RESPI NOTES

DIAGNOSTIC TESTS:

1. Chest X-Ray2. Sputum SpecimenInterventions: Early morning sterile specimen by suctioning or expectoration Rinse mouth with H20 prior Obtain 15 mL of sputum Deep breaths then cough Transport sputum to laboratory immediately3. Laryngoscopy/Bronchoscopy Informed consent NPO midnight prior IV access for medication administration (SEDATIVE) PostOp Semi fowlers postion Assess for return of gag reflex; NPO until then Monitor for bloody sputum & respiratory status WOF Bronchospasm/perforation indicated by Facial or Neck Crepitus, Dysrthymias, Hemorrhage, Hypoxemia and Pneumothorax, Fever4. Endobronchial Ultrasound (EBUS) Tissue samples are obtained from central lung masses and lymph nodes using a bronchoscope with the help of ultrasound guidelines. For diagnosing and staging lung cancerPostOp- Monitor for signs of bleeding and respiratory distress5. Pulmonary Angiography Invasive fluoroscopic procedure in which a catheter is inserted through the antecubital or femoral vein into the pulmonary artery.Interventions: Informed consent Assess for allergy to iodine or seafood NPO for 8 hours IV access for sedationPostOp V/S No BP on insertion side Assess site for bleeding

6. Thoracentesis Removal of fluid or air from the pleural space via transthoracic aspirationInterventions: Informed consent V/S Orthopnic Position or Side lying UNAFFECTED SIDE with HoB elevated Instruct client NOT to cough , breathe deeply or move during procedurePostOp: Apply pressure dressing and assess puncture site for bleeding and crepitus Monitor for signs of pneumothorax, air embolism or pulmonary edema7. Pulmonary Function Test Test used to evaluate lung mechanics, gas exchange, and acid-base disturbance through spirometric measurements, lung volumes and ABG levels.Interventions: Check for medications that may affect respiratory function Withhold broncodilators before testing Void prior to procedure/ Wear loose clothing Refrain from smoking 4-6 hours prior to testPostOp: Resume normal diet and medications8. Lung Biopsy Transbroncial biopsy and a transbronchial needle aspiration may be performed to obtain tissue for analysisInterventions: Informed consent NPO Inform that local anesthetic will be used Analgesics and sedatives prior PostOp: Dressing to biopsy site and monitor drainage9. Ventilation Perfusion Lung Scan Evaluates blood flow to the lungs Determines the patency of the pulmonary airways and detects abnormality in ventilation A radionuclide may be injectedInterventions: Informed Consent Allergies to dye/Iodine IV access/SedatePostOp: Instruct dye will leave the system after 8 hours10. Skin Test11. ABG12. Pulse Oximetry

MECHANICAL VENTILATION

Types:1. Pressure-cycled ventilator The ventilator pushes air into the lungs until a specific airway pressure is reached. Used for short periods (PACU)2. Time-cycled ventilator The ventilator pushes air into the lungs until a preset TIME has elapsed. Used for PEDS/NEONATE3. Volume-Cycled Ventilator The ventilator pushes air into the lungs until preset VOLUME is delivered. Constant tidal volume is delivered4. Microprocessor Ventilator A computer or microprocessor is built into the ventilator to allow continuous monitoring of ventilator functions, alarms and client parameters

Modes of Ventilation1. Noninvasive positive pressure ventilation or bilevel positive airway pressure (BiPAP) IPAP & EPAP are set on a large ventilator with a desired pressure support and PEEP Can be used for COPD distress, HEART FAILURE, ASTHMA, PULMONARY EDEMA

2. Controlled Client receives a set TIDAL VOLUME Used for clients who CANNOT INITIATE respiratory effort

3. Assist-Control Tidal volume and ventilatory rate are present Ventilator TAKES OVER the work of breathing for the client Ventilator is programmed to respond to clients inspiratory effort if the client does initiate breath. Ventilator delivers the preset tidal volume when client initiates a breath while allowing the client to control the rate of breathing

4. Synchronized intermittent mandatory ventilation (SIMV) Allows the client to breathe spontaneously at her own rate and tidal volume between the ventilator breaths Can be used as a primary ventilator mode or as a WEANING MODE When used as a weaning mode. The number of SIMV breaths is decreased gradually and the client gradually resumes spontaneous breathing.

If a cause for an alarm cannot be determined, VENTILATE the client manually with a resuscitation bag until the problem is corrected.

VENTILATOR ALARMS1. High Pressure Alarms Increased secretions Wheezing/Bronchospasm ET tube is displaced Kinks Client coughs, gags or bites Client is anxious

2. Low Pressure Alarms Disconnection or Leak Client stops spontaneous breathing

COMPLICATIONSa. Hypotensionb. Pneumothoraxc. GI Alterationsd. Infectionse. Ventilator dependence

Ventilator Controls/Settings

1. Tidal Volume Vol of air the client receives with each breath2. FIO2 The oxygen concentration delivered to the client; determined by the clients condition and ABG levels3. Peak Airway Inspiratory Pressure The pressure needed by the ventilator to deliver set tidal volume at a given compliance4. CPAP Keeps the alveoli open during inspiration and prevents alveolar collapse, used as a weaning modality5. PEEP Positive pressure is exerted during the expiratory phase of ventilation, eich imporves oxygenation by enhancing gas exchange and preventing atelectasis The need for PEEP indicates a severe gas exchange

DISEASES:

1. ACUTE RESPIRATORY FAILURE- Respiratory failure is a sudden and life-threatening deterioration of the gas exchange function of the lung and indicates failure of the lungs to provide adequate oxygenation or ventilation for the blood. Pathophy: Can be caused by impaired function of the CNS (hemorrhage, drug overdose, head trauma, infection) Neuromuscular dysfuction (MG, GBS, SC trauma) PostOp period after major throcic surgery/abdominal surgery, inadequate ventilation May be caused by anesthesia, analgesic, sedative, opioidsS/Sx: Restlessness, Fatigue, Headache, Dyspnea, Tachycardia, Hypertension Decrease LOC, confusion, diaphoresisInterventions: Identify and treat underlysing cause O2 (PaO2 level higher than 60-70mmHg) 30-45 degrees Deep breathing Bronchodilators Standby Intubation kit

2. ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS)- Severe form of acute lung injury, SUDDEN AND PROGRESSIVE pulmonary edema. Major site: Alveolar capillary membrane- The interstitial edema causes compression and obliteration of the terminal airways and leads to reduced lung volume and compliance.Pathophy/Causes: Diffused alveolar damage Sepsis, Fluid overload, shock, trauma, burns aspiration, inhalation of toxic substances Alveoli collapse because of the inflammatory infiltrate, blood, fluid and surfactant dysfunction. Small airways are narrowed because of interstitial fluid and bronchial obstruction.S/Sx: Tachypnea, Dyspnea, decreased breath sounds, deteriorating ABG levels (REPIRATORY ACIDOSIS), Hypoxemia, Pulmonary infiltrates Rapid onset of dyspnea that occurs 12-48H Xray: Bilateral InfiltratesInterventions: Identify/treat underlying cause O2 Fowlers position RESTRICT FLUID INTAKE DIURETICS, ANTICOAGULANTS, CORTICOSTEROIDS, SURFACTANT REPLACEMENT Standby Intubation

3. ASTHMA Chronic inflammatory disorder of the airways that causes obstruction, airway hyperresponsiveness, mucosal edema and mucus production Often occurs at night or early in the morningS/Sx: Cough Dyspnea Wheezing Generalized chest tightnessInterventions-