorax, subcutaneous ------------, and -------------
Respiratory
III. Mechanical Ventilation
E. Complications
2. Pulmonary--65% of vented pts have some lung damage
a. Barotrauma--damage to lungs by excessive pressure
ii. Can cause pneumothorax, subcutaneous emphysema, and pneumomediastinum
Respiratory
III. Mechanical Ventilation
E. Complications
2. Pulmonary--65% of vented pts have some lung damage
a. Barotrauma--damage to lungs by excessive pressure
iii. Risk to pt w/----------- lungs (ex. COPD)
Respiratory
III. Mechanical Ventilation
E. Complications
2. Pulmonary--65% of vented pts have some lung damage
a. Barotrauma--damage to lungs by excessive pressure
iii. Risk to pt w/ compliant lungs (ex. COPD)
Respiratory
III. Mechanical Ventilation
E. Complications
2. Pulmonary--65% of vented pts have some lung damage
b. Volu-trauma--injury from ↑-------- volume on pt with -------------/stiff lungs (ARDS)
Respiratory
III. Mechanical Ventilation
E. Complications
2. Pulmonary--65% of vented pts have some lung damage
b. Volu-trauma--injury from ↑tidal volume on pt with noncompliant/stiff lungs (ARDS)
Respiratory
III. Mechanical Ventilation
E. Complications
2. Pulmonary--65% of vented pts have some lung damage
c. Alveolar _________--excessive lung secretions, leaking cuff, etc.
Respiratory
III. Mechanical Ventilation
E. Complications
2. Pulmonary--65% of vented pts have some lung damage
c. Alveolar Hypoventilation--excessive lung secretions, leaking cuff, etc.
Respiratory
III. Mechanical Ventilation
E. Complications
2. Pulmonary--65% of vented pts have some lung damage
d. Alveolar _________--pt anxious ↑tidal volumes
Respiratory
III. Mechanical Ventilation
E. Complications
2. Pulmonary--65% of vented pts have some lung damage
d. Alveolar Hyperventilation--pt anxious ↑tidal volumes
Respiratory
III. Mechanical Ventilation
E. Complications
2. Pulmonary--65% of vented pts have some lung damage
e. Ventilator-assisted pneumonia--ET tube bypasses ------------ defenses
III. Mechanical Ventilation
E. Complications
2. Pulmonary--65% of vented pts have some lung damage
e. Ventilator-assisted pneumonia--ET tube bypasses normal upper airway defenses
III. Mechanical Ventilation
E. Complications
2. Pulmonary--65% of vented pts have some lung damage
e. Ventilator-assisted pneumonia--ET tube bypasses normal upper airway defenses
i. Critical care pt at risk because of -------- and poor -------- status
III. Mechanical Ventilation
E. Complications
2. Pulmonary--65% of vented pts have some lung damage
e. Ventilator-assisted pneumonia--ET tube bypasses normal upper airway defenses
i. Critical care pt at risk because of immobility and poor nutritional status
III. Mechanical Ventilation
E. Complications
2. Pulmonary--65% of vented pts have some lung damage
e. Ventilator-assisted pneumonia--ET tube bypasses normal upper airway defenses
ii. Sputum cultures often grow ----------- (pseudomonas, serratia, klebsiella)
III. Mechanical Ventilation
E. Complications
2. Pulmonary--65% of vented pts have some lung damage
e. Ventilator-assisted pneumonia--ET tube bypasses normal upper airway defenses
ii. Sputum cultures often grow gram(-)bacteria (pseudomonas, serratia, klebsiella)
III. Mechanical Ventilation
E. Complications
2. Pulmonary--65% of vented pts have some lung damage
e. Ventilator-assisted pneumonia--ET tube bypasses normal upper airway defenses
ii. Sputum cultures often grow gram(-)bacteria (pseudomonas, ---------, ----------)
FIX
III. Mechanical Ventilation
E. Complications
2. Pulmonary--65% of vented pts have some lung damage
e. Ventilator-assisted pneumonia--ET tube bypasses normal upper airway defenses
ii. Sputum cultures often grow gram(-)bacteria (pseudomonas, serratia, klebsiella)
III. Mechanical Ventilation
E. Complications
2. Pulmonary--65% of vented pts have some lung damage
e. Ventilator-assisted pneumonia--ET tube bypasses normal upper airway defenses
iii. Decrease risk by using strict ------------ technique while suctioning (hand washing, drain condensation from tubes, etc.)
III. Mechanical Ventilation
E. Complications
2. Pulmonary--65% of vented pts have some lung damage
e. Ventilator-assisted pneumonia--ET tube bypasses normal upper airway defenses
iii. Decrease risk by using strict aseptic technique while suctioning (hand washing, drain condensation from tubes, etc.)
III. Mechanical Ventilation
E. Complications
3. Gastrointestinal
a. Risk of stress ulcers and ----------- bleeding
III. Mechanical Ventilation
E. Complications
3. Gastrointestinal
a. Risk of stress ulcers and GI bleeding
III. Mechanical Ventilation
E. Complications
3. Gastrointestinal
b. Nursing Implication--______receptor blockers or PPIs and monitor pH of gastric aspirate
III. Mechanical Ventilation
E. Complications
3. Gastrointestinal
b. Nursing Implication--H2-receptor blockers or PPIs and monitor pH of gastric aspirate
III. Mechanical Ventilation
E. Complications
3. Gastrointestinal
b. Nursing Implication--H2-receptor blockers or ----------- and monitor pH of gastric ----------
III. Mechanical Ventilation
E. Complications
3. Gastrointestinal
b. Nursing Implication--H2-receptor blockers or PPIs and monitor pH of gastric aspirate
III. Mechanical Ventilation
E. Complications
4. Neurologic
a. Potential for increase in intracranial pressure from ↓ _______ return (keep HOB ____-45°)
III. Mechanical Ventilation
E. Complications
4. Neurologic
a. Potential for increase in intracranial pressure from ↓ venous return (keep HOB 30-45°)
III. Mechanical Ventilation
E. Complications
5. Fluid_________--fluid overload potential (↓CO↓kidney flow↑ReninNa/H2O retention)
III. Mechanical Ventilation
E. Complications
5. Fluid Imbalance--fluid overload potential (↓CO↓kidney flow↑ReninNa/H2O retention)
III. Mechanical Ventilation
E. Complications
5. Fluid Imbalance--fluid overload potential (↓---------↓-----------↑ReninNa/H2O retention)
III. Mechanical Ventilation
E. Complications
5. Fluid Imbalance--fluid overload potential (↓CO↓kidney flow↑ReninNa/H2O retention)
III. Mechanical Ventilation
E. Complications
5. Fluid Imbalance--fluid overload potential (↓CO↓kidney flow↑-------------/H2O retention)
III. Mechanical Ventilation
E. Complications
5. Fluid Imbalance--fluid overload potential (↓CO↓kidney flow↑ReninNa/H2O retention)
III. Mechanical Ventilation
E. Complications
6. Musculoskeletal Problems--due to --------
III. Mechanical Ventilation
E. Complications
6. Musculoskeletal Problems--due to immobility
III. Mechanical Ventilation
E. Complications
7. Psychosocial Effects--assess for causes of ----------- and meeting basic needs
III. Mechanical Ventilation
E. Complications
7. Psychosocial Effects--assess for causes of anxiety and meeting basic needs