(Jessica) Call Girl in Jaipur- 09257276172 Escorts Service 50% Off with Cash ...
Respiratory-for-lec.pptx
1.
2. RESPIRATORY SYSTEM
Objectives:
1. To recognize, recall, and
explain the functions of the
respiratory system
2. To assess related pathology/
diseases of respiratory system
3. To learn accompanying
diagnostic and therapeutic
interventions
4. Neurochemical Control
Respiratory center: lateral medulla oblongata
Group of Respiratory Neurons
a. Dorsal – autonomic rhythm
b. Ventral – active when there is a demand for
increased ventilatory effort
c. Pneumotaxic and apneustic – modulate an
established rhythm
Pneumotaxic – affects inspiratory effort by
limiting the volume of air inspired
Apneustic – prevents excessive inflation of
the lungs
HERING-BREUER INFLATION REFLEX-inhibitory
impulses sent to inspiratory neurons in the
brainstem to prevent lung overdistention
5. FUCTIONS OF RESPIRATION:
DEFReSS
1. Deliver O2 to blood for transport
to tissues/ cells
2. Excrete waste products of cellular
metab_
3. Filter, cleanse, warm, humidify air
to the lungs
4. Regulate Blood Ph_
5. Sound for speech, singing
6. Stimulus for Olfaction
_
6. EXTERNAL RESPIRATION- gas
exchange between air in ALVEOLI
and blood PULMONARY
CAPILLARIES
INTERNAL RESPIRATION- gas
exchange between TISSUE CELLS
and blood SYSTEMIC CAPILLARIES
8. FUNCTIONS:
Upper portion- filters, moistens, warms air
NOSE
PHANRYNX divisions:
- NOL
- laryngopharynx opens to esophagus and larynx
- Phonation
- TONSILS: Adenoids, Palatine, Lingual
LARYNX (Voice box)
- composed of 9 cartilages in box-like formation
- thyroid cartilage (Adam’s Apple)
- epiglottis
- cricoid
- vocal cords: TRUE and FALSE
9. FUNCTIONS:
Lower Portion – gas exchange and regulation of pH,
PO2, PaCO2
TRACHEA
- smooth muscle, C-shaped cartilage
- 10-11 cm (4 ½ inches)
BRONCHIAL TREE
- bronchi: Left and Right
- right: more vertical and larger than the left
- bronchioles
- terminal bronchioles
10. LUNGS
- Lobes: Left and Right
- mediastinum
- carina
- bronchi
- bronchioles
- alveoli
- surfactant
- Pleura: Visceral, Parietal
- Pleurisy
- Pleural Effusion
11.
12.
13. Defense Mechanisms
1.Mucociliary system
- Production of mucus and cilia action
2. Secretory immunity
- Production of antibody in mucosal
secretions that initiates immune
response
- Macrophage
3. Surfactant – keeps alveoli open
4. Irritant reflex
- Reflex brochospasm, followed by
coughing
14. INSPIRATION
1.Respiratory Muscle Contract
2.Thorax increases in size
3.Lungs increases in size
4.Diaphragm flattens
5.Negative pressure in the
pleural space_
6.Gas rushes from higher
atmospheric pressure to
negative intrapulmonic
pressure
Inspiration is complete
EXPIRATION
relax
decreases
decreases
Elevates
Positive pressure in
the pleural space
high pressure in the
lung to lower
pressure in the
atmosphere
Expiration is
complete
PHYSIOLOGY OF RESPIRATION
16. TERMS
Tidal Volume (V1)
- Movement of air in and out of the lungs with
each respiration
- 500-700ml
Hyperventilation
- Excess 02 causing C02 to fall below normal
- 38-42 mmHg
Compliance- volume of air lung is able to accept
vs pressure from properties that inhibit
adequate lung expansion
The greater the pressure needed to provide a
given volume of air to overcome inhibiting
properties, the lower is the lung compliance.
