Respiratory and Hemodynamics

• quantitative info about:
• vascular capacity
• blood volume
• pump effectiveness
• tissue perfusion

fluid volume status...and pressures in right atrium

looks at blood volume and venous return

right

• hypovolemia
• venodilation
• decreased venous return

0-8 mm/Hg

• Hypervolemia
• Impedance to right atria emptying

• evaluates how the left ventricle is working
• overall cardiac fxn

left ventricle function by measuring the amount of pressure generated by the left ventricle

5-15mmHg

• Hypervolemia
• Impedence to LA emptying

the volume that fills the L ventricle at the end of diastole

wall tension generated by the LV during systole to open the aortic valve and eject it's contents

reflects the balance btwn oxygen supply and demand

60-80%

• afterload
• 800-1200

arterial blood pressure and correlates it to cuff BP

• fluids
• blood products
• volume expanders

• diuretics
• ACE inhibitors
• Venous dilators

• Norepinephrine
• Epinephrine
• Dopamine
• Vasopressin
• Phenylephrine

• Calcium channel blocker-anti hypertensives
• Nitroglycerine
• Nitroprusside

Respiratory opposite (pH and CO2 going in opposite directions)

Metabolic equal (pH goes down so does HCO3...or both go up)

inability of the cardiac and pulmonary systems to maintain an adequate exchange of oxygen and carbon dioxide in the lungs

abnormal blood gas

inadequate O2 transfer between the alveoli and the pulmonary capillary bed.

• mismatch of ventilation and perfusion
• hypoventilation

mismatching in which the perfusion is normal, but ventilation is inadequate.

Thoracic pressure cant be changed enough to move air in and out of the lungs

• abnormalities of the alveoli and airways
• CNS depression
• neuromuscular conditions
• abnormalities of the chest wall

• lung sounds
• LOC/cap refill/skin color
• ABG
• CBC
• Hemodynamics
• dysrhythmias

• RR and depth
• changes in tidal volume and tidal capacity
• ventilator management

• monitor weaning from vent
• decrease use of respiratory muscle depressant meds
• provide periods of rest and activity

• assess secretions
• hydration
• monitor tidal volume and vital capacity
• TCDB
• suction
• position
• chest physiotherapy

• severely inadequate gas exchange
• hypoxemia
• progressive alveolar hypoventilation
• respiratory acidosis

• to maintain alveolar ventilation appropriate for the client's metabolic needs
• to correct hypoxemia
• maximize oxygen transport

• acute onset of hypoxemia
• bilateral chest imaging opacities
• damaged alveolar capillary membrane causing it to become filled with fluid

• intubation and mechanical ventilation with PEEP
• positioning....prone
• F&E

• morphine
• sedatives and paralytics
• heparin 
• diuretics

• dysrhythmias
• Infection/sepsis
• stress ulcers
• DIC
• Barotrauma
• CHF
• VA-PNA
• Volutrauma

the renal tissue doesnt get perfused due to hypotension, hypoxemia or hypercapnia

Also....they are given vanco a lot to prevent/treat infections

• apnea...or impending apnea
• acute respiratory failure
• severe hypoxia
• respiratory muscle fatigue

• resolve hypoxemia and hypoxia
• maximize oxygen carrying capacity of arterial blood
• adequate cardiac output, Hgb

• supports patients until they recover the ability to breathe independently
• a bridge to long term mechanical ventilation...or until a decision is made to withdraw ventilatory support

• End tidal CO2 detector...watch for a color change
• Auscultate lungs for breath sounds
• Auscultate epigastrum for the absence of air
• X RAY!!!

the ventilator monitors each breath and compares it to the tidal volume

If the delivered volume is too low, the pressure is increased on the next breath, and vice versa

used to assist with the weaning of a patient off a vent

patient must be able to initiate breath in this modality

BIPAP-two different pressure levels, one for inspiration and one for expiration

CPAP-constant pressure is delivered

**Have to be able to breathe spontaneously on their own

ET or trach is placed in the patient and air is pushed in to the patients lungs(inhalation) and exhalation is passive

positive pressure applied at the end of expiration to improve oxygenation by opening collapsed alveoli

to maintain or improve oxygenation while limiting the risk  of O2 toxicity

small airway collapse at the end of expiration to increase oxygenation

• assess position/placement of tube
• doc tube placement in cm at teeth/lips
• soft wrist restraints to prevent extubation
• suction oral/tracheal secretions
• assess respirotary status q1-2 hrs
• reposition ET tube q24h
• assess for skin breakdown
• provide adequate nutrition

• do q8h
• must be below 20mmHg
• assess for air leaks

• clients speaking
• air hissing
• decreasing SaO2

possible disconnection or leak in the system

• loss of airway from total/partial extubation
• ET tube/Trach cuff leak

an increase pressure from sputum, fluid condensation, coughing, pneumothorax, bronchospasm, kink in tube

anything that will cause an increased resistance, obstruction

coughing, coarse rhonchi, high pressure, decreased spo2

• sterile technique
• hyperoxygenate....120max for 15 sec
• assess for dysrhythmias....stop
• monitor SaO2....<85% stop
• dont put saline down ET Tube

• hand hygiene
• suction
• oral care with Peridex and tooth brushing
• prophylactic antibiotics
• positioning to prevent aspiration...HOB at 30
• residual checks
• prophylactic stress ulcer meds
• dont change tubes regularly

• fever
• increased WBC
• purulent sputum
• odorous sputum
• crackles/rhonchi
• CXR with pulmonary infiltrates

• oversedation
• immobility
• development of delirium

all of which harm patients

• Awakening trial
• Breathing trial..see if can spont. breath on own
• Coordination....work with RT to get off vent
• Delirium...are they delirious?
• Early...can they get up and walk around the room while vented?

• awake and alert
• negative inspiratory pressure >-20 H2O
• PEEP<5
• Not on resp. depressant meds or anesthesia
• Protective reflexes in tact
• patent airway
• Stable CVS....WNL
• clear breath sounds
• ABG WNL

CPAP

• SBP increase/decrease by 20
• RR increase by 10 or above 30
• HR increase/decrease by 20 or above 120
• arrhythmias
• TV <300
• Increased PaCO2
• Increased WOB

change in mental status

persons consuming more oxygen than the body has in reserves

• anemia
• hemorrhage
• hypoxemia
• shock

there's a maldistribution of blood related to SEPSIS