Patient Management

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Author:
kjeidsness
ID:
186576
Filename:
Patient Management
Updated:
2012-12-03 15:08:03
Tags:
Resp 210
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Description:
Chapter 8
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  1. What do you look at when evaluating a patient?
    • color
    • resp. rate
    • breathing pattern
    • use of accessory muscles
    • breath sounds
    • work of breathing
  2. RT Dept. maintains a record or a flow sheet of the following
    • Basic pt. info-name, diagnosis, age, ht, wt, IBW
    • Initial settings-mode, MV, TV, Peak, Plateau, Compliance, Initial parameters, ET size, ABG's
    • Checks-alarms and correct settings
  3. What do you do in your initial assessment
    • Listen to breath: adequate volumes & proper tube placement
    • Alarms set: apnea, low & high pressure, power failure
    • Obtain ABG's: 15 min after
    • Chest x-ray: tube placement
    • Mode selection: If auto PEEP or PEEP is present harder to assist
    • Minute ventilation, tidal volume, and rate: machine tells
    • Tubing compliance: 
    • Alveolar ventilation: affected by closed suction & HME
  4. Three factors to consider with alveolar ventilation
    • anatomical deadspace
    • normal mechanical deadspace
    • added mechanical deadspace
  5. Normal Mechanical Deadspace
    • vent circuits volume lost up to 75-150 mls
    • rebreathed volume
    • caused by artificial nose
  6. Anatomical Deadspace
    • calculated as 1 ml/Ib of IBW
    • subtracted from delivered TV to estimate alveolar ventilation
    • using an ET tube changes calculated anatomical deadspace-1 ml/kg of IBW
  7. Added Mechanical Deadspace
    • must be subtracted to determine actual alveolar ventilation
    • exhaled Tv-added-anatomic=alveolar
    • final alveolar ventilation calculated (TV-Anatomic)x(f)=minute volume
  8. Peak inspiratory pressure
    • highest pressure during inspiration
    • used to calculate dynamic compliance
    • pressure decreases-leak?
  9. Plateau pressure
    • use insp. pause control
    • press. drops during hold
    • calculate static compliance
  10. What modes do you have a set pressure in?
    • PC-CMV
    • PC-SIMV
    • PS
    • Volume changes with compliance & resistance
  11. What is mean airway pressure affected by?
    • peak inspiratory pressure
    • end expiratory pressure (PEEP)
    • cycle time
    • Could affect cardiac output
  12. End expiratory pressure
    • measures Auto Peep
    • allows longer time to exhale
  13. If pressure limit is activated patient may need
    • suctioned
    • lung compliance decreased
    • pt. is coughing or biting tube
    • water may be inline
    • pulmonary edema
    • pneumonia
    • pneumothorax 
    • pleural effusion
  14. checking for leaks
    • check cuff
    • check vent circuit
    • check humidifiers
  15. Hyperthermia
    • infections
    • tissue necrosis
    • late stage carcinoma
    • leukemia
    • metabolic disorder
  16. Hypothermia
    • hypothyroidism
    • drugs
    • alcohol/carbon monoxide
  17. Monitor VS
    • HR
    • Temp
    • Systemic arterial BP
    • CVP-measure at the end of a expiration 
    • PAP
    • Exam of chest-BS 
    • Monitor cuff
  18. Monitor cuff pressure
    • every 8-12 hrs
    • don't exceed 25 mmHg
    • Decrease risk of tracheal narcosis, min. leak techn., min. occluding tech. 
  19. What causes decrease static compliance?
    • airtrapping
    • pulmonary edema
    • atelectasis
    • consolidation
    • pneumonia
    • pneuothorax
    • hemothorax
    • pleural effusion
    • abdominal distention
  20. How is decrease static compliance easily detected?
    • 1. BS, percussion sounds, palpation, x-ray
    • 2. decreased compliance implies vent. is less effective
    • 3. results in decreased PaO2 and  increase PaCO2
    • 4. pressure limited vent will need an increase in pressure to deliver an adequate volume. 
  21. Dynamic compliance 
    • if constant or decreased & static is decreased=lung compliance down
    • if decreased & static constant=airway resistance increased
  22. When does airway resistance increase?
    • increased secretions
    • mucosal edema
    • airway problem
    • bronchospasm
    • artificial
    • aspiration
  23. Calculate airway resistance
    • Peak-Plateau/Flow 
    • Norm. .6-2.4 cmH2O/l/sec
    • ET tube increass to 6 cmH2O/l/sec
    • Bronchospasm increases from 3-18 cmH20/l/sec
  24. How do you compensate for airway resistance?
    removing obstruction or decreasing flowrate
  25. What do delivery of oxygenation to the dissues depends on?
    • FiO2
    • arterial oxygen content
    • cardiac output
  26. Desired FiO2
    PaO2 desired x FiO2 known/PaO2 known
  27. Selection of PEEP
    • adequate for pt. to maintain PaO2
    • if more than 50% of FiO2 is needed
  28. Four basic categories of hypoxia
    • histotoxic-cells are unable to utilize oxygen
    • anemic hypoxia- hemoglobin concentrations lower than norm. unable to transport O2. 
    • circulatory hypoxia- cardiovascular system fails to transport O2
    • hypoxemic hypoxia- hypoventilation, shunting, vent perfusion mismatching and diffussion defects. 

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