Respiratory Therapy Review

Flashcards about Non-Invasive Ventilation, ABG, COPD, HFNC, IPV, PAP, DPI, SMI, MDI, Cough Assist, Oxymask, and Volara

CPAP

Continuous Positive Airway Pressure, a non-invasive mechanical ventilation method.

BIPAP

Bilevel Positive Airway Pressure, a non-invasive mechanical ventilation method.

Non-invasive mechanical ventilation

Improves oxygenation, ventilation, and provides respiratory muscle rest.

Refractory Asthma

A contraindication for BIPAP/CPAP (asthma that doesn't get better when using NIV)

Indications for NIV (Acute)

Hypercapnic respiratory failure, COPD exacerbation, Asthma, Facilitation of extubation in COPD, Hypoxemic respiratory failure, Acute cardiogenic pulmonary edema, Pneumonia, ARDS or ALI, Respiratory failure in immunocompromised patients, End of life care or DNI orders (do not intubate), Postoperative respiratory failure, Prevention of intubation in high risk patients, Post Extubation respiratory failure

Indications for NIV (Chronic)

Nocturnal hypoventilation, Restrictive thoracic disease, ALS (Amyotrophic lateral sclerosis), COPD, OHS (obesity hypoventilation syndrome)

Goals of NIV (Acute Care Setting)

Improve gas exchange, Avoid intubation, Decrease mortality, Decrease length of time on ventilator, Decrease length of hospitalization, Decrease incidence of ventilator-associated pneumonia, Relieve symptoms of respiratory distress, Improve patient-ventilator synchrony, Maximize patient comfort

Goals of NIV (Long Term Care Setting)

Relieve or improve symptoms, Enhance quality of life, Avoid hospitalization, Increase survival, Improve mobility

CPAP Use

Used for oxygenation (spontaneous breathing). Starting pressure is 5 - 10 cm H2O. Best used in patients with OSA and CSA or obese

BIPAP Use

Used for oxygenation and ventilation. Starting IPAP (ventilation) at 10 cm H20, starting EPAP (oxygenation) at 5 cm H20. Pressure support is the difference between IPAP and EPAP

BIPAP: S/T Settings

Spontaneous time settings: IPAP controls tidal volume. EPAP changes oxygen

BIPAP Alarms

Set HI and low rate 10 above and 10 below what your patient gives back to you in the rate. Lo Rate never set less than 8, Tidal volume levels will be 10-15% above and below what patient is giving you back on tidal volume values

Modified Allen's Test (Unconscious Patient)

Hold the patient's hand over their heart while performing the test.

ABG Vile Placement in Ice

Vertically, blood side down, surrounded by ice. If you are going to take longer than 30 minutes to get it to the lab.

Why radial artery for ABG?

Easiest access, easiest to palpate, because of collateral circulation

Collateral Circulation

Extra blood vessels (ulnar artery) can still supply blood to the area if the main artery (radial artery) gets blocked.

ABG Needle Repositioning Limits

Reposition the needle TWICE, and only take the needle out completely ONCE

ABG Hematoma Reporting

Inform vascular surgery.

Radial Artery ABG Needle Angle

Bevel up, 45-degree angle.

Modified Allen's Test Timing

Hold for 6 seconds, blood flow returns in 3 seconds.

ABG Sites (No Hands)

Brachial, Inguinal ligament, Femoral (needs special order), Posterior tibial, Dorsalis pedis arteries.

COPD Therapy

Pursed lip breathing PRN, Deep breath and cough PRN, IS (10X/hr), O₂ therapy titrate 88%-92%, Assess for NIV, MV, and Bronchopulmonary hygiene.

COPD Pharmacology (Acute)

Broad-spectrum antibiotics (if infection is present), SABA/SAMA STAT (DuoNeb), SABA PRN (Albuterol), Systemic corticosteroids IV (Solu-medrol), O₂ Therapy 88%-92%.

HFNC Starting Point

30-40 LPM

HFNC Temperature

31, 34, 37 degrees Celsius

HFNC water vapor

44 mg/L

IPV Description

Rapid vibratory movements of small volumes of air back and forth in respiratory tract; delivers pressurized gas minibursts at rates of 100-225 cycles/min.

IPV Nebulizer

Fill nebulizer with prescribed medications and dilute to at least 6 cc for lab, in hospital 10 - 20 mL. IPV therapy can not be administered without normal saline or other medications. Can not run dry

When to use Positive Airway Pressure (PAP)

devices w/ a mouthpiece (or mask) and an expiratory valve that creates a resistance of 10 - 20 cmH2O on exhalation used to Prevents airway collapse and Aids in mobilization of secretions during expiratory phase.

Examples of Positive Airway Pressure (PAP) Devices

EZPAP, IPPB, METANEB, VOLARA, CPAP, BiPAP

DPI Requirement

NEED strong inspiratory force!

SMI Soft Mist Inhaler

Combivent Respimat; used for pts with COPD Provides a soft metered dose of drug for each actuation. (Sterile, aqueous solution of Ipratropium Bromide & Albuterol Sulfate filled in a 4-5 mL plastic container )

MDI Description

Most common aerosol generators prescribed for patients with asthma or COPD; contains multiple doses of accurately metered meds.

Cough Assist Description

A device used to help stimulate a cough by delivering positive pressures with abrupt reversal to negative pressures.

Oxymask

Allows pt to eat and drink, Shape & pin allow O2 to not get lost/leave the mask so pt get all O2

Volara Summary

Provides both lung expansion and airway clearance

Volara modes

Aerosol delivery, CPEP, CHFO