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LARYNX Located above the trachea & just below the pharynx at
the root of the tongue
Commonly called the VOICE BOX
Contains 2 pairs of vocal cords, the false & true cords The opening between the true vocal cords is theGLOTTIS
GLOTTIS - Valsalva Maneuver
EPIGLOTTIS Leaf-shaped elastic structure that is attached along
one end to the top of the larynx
Prevents the food from entering the tracheo-bronchial
tree by closing over the glottis during swallowingJulie Ann Castillo Barut RN (RP US),MAN (on going)
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Julie Ann Castillo Barut RN (RP US),
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TRACHEA Located in front of the esophagus
Branches into the right & left mainstem bronchi at the
carinaMAINSTREAM BRONCHI Begin at the carina RIGHT BRONCHUS is slightly wider, shorter, &
more vertical than the left bronchus
Mainstream bronchi divide into 5 secondary or lobar
bronchi that enter each of the 5 lobes of the lung
The bronchi are lined with cilia which propel mucus up
& away from the lower airway to the trachea where it
can be expectorated or swallowed
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BRONCHIOLESBranch from the secondary bronchi & subdivide into small
terminal & respiratory bronchioles
Contain no cartilage & depend on the elastic recoil of the lung
for patency
Terminal bronchioles contain no cilia & dont participate in gasexchange
ALVEOLAR DUCTS & ALVEOLI- used to indicate all structures distal to the terminal bronchiole
Alveolar ducts branch from the respiratory bronchioles
Alveolar sacs which arise from the ducts contain clusters ofalveoli which are basic units of gas exchange
Cells in the walls of the alveoli secrete surfactant
- phospholipid CHON the reduces the surface tension in the
alveoli
- without surfactant the alveoli would collapseJulie Ann Castillo Barut RN (RP US),
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LUNGS Located in in the pleural cavity in the thorax
Extend from just above the clavicles to the diaphragm -
the diaphragm is the major muscle of respiration
RIGHT LUNG - is larger than the left; divided into 3 lobes:
the upper, middle & lower lobes LEFT LUNG - somewhat narrower than the right lung to
accommodate the heart ; divided into 2 lobes
Innervation of the respiratory structures is accomplished
by the PHRENICPHRENIC NERVE, VAGUS NERVE & THORACICNERVE, VAGUS NERVE & THORACIC
NERVESNERVES PARIETAL PLEURAPARIETAL PLEURA - lines the inside of the thoracic
cavity including the upper surface of the diaphragm
VISCERAL PLEURAVISCERAL PLEURA - covers the pulmonary surfaces
A thin fluid layer produced by the cells lining the pleura,
lubricates the visceral & parietal pleuraJulie Ann Castillo Barut RN (RP US),
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ACCESSORY MUSCLES OFACCESSORY MUSCLES OFRESPIRATIONRESPIRATION
SCALENE MUSCLESSCALENE MUSCLES Elevate the first 2 ribsElevate the first 2 ribs
STERNOCLEIDOMASTOID MUSCLESSTERNOCLEIDOMASTOID MUSCLES Raises the sternumRaises the sternum
TRAPEZIUS & PECTORALISTRAPEZIUS & PECTORALIS
MUSCLESMUSCLES Fix the shouldersFix the shoulders
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MAN (on going)
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the diaphragm descends into the abdominal cavityduring inspiration causing (-) pressure in the lungs
the (-) pressure draws the air from the area of greater
pressure (THE ATMOSPHERE)(THE ATMOSPHERE) into an area of lesser
pressure (THE LUNGS)(THE LUNGS)
In the lungs, air passes thru the terminal bronchiolesinto the alveoli to oxygenate the body tissues
At the end of inspiration, the diaphragm & intercostal
muscles relax & the lungs recoil
As the lungs recoil, pressure within the lungs becomes
greater than atmospheric pressure, causing the airwhich now contains the cellular waste products of CO2
