Interventions for Critically Ill Interventions for Critically Ill Clients with Respiratory Clients with Respiratory

ProblemsProblems

Pulmonary EmbolismPulmonary Embolism

A collection of particulate matter (solids, liquids, A collection of particulate matter (solids, liquids, or gases) that enters venous circulation and or gases) that enters venous circulation and lodges in the pulmonary vessels.lodges in the pulmonary vessels.

Large emboli obstruct pulmonary circulation, Large emboli obstruct pulmonary circulation, leading to decreased systemic oxygenation, leading to decreased systemic oxygenation, pulmonary tissue hypoxia, and potential death. pulmonary tissue hypoxia, and potential death. Any substance can cause an embolism, but a Any substance can cause an embolism, but a blood clot is the most common.blood clot is the most common.

In most people with pulmonary embolism, a blood In most people with pulmonary embolism, a blood clot from a deep vein thrombosis breaks loose clot from a deep vein thrombosis breaks loose from one of the veins in the legs or the pelvis.from one of the veins in the legs or the pelvis.

Etiology Etiology Prolonged immobilizationProlonged immobilization Central venous cathetersCentral venous catheters SurgerySurgery ObesityObesity Advancing ageAdvancing age HypercoagulabilityHypercoagulability History of thromboembolismHistory of thromboembolism Cancer diagnosisCancer diagnosis

Health Promotion and Health Promotion and Illness PreventionIllness Prevention

Stop smoking.Stop smoking. Reduce weight.Reduce weight. Increase physical activity.Increase physical activity. If traveling or sitting for long If traveling or sitting for long

periods, get up frequently and periods, get up frequently and drink plenty of fluids.drink plenty of fluids.

Refrain from massaging or Refrain from massaging or compressing leg muscles.compressing leg muscles.

Clinical ManifestationsClinical Manifestations

Assess the client for:Assess the client for:– Respiratory manifestations: dyspnea, Respiratory manifestations: dyspnea,

tachypnea, tachycardia, pleuritic tachypnea, tachycardia, pleuritic chest pain, dry cough, hemoptysischest pain, dry cough, hemoptysis

– Cardiac manifestations: distended Cardiac manifestations: distended neck veins, syncope, cyanosis, neck veins, syncope, cyanosis, hypotension, abnormal heart sounds, hypotension, abnormal heart sounds, abnormal electrocardiogram findingsabnormal electrocardiogram findings

– Low-grade fever, petechiae, symptoms Low-grade fever, petechiae, symptoms of fluof flu

Interventions Interventions

• Evaluate chest painEvaluate chest pain• Auscultate breath soundsAuscultate breath sounds• Encourage good ventilation and Encourage good ventilation and

relaxationrelaxation

(Continued)(Continued)

Interventions Interventions (Continued)(Continued)

• Monitor the following:Monitor the following:– respiratory patternrespiratory pattern– tissue oxygenationtissue oxygenation– symptoms of respiratory failuresymptoms of respiratory failure– laboratory valueslaboratory values– effects of anticoagulant medicationseffects of anticoagulant medications

• SurgerySurgery

Decreased Cardiac Decreased Cardiac OutputOutput

Interventions include:Interventions include:– Intravenous fluid therapyIntravenous fluid therapy– Drug therapyDrug therapy

Positive inotropic agentsPositive inotropic agents VasodilatorsVasodilators

Anxiety Anxiety

Interventions include:Interventions include:– Oxygen therapyOxygen therapy– CommunicationCommunication– Drug therapy: antianxiety agentsDrug therapy: antianxiety agents

Risk for Injury (Bleeding)Risk for Injury (Bleeding)

Interventions include:Interventions include:– Protect client from situations that Protect client from situations that

could lead to bleeding.could lead to bleeding.– Closely monitor amount of bleeding.Closely monitor amount of bleeding.– Assess often for bleeding, Assess often for bleeding,

ecchymoses, petechiae, or purpura.ecchymoses, petechiae, or purpura.– Examine all stool, urine, nasogastric Examine all stool, urine, nasogastric

drainage, and vomitus and test for drainage, and vomitus and test for occult blood.occult blood.