18. Lung Compliance
Alteration may occur from the lung
or chest wall from thoracic
deformity, muscle spasm and
abdominal distention_
Resistance
Changes may occur in lung tissues,
chest wall or airways
Opposition to airflow
19. Refers to homeostasis of the
hydrogen ion concentration in body
fluids in the ECF
Acid – substance that donates
hydrogen ions
Base – substance that accepts
hydrogen ions
20. Regulation of Acid-Base Balance
1. Buffer System-
-control hydrogen ion concentration in the
blood and kidney tubules
Bicarbonate-carbonic acid system
(Carbonate System) – body’s primary
buffer system
Bicarbonate helps stabilize pH by
combining reversibly with hydrogen ions
◦ Carbonic Acid (H2CO3)-dissolved
C02 in water
◦ Sodium Bicarbonate (NaHCO3)-
electrolyte, alkalinizing agent
21. Production of Bicarbonate
Increase
◦H2CO3=CO2 + H2O (breakdown
of carbonic acid)
Decrease
◦H2CO3= H+ HCO3 (formation of
carbonic acid)
22. ARTERIAL BLOOD GAS
– a diagnostic laboratory studies that
measures the amount of dissolved O2
and CO2 in arterial blood and indicate
the acid-base state.
Blood pH– 7.35 to 7.45
PaCO2 – 35 to 45 mmHg
PaO2 – 80 to 100 mmHg
HCO3 – 22 to 26 meq/L
O2 Sat – 96-100%
26. Procedure:
Draw blood into heparinized syringe (90°
angle)
Apply pressure to the puncture site for 5 to
10 mins
Sterile technique should be observed
SITE: right radial artery
27. Normal Values:
Blood pH – 7.35 to 7.45
PaCO2 – 35 to 45 mmHg
PaO2 – 80 to 100 mmHg
HCO3 – 22 to 26 meq/L
O2 Sat – 96-100%
28. HOW TO ANALYZE ABG
1. Check the pH
pH < 7.35 ( acidosis)
pH = 7.40 (normal)
pH > 7.45 (alkalosis)
29. 2. Determine primary cause of
disturbance
Acidosis
If PCO2 > 40 – respiratory
If HCO3 < 24 – metabolic
Alkalosis
If PCO2 < 40 – respiratory
If HCO3 > 24 – metabolic
ROME
30. 3. Determine the degree of compensation
Fully compensated
-pH is normal
Partially compensated
-PCO2 & HCO3 are abnormal, pH
abnormal
Uncompensated
-pH is abnormal, either of PCO2 or
HCO3 is normal
31.
32. Health History
Presenting problem
◦ Nose/nasal sinuses: symptoms may
include colds, discharge, epistaxis, sinus
problems (swelling, pain)
◦ Throat: symptoms may include sore throat,
hoarseness, difficulty swallowing, strep
throat
◦ Lungs: symptoms may include
Cough: note duration; frequency; type (dry,
hacking, bubbly, barky, hoarse, congested);
sputum (productive vs nonproductive);
circumstances related to cough (time of day,
positions, talking, anxiety)
treatment
33. Health History
Presenting problem
Dyspnea: note onset, severity, duration,
efforts to treat,
if accompanied by cough or diaphoresis
time of day when it most likely occurs
interference with ADL
whether precipitated by any specific
activities,
whether accompanied by cyanosis.
Wheezing
Chest pain
Hemoptysis
PAIN
34. Health History
Life-style:
smoking
occupation
geographical location
type and frequency of exercise/recreation
◦ Nutrition/diet:
◦ Past medical history:
immunizations (yearly immunizations for
colds/flu
frequency and results of tuberculin skin
testing)
allergies (foods, drugs, contact or inhalant
allergens
precipitating factors, specific treatment,
desensitization)
35. Types of secretions
Sputum – an aggregation of secretions from
the tracheobronchial tree, mouth, pharynx,
nose and sinuses
Phlegm – refers to secretion of the
tracheobronchial tree and lungs. Normal is
100 ml/24 hours
37. Physical Examination
Inspect for configuration of the
chest (kyphosis, scoliosis, barrel
chest) and cyanosis.
Determine rate and pattern of
breathing (normal rate 12-
18/minute); note tachypnea,
hyperventilation, or labored
breathing pattern.
Palpate skin, subcutaneous
structures, and muscles for texture,
temperature, and degree of
development.