& H2O to move from the alveoli in the lungs to the
atmosphere
Expiration is a passive process
THE RESPIRATORY PROCESSTHE RESPIRATORY PROCESS
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Ventilation (breathing) is accomplished through inspiration(inhalation) when air flow into the lungs and expiration(exhalation) when air moves out of the lungs
Respiratory centers of the medulla and pons in the brain stem
control breathing The degree of chest expansion during normal breathing is
minimal and requires little energy
COPD
Pneumothorax (air in the pleural space) Hemothorax (blood
Pleural effusion (fluid) interferes with lung expansion
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Diffusion is the movement of the respiratoryprocess or other particles from an area of greaterpressure or concentration to an area of lower
pressure or concentration When the pressure of O2 is > in the alveoli than
in the blood, oxygen diffuses into the blood
When the pressure in venous blood is greater
than the pressure of CO2 in the alveoli, where itcan be eliminated with expired air
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Oxygen needs to be transported from the lungs tothe tissues, and CO2 must be transported from thetissues back to the lungs
Normally 97% of the oxygen combines looselywith Hemoglobin
It is carried to the tissues as oxyhemoglobin
The remaining oxygen is dissolved and
transported in the fluid of the plasma and cells
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1. CARDIAC OUTPUTN=5L/minuteThe amount of blood pumped by the heartAny pathologic condition that decreases cardiac output
diminishes the amount of oxygen delivered to the tissues2. NO. OF ERYTHROCYTESHematocrit is a measurement of the percentage of RBCs in the
bloodMale N= 40%-54% Female N= 37%-47%
Excessive increase in the blood Hct, raise the blood viscosity(thickness), reducing the CO and O2 transport
3. EXERCISEWell trained athletes, O2 can be inc. up to 20x the normal rate, ---
inc. cardiac output and to efficient use of O2 by the cellsJulie Ann Castillo Barut RN (RP US),
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The movement of air into or out of the lungs
The diffusion of oxygen and carbon dioxidebetween the alveoli and the pulmonarycapillaries
Transport of O2 and CO2 via the blood to andfrom the tissue cells
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1. HYPOXIA
- Hypoventilation (inadequate alveolar ventilation, canlead to hypoxia)
- CO2 accumulate in the blood- Hypercarbia/ hypercapnia
Cyanosis bluish discoloration of the skin, nail beds, andmucus membranes due to reduced hemoglobin-oxygen saturation
Clubbing of fingers late sign of hypoxia
Manifestations of hypoxia; rapid pulse, rapid shallowrespirations, dyspnea, restlessness, flaring of the nares,substernal or intercostal retractions, cyanosis
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Upper Airway Obstruction
Caused by a foreign object such as food, by thetongue blocking the oropharynx, when a person is
unconcious, or by collecting in the passageways
Lower Airway Obstruction
Partial/complete blockage of the passageways in the
bronchi and lungs (caused by bronchospasm),increased production of secretions; bronchialinflammation
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The heart, blood vessels, and blood form the majortransport system of the body.
The heart serves as the system pump, moving
blood through the vessels to the tissuesTHE HEART
hollow cone-shaped organ about the size of a fist.
3 Layers
Endocardium internal layer Myocardium cardiac muscle; contract w/ each
beat
Epicardium outer layer; enclosed by a doublelayered membrane calledpericardium
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Cardiovascular function can be altered byconditions that affect:
1. The function of the heart as a pump (cardiac
output)
2. blood flow to organs and peripheral tissues(tissue perfusion)
3.