Acute Respiratory FailureAcute Respiratory Failure

Pressure of arterial oxygen < 60 Pressure of arterial oxygen < 60 mm Hgmm Hg

Pressure of arterial carbon Pressure of arterial carbon dioxide > 50 mm Hgdioxide > 50 mm Hg

pH < 7.3pH < 7.3 Ventilatory failure, oxygenation Ventilatory failure, oxygenation

failure, or a combination of both failure, or a combination of both ventilatory and oxygenation ventilatory and oxygenation failurefailure

Ventilatory FailureVentilatory Failure

Type of mismatch in which perfusion is Type of mismatch in which perfusion is normal but ventilation is inadequatenormal but ventilation is inadequate

Thoracic pressure insufficiently Thoracic pressure insufficiently changed to permit air movement into changed to permit air movement into and out of the lungsand out of the lungs

Mechanical abnormality of the lungs or Mechanical abnormality of the lungs or chest wallchest wall

Defect in the brain’s respiratory Defect in the brain’s respiratory control centercontrol center

Impaired ventilatory muscle functionImpaired ventilatory muscle function

Oxygenation FailureOxygenation Failure

Thoracic pressure changes are Thoracic pressure changes are normal, and air moves in and out normal, and air moves in and out without difficulty, but does not without difficulty, but does not oxygenate the pulmonary blood oxygenate the pulmonary blood sufficiently.sufficiently.

Ventilation is normal but lung Ventilation is normal but lung perfusion is decreased.perfusion is decreased.

Combined Ventilatory Combined Ventilatory and Oxygenation Failureand Oxygenation Failure

Hypoventilation involves poor Hypoventilation involves poor respiratory movements.respiratory movements.

Gas exchange at the alveolar-Gas exchange at the alveolar-capillary membrane is capillary membrane is inadequate—too little oxygen inadequate—too little oxygen reaches the blood and carbon reaches the blood and carbon dioxide is retained.dioxide is retained.

EtiologyEtiology COMMON CAUSES OF VENTILATORY FAILURE COMMON CAUSES OF OXYGENATION FAILURE

EtiologyEtiologyCOMBINED VENTILATORY AND OXYGENATION FAILURECOMBINED VENTILATORY AND OXYGENATION FAILURE

A combination of ventilatory failure and oxygenation failure A combination of ventilatory failure and oxygenation failure occurs in clients who have abnormal lungs, such as those occurs in clients who have abnormal lungs, such as those who have any form of who have any form of chronic airflow limitation chronic airflow limitation (CAL), (CAL), such as chronic bronchitis, emphysema, or asthma). such as chronic bronchitis, emphysema, or asthma).

The bronchioles and alveoli are diseased (causing The bronchioles and alveoli are diseased (causing oxygenation failure), and the work of breathing increases oxygenation failure), and the work of breathing increases until the respiratory muscles are unable to continue until the respiratory muscles are unable to continue (causing ventilatory failure). Acute respiratory failure (causing ventilatory failure). Acute respiratory failure results. results.

This process can also occur in clients who have cardiac This process can also occur in clients who have cardiac failure, as well as respiratory failure. failure, as well as respiratory failure.

This is a very dangerous situation because the cardiac This is a very dangerous situation because the cardiac system cannot compensate for the decreased oxygen by system cannot compensate for the decreased oxygen by increasing the cardiac outputincreasing the cardiac output

AssessmentAssessment

The nurse assesses for The nurse assesses for dyspnea dyspnea (difficulty (difficulty breathing), the hallmark of respiratory failurebreathing), the hallmark of respiratory failure

Dyspnea tends to be more intense when it Dyspnea tends to be more intense when it develops rapidly. develops rapidly.

Slowly progressive respiratory failure may first Slowly progressive respiratory failure may first manifest as dyspnea on exertion (DOE) or when manifest as dyspnea on exertion (DOE) or when lying down. lying down.

