Chapter 11 (Block 2)

minute volume formula and reason to use

tidal volume x respiratory rate

total volume breathed in or out in 1 min

phrenic nerve

nerve that originates in neck (C3-C5)

for breathing

hypoxic/hypoxia

tissues that don’t have enough oxygen to be sustainable

aerobic metabolism

process your cells use to make more ATP using oxygen

anaerobic metabolism

process cells use to make ATP without enough oxygen

small amount of ATP made + more lactic acid

when does anaerobic metabolism occur

when tissues aren’t receiving enough oxygen

ex: during shock/hypoperfusion

what has a fast metabolism`

heart and brain

timeline of cardiac effects after oxygen deprivation (0-1 min)

cardiac irritability

timeline of cardiac effects after oxygen deprivation (2-4 min)

brain damage not likely

timeline of cardiac effects after oxygen deprivation (4-5 min)

brain damage possible

timeline of cardiac effects after oxygen deprivation (6-10 min)

brain damage likely

timeline of cardiac effects after oxygen deprivation (10+ min)

irreversible brain damage

agonal breaths

ineffective gasping

You assess an unresponsive patient who has no pulse but occasionally makes irregular, gasping breaths. What do these breaths indicate, and what should you do?

cardiac arrest —> begin CPR

provide appropriate ventilation

cheyne-stokes

definition

S&S

causes

type of irregular breathing pattern

crescendo and decrescendo breaths followed by apnea

brain trauma, drugs, etc

Biot’s / ataxic respirations

definition

treatment if unconscious, irregular breathing, with pulse

irregular, unpredictable breathing with periods of apnea

open, clear, and maintain airway

assist with BVM (6 seconds/breath for adults, 2-3 seconds/breath)

Kussmaul respirations

definition

what is body trying to do

causes

deep, rapid respirations

body is trying to breathe out more carbon dioxide bc blood is too acidic so breathing deep and fast

DKA (diabetic ketoacidosis): body lacks enough insulin to use blood sugar for oxygen

Eupnea

normal breathing

hyperpnea

deep breathing

if patient is breathing adequately on their own but unresponsive and no spinal injury, what can you do to help with their breathing

put in recovery position and continue monitoring

max suction time for adults

15 seconds

max suction time for children

10 seconds

max suction time for infants

5 seconds

if there is fluid in an adult’s lungs after suctioning for 15 minutes what should you do?

ventilate for 2 mins —> suction again for 15 mins —> repeat

if something can’t be suctioned like thick mucus, what do you do?

roll patient on side —> use gloved finger or tongue depressor to scrape thick mucus out

log roll if spinal injury

how do you make sure a OPA is adequate for someone to use

measure it from their mouth to earlobe

What should be the minimum capacity of a portable oxygen cylinder?

500 mL

capacity for full cylinder oxygen tank in psi

2000 psi

flow rate of oxygen regulator can deliver

1-15 L/min

minimum pressure for oxygen tank

500 psi

how to leave oxygen tank (upright, down?) 3 ways

upright if holding with a hand on it

upright if strapped up

laying down

what does pressure regulator do and how much psi

reduces oxygen tank psi so its useable for patients (40-70 psi)

hazards of oxygen administration

keep fire source away bc combustible

never leave oxygen cylinder standing unattended

oxygen toxicity

oxygen toxicity

S&S

causes damage to cellular tissue due to excessive oxygen levels in blood

pale or cyanotic

low pulse oximetry reading

abnormal breathing/dyspnea

altered level of consciousness

nasal cannula

flow rate

how it works

things to consider

low flow oxygen 1-6L/min

pure oxygen straight into nose

pure oxygen can dry out nose, so try adding a dehumidifier if possible

nonrebreathing masks (NRB)

flow rate

how it works

things to consider

high flow oxygen

combination of mask and reservoir bag system, patient breathes on their own with mask on

adjust rate so bag doesn’t collapse less than 2/3 when patient inhales

what is the go-to oxygen delivery choice

Nonrebreathing mask NRM

when to use assisted artificial ventilation

when something wrong with rate, rhythm, quality, depth of breaths

bag valve mask (BVM)

flow rate

how it works

things to note

rate of 15L/min, can deliver almost 100% oxygen

manually squeezing bag to deliver oxygen

provides less tidal volume than mouth to mask ventilation

when to use BVM

abnormal ventilation and decompensation

decompensation

when body can no longer compensate for a problem—>patient conditions worsen

signs of decompensation

altered level of consciousness

cyanotic skin

bradypnea

bradycardia

A patient is alert and conscious but breathing very rapidly. Which oxygen/ventilation device should you use?

NRB

A semiconscious patient has slow, shallow, inadequate respirations. What should you do?

BVM

An alert, conscious patient is having an asthma attack and is breathing adequately but needs supplemental oxygen. Which device should you use?

NRB

An unconscious patient has irregular, inadequate respirations. What should you do?

BVM

A conscious patient is decompensating and developing inadequate respirations. How do you assist their breathing with a BVM?

explain procedure that you are going to change how they breathe

put mask over nose and mouth

squeeze bag in coordination with patients breaths

deliver enough volume so you see chest rise

why should a tube be put in the trachea and not esophagus and how to check to make sure

gas will go into the stomach and cause them to vomit (gastric distention)

osculate lung sounds by listening to stomach

What are the complications of positive-pressure ventilation (BVM)?

increased intrathoracic pressure

passive ventilation

chest expands and contracts —> moves air in and our of the lungs

CPAP

Noninvasive respiratory support that provides continuous positive airway pressure to a spontaneously breathing patient

How does CPAP improve breathing?

keeps alveoli open

improves oxygen exchange

helps move fluid out of alveoli in pulmonary edema

makes breathing/oxygenation easier

What are common indications for CPAP?

moderate to severe respiratory distress

tachypnea

pulse oximetry <90%

What are contraindications to CPAP?

altered mentally, can’t sit up, any trauma, vomiting

How do you ventilate a patient with a stoma?

put BVM mask over stoma

pinch their nose and mouth so no air escapes

What if a stoma patient has an airway obstruction?

check stoma for obstruction

suction and clear if needed

ventilate through stoma