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List the techniques to treat or prevent oxygenation, bronchospasm/mucosal edema, and ventilation (Table 2-2).
- a. Oxygenation:
- i. Nasal cannula
- ii. Oxygen mask (simple/partial/nonrebreather)
- iii. High-slow systems
- iv. CPAP by mask
- v. PEEP (may require mechanical ventilation)
- b. Bronchospasm/ mucosal edema:
- i. Bronchodilator therapy (SVN, MDI, DPI)
- ii. Anti-inflammatory agents (steroids)
- iii. Antiasthmatic aerosol agents
- c. Ventilation:
- i. Non-invasive mechanical ventilation (includes BiPAP)
- ii. Invasive mechanical ventilation
-
Design a respiratory care plan to mobilize secretions (Table 2-2).
- a. Directed cough and deep-breathing instruction
- b. Suctioning (NT, ET, tracheostomy suctioning)
- c. Chest physiotherapy (postural drainage, percussion, vibration)
- d. High-volume bland aerosol therapy (ultrasonic nebulizer, heated large-volume nebulizer)
- e. Mucus-controlling agents (mucolytics)
-
Propose a respiratory care plan for the treatment and/or prevention of atelectasis and pneumonia (Box 2-11).
- a. Lung expansion therapy
- i. Incentive spirometry
- ii. IPPD
-
Compare and contrast respiratory failure, acute respiratory failure and hypoxemic respiratory failure.
- a. Respiratory failure: Indicated the inability of the heart and lungs to provide adequate tissue oxygenation and/or carbon dioxide removal
- b. Acute respiratory failure: Defined as a sudden decrease in arterial blood oxygen levels (PaO2 <50 to 60 mmHg; SaO2 <88% to 90%), with or without carbon dioxide retention
- c. Hypoxemic respiratory failure: Refers to a primary problems with oxygenation
-
Compare and contrast ventilatory failure, acute ventilatory failure and chronic ventilatory failure.
- a. Ventilatory failure: Defined as an elevated PaCO2
- b. Acute ventilatory failure: Defined as the sudden ride in arterial CO2 levels with a corresponding decrease in pH.
- c. Chronic ventilatory failure: Defined as a chronically elevated PaCO2 with a normal or near-normal pH
-
Explain the characteristics of ALI/ARDS.
- a. The berlin definition of ARDS was proposed based on symptom timing, chest imagaing, and PaO2/FiO2 ratio while receiving at least 5 cm H20 of PEEP or CPAP. Revised definition involves aspects of both ALI and ARDS.
- i. Identification of respiratory symptoms within one week of new or worsening symptoms or a known clinical insult
- ii. Bilateral opacities upon chest imaging
- iii. Monary edema that cannot be due to cardiac failure or fluid overload as assessed by echocardiography or other measures to exclude hydrostatic edema
-
Compare and contrast mild, moderate and severe oxygenation and ARDS.
- a. Mild: PaO2/FiO2 </equal to 300 mmHg
- b. Moderate: PaO2/FiO2 </equal to 200 mmHg
- c. Severe: PaO2/FiO2 </equal to 100 mmHg
-
Identify the types of care provided in the respiratory care plan and provide examples of each (Table 2-1).
- a. Basic Respiratory Care:
- i. Oxygen therapy
- ii. Secretion management
- iii. Sputum induction
- iv. Management if bronchospasm and mucosal edema
- v. Lung expansion therapy
- b. Critical respiratory care:
- i. Invasive mechanical ventilation
- ii. Noninvasive mechanical ventilation
- iii. Physiologic monitoring
- iv. Cardiac and hemodynamic monitoring
- v. Suctioning and airway care
- vi. Airway intubation
- vii. Advanced cardiovascular life support
- viii. Metabolic studies
- ix. Extracorporeal membrane oxygenation
- x. Mechanical circulatory assistance
- xi. Basic care in the ICU setting
- c. Diagnostic testing
- i. Oximetry
- ii. ABG
- iii. PFT
- iv. Cardiac testing
- v. Ultrasound
- vi. Sleep studies
- vii. Exercise testing
- d. Special procedures
- i. Transport
- ii. Patient education
- iii. Smoking cessation
- iv. Disease management
- v. Pulmonary rehabilitation
- vi. Cardiac rehabilitation
-
Explain the purpose of a respiratory care plan.
a. The respiratory care plan provides a written description of the care the patient is to receive.
-
List the indications for oxygen therapy.
- a. Documented hypoxemia
- i. Adults and children: PaO2 < 60 and/or SpO2 <90
- ii. Neonates (< 28 days): PaO2 < 50 and/or SpO2 <88% or a capillary PaO2 < 40 torr
- b. Suspected hypoxemia based on patient condition and/or clinical manifestation of hypoxia
- c. Severe trauma
- d. Acute myocardial infarction
- e. Postoperative recovery
-
Explain intermittent positive pressure breathing (IPPB) and Incentive spirometry (IS) and provide examples when each is indicated.
- a. Incentive spirometry:
- i. Should be considered in patients who are able to perform the maneuver ever 1 to 2 hours while awake and are able to achieve an inspired volume of at least one-third of the predicted inspiratory capacity
- b. IPPD:
- i. Should generally be reserved for patients who have clinically important atelectasis in which therapy has been unsuccessful.
-
Explain what SOAP stands for and provide examples of each.
- a. Subjective
- i. Chief complaint is the leading statement reported by the patient
- ii. History of present illness and past medical history are also subjective
- b. Objective
- i. Includes physical assessment, vital signs, inspection, palpation, percussion, and auscultation
- c. Assessment
- i. Commonly an assessment of the clinical signs and symptoms followed by the disease or disorder that is suggested by the finding
- ii. For example, the symptoms, physical findings, and diagnostic data noted during examination of the asthmatic patient present a very characteristic disease state
- d. Plan
- i. Plan should address the treatment and/or monitoring of the patients disease state, conditions or complaint
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