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