Care of acutely unwell patients Flashcards
(44 cards)
1
Q
what is positive pressure breathing?
A
- delivery of air or a mixture of oxygen combined with other gases by positive pressure into the lung
2
Q
what are the two types of positive pressure breathing?
A
- non- invasive
- invasive
3
Q
what are the two types of invasive positive pressure breathing?
A
- ETT
- tracheostomy tube
4
Q
how does positive pressure breathing work?
A
- gas enters the lung
- interalveolar pressure increases until a change in flow/ pressure are detected by the machine, delivering the mixture, or the set volume of gas was delivered to signal the end of a breath
5
Q
what are the two functions of a mask/ ventilator?
A
- delivers breaths
- reduces work of breathing
6
Q
what is VC?
A
- volume control ventilator
- non- invasive
7
Q
how much does VC deliver?
A
- 450ml
- pushes pressure in until it reaches volume
8
Q
how much volume is delivered in VC ventilation? why?
A
- delivers 200ml so pressure has to increase
9
Q
what does VC ventilation cause?
A
- barotrauma
10
Q
what is PC?
A
- polycarbonate mask
11
Q
how much does a PC mask deliver?
A
- 20cmH20
12
Q
what are the four indications for mask/ ventilation?
A
- airway protection in a patient who cannot maintain or protect an open airway
- hypercapnic respiratory failure
- hypoxemic respiratory failure
- circulatory failure
13
Q
when are people unable to maintain their airways?
A
- from an altered level of consciousness or trauma
14
Q
what are the 7 contraindications for using a mask/ ventilator?
A
- need for intubation
- encephalopathy or altered mental status
- hemodynamic instability
- facial trauma/ facial defects
- airway obstruction secondary to a mass
- anticipated need for prolonged mechanical ventilation
- gastrointestinal bleeding
15
Q
what is a NIPPY?
A
- non invasive positive pressure ventilation
16
Q
what does a NIPPY assist?
A
- it is a cough assist machine that works by inflating the lungs with positive airway pressure
- rapidly switches to negative pressure to stimulate a cough
17
Q
who is NIPPY effective for?
A
- effective in clearing mucus and secretions from the airways of patients with a weak cough
18
Q
what does NIPPY offer?
A
- offers oscillatory insufflations/ exsufflations
19
Q
who is NIPPY used on? (3)
A
- frail individuals
- neurological patients: spinal cord and MD
20
Q
what is the inspiratory pressure in NIPPY?
A
- 30 inspiratory pressure
21
Q
what is the expiratory pressure in NIPPY?
A
- 20 expiratory pressure
22
Q
what does IPPB stand for?
A
- intermittent positive pressure breathing
23
Q
what is an incentive spirometer?
A
- simple, plastic medical device that exercises lungs
24
Q
when should incentive spirometer be used?
A
- should be used before and after mobilisation to see the effect
25
what should incentive spirometry not be used for?
- shouldn't be used for treatment
26
when is incentive spirometry recommended? (3)
- after an illness
- after a surgery
- after an injury to your chest/ abdomen
27
what does incentive spirometry prevent?
- prevents lung infections by expanding your lungs
28
what does incentive spirometry help with? (3)
- helps strengthen the lungs
- keeps the lungs inflated
- clears mucus
29
how do you use incentive spirometry?
- place the mouthpiece in your mouth and tightly seal your lips around it
- breathe in slowly through the mouthpiece
- hold your breath in for 3 seconds and then let it out
30
what should you do before using an incentive spirometer?
- take a deep breath in and let it out
31
what is suction?
- procedure that uses a catheter to remove secretions from the upper airway using negative pressure
32
when is suctioning performed?
- when the patient is unable to effectively move secretions from the respiratory tract
33
what is required for suctioning? (3)
- cather and negative pressure
- patient airway
- sterile glove
34
when is suctioning considered? (6)
- visible or audible secretions
- difficulty coughing
- low oxygen levels
- normal breathing
- secretions preventing patient from breathing properly
- secretions cause patient distress
35
what are the six contraindications of suctioning?
- severe bronchospasm
- significant CV instability
- frank haemoptysis
- significantly deranged clotting
- facial fracture/ BOS fracture (NP)
- combative patient
36
what is an example of a closed suction?
- adult tracheostomy closed suction system
37
what is an example of an open suction?
- oropharyngeal/ guedel
38
how do you size up the airway in oropharyngeal suctioning?
- measure oropharyngeal airway against a patient's face
- along airway up to ear
39
why do you need to open the patient's mouth?
- because it ensures that no foreign material is pushed into the larynx
40
what happens if foreign material is present?
- attempt removal using suction
41
how do you insert the oropharyngeal suction?
- insert upside down until you reach the junction of the hard and soft plate at which point you rotate 180 degrees
42
why is the oropharyngeal airway put in upside down?
- reduces risk of pushing the tongue backwards and worsening the airway obstruction
43
what part can you touch on the tube?
- only touch the black part
44
how is the oropharyngeal airway inserted in paediatric patients?
- inserted the right way up using a tongue depressor
