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47 Cards in this Set
- Front
- Back
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q.d. (qd or QD)
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once a day
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BID
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two times a day
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TID
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three times a day
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q.i.d
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means 4 times a day
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Indications for positive pressure ventilation
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1. Acute exacerbation of COPD
2. status asthmaticus 3 Hypoxemia (CF, Pneumonia, CHF), Neuromuscular pt (GB, ALS, MG) 5 DNR 6 Facilitate weaning 7 Chronic respiratory failure 8 Nocturnal hypoventilation, desaturation. 9. Acute cardiogenic pulmonary edema 10. community acquired PNA YOU MUST BE SPONTANEOUSLY BREATHING TO USE NIPPV |
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In acute asthmatic crisis, patients present with
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hypercarbia and hypoxemia
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IPAP
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Inspiratory level
increased pressure for boost on inhalation increased ventilation when raised Aids ventilation (PaCO2) Reduces WOB |
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EPAP
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Expiratory level (FRC)
Same as PEEP / CPAP while exhaling Aids oxygenation (PaO2) Increases FRC Keeps lungs at a baseline pressure |
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The difference between IPAP and EPAP is
Increased PS = |
PSV (pressure support ventilation)
Increased ventilation (PCO2) |
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NIPPV - BiLevel
Treatment Goals |
CHF
Cardiogenic pulmonary edema |
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PEEP/CPAP/EPAP
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elevates the baseline airway pressure.
Keeping the baseline pressure aids in oxygenation by recruiting alveoli increasing FRC Decreases WOB Alveoli splinting = Pulmonary Edema clearing Decreases preload to heart by positive thoracic pressures |
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IPAP
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is pressure for tidal volume enhancement
aids in reduction of work of breathing as well as ventilation of PCO2 |
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BPAP Contraindications
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Hemodynamic instability
ICP > 20 mm HG Patient with Hypoventilation (absolute, must be spontaneously breathing) |
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Hazards and complications of CPAP
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Barotrauma
Hypoventilation PcO2 (must be spontaneously breathing Gastric distention Vomiting and aspiration |
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Hazards of NPPV
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leaks
nasal, sinus or patient discomfort gastric insufflation eye irritation barotrauma aspiration pneumonia mucous plugging hypoxemia |
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pulmonary toilet
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If a patient is determined to have thick secretions and he is having trouble expectorating (spitting up), and this is deemed to be causing respiratory distress, than any effort necessary is done to break up secretions so the patient can spit them up. This usually includes bronchodilator therapy, mucolytic (mucomyst), and chest physiotherapy, cough and deep breathing and incentive spirometry.
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LAM
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LAM, or lymphangioleiomyomatosis (lim-FAN-je-o-LI-o-MI-o-ma-TO-sis), is a rare lung disease that mostly affects women of childbearing age.
In LAM, abnormal, muscle-like cells begin to grow out of control in certain organs or tissues, especially the lungs, lymph nodes, and kidneys. Over time, these LAM cells can destroy the normal lung tissue. As a result, air can’t move freely in and out of the lungs. In some cases, this means the lungs can’t supply the body’s other organs with enough oxygen. |
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Report Expectations
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Age
Sex DX Hx Therapy BS 02 Therapy / Sat (last) Cough Code Status |
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ETOH
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stands for ethanol. The acronym is commonly used in the description of a patient who displays symptoms of over consumption or even withdrawal form alcohol beverages.
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Eosinophilic pneumonia (EP)
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a disease in which a certain type of white blood cell called an eosinophil accumulates in the lung. These cells cause disruption of the normal air spaces (alveoli) where oxygen is extracted from the atmosphere. Several different kinds of eosinophilic pneumonia exist and can occur in any age group. The most common symptoms include cough, fever, difficulty breathing, and sweating at night. EP is diagnosed by a combination of characteristic symptoms, findings on a physical examination by a health provider, and the results of blood tests and x-rays. Prognosis is excellent once most EP is recognized and treatment with corticosteroids is begun.
When a cause can not be found, the EP is labeled "idiopathic." Idiopathic EP can be divided into "acute eosinophilic pneumonia" (AEP) and "chronic eosinophilic pneumonia" (CEP) depending on the symptoms a person is experiencing. Individuals with CEP are often diagnosed with asthma before CEP is finally recognized. The common characteristic among different causes of EP is eosinophil overreaction or dysfunction in the lung. Chronic eosinophilic pneumonia was first described by Carrington[8] in 1969, and it is also known as Carrington syndrome. Prior to that, eosinophilic pneumonia was a well described pathologic entity usually associated with medication or parasite exposures. Acute eosinophilic pneumonia was first described in 1989 |
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The most common causes of obstructive lung disease are:
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Chronic obstructive pulmonary disease (COPD), which includes emphysema and chronic bronchitis
Asthma Bronchiectasis Cystic fibrosis Obstructive lung disease makes it harder to breathe, especially during increased activity or exertion. As the rate of breathing increases, there is less time to breathe all the air out before the next inhalation. |
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Restrictive Lung Disease
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People with restrictive lung disease cannot fully fill their lungs with air. Their lungs are restricted from fully expanding.