The composition of the blood and its ability totransport oxygen and carbon dioxide (bloodalterations)
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M.I., CHF.Infections cause damage to the heartmuscle, the heart can no longer pumpeffectively
Very irregular or excessively rapid or slowheart rates can decrease cardiac output
Abnormalities of the heart rate are known asdysrhythmias ( can be identified ECG)
Alterations in the heart structure such as CHD,infectious heart drs causes dec cardiac output
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Ischemia
lack of blood supply to tissues and organsdue to obstructed circulation
Atherosclerosis
-narrowing and obstruction of the circulatoryblood vessels (most common cause of ischemia
RISK Factors; tobacco smoking, high fat intake,obesity, sedentary lifestyle, hypertension,
uncontrolled DM
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If veins do not function properly Veins can also be inflamed , reducing blood
flow and increasing the risk of thrombus (clot)formation
The thrombus may then break loose, becomingan embolus (pleural emboli)
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When blood is unable to transport oxygen totissues, effectively , impaired tissue perfusionoccurs
Hypovolemia BP and cardiac putput fall
Hypervolemia fluid retention/ kidneyfailure; tissue ischemia
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Diseases of the CVS and RS
Medications
Stress
Anger
Type A personality
Gender
Lifestyle Environment
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SmokingSmoking Use of chewing tobaccoUse of chewing tobacco
AllergiesAllergies Frequent respiratory illnessesFrequent respiratory illnesses Chest injuryChest injury SurgerySurgery Exposure to chemicals &Exposure to chemicals & environmentalenvironmental
pollutantspollutants Family history of infectious diseaseFamily history of infectious disease Geographic residence & travel toGeographic residence & travel to foreignforeign
countriescountriesJulie Ann Castillo Barut RN (RP US),
MAN (on going)
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CHEST XCHEST X--RAY (CXR) FILMRAY (CXR) FILM(RADIOGRAPH)(RADIOGRAPH)
- information on the anatomic location & appearance
PREPRE--PROCEDURE NURSING CAREPROCEDURE NURSING CARE Remove all jewelry & other metal objects
Assess ability to inhale & hold the breath
Question regarding pregnancy of possibility of pregnancy
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Pulse Oximetry
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Detects hypoxemia
Normal SaO2 95%-100%
Below 70% life threatening
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PULSE OXIMETRYPULSE OXIMETRY- a non-invasive test that registers arterial O2 saturation
(SaO2)- NORMAL VALUE: 95%NORMAL VALUE: 95%--100%100%
- alert hypoxemia before clinical signs occurs
PROCEDUREPROCEDUREA sensor is placed: finger, toe, nose, earlobe or forehead
Dont select an extremity with an impediment to blood flow
Results lower than 91% - immediate treatment
If the SaO2 is below 85% - hypo-oxegenation If the SaO2 is 70% - life-threatening situation
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Allows continuous observation of the clientscardiac rhythm
Electrodes attached to the clients chest
Used to warn of potential problems such as avery fast or very slow heart rates
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SPUTUM SPECIMENSPUTUM SPECIMEN-- obtained by expectoration or tracheal suctioningobtained by expectoration or tracheal suctioning
-- identify organisms or abnormal cellsidentify organisms or abnormal cells
PREPRE--PROCEDURE NURSING CAREPROCEDURE NURSING CARE Determine specific purposeDetermine specific purpose Early morning sterile specimenEarly morning sterile specimen 15 ml of sputum15 ml of sputum
Rinse the mouth with water prior to collectionRinse the mouth with water prior to collection Take several deep breaths and then cough forcefullyTake several deep breaths and then cough forcefully Collect the specimen before antibioticsCollect the specimen before antibiotics
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SUCTIONING PROCEDURE INSUCTIONING PROCEDURE INOBTAINING SPUTUM SPECIMENOBTAINING SPUTUM SPECIMENAseptic technique
Hyperoxygenate Lubricate the catheter with sterile water
Tracheal suctioningTracheal suctioning: 4 inches
NasotrachealNasotracheal suctioningsuctioning: insert to induce cough reflex
Dont apply suction while inserting
Suction intermittently for 10-15 seconds Rotate and withdraw
Hyperoxygenate & deep breaths
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SPUTUM SPECIMENSPUTUM SPECIMEN