38. FACTORS AFFECTING THE
APPERANCE OF CYANOSIS
1. Pigmentation and thickness
Cyanosis must be examined carefully
Very thin skin, unpigmented and whose
capillaries are superficial and
numerous (e.g. tip of the tongue,
buccal mucosa, cutaneous surfaces of
lips, tips of fingers and toes, nail
beds, earlobes and tips of the nose)
must be observed
Some areas are highly vascular (e.g.
heels of the newborns)
Mucous membranes (for dark skin
patients)
39. Anemia – may not appear cyanotic
Polycythemia Vera – cyanotic with
lesser degree of dissaturation than
the normal individuals
40. Breath Sounds & Patterns
Normal Breath Sounds
◦ Vesicular – heard over most of the lungs
◦ Bronchovesicular – main stem bronchi
◦ Bronchial / Tubular – trachea
41. Abnormal Breath Sounds
Rales – discrete, non-continuous
sounds produce by moisture in the
tracheobronchial tree. Heard best on
inspiration
Fine Crackles - COPD, CHF,
Pneumonia
Coarse Crackles – Pneumonia,
pulmonary edema, bronchitis and
atelectasis
42. Rhonchi & Wheezes-passage of
air in narrowed airways
(inflammation, tumor,
spastic). Prominent on
expiration
◦Asthma, bronchitis, tumor,
bronchiolar spasm, foreign
body obstruction
43. Friction rubs
-cracking, grating sounds
originating in an inflamed
pleura
-predominant in inspiration &
expiration
◦Pleurisy, TB, pulmonary
infarction, lung abscess
44. Stridor – crowing. harsh, high
pitched sounds usually associated
with an obstruction in the upper
trachea or vocal cords Predominantly
in inspiration
◦Croup, foreign body obstruction,
large airway obstruction
46. DIAGNOSTIC ASSESSMENTS
Radiographic Studies – used for
screening and diagnostic purposes
Chest X-ray – identify pathologic
changes in the lungs
◦ Also used to determine
placement of catheters and
tubes
47. Possible Findings
Infiltrates
Solid masses (tumor)
Areas of necrosis (TB)
Excessive air trapping (Emphysema)
Abnormal accumulation of air or fluid
in the pleural space (pleural effusion
or pneumothorax)
Gross abnormalities
48. ◦Tomography (Plamigraphy,
Laminography or Sectional Radiograph)
◦ techniques used to demonstrate
intrathoracic lesions (such as
cavities, cysts or calcification) that
are observed by overlying structures
49. ◦Fluoroscopy – observation of the
motion of the pulmonary and cardiac
structures
◦Pulmonary Angiography – rapid
injection of the radiopaque dye into
the pulmonary circulation. Useful in
the determination of the site of
pulmonary embolism
50. ◦Bronchography – refer to roent-
geographic visualization of the size,
shape, patency and number of bronchi
51. ◦Lung scan (Pulmonary
Scintiphotography) – use of scanning
device that records and outline of the
pulmonary radioactivity following
injection or inhalation of radiopaque
particles
◦Sinus X-ray – obtains information
about the size and shape of the
sinuses
52. Examination by Direct Visualization
Rhinoscopy – examination of the
interior of the nasal cavities
Laryngoscopy
b.1 Indirect – instructed to stick out
the tongue and produce a sounds
as in “ah” or “e-e-e”
b.2 Direct – preparation
53. ◦ Bronchoscopy – visualization of the
larger bronchi of the
tracheobronchial tree wherein a
bronchoscope is inserted through
the mouth
Prep: NPO 6-8 hours, dentures
removal, oral hygiene
54. Post Procedure:
◦NPO until cough, swallowing and gag
reflex returns. Talking should be
discouraged (complication: laryngeal
edema /hemorrhage)
55. ◦ Bronchofiberoscopy (flexible fiber
optic bronchoscopy –FFB) – direct
visualization using fiber optic
bronchoscope which are flexible
tube that transmit light and a clear
image around corners
- Used to diagnose tumors,
granulomatous lesions, to find
hemorrhage sites, to evaluate
trauma or nerve paralysis, obtain
biopsy
56. ◦Media Tinoscopy – a small incision is
made in the supersternal notch where