Restrictive lung disease most often results from a condition causing stiffness in the lungs themselves. In other cases, stiffness of the chest wall, weak muscles, or damaged nerves may cause the restriction in lung expansion. Some conditions causing restrictive lung disease are: Interstitial lung disease, such as idiopathic pulmonary fibrosis Sarcoidosis, an autoimmune disease Obesity, including obesity hypoventilation syndrome Scoliosis Neuromuscular disease, such as muscular dystrophy or amyotrophic lateral sclerosis (ALS) |
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what causes respiratory acidosis?
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insufficient alveolar ventilation
pulmonary disease, CNS depression, drugs causing respiratory depression |
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What causes respiratory alkalosis?
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Alveolar hyperventilation
Stress, emotional upset, hypoxia, fever, CNS trauma |
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what causes metabolic acidosis?
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Lactic acidosis, ketoacidosis (diabetes), renal failure, diarrhea
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what causes metabolic alkalosis
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Hypokalemia (most common cause), low chloride, diuretics, corticosteroids, vomiting, nasogastric tube
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Duoneb
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SVN:
Ipratropium Bromide 0.5 mg and Albuterol 2.5mg, qid |
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Advair
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Fluticasone propionate/salmeterol
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Spiriva
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Tiotropium Bromide
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Tobramycin
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TOBI
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Pulmicort Respules
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Budesonide
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How many RTs on staff at Palomar?
How many RTs on staff at Pomerado? |
7-10
2 minimum |
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Vent settings to note
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Rate
Tidal volume FIO2 PEEP |
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Suctioning
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90% preparation
10% execution side effect - Vagal stimulation (potential brady cardia) continuous pulse ox suction pressure 80-120 (adult) 60-80 neonate Hyperoxygenate first suction 2 times max, O2 in between cough? pause suction |
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oxygen dissociation curve
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Shifts to the right: Low affinity for oxygen Releases oxygen more easily
High CO2 High H+ (low pH) High temperature High 2,3, DPG (product of anaerobic glycolysis Shifts to the left: high affinity for oxygen - Holds on to oxygen more tightly Fetal hemoglobin Low CO2 |
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AFB x 3
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Also known as: TB culture and sensitivity; Mycobacterial smear and culture
Formal name: Acid-fast bacillus smear and culture and sensitivity Related tests: TB Screening Tests; Bacterial Wound Culture; Susceptibility Testing; Mycobacteria tuberculosis nucleic acid amplification test; TB NAAT; Body Fluid Analysis; Sputum Culture; Adenosine Deaminase http://labtestsonline.org/understanding/analytes/afb-culture/tab/test |
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Ipap
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Ventilation
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epap
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oxygenation
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ezpap
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5-15 liters per minute
goal: 20 cm H20 |
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splint cough
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Pillow splinting is done either seated upright or lying down, holding a pillow over the incision site -- whether abdominal, chest or on either side. The best technique is to wrap both arms or hands as fully as possible across the pillow and press firmly. A slow, deep breath in produces less discomfort in this position. You can cough at the top of this deep breath, pressing firmly as you do so. Splinting is also used at least four times an hour to make it easier to take a series of slow, relaxed deep breaths in and out to keep your lungs expanded, mucus-free and healthy.
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MDI components
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Medication
Propellant Surfactant |
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Albuterol
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onset: 15 mins
Peak: 30-60 mins Duration: 5-8 hours |
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tension pneumothorax
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laceration of lung
air forced into pleural space |
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Hyponatremia
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is an electrolyte disturbance in which the sodium ion concentration in the plasma is lower than normal.
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MDI administration
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tight seal on MP
slow deep breath in hold for 5 seconds |
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Signs and Symptoms of Pneumothorax
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sudden, sharp pain
shortness of breath unilateral chest wall rise increased heart rate increased respiratory rate IPPB reaches pressure limit much sooner than before |
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What if Pt has an order for Duoneb and Spiriva?
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Consult nurse regarding double dosing same family of medicines:
Iptratropium bromide (Duoneb) and Tiotropium bromide (Spiriva) |