The client notes The client notes orthopnea, orthopnea, finding it is easier to finding it is easier to breathe in an upright position. In the client with breathe in an upright position. In the client with chronic respiratory problems, a minor increase in chronic respiratory problems, a minor increase in dyspnea from the baseline condition may represent dyspnea from the baseline condition may represent severe gas exchange abnormalitiessevere gas exchange abnormalities

AssessmentAssessment

The nurse assesses for a change in the The nurse assesses for a change in the client's respiratory rate or pattern, a change client's respiratory rate or pattern, a change in lung sounds, and the signs and symptoms in lung sounds, and the signs and symptoms of hypoxemia and hypercapniaof hypoxemia and hypercapnia. .

Pulse oximetry may indicate decreased Pulse oximetry may indicate decreased oxygen saturation, but an arterial blood gas oxygen saturation, but an arterial blood gas (ABG) analysis is needed for adequate (ABG) analysis is needed for adequate assessment of oxygenation status. The assessment of oxygenation status. The health care provider reviews the ABG studies health care provider reviews the ABG studies to identify the degree of hypercapnia and to identify the degree of hypercapnia and hypoxemiahypoxemia

Dyspnea Dyspnea Encourage deep breathing Encourage deep breathing

exercises.exercises. Oxygen administrationOxygen administration Help the client find a position of Help the client find a position of

comfortcomfort Energy-conserving measuresEnergy-conserving measures Pulmonary drugs (e.g. Pulmonary drugs (e.g.

bronchodilators)bronchodilators)

Acute Respiratory Acute Respiratory Distress SyndromeDistress Syndrome

Hypoxia that persists even when Hypoxia that persists even when oxygen is administered at 100% oxygen is administered at 100%

Decreased pulmonary complianceDecreased pulmonary compliance DyspneaDyspnea Noncardiac-associated bilateral Noncardiac-associated bilateral

pulmonary edemapulmonary edema Dense pulmonary infiltrates seen Dense pulmonary infiltrates seen

on x-rayon x-ray

Acute Respiratory Acute Respiratory Distress SyndromeDistress Syndrome

ARDS usually occurs after an acute ARDS usually occurs after an acute catastrophic event in people with no catastrophic event in people with no previous pulmonary disease. previous pulmonary disease.

The mortality rate remains at The mortality rate remains at 50% 50% to to 60% 60% despite continuing research. despite continuing research.

Terminology for ARDS includes the Terminology for ARDS includes the current term current term noncardiogenic noncardiogenic pulmonary edema pulmonary edema and the former and the former term term shock lungshock lung

Causes of Lung Injury in Acute Causes of Lung Injury in Acute Respiratory Distress SyndromeRespiratory Distress Syndrome Systemic inflammatory response is Systemic inflammatory response is

the common pathway.the common pathway. Intrinsically the alveolar-capillary Intrinsically the alveolar-capillary

membrane is injured from conditions membrane is injured from conditions such as sepsis and shock.such as sepsis and shock.

Extrinsically the alveolar-capillary Extrinsically the alveolar-capillary membrane is injured from conditions membrane is injured from conditions such as aspiration or inhalation such as aspiration or inhalation injury.injury.

EtiologyEtiology

Diagnostic AssessmentDiagnostic Assessment The nurse assesses the client's respirations and notes whether The nurse assesses the client's respirations and notes whether

increased work of breathing is evident, as indicated by increased work of breathing is evident, as indicated by hyperpnea, grunting respiration, cyanosis, pallor, and hyperpnea, grunting respiration, cyanosis, pallor, and retraction intercostally (between the ribs) or suprasternally retraction intercostally (between the ribs) or suprasternally (above the ribs). (above the ribs).

The presence of diaphoresis and any change in mental status The presence of diaphoresis and any change in mental status is documented. is documented.

No abnormal lung sounds are present on auscultation because No abnormal lung sounds are present on auscultation because the edema of acute respiratory distress syndrome (ARDS) the edema of acute respiratory distress syndrome (ARDS) occurs first in the interstitial spaces and not in the airways. occurs first in the interstitial spaces and not in the airways.