the media tinoscope is inserted usually
performed under general anesthesia
-Can identify carcinoma,sarcoidosis,
histoplasmosis
-Used for staging lung tumors
57. ◦ Transillumination – method of
examining the frontal and the
maxillary sinuses by directing a
beam
◦ Lung biopsy – aspiration of secretion
of a needle
58. 2 Approaches
Transtracheobronchial – performed during
bronchoscopy with the aid of a fluoroscope
Transthoracic – includes percutaneous
needle lung biopsy or aspiration and the
open thorachotomy technique (open lung
biopsy)
59. Pleural biopsy – specimen may be obtained
from percutaneous needle lung biopsy
60. Laboratory Studies
◦ Hematological
◦ Cytological Studies – sputum,
tracheobronchial secretions and
pleural fluid to detect the presence
of CA cells (e.g. PAP Smear)
◦ Bacteriological – secretions from
nasopharynx, chest and pleural
cavities
61. ◦ Sputum Studies – goblet cells
normally produce 100 ml of mucus
per day
d.1 Culture of sputum
d.2 Sensitivity studies
62. Sputum Color Pathology
•Mucoid •Tracheobronchitis,
asthma
•Yellow or green •Bacterial infection
•Rust or blood tinge •Pneumonia,
pulmonary
infarction, TB
64. d.3 Cytologic Exam (CA)
5 to 10 ml of sputum is sufficient; c/s
must be done prior to antimicrobial
therapy. Occasionally all sputum collected
over a period of 24-72 hours is needed and
can be refrigerated in cases of delay
65. e. Thoracentesis – aspiration of fluids or air
from the pleural space. May be diagnostic or
therapeutic purposes.
SITE: 2nd or 3rd ICS MCL for air, 7th or 8th
ICS PAL for fluid
POSITION: Over bed table; seated in bed
with the affected hand raised over the head
66. NURSING RESPONSIBILITIES:
Inform patient to remain immobile
Pressure sensation during procedure
No anticipated discomforts after the
procedure
Place patient on unaffected side
approximately 1 hour to permit the pleural
site to seal itself and prevent fluid seepage
from cough or gravitational force
67. f. Skin Test for TB – PPD (Purified Protein
Derivatives)
f. 1 Mantoux Test – read after 42-
72 hours
Interpretation:
10 mm – positive (either infected or
indicative of presence of antibodies)
5-9 mm – doubtful
<5mm – negative
68. ASSESSMENT OF PULMONARY
FUNCTION
Pulmonary Function Test
◦ to assess lung functions
◦ to rule-out non-organic types of
dyspnea such as that cause by
psychoneurotic disorders
◦ to differentiate diseases of the lungs
(obstruction, restriction or both)
69. Lung Capacities – sum of two or more
primary non-overlapping lung volume
a.1 Vital Capacity (VC) – quantity of air
that a person can expel by a forcible
expiration after the deepest
inspiration possible;
average: 4000-4800 ml for an adult man
a.2. Normal Capacity (NC)
average: 2900-3000 ml
70. a.3 Total Lung Capacity (TLC) –
total amount of air in the lungs after
maximal expiration
average: 5400 to 5800 ml
a.4 Inspiratory Capacity (IC) – maximal
amount of air that can be inspired after
a normal expiration
a.5 Functional Residual Capacity (FRC)
amount of air left in the lungs after
normal expiration
71. Lung Volumes
b.1 Tidal Volume (TV) – volume of air inspired
and expired with a normal breath. Average
is 500 ml.
b.2 Inspiratory Reserve Volume (IRV) – maximal
volume that can be inspired from the end of
normal inspiration. 1800-2000 ml
72. b.3 Expiratory Reserve Volumes (ERV) –
maximal volume that can be exhaled by force
expiration after a normal expiration. About
1400 ml
73. b.4 Residual Volume (RV) – volume of air left in
the lung after maximal expiration. Approx.
1200 ml or “Dead Space” (does not contribute
to gas exchange)
b.5 Minute Volume (MV) – volume inspired and
expired in one minute of normal breathing.
About 1000 ml
74.
75. Spirometry – the means by which the lung
capacity volumes and flow rate are measured.