POSTPOST--PROCEDURE NURSING CAREPROCEDURE NURSING CARE
Transport specimen to lab stat
Mouth care
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BRONCHOSCOPYBRONCHOSCOPY
- visual examination of the larynx, trachea & bronchi with a
fiber-optic bronchoscope
PREPRE--PROCEDURE NURSING CAREPROCEDURE NURSING CARE Informed consent
NPO prior
Assess coagulation studies
Remove dentures or eyeglasses Prepare suction
Sedatives as Rx
Have resuscitation equipment available
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POSTPOST--PROCEDURE NURSING CAREPROCEDURE NURSING CARE V/S Fowlers position
Assess gag reflex
NPO until gag reflex returns
Monitor for bloody sputum Monitor respiratory status
Monitor for complications: bronchospasm, bronchial
perforation, crepitus, dysrhythmia, fever, hemorrhage,
hypoxemia, and pneumothorax
Notify the MD if complications occur
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PULMONARY ANGIOGRAPHYPULMONARY ANGIOGRAPHY- insertion of a flouroscopy via the antecubital or femoral
vein into the pulmonary artery
- it involves iodine or radiopaque or contrast material
PREPRE--PROCEDURE NURSING CAREPROCEDURE NURSING CARE Informed consent
Assess for allergies to iodine, seafood & dyes
NPO prior to procedure
V/S
Assess coagulation studies
Establish an IV
Administer sedation
Client must lie still during the procedureJulie Ann Castillo Barut RN (RP US),
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PULMONARY ANGIOGRAPHYPULMONARY ANGIOGRAPHYPREPRE--PROCEDURE NURSING CAREPROCEDURE NURSING CARE Urge to cough, flushing, nausea, or a salty taste
Emergency equipment available
POSTPOST--PROCEDURE NURSING CAREPROCEDURE NURSING CARE
V/S
No BP for 24 hrs in the affected extremity Monitor peripheral neurovascular status
Assess for bleeding
Monitor dye reaction
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THORACENTESISTHORACENTESISPREPRE--PROCEDURE NURSING CAREPROCEDURE NURSING CARE Informed consent
V/S
CXR or U/S prior to the procedure Assess coagulation studies
Upright
Do not to cough, breath deeply, or move during the
procedure
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POSTPOST--PROCEDURE NURSINGPROCEDURE NURSING
CARECARE V/S
Monitor respiratory status
Pressure dressing Assess site for bleeding and crepitus
Monitor for signs of PNEUMOTHORAX, AIR EMBOLISM &PNEUMOTHORAX, AIR EMBOLISM &PULMONARY EDEMAPULMONARY EDEMA
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POSTPOST--PROCEDURE NURSING CAREPROCEDURE NURSING CARE
V/S
Pressure dressing
Monitor for bleeding
Monitor for respiratory distress
Monitor for complications: pneumothorax and air emboli Prepare for CXR
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Julie Ann Castillo Barut RN (RP US),
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VENTILATION PERFUSION LUNG
VENTILATION PERFUSION LUNGSCANSCAN
- determines the patency of the pulmonary airways
- a radionuclide may be injected
PREPRE--PROCEDURE NURSING CAREPROCEDURE NURSING CARE Informed consent
Assess for allergies to dye, iodine, or seafood
Remove jewelry
Review breathing methods
IV access
Administer sedation
Emergency resuscitation equipment
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POSTPOST--PROCEDURE NURSINGPROCEDURE NURSING
CARECARE Monitor reaction to radionuclide
For 24 hrs following the procedure, handle body secretions carefully,
rubber gloves worn when urine is being discarded should be washed
with soap & H2O before removing, then the hands should be washedafter the gloves are removed
Instruct the client to wash hands carefully with soap and H2O for 24
hrs following the procedure
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Provides a graphic recording of the hearts electricalactivity
Detects dysrhythmias and alterations in
conduction, indicative of myocardial damage,enlargement of the heart
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Julie Ann Castillo Barut RN (RP US),
MAN (on going)
SKIN TESTSSKIN TESTS
PREPRE--PROCEDURE NURSING CAREPROCEDURE NURSING CARE Determine hypersensitivity or previous reactions to skin
tests
PROCEDUREPROCEDURE Should be of excessive body hair & dermatitis
Upper 1/3 of inner surface
Circle, document the date, time and test site
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POSTPOST--PROCEDURE NURSING CAREPROCEDURE NURSING CARE
Do not to scratch
Do not wash
Assess for induration (hard swelling), erythema and
vesiculation (small blister-like elevations)
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CHEST PHYSIOTHERAPY (CPT)CHEST PHYSIOTHERAPY (CPT)
NURSING CARENURSING CARE Best time - morning upon arising, 1 hr before meals or 2-3hrs after meals
