Resp Assessment
4 clinical signs for respiratory assessment
1. Loc
2. RR
3. Respiratory effort
4. Skin and mucous membrane color
Differentiate between status asthmaticus and asthma exacerbation
Asthma exacerbation is a flare-up of asthma symptoms that can usually be managed with standard treatments, while status asthmaticus is an extreme, life-threatening exacerbation that does not respond to standard rescue medications
ETT vs Trach
-EET is temporary and through the mouth
-Trach is long term and directly in the trachea
What are the 2 types of non invasive positive pressure ventilation?
1. CPAP (continuous positive airway)
2. BiPAP (Bilevel positive airway pressure)
What is the number one risk factor for COPD?
Smoking
Tachypnea vs hyperventilation
Tachypnea is abnormally fast and shallow breathing rate
Hyperventilation is rapid, deep breathing causing low CO2
What are essential findings when assessing a patient with an acute asthma exacerbation?
- Ability to speak
- Use of accessory muscles
- Auscultation (silent chest)
- Body position (orthopnea)
- VS abnormalities
What is a risk with nasotracheal suctioning?
Infection in the lungs because youre going from a non-sterile field to sterile field
When does respiratory failure occur?
When the lungs are unable to maintain O2 and/or eliminate CO2. NOT A DISEASE PROCESS!
What are characteristics of COPD?
- Bronchioles are narrowed, inflamed and produce mucus
- Alveoli lose surface area resulting in emphysema within the alveoli
What is Peak Expiratory Flow Rate (PEFR)?
Handheld device used to determine how well air moves out of the lungs, very beneficial for people with asthma
MDI vs DPI
MDI- It uses a liquid mist and a gentle puff of air to push the medicine out. You have to press down on the top and breathe in slowly and steadily at the exact same time
DPI- It does not use any spray or mist. You do not need to press any buttons. Instead, you put your mouth on it and take a fast, deep breath (like sucking a thick milkshake through a straw)
What do you need to do before trach suctioning?
-Gather supplies
-Pre-oxygenate for 60 seconds
What are the normal ABG values (pH, PaCO2, HCO3, PaO2)?
1. pH- 7.35-7.45
2. PaCO2- 35-50
3. HCO3- 24-30
4. PaO2- >75
What are 3 respiratory care actions to help with secretions?
1. Shaker vest
2. Huff coughing
3. Flutter valve
What are some signs of severe respiratory distress in infants?
- Decreased responsiveness
- Air hungry
- Grunting
- Low O2 sat
- Head bobbing
What are controller medications and which medications are they?
- Medications that provide long acting SNS stimulation and corticosteroids to decrease inflammation
-Budesonide/formoterol (LABA)
-Tiotropium (PNS blocker)
-Diphenhydramine + Montelukast (histamine & leukotriene antagonist)
-Prednisone (corticosteroid)
For trach suctioning...
1. How deep should the suction catheter be inserted
2. Length of suction time with each pass
3. Length of time between suction passing
and
4. Safe # of suction passes in one session
1. 4 inches
2. 10 seconds
3. 30-60 seconds
4. No more than 3... if more needed then call RT
How do you interpret a patient with the following ABGs...
pH= 7.46
PaCO2= 32
HCO3= 25
PaO2= 70
SpO2= 85%
Uncompensated respiratory alkalosis with hypoxemia
BONUS- what type of respiratory failure is this?
What are the diet/nutritional preferences for someone with COPD?
- Smaller more frequent calorie dense meals and supplements
- Focus on protein rather than carbs
- Nasal O2 while eating
- Low sodium diet if heart failure present
- Weight checks, calorie counts, and lab values
Signs and symptoms of respiratory distress in regard to the central nervous system
- Change in MS
- Anxiety r/t hypoxia
- Lethargy somnolence r/t hypercapnia
What are rescuer medications and which are they?
SNS stimulant that triggers flight/fight and opens airways but also increases HR
-Albuterol (SABA)
-Budesonide/Formoterol (LABA)
-Ipratropium (PNS blocker)
-Methylprednisolone (corticosteroid)
How often do you need to do trach care and how often do you do trach suctioning
-Trach care once a shift
-Trach suctioning PRN
How do you know the difference between hypoxemic respiratory failure and hypercapnia respiratory failure?
Hypoxemia resp failure- PaO2 < 60 mm Hg
Hypercapnia resp failure- PaCO2 >50 mm Hg and pH <7.35
Medications for COPD
Bronchodilator's and inhaled corticosteroids
(systemic corticosteroids are given cautiously d/t risk for infection)