Vital signs are monitored at least hourly to assess for Vital signs are monitored at least hourly to assess for hypotension, tachycardia, and dysrhythmiashypotension, tachycardia, and dysrhythmias

Lower PaOLower PaO22 value on arterial blood gas value on arterial blood gas Poor response to refractory hypoxemiaPoor response to refractory hypoxemia Ground-glass appearance to chest x-rayGround-glass appearance to chest x-ray No cardiac involvement on ECG No cardiac involvement on ECG The placement of a Swan-Ganz hemodynamic monitoring The placement of a Swan-Ganz hemodynamic monitoring

catheter: the pulmonary capillary wedge pressurecatheter: the pulmonary capillary wedge pressure (PCWP) is (PCWP) is usually low to normalusually low to normal

Interventions Interventions

Endotracheal intubation and Endotracheal intubation and mechanical ventilation with mechanical ventilation with positive end-expiratory pressure positive end-expiratory pressure or continuous positive airway or continuous positive airway pressurepressure

Drug therapyDrug therapy Nutrition therapy; fluid therapyNutrition therapy; fluid therapy

InterventionsInterventions Case managementCase management Phase Phase 1. 1. This phase includes early changes with This phase includes early changes with

the client exhibiting dyspnea and tachypnea. Early the client exhibiting dyspnea and tachypnea. Early interventions focus on supporting the client and interventions focus on supporting the client and providing oxygenproviding oxygen

Phase Phase 2. 2. Patchy infiltrates form from increasing Patchy infiltrates form from increasing pulmonary edema. Interventions include pulmonary edema. Interventions include mechanical ventilation and prevention of mechanical ventilation and prevention of complications.complications.

Phase Phase 3. 3. This phase occurs over days This phase occurs over days 2 2 to to 10, 10, and and the client exhibits progressive refractory the client exhibits progressive refractory hypoxemia. Interventions focus on maintaining hypoxemia. Interventions focus on maintaining adequate oxygen transport, preventing adequate oxygen transport, preventing complications, and supporting the failing lung until complications, and supporting the failing lung until it has had time to healit has had time to heal

InterventionsInterventions

Phase Phase 4. 4. Pulmonary fibrosis pneumonia with Pulmonary fibrosis pneumonia with progression occurs after progression occurs after 10 10 days. This phase is days. This phase is irreversible and is frequently referred to as "late" irreversible and is frequently referred to as "late" or "chronic" ARDS. Interventions focus on or "chronic" ARDS. Interventions focus on preventing sepsis, pneumonia, and multiple organ preventing sepsis, pneumonia, and multiple organ dysfunction syndrome (MODS), as well as weaning dysfunction syndrome (MODS), as well as weaning the client from the ventilator. The client in this the client from the ventilator. The client in this phase may be ventilator dependent for weeks to phase may be ventilator dependent for weeks to months. He or she may be cared for in specialized months. He or she may be cared for in specialized units or facilities that focus on rehabilitation and units or facilities that focus on rehabilitation and long-term weaning. Some clients may not be long-term weaning. Some clients may not be weanable and go home ventilator dependentweanable and go home ventilator dependent

Endotracheal Intubation Endotracheal Intubation

The goals of intubation include The goals of intubation include maintaining a patent airway, reducing the maintaining a patent airway, reducing the work of breathing, providing a means to work of breathing, providing a means to remove secretions, and providing remove secretions, and providing ventilation and oxygenventilation and oxygen

Components of the endotracheal tube: Components of the endotracheal tube: – The shaft of the tube contains a radiopaque vertical line The shaft of the tube contains a radiopaque vertical line

for the length of the tube, which permits demonstration for the length of the tube, which permits demonstration of correct placement by chest x-ray examination. of correct placement by chest x-ray examination.

– Short horizontal lines (depth markings) are used to Short horizontal lines (depth markings) are used to designate correct placement of the tube at the nares or designate correct placement of the tube at the nares or mouth (at the incisor tooth) and to identify how far the mouth (at the incisor tooth) and to identify how far the tube has been inserted.tube has been inserted.