77. Nursing Management:
Assess and monitor
◦ Fluid and electrolyte status
◦ Respiratory status
Nursing activities
◦ Administer oxygen as prescribed
◦ Maintain direct pressure over arterial
puncture site for 5 to 10 minutes after
drawing the sample
◦ Avoid O2 contamination of arterial specimen
◦ Report result as soon as possible
78. PLANNING
1. Health Promotion
Adequate ventilation
Prevent inhalation of dust and fumes
discourage over use of inhalers, sprays and
nose drops
80. 3. Preventing and controlling infection
Medical asepsis
Prophylaxis (e.g. vaccines)
Medications
81. Oxygen therapy
Purposes:
Improved tissue oxygenation
Decrease work of breathing in
dyspneic clients
Decrease work of the heart in
clients with cardiac disease
82. Hypoxemia
Hypoxia
Types
Hypoxic hypoxia – results from decrease in
the diffusion of O2 from the lungs into
the arterial blood (e.g. decrease O2 in
inspired air (high altitude): lung problems
– Atelectasis, pneumonia and pulmonary
edema
83. Anemic hypoxia – occurs in conditions where
there is insufficient hgb as in anemic
problems and CO poisoning
Ischemic hypoxia – results from decrease
tissue perfusion (e.g. MI, CHF, hypovolemic
shock, vascular diseases and thrombosis
84. Histotoxic Hypoxia / Cellular Hypoxia –
conditions in which cells have an increase
demand for O2 (e.g. hypermetabolism)
85. Assessment for the Need for Oxygen
Increase HR
Dyspnea, rapid, shallow breathing
cardiac dysrhythmias
Drowsiness
Headache
disorientation, excitement,
apprehension
87. GOALS OF O2 THERAPY
Psychological ad physical comfort
◦ Information regarding purposes
◦ Comfort measures such as hygiene (skin. Oral, nasal
at least q 2 hours
◦ Proper positioning and repositioning
88. Promoting safety
Knowledge dissemination regarding O2
properties such as odorless, colorless,
tasteless and heavier than air
O2 supports combustion (no smoking rule,
electrical equipment should be far from O2
proximity
Drying effect of O2
89. Maintaining adequate oxygen
Mode of Supply
Low-flow System – system that delivers
O2 at a rate less than the inspiratory rate
requirement
90. Types
Nasal Cannula (Nasal Prong) – O2 flow 1-
6 lpm which delivers 21-24%. Mouth
breathing is discouraged
Face mask – O2 flow rates from 35-60 %
between 5-10 lpm. Inspired air should be
equal or higher than minute ventilation
of the client. The following may be used:
91. ◦ Partial re breathing mask (50 to 70%)
◦ Face tents or hoods
◦ Incubators (22 – 40%)
◦ Humidifying tent – provide mists to transport O2 to
terminal alveoli
◦ O2 tent – suitable for administration of moderately
high concentration of O2. (croup disease – 21 to
30%)
96. Venturi Mask – deliver a precise,
fixed concentration of O2 ranging
from 24-50%
◦ Humidifier is not required to 30% below
◦ Used in COPD because increase
concentration of O2 might depress
ventilation. It prevents abrupt changes on
PaO2 and PCO2 and is thereby an
effective method to control the amount of
inspired air.
97. Other ways
Tracheostomy
Portable O2
Hyperbaric oxygenation – delivering a 100%
O2 in an environment of increase
atmospheric pressure. Used to treat carbon
monoxide poisoning, air embolism, acute
cyanide poisoning
98. Incentive Spirometry - The client will blow
air out of the lungs and then to inhale
deeply through a mouth piece attached to a
device that measures the client’s maximum
inspiration.
101. Aerosol Therapy
To add moisture to oxygen delivery systems
To hydrate thick sputum and prevent mucus
plugging
To administer various drugs in the airway
◦ NSS
◦ Detergents – e.g. propyl glycol or glycerine
to decrease viscosity of secretions by
reducing surface tension
106. IPPB – refers to pressure greater than the
atmospheric pressure at the airway opening during
the inspiration. The client’s inspiratory effort
triggers the ventilator which pushes air to the
lungs
Pressure assisted
Client controlled
Prescribed QID
adults – 10 to 15 minutes
children – 10 to 15 minutes
107. Observe for signs of
Hyperventilation:
◦ Headache, chest pain, tingling of the fingers and
toes, numbness, vertigo, syncope
Gastric distention
Dangers of worsening pneumothorax
Possible air trapping in clients with obstructive
diseases
108. Artificial airway
Functions:
Ensure open airway
Facilitate administration of high
concentration of oxygen and
humidification
Facilitate mechanical ventilation
109. TYPES:
Oropharyngeal airway – prevents the tongue
from falling back and blocking the airway
Endotracheal intubation – inserted through
the mouth (orotracheal) or nostril
(nasotracheal)
112. Tracheostomy – inflated with at least 1-3 cc
of air to seal off. A slight air leak should
always be left to decrease pressure in the
trachea and prevent ischemic necrosis thus
preventing the development of tracheo-
esophageal fistulas.
