14826626
Descripción
Fichas por Elizabeth Then, actualizado hace más de 1 año
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Creado por Elizabeth Then
hace alrededor de 6 años
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| Pregunta | Respuesta |
| The Respiratory tract | Pulmonary functional unit Ciliated mucous membrane |
| Goals of the respiratory system | - transport oxygen from atmosphere to alveoli, where it is collected by HB and transported to active tissue - O2 is used with mitochondria to support aerobic metabolism by-product is CO2 -CO2 is transported out of the body in blood, across alveolar membrance and expired |
| Non- Respiratory functions of the lungs | - Filtration of micro-emboli - Metabolic function of lungs: - inactivation of damaging enzymes (Alpha 1 antitrypsin) - alteration of hormonal levels (angiotensin 1 converted to angiotensin 2) - involvement in lipid metabolism - acts as a reservoir for blood - storage of megakaryocytes |
| Oxygen Delivery - step by step process | 1 - atmosphere to alveoli (Ventilation) 2- Alveoli to blood (Diffusion) 3 - Transport to gases in blood (HB binding) 4 - Convection (Cardiovascular) 5 - Blood to tissues (Diffusion) |
| Tissue and cellular oxygenation relies on: | Oxygen delivery Pulmonary gas exchange Oxygen consumption |
| Respiratory system consists of: | - Ventilatory pump (Pleura, peripheral nerve, bones, muscles, soft tissues) - Gas exchanger - Respiratoy controller (Automatic, behavioural, sensory) |
| Respiration | Process of supply and demand Supplied oxygen and carbon dioxide are elimiinated |
| Oxygen delivery depends on: | - Ventilation - Diffusion of o2 into the blood - Binding with hb - Adequate cardiac output - Diffusion into the cell - DO2 = HB x 10 x sao2 x1.3 x co |
| Laryngospasm | -Precipitating causes: airway irritation and or obstruction - failure of anaesthetic delivery clinical signs: - Inspiratory stridor/airway obstruction - increased inspiratory efforts/ trachel tug |
| Laryngospasm management | - 100% oxygen - chin lift and jaw thrust - positive pressure |
| Definition of respiratory failure | PAO2 of 60mmhg or less when the pt is receiving is receiving an inspired oxygen concentration of 60% or greater |
| Classification of respiratory failure | Hypoxaemic - oxygenation failure, less than 60mmhg Hypercapnic - Ventilatory failure, greater than 50mmhg acute - minutes to hours chronic - several days or longer |
| Hypoxaemic respiratory failure | - ventilation-perfusion VQ mismatch - Shunt - Diffusion limitation - Alveolar hypoventilation |
| Hypercapnic respiratory failure | - airways and alveoli - central nervous system - chest wall - neuromuscular conditions - tissue oxygen needs |
| Acute Respiratory Distress syndrome ARDS | - injury or exudate phase - clinical progression - fibrotic phase |
| ARDS | stages of oedema formation in ARDS, - Alveoli oedema occurs when the fluid crosses then blood- gas barrier |
| Complications of ARDS | -nosocomial pneumonia - Barotrauma - Volu-pressure trauma - physiological stress ulcers - renal failure |
| Respiration versus ventilation | External respiration (Ventilation) - transfer of gas to enable the exchange of carbon dioxide and oxygen occurring in the alveoli Internal Respiration (Respiration) - consumption of oxygen and production of carbon dioxide within the tissues |
| Principles of ventilation | Ventilation therapy is provided via non invasive or invasive means and usually with positive pressure breaths |
| Non-invasive ventilation | - NIV delivers positive pressure breaths to a spontaneous breathing patient by face or nasal mask within an airtight seal - Positive end expiratory pressure (PEEP) - Bilevel positive airway pressure (BiPAP) - Continuous positive airway pressure (CPAP) |
| Optimising success: | Initial application technique - good tolerance without frequent intervention - Titrate to achieve and maintain patient in a 'zone of comfort' - Secure the mask and evaluate leak |
| Recognising failure of interventions | - poor tolerance - PaO2/FiO2 less than 175 after 1 hour - Worsening PH and PACo2 -Haemodynamic instability - reduction in loss of consciousness |