Endotracheal IntubationEndotracheal Intubation– The cuff at the distal end of the tube, with proper inflation, The cuff at the distal end of the tube, with proper inflation,

produces a seal between the trachea and the cuffproduces a seal between the trachea and the cuff sures sures delivery of a set tidal volume when mechanical ventilation delivery of a set tidal volume when mechanical ventilation is used. When the cuff is inflated to an adequate sealing is used. When the cuff is inflated to an adequate sealing volume, no air can pass through the cuff to the vocal cords, volume, no air can pass through the cuff to the vocal cords, nose, or mouth; therefore the client is not able to talk when nose, or mouth; therefore the client is not able to talk when the cuff is inflated. The cuff should be inflated to a pressure the cuff is inflated. The cuff should be inflated to a pressure of of 20 20 to to 25 25 cm H2O using minimal-leak or no-leak cm H2O using minimal-leak or no-leak techniquestechniques

– The pilot balloon with a one-way valve permits air to be The pilot balloon with a one-way valve permits air to be inserted into the cuff and yet prevents air from escaping. inserted into the cuff and yet prevents air from escaping. This balloon is used as a general guideline for determining This balloon is used as a general guideline for determining the absence or presence of air in the cuff, although it will the absence or presence of air in the cuff, although it will not show how much or how little air is present.not show how much or how little air is present.

– The universal adaptor, which is The universal adaptor, which is 15 15 mm in diameter, enables mm in diameter, enables attachment to ventilator tubing or other types of oxygen attachment to ventilator tubing or other types of oxygen delivery systems. The tubing size is indicated on the delivery systems. The tubing size is indicated on the adaptor or the shaft of the tube. Adult tube sizes range adaptor or the shaft of the tube. Adult tube sizes range from from 5 5 to to 10 10 mm. Sizes used are mm. Sizes used are 8.0 8.0 to to 9.0 9.0 for large adults, for large adults, 7.0 7.0 to to 8.0 8.0 for medium-size adults, and for medium-size adults, and 6.0 6.0 to to 7.0 7.0 for small for small adultsadults

MAJOR INDICATIONS FOR INTUBATION

Endotracheal IntubationEndotracheal Intubation Preparation for intubationPreparation for intubation Verifying tube placementVerifying tube placement

– The nurse assesses for bilateral equal breath The nurse assesses for bilateral equal breath sounds, bilateral equal chest excursion, and air sounds, bilateral equal chest excursion, and air emerging from the ET tube. If breath sounds and emerging from the ET tube. If breath sounds and chest wall movement are absent on the left side, chest wall movement are absent on the left side, the tube may be in the right mainstem bronchus. the tube may be in the right mainstem bronchus. The person intubating the client should be able to The person intubating the client should be able to reposition the tube without repeating the entire reposition the tube without repeating the entire intubation procedure.intubation procedure.

– The nurse auscultates over the stomach to rule out The nurse auscultates over the stomach to rule out esophageal intubation. If the tube is in the stomach, esophageal intubation. If the tube is in the stomach, louder breath sounds are heard over the stomach louder breath sounds are heard over the stomach than over the chest and abdominal distention may than over the chest and abdominal distention may be present. be present.

– Chest wall movement and breath sounds are Chest wall movement and breath sounds are continuously monitored until tube placement is continuously monitored until tube placement is verified by chest x-ray examinationverified by chest x-ray examination

Endotracheal IntubationEndotracheal Intubation Stabilizing the tubeStabilizing the tube

– The nurse, respiratory therapist, or The nurse, respiratory therapist, or anesthesia personnel stabilize the ET tube anesthesia personnel stabilize the ET tube at the mouth or nose. The tube is marked at the mouth or nose. The tube is marked at the level at which it touches the incisor at the level at which it touches the incisor tooth or naris.tooth or naris.