Stop if pain occurs
Provide mouth care
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Julie Ann Castillo Barut RN (RP US),
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CONTRAINDICATIONS OFCONTRAINDICATIONS OFCHESTPHYSIOTHERAPY (CPT)CHESTPHYSIOTHERAPY (CPT)
respiratory distress
Hx of fractures
Chest incisions
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POSTURAL DRAINAGEPOSTURAL DRAINAGE- use of the gravity
NURSING CARENURSING CARE Position the client Best time A.M. upon arising, 1 hr before meals, 2-3 hrs
after meals
Stop if cyanosis or exhaustion occurs
Maintain position 5-20 mins after Provide mouth care after the procedure
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Julie Ann Castillo Barut RN (RP US),
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CONTRAINDICATIONS OFCONTRAINDICATIONS OFPOSTURAL DRAINAGEPOSTURAL DRAINAGE Unstable V/S
Increased ICP
CLIENT INSTRUCTIONS FORCLIENT INSTRUCTIONS FORINCENTIVE SPIROMETRYINCENTIVE SPIROMETRY Use the lips to form seal around the mouth piece
Inspire deeply Hold inspiration for a few seconds
Forcefully exhale
Avoid the use of spirometry at mealtimes
- it may cause nausea
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OXYGEN (OOXYGEN (O22) ADMINSITRATION) ADMINSITRATION
NURSING CARENURSING CARE
V/S
OXYGEN IN USEOXYGEN IN USE sign
Humidify the O2
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NASAL CANNULA (NASAL PRONGS)NASAL CANNULA (NASAL PRONGS)- flow rates of 1-6L/min; 24% (at 1L/min) to 44%
(at 6L/min)
- flow rates higher than 6L/min dont significantly increaseoxygenation
NOTE: Client who retains CONOTE: Client who retains CO22 should never receive Oshould never receive O22 at ratesat rates
higher than 2higher than 2--3 L/min unless on a mechanical ventilator3 L/min unless on a mechanical ventilator
- effective O2 concentration can be delivered to both nose
breathers & mouth breathers with the use of a nasalcannula
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Julie Ann Castillo Barut RN (RP US),
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FFII0022 DELIVERED VIADELIVERED VIANASAL CANNULANASAL CANNULA
24% at 1L/min
28% at 2L/min
32% at 3L/min
36% at 4L/min
40% at 5L/min 44% at 6L/min
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NURSING CARENURSING CARE
Add humidification
Monitor humidifier
Assess RR Assess the mucosa
- high flow rates have a drying effect & increase
mucosal irritation
Assess the skin integrity
- O2 tubing can irritate the skinProvide water-soluble jelly
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SIMPLE FACE MASKSIMPLE FACE MASK
- 40%-60% for short term O2 therapy or to deliver O2 in an
emergency
- minimal flow rate of 5L/min - to prevent the rebreathing of
exhaled air
NURSING CARENURSING CARE Be sure the mask fits
Provide skin care
- pressure & moisture under the mask may cause skin
breakdown
Monitor for aspiration- the mask limits the clients ability to clear the mouth esp if
vomiting occurs
Provide emotional support to decrease anxiety in the client
who feels claustrophobicJulie Ann Castillo Barut RN (RP US),MAN (on going)
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NONNON--REBREATHER MASKREBREATHER MASK- 90%
- most frequently deteriorating respiratory status requiring
intubation- has a one-way valve between the mask & reservoir and
two flaps over the exhalation ports
- entire quantity of O2 from the reservoir bag
- the flaps prevent room air from entering thru the
exhalation ports
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NONNON--REBREATHER MASKREBREATHER MASKFFIOIO22 DELIVERED: 60% to 100%DELIVERED: 60% to 100% FFIOIO22 at a liter flow that maintainsat a liter flow that maintains
the bag 2/3 fullthe bag 2/3 full
NURSING CARENURSING CARE
Remove the mucus or saliva from the mask
Assess the client
Ensure the valve & flaps are functional Valves should open during expiration & close during
inspiration
Monitor for kinks & twisting
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HIGHHIGH--FLOW OXYGEN DELIVERY SYSTEMFLOW OXYGEN DELIVERY SYSTEM
- 24% to 100% at 8-15L/min
- high-flow systems include the Venturi mask, aerosol
mask, face tent, tracheostomy collar, and T-piece
- deliver a consistent and accurate O2 concentrationVENTURI MASKVENTURI MASK
- give accurate O2 concentration
- an adapter is located between the bottom of the mask &
the O2 source
- the adapter contains holes of different sizes that allowonly specific amounts of air to mix with the O2
- the adapter allows selection of the amount of O2 desired
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VENTURI MASKVENTURI MASKFFIOIO22 DELIVERED: 24% to 55%DELIVERED: 24% to 55% FFIOIO22 with flow rates of 4with flow rates of 4--10L/min10L/min