113.
114. Signs to Determine Adequate Amount of
Air
Aphonia because air flow in the vocal
cords
Absence of an audible escape of air from
the nose, mouth and tracheostomy tube
when occluded
115. TRACHEOSTOMY CARE
3 MAIN PRINCIPLES
1. maintain patent airway – suction
10-15 minutes during the first 24
hours
Sign of mental occlusion
changes in vital signs
changes in mental attitude
116. 2. Prevent infection
Remove inner cannula and cleanse it as
often as necessary
Dressing should be change and sites must
be inspected for inflammation
3. Prevent drying and crusting of the
mucosa
Provide adequate hydration
Installation of at least 2-3 cc of
NSS
117.
118.
119. Ventilation Therapy (Mechanical
Ventilation) – use of mechanical device
Purposes:
To maintain adequate alveolar
ventilation
To provide pulmonary system the
mechanical power to maintain
physiologic ventilation
120. To manipulate ventilatory patterns and
airway pressures to improve efficiency of
ventilation
To decrease myocardial workload by
diminishing the work of breathing
122. 2. Impaired gas exchange and diffusion
ARDS
Atelectasis
Pneumonia
Tumor
123. 3. Respiratory Failure as evidenced by ABG
Continuous decrease in oxygenation
An increase in arterial carbon dioxide
Persistence of acidosis
124. Types:
POSITIVE-PRESSURE VENTILATORS
Pressure cycled
– permits air to flow into the client’s lung until a
predetermined pressure is reached (e.g. Bird
and Bennet, PR-1, PR-2)
- The major limitation is that the volume of air
can vary as the patient’s airway resistance or
compliance change
125. Volume cycled
◦ delivers a predetermined volume of gas into the
patient’s lung with each breath and exhalation
occurs passively
◦ Intended for long term use for patient with
primary pulmonary disease
◦ Volume may range up to 2000 cc or more (e.g.
Bennet MA-1, Engstron, Ohio and Emerson
Critical Care Ventilators)
126. Time cycled ventilators
◦Terminates or control inspiration after
preset time
◦Volume of air the patient receives is
regulated by the length of inspiration and
flow rate of the air
◦Used in newborns and infants
127. Accessory Attachments:
Intermittent Mandatory Ventilation (IMV)
– a method for providing both spontaneous
breathing and breathing by machine. This
is also used for weaning.
128. Continuous Positive Airway Pressure
(CPAP) - a non-mechanical means of
ventilation.
◦ It provides continuous positive airway
pressure by maintaining pressure above zero
at the end of expiratory phase thereby
preventing alveolar collapse
◦ An endotracheal tube or face mask may be
used to delivered measured concentration of
O2.
129. Positive End-Expiratory Pressure (PEEP)
– a method of maintaining a pressure
higher than the atmospheric pressure in
the lungs at the end of expiration
◦ - CPAP differs from PEEP in that in the
client in CPAP is breathing spontaneously and
may not be on ventilator whereby in PEEP, it
is controlled by a ventilator.
