nursing interventions for proper respiration
maintain airway
ensure proper ventilation and oxygenation
**ventilation vs oxygenation
exchange or movement of O2 and CO2 in and out of alveoli - mechanical
oxygenation - exchange of gas
what is work of breathing
amount of effort required to maintain ventilation
what is resistance
opposition - bronchi spasticity
when taking a health hx what questions do you want to ask
hx of asthma, smoking
genetic predisposition
what meds are you taking (how long, how much)
normal blood gas values
pH: 7.35(A) - 7.45(B)
PaCO2 - 35(B) - 45(A)
HCO3 - 22(A) - 26(B)
PaCO2 represents
Respiratory
HCO3 represents
Metabolic
non-invasive respiratory assessment technique
Pulse Ox (SpO2)
to ensure an accurate reading with Pulse Ox (SpO2)
avoid edema, nail polish
min. movement
what does SpO2 measure
oxygen saturation - amt(%) of O2 attached to hemoglobin
oxygen is a drug, t or f
true
Oxygen delivery devices
nasal cannula
high flow cannula
simple face mask
face masks w/reservoirs
oxygen delivery is recorded as
fraction of delivered oxygen (FiO2)
room air is what % of O2
21% or 0.21 FiO2 (21/200)
how much pure O2 is delivered to a pt on nasal cannula
0.24 - 0.44 FiO2
how much pure O2 is delivered to a pt w/hi flow cannula
0.60 - 0.90 FiO2
how much pure O2 is delivered to a pt w/simple face mask
0.30 - 0.60 FiO2
how much pure O2 is delivered w/face mask w/reservoir
partial re-breather 0.35 - 0.60 FiO2
nonrebreather 0.60 - 0.80 FiO2
why do we use an ET tube/intubate
maintain airway
remove secretions
prevent aspirations
mechanical ventilation
why do we get a tracheostomy
long-term medical ventilation freq suctioning protect airway bypass an airway obstruction reduce WOB (work of breathing)
where do we do a tracheostomy
OR or bedside
suctioning is indicated for
secretions r/t increased WOB
coughing
alarms
2 ways to suction
conventional - separate ventilator from pt.
closed - more common - infection
*when suctioning a pt be sure to
hyper-oxygenate them
avoid saline due to risk of infections
indications for ventilating a pt.
hypoxemia PaO2 .50
hypercapnea PCO2 >=50 with pH
what is positive pressure ventilation (PEEP)
the force of oxygen into alveolar sacs
intermittent
what is CPAP
continuous positive airway pressure for pt who is spontaneously breathing
noninvasive ventilation treatments
tight sealed masks (nasal, oronasal, total face masks)
when is non-invasive ventilation used
COPD, HF, palliative care
complications of ventilation
oxygen toxicity infection aspirations stress ulcers/GI bleed altered sleep patterns - anxiety dependency
what is oxygen toxicity
carbon dioxide retention - COPD pt. at risk
absorption atelectasis - washes out nitrogen
s/s of oxygen toxicity
subtle s/s - loopy, confused
**what is a ventilator bundle
HOB 30 degrees assess daily readiness to wean stress ulcer prophylaxis (PPI) DVT prophylaxis (heparin) oral
what is associated with ventilator associated pneumonia
oral care - swab their mouth daily - use chlorhexidine
hand hygiene
the first time a pt weans from ventilator are they successful
not always