– An oral airway may also need to be inserted An oral airway may also need to be inserted to keep the client from biting an oral tube. to keep the client from biting an oral tube. One person stabilizes the tube at the One person stabilizes the tube at the correct position and prevents head correct position and prevents head movement while a second person applies movement while a second person applies the tape. After the procedure is completed, the tape. After the procedure is completed, the nurse verifies the presence of bilateral the nurse verifies the presence of bilateral and equal breath sounds and the level of and equal breath sounds and the level of the tubethe tube

Nursing careNursing care

Mechanical VentilationMechanical Ventilation

Types of ventilators:Types of ventilators:– Negative-pressure ventilatorsNegative-pressure ventilators– Positive-pressure ventilatorsPositive-pressure ventilators

Pressure-cycled ventilatorsPressure-cycled ventilators Time-cycled ventilatorsTime-cycled ventilators Microprocessor ventilatorsMicroprocessor ventilators

Modes of VentilationModes of Ventilation

The ways in which the client The ways in which the client receives breath from the receives breath from the ventilator include:ventilator include:– Assist-control ventilation (AC)Assist-control ventilation (AC)– Synchronized intermittent Synchronized intermittent

mandatory ventilation (SIMV)mandatory ventilation (SIMV)– Bi-level positive airway pressure Bi-level positive airway pressure

(BiPAP) and others(BiPAP) and others

Ventilator Controls and Ventilator Controls and SettingsSettings

Tidal volumeTidal volume (Vt) is the volume of air that the client receives (Vt) is the volume of air that the client receives with each breath; it can be measured on either inspiration or with each breath; it can be measured on either inspiration or expiration. The average prescribed Vt ranges between expiration. The average prescribed Vt ranges between 7 7 and and 10 10 mL/kg of body weight. Adding a zero to the weight of mL/kg of body weight. Adding a zero to the weight of clients in kilograms gives an estimate of tidal volumeclients in kilograms gives an estimate of tidal volume

RateRate: breaths per minute – is the number of ventilator : breaths per minute – is the number of ventilator breaths delivered per minute. The rate is usually set between breaths delivered per minute. The rate is usually set between 10 10 and and 14 14 breaths per minute.breaths per minute.

Fraction of inspired oxygen (Fio2) Fraction of inspired oxygen (Fio2) is the oxygen is the oxygen concentration delivered to the client. The prescribed Fio2 is concentration delivered to the client. The prescribed Fio2 is determined by the arterial blood gas (ABG) value and the determined by the arterial blood gas (ABG) value and the condition. Ventilators can provide condition. Ventilators can provide 21% 21% to to 100% 100% oxygen, oxygen, depending on need. The oxygen delivered to the client is depending on need. The oxygen delivered to the client is warmed to body temperature warmed to body temperature (98.6° (98.6° F F [37° [37° C]) and humidified C]) and humidified to to 100%. 100%. Humidification and warming are necessary because Humidification and warming are necessary because upper air passages of the respiratory tree, which normally upper air passages of the respiratory tree, which normally warm, humidify, and filter air, are bypassed by the warm, humidify, and filter air, are bypassed by the endotracheal (ET) tube or tracheostomy tube. Humidification endotracheal (ET) tube or tracheostomy tube. Humidification and warming prevent mucosal damage and facilitate and warming prevent mucosal damage and facilitate clearance of secretionsclearance of secretions

Ventilator Controls and Ventilator Controls and SettingsSettings

SighsSighs are volumes of air that are are volumes of air that are 1.5 1.5 to to 2 2 times the set tidal times the set tidal volume, delivered volume, delivered 6 6 to to 10 10 times per hour. These may be used to times per hour. These may be used to prevent atelectasis in special circumstances. Sighs are rarely used, prevent atelectasis in special circumstances. Sighs are rarely used, however, because they can cause however, because they can cause barotrauma barotrauma (lung damage (lung damage from excessive pressure) and have not been shown to be usefulfrom excessive pressure) and have not been shown to be useful

Peak airway (inspiratory) pressurePeak airway (inspiratory) pressure (PIP) indicates the pressure (PIP) indicates the pressure needed by the ventilator to deliver a set tidal volume at a given needed by the ventilator to deliver a set tidal volume at a given dynamic compliancedynamic