GasExchangeandRespiratoryFunctionPartOne.pptVIP

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Respiratory Care Modalities Oxygen Hypoxemia—decrease in arterial oxygen tension in blood Hypoxia—decrease on oxygen supply to tissues Oxygen toxicity—can occur if delivering 50% for longer than 48h. Caused by free radical production. Signs/symptoms of oxygen toxicity—paresthesias, fatigue, refractory hypoxemia, alveolar atelectasis, alveolar infiltrates Consider alveolar collapse with high levels of oxygen Tracheostomy Surgical procedure in which an opening is made into the trachea Tracheostomy tube Temporary or permanent Used to bypass an upper airway obstruction, allow removal of tracheobronchial secretions, permit long term use of mechanical ventilation, to prevent aspiration in unconscious patient or to replace endotracheal tube Complications of tracheostomy Bleeding, pneumothorax, air embolism, aspiration, subcutaneous or mediastinal emphysema, recurrent laryngeal nerve damage Airway obstruction from accumulation of secretions ,tracheoesophageal fistula, tracheal ischemia Nursing Care of the Patient with Tracheostomy Initially, semi-fowler’s position to facilitate ventilation, promote drainage, minimize edema, and prevent strain on the sutures Allow method of communication Ensure humidity to trach Suction secretions as needed Manage cuff—usually keep pressure less than 25 mm Hg but more than 15 mm Hg to prevent aspiration Endotracheal Intubation Pass ETT via nose or mouth into trachea Method of choice in emergency situation Passed with aid of a laryngoscope ETT generally has a cuff, ensure that cuff pressure is between 15-20 mm Hg. Use warmed, humidified oxygen Should not be used for more than 3 week Preventing Complications Associated with Endotracheal and Tracheostomy Tubes Administer adequate warmed humidity Maintain cuff pressure at appropriate level Suction as needed Maintain skin integrity Auscultate lun