NURSING CARENURSING CARE Monitor closely to ensure an accurate flow rate eep the orifice for the Venturi adapter open uncovered to
ensure adequate oxygen delivery
Ensure the mask fits snugly & that tubing is free of kinks
Monitor mucous membranes
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FACE TENTFACE TENT
- fits over the clients chin, with top extending halfway
across the face
- the O2 concentration varies
- useful for the client who has facial trauma or burns
because it is not tightAEROSOL MASKAEROSOL MASK
- used for the client who has thick secretions
TRACHEOSTOMY COLLAR OR TTRACHEOSTOMY COLLAR OR T--PIECEPIECE- the tracheostomy collar can be used to deliver high
humidity & the desired O2 to the client with a
tracheostomy
- a special adapter, called T-piece can be used to deliver
any desired FIO2 to the client with a tracheostomy,
laryngectomy or endotracheal tube
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Julie Ann Castillo Barut RN (RP US),
MAN (on going)
Face te t
er s l as
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Julie Ann Castillo Barut RN (RP US),
MAN (on going)
FACE TENT, AEROSOL MASK, TRACHEOSTOMYFACE TENT, AEROSOL MASK, TRACHEOSTOMY
COLLAR & TCOLLAR & T-- PIECEPIECEFFIOIO22 DELIVERED: 24% to 100%DELIVERED: 24% to 100% FFIOIO22 with flow rates of at leastwith flow rates of at least
10L/min10L/min
NURSING CARENURSING CARE Change to nasal cannula during meals
Empty condensation Monitor water in the canister & change the aerosol water
container as needed
eep the exhalation port in the T-piece open
Position the T-piece so that it does not pull on the
tracheostomy or endotracheal tube- it may cause erosion of the skin at the tracheostomy
insertion site
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Julie Ann Castillo Barut RN (RP US),
MAN (on going)
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Julie Ann Castillo Barut RN (RP US),
MAN (on going)
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A. Endotracheal Tube
Purpose:
1. Tracheal Suctioning2. Positive Pressure Breathing
Nsg. Care:1. Humidify air
2. Suction PRN
3. NGT
4. Promote Communication
5. Confirm placement
6. Monitor the cuffJulie Ann Castillo Barut RN (RP US),
MAN (on going)
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Julie Ann Castillo Barut RN (RP US),
MAN (on going)
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NSG. CARE:
1. Asepsis2. No sedative
3. Suction PRN
4. Hemostats
5. NGT, TPN & Oral nutrition
6. Wash the stoma7. Tub bath
8. Avoid swimming
9. Weaning
Julie Ann Castillo Barut RN (RP US),
MAN (on going)
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Julie Ann Castillo Barut RN (RP US),
MAN (on going)
Anti-emboli stockings preventsdegrees of immobility
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a combination of oral resuscitation , whichsupplies O2 to the lungs and external cardiacmassage which is intended to reestablish
cardiac function and blood circulation
Julie Ann Castillo Barut RN (RP US),
MAN (on going)
A cardiac arrestis the cessation of cardiac function; heartstops beating. Within 20 to 40 seconds of a cardiac arrest, thevictim is clinically dead. After 4-6 min irreversoble braindamage occur
ARes irat ry arrestis the cessation of breathing itoften occur follo ing a cardiac arresr
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Maintaining a patent airway with breath soundclear and absence of dyspnea
Demonstrating behaviors to improve airwayclearance
Demonstrating improved ventilation andadequate oxygenation of tissues by ABGswithin the clients normal range and by freesmptoms of respiratory distress
Establishing a normal/ effective respiratory
distress Be free of cyanosis and other signs and
symptoms of hypoxia
Julie Ann Castillo Barut RN (RP US),
MAN (on going)
CONTINUING CARE
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Nurse provides client education regarding:
Behaviors and lifestyle changes to regain andor maintain appropriate weight
Identifying interventions to prevent or reduce
risk of infections Verbalization of condition or disease process
and treatment
Identification of relationship of current signs/
symptoms to the disease process andcorrelation of these with causative factors
Julie Ann Castillo Barut RN (RP US),
MAN (on going)
CONTINUING CARE
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Julie Ann Castillo Barut RN (RP US),
MAN (on going)
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Julie Ann Castillo Barut RN (RP US),
MAN (on going)
Ph 7.35 7.45
ph acidosis ( H ion conc.)
ph alkalosis( H ion conc.)