| Complications of NIPPV | - Drying of eyes - nasal bridge ulceration - leaks leading to hypoventilation - sleep disturbances |
| Invasive ventilation | - inability to protect airway - inadequate breathing pattern - inability to sustain adequate oxygenation for metabolic demands - hypercarbia |
| Gold standard | ETT |
| Components of a ventilator | - pneumatic system: - inspiratory ventilator circuit - expiratory valve closes or partially closes - Electronic system: - microprocessor: insp/exp valve - Information/monitoring systems - ventilator alarms |
| Modes of ventilation and breath delivery | - breath type and breath delivery during mechanical ventilation constitute mode of ventilation Factors to consider are: - type of breath - targeted control variable (volume or pressure) - Timing of breath delivery (Mandatory or spontaneous) |
| mandatory breaths | Ventilator controls timing, patient triggered, volume targeted and volume cycled |
| Spotaneous breaths | patient controls timing and tidal volume, the volume and pressure of both delivered is based on patient characteristics not a set value |
| Assisted breath | Characteritics of above, but all or part of breath is generated by ventilator, which does part of WOB for patient. - A target pressure is set by clinician and ventilator delivers the set pressure above baseline pressure to assist breathing effort |
| Modes of ventilation | - volumes modes: volume controlled (VC), Synchronised Intermittent Volume Controlled (SIMV) - Pressure modes: Pressure controlled (PC), pressure support (PS) - Others: PEEP, CPAP, BIPAP, high frequency |
| Ventilator setting for specific patient situations | COPD: - maximise patient ventilator synchrony and decrease WOB and anxiety - Asthma: most difficult to ventilate, secretions lead to oedema, tight airways make gas movement impossible in some areas ARDS: Increase vascular permeability, lung water and protein, issues with oxygenation and ventilation |
| Sedated and critically ill patients with resp failure rely on nurse to: | - correct circuit disconnections - provide suction - monitor ventilator effects - observe for complications of ventilation - optimise sedation level |
| Nursing care | - check ventilation order against what is giving - Check ETT length - check pilot ballon - check resp status - check for leaks in system |
| Ventilator bundle | - series of interventions that should be done on each mechanically ventilated patient to move this closer to removal of mechanical ventilation purpose: to eliminate ventilator associated complications and reduce duration of ventilator, risk of death |
| Complications associated with ventilation | - VAP, ALI - na and h20 imbalance - gastro bleeding - resp muscle weakness - PTS |
| Mutisystem effects of positive pressure ventilation | - volutrauma/ barotrauma/ alectrauma= increase gas flow to nodependent lund, increase dead space - resdistribution of pulmonary blood flow - oxygen toxicity - ventilator associated pneumonia , altered VQ mismatching |
| Effects of PPV cardiovascular | decrease CO, SV, Right ventricular preload clinical manisfestations - decrease BP |
| Effects of PPV Neurovascular | CPP = MAP - ICP (Difference b/w MAP and IP clinical manisfestations: possible increase in ICP, altered LOC |
| Effects of PPV Renal | Redistribution of blood flow to kidneys clinical manisfestations: decrease UO, increase NA and creatinine |
| Effects of ppv Gastrointestinal | Decrease blood flow to intestinal viscera clinical manifestations - increase risk of ulcer, GI bleed |
| Ventilator bundle of care | - DVT prophylaxis TEDS gastric bleeding prophylaxis Head of bed elevation sedation vacation nutrition Tight glycaemic control 'FASTHUG' |
| Pharmacology | - Neuromuscular blocking agents (atracurium/rocuronium/vecuronium) - Anaesthetic agents (Propofol/Thiopentone) - Sedation agents (Midazolam) - Opioid analgesics (Morphine/fentanyl) |
| Weaning | - weaning methods: T-Piece still around SIMV PSV |
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