respiratory
names parts of the upper respiratory tract
nose, pharynx, epiglottis, larynx, and trachea
what is respiratory physiotherapy?
Diaphragmatic breathing, pursed lip breathing, airway clearance techniques, huff coughing, and chest physical therapy (CPT).
what does CPAP provide? what is it most commonly used for? what is important to know about CPAP (bonus points)
Provides 1 level of pressure that is delivered continuously during both inspiration and expiration.
Commonly used for OSA
bonus points: Increases work of breathing (WOB) for patient, use in cation in patient with heart problems/severe respiratory distress.
what is the main method of mechanical ventilation with acutely ill patients?
postive pressure ventilation
modes of ventilation! please tell me the types for full mechanical support (3), partial support (1), and spontaneous mode (1)
full support = AC, PC, and PRVC
partial support = SIMV
spontaneous = PSV
name parts of the lower respiratory tract
right/left lung, bronchi, bronchioles, alveolar ducts, and alveoli
what is the common treatment for hypoxemia or hypoxia
oxygen therapy
what does biPAP provide? when is this used?
Provides 2 levels of positive pressure support
- Used in acute conditions like pneumonia,
exacerbations of chronic conditions (HF, ARF,
COPD).
what is volume ventilation and what is pressure ventilation?
• Volume ventilation- Predetermined tidal volume delivered with each inspiration. Provides consistent tidal volume, but airway pressure needed to deliver ventilation may vary.
• Pressure ventilation- Tidal volume delivered varies based on selected pressure and resistance factors of lungs.
what is a ventilator associated pneumonia
pneumonia that occurs 48 hours or more after intubation
describe parts of the chest wall
- Supported by 12 ribs on each side.
- Mediastinum, parietal/visceral pleura, intrapleural
space, diaphragm
modes of oxygen administration we need to know
NIV, artificial airways, artificial ventilation
what is the difference between IPAP and EPAP?
• Inspiratory positive airway pressure (IPAP)- provides pressure during inhalation.
• Expiratory positive airway pressure (EPAP)-provides lower pressure during exhalation to keep alveoli open.
what is the endotracheal intubation procedure? this can be what?
Intubation is process of securing airway with oral or nasal ET tube. this can be voluntary or emergent.
how can a VAP occur?
Can occur from contaminated respiratory equipment, inadequate hand washing, adverse environment conditions, and decreased ability to cough/clear secretions.
describe oxygenation, ventilation, compliance, resistance, and control of respiration
Oxygenation- process of obtaining O2 from atmospheric air and making it available to organs and tissues.
• Ventilation- Inspiration/inhalation and expiration/exhalation.
• Compliance- Ability of lungs to expand.
• Resistance- Obstacle to airflow during inspiration/expiration
o Changes in compliance/resistance can affect oxygenation and ventilation.
• Control of respiration
o Chemoreceptors- responds to changes in PaCO2 and pH
o Mechanical receptors- helps initiate cough reflex, prevent overdistention of lungs, and can
initiate tachypnea
what are types of artificial airways (include advanced)
Nasopharyngeal airway (NPA)
• Oropharyngeal airway (OPA)
• Advanced airways
o Endotracheal tube (ET)
o Nasotracheal Tube (NT)
o Tracheostomy
what is mechanical ventilation
Process by which ventilator is used to deliver oxygen to lungs. Supports patients until they recover ability to breath independently.
what are the required tools for a Endotracheal Intubation Procedure?
Oxygen, BVM, ET tube, laryngoscope, ETCo2 detector, stethoscope, IV, RSI medications (HCP preference), ET securement device.
clinical manifestations of VAP?
Fever, leukocytosis, change in sputum color/amount, adventitious lungs sounds, new lung infiltrates on CXR.
why would we need to know ABG's. What can can you see with ABG's
Can help determine oxygenation/ventilation
status of patient.
• Can be compensated/uncompensated.
what is non invasive ventilation? what are two types? (bonus points if you know what you need to do if a patient is on this?)
Utilizes mask instead of ET tube to help oxygenate and ventilate.
• Ideal for higher level of ventilatory support, but condition not bad enough to require mechanical ventilation.
• CPAP and Bi-PAP
•bonus points: pt needs to be able to protect airway andHOB needs to be 30-45 degrees
what are the indications of mechanical ventilation? (6)
ARF, apnea, inability to breathe/protect airway, acute respiratory distress, severe hypoxemia and/or hypercarbia, and respiratory muscle fatigue.
what needs to be assessed during a Endotracheal Intubation Procedure?
Assess for correct placement (ETCo2 detector, symmetric chest rise, bilateral breath sounds, CXR).
• Monitor vitals closely during intubation
management and guidlines of VAP
• Management: Sputum cultures, broad spectrum antibiotics.
• VAP guidelines: Minimize sedation, daily SATs or daily SBTs unless contraindicated, early mobilization, use of subglottic secretion drainage ports, elevating HOB to 30-45 degrees unless contraindicated, oral care with chlorohexidine, no routine changes of ventilator circuit tubing