131. Ventilator Setting
FiO2 – fraction of inspired oxygen; the
concentration of O2 delivered (21 – 100%)
Tidal Volume – the amount of air the machine has
been set to deliver with each ventilator breath
◦ Pt’s wt. in kilograms multiplied by 10-15 cc
Respiratory rate – no. of positive pressure per
minute
Sigh – additional volumes of air delivered several
times each hour. Average is 10 to 15 per hour
Respirator mode
132. Potential Complications:
ET displacement or trache extubation
Infections
Barotrauma – leads to rupture of over distended alveolus
Central nervous system disturbances due to decrease
cerebral venous return
Psychological trauma – fear, anxiety, inability to
communicate
Oxygen toxicity – high alveolar oxygen tensions can impair
respiratory function
133. Hemodynamic alterations caused by
◦ Restriction of left ventricular filling
◦ Limitation of expansion and filling of the
ventricles during systole
◦ Limitation of the intrathoracic pump
Musculoskeletal complications
◦ Tissue necrosis on mouth (ET), trache stoma,
infection and pressure sores
134. CARE OF MECHANICALLY
VENTILATED PATIENTS
Basic airway care
Prevention of respiratory complications
◦ Humidification, USN, suctioning, turning, deep
breathing, CPT
Prevention of infection
◦ Aseptic technique
◦ Clean possible sources of contamination
135. ◦ Use sterile supplies
◦ Daily dressing
◦ Nutrition and hygiene
Prevention of Oxygen toxicity
◦ Limit the use of 100% O2 to brief periods
◦ Decrease FiO2 to lowest possible level to maintain
PaO2 at 60 to 90 mmHg
◦ Up to 70% O2 may be used safely for 24 hours
136. ◦ After 2 days, an FiO2 about $0% is potentially
toxic
◦ Prolonged use of FiO2 below 40% rarely causes O2
toxicity
◦ Up to 50% O2 may be used safely for 2 days
137. Prevention of other complications
◦ Bedsore formation
Areas of Concerns:
Nutrition
Fluid and electrolyte balance
Muscle tone and skin integrity
Communication, emotional and psychological support
Environmental factors
138. TROUBLE SHOOTING
VENTILATOR PROBLEMS
CAUSES INTERVENTIONS
Increased secretions Suction the patient
Kinked ventilator tubing
or ET tube
Unkink the tubing
Assess & check the cm
markings on the ET at
the lips or nares
Check for air entry
bilaterally
ALARM TYPE: HIGH PRESSURE
139. CAUSES INTERVENTIONS
Patient biting the ET Place an oral airway
Water in the ventilator
tubing
Disconnect the tubing
at a connection point
near the patient and
drain water using
special receptacle for
contaminated drainage
140. CAUSES INTERVENTIONS
ET advance into the right
main stem bronchus
Notify doctor
CXR or pulling back
Barotrauma (rupture of
over distended alveolus)
Assess for palpable SQ
emphysema, tracheal
deviation, unequal breath
sounds, shock and cardiac
or respiratory arrest
from tension
pneumothorax and inform
MD
141. CAUSES INTERVENTIONS
Brochospasm from
constricted bronchioles
Ensure proper ET
position by auscultating
the lungs and abdomen.
Check marking cm
Rule out other causes of
high alarms and notify
doctors for sedation
and bronchodilators
142. CAUSES INTERVENTIONS
Patient fighting
(“bucking”) the
ventilator
Manual ventilation.
Determine the cause of
discomforts.
Provide health
teachings
If with hypoxemia,
hyper oxygenate the
patient and monitor
pulse and ABG.
144. ALARM TYPE: LOW PRESSURE
CAUSES INTERVENTIONS
Disconnected tubing Secure all disconnections
Accidental extubation Reposition the tube if
slightly disconnected.
If completely blocking
the airway, remove tube
and manually ventilate
the patient. Re-
intubation.
145. CAUSES INTERVENTIONS
Cuff leak Deflate and re-inflate
the cuff. If persistent,
change the tube
Accidental removal of
trache tube
Insert a new tube with
the obturator and then
remove the obturator.
Always have an extra
trache tube at the
bedside.
146. CAUSES INTERVENTIONS
The patient being
weaned fails to breath
during preset periods
Assess respirations,
ABG’s as indicated during
weaning. Consult
respiratory therapist and
MD to determine if
weaning will be
discontinued.
If prolonged, check for
respiratory arrest.
Stimulate and ventilate
the patient
ALARM TYPE: APNEA
147. ALARM TYPE: LOW EXHALED TIDAL VOLUME
CAUSES INTERVENTIONS
The ventilator detects a
single shallow low
exhaled volume during
weaning
Assess respirations and
ABG’s as indicated
during weaning. consult
149. CAUSES INTERVENTIONS
The O2 supply is
insufficient or isn’t
properly connected
Correct malfunction and
manually ventilate the
patient.
Monitor O2 saturation.
ALARM TYPE: OXYGEN