BUFFER SYSTEM:Bicarbonate : Carbonic acid
HCO3 : CO3
Strong base : Weak acid20 : 1
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Julie Ann Castillo Barut RN (RP US),
MAN (on going)
A. Respiratory System: CO2 (acid)
Metabolic acidosis (Lungs) excrete CO2
Metabolic alkalosis (Lungs) retain CO2
B. Renal or Metabolic System: H ion(acid) ; HCO3(base)
Respi. acidosis (Kidney) excrete H+ ; retain HCO3
Respi. alkalosis (Kidney) retain H+ ; excrete HCO3
Normal ABG Values:
Ph : 7.35 7.45 SaO2 95%-100%PCO2 : 35 45 mgHG
HCO3 : 22-26 meq/L
PO2 : 80-100 mgHg
Base excess : (+2 or 2)
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SITE: Radial Artery
TEST: Allens Test
Ph - acidosis alkalosis
PCO2 - alkalosis acidosis
HCO3 - acidosis alkalosis
Julie Ann Castillo Barut RN (RP US),
MAN (on going)
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Julie Ann Castillo Barut RN (RP US),
MAN (on going)
1. Assess ph, PCO2 & HCO3
2. Identify imbalance. If ph is normal use 7.4
7.4 acidosis
7.4 alkalosis3. Identify if compensated or uncompensated
uncompensated- if one component is normal & the other is
abnormal
compensated if both PCO2 & HCO3 are abnormal in
opposite directions4. If compensated, identify if partially or fully
partially if ph is abnormal
fully - if ph is normal
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Julie Ann Castillo Barut RN (RP US),
MAN (on going)
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Julie Ann Castillo Barut RN (RP US),
MAN (on going)
YOU CAN MAKE IT, OUR GOALISTO TAKE IT ONE TIME.
GOODLUCK & MAY GOD BLESS
YOU ALL
BY: Julie Ann C. Barut, RN (USA, RP)
INSTRUCTOR
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Julie Ann Castillo Barut RN (RP US),
MAN (on going)
PULMONARY FUNCTION TESTPULMONARY FUNCTION TEST(PFTs)(PFTs)
- include a number of different tests used to evaluate lung mechanics,
gas exchange, & acid-base disturbance thru spirometric
measurements, lung volumes, and arterial blood gases
PREPRE--PROCEDURE NURSING CAREPROCEDURE NURSING CARE Determine if an analgesic that may depress the respiratory function is
being administered
Consult with MD regarding holding bronchodilators prior to testing
Instruct the client to void prior to procedure and to wear loose clothing
Remove dentures
Instruct the client to refrain from smoking or eating a heavy meal for 4-
6 hrs prior to the test
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Julie Ann Castillo Barut RN (RP US),
MAN (on going)
POSTPOST--PROCEDURE NURSINGPROCEDURE NURSINGCARECARE Resume normal diet and any bronchodilators &
respiratory treatments that were held prior to the
procedure
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Julie Ann Castillo Barut RN (RP US),
MAN (on going)
ARTERIAL BLOOD GASES (ABGs)ARTERIAL BLOOD GASES (ABGs)- measure the dissolved O2 & CO2 in the arterial blood and renal acid-
base state & how well the O2 is being carried to the body
- the ventilation scan determines the patency of the pulmonaryairways and detects abnormalities in ventilation
- a radionuclide may be injected for the procedure
PREPRE--PROCEDURE NURSING CAREPROCEDURE NURSING CARE Perform Allens test prior to drawing radial artery specimens Have the client rest for 30 mins prior to specimen collection
Avoid suctioning prior to drawing ABGs
Dont turn off O2 unless the ABGs are ordered to be drawn at room air
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POSTPOST--PROCEDURE NURSING CAREPROCEDURE NURSING CARE Place the specimen on ice
Note the clients temperature on the laboratory form
Note the O2 & type of ventilation that the client is receiving on the
laboratory form
Apply pressure on the puncture site for 5-10 mins & longer if the clientis on anticoagulant therapy or has bleeding disorder
Transport the specimen to the laboratory within 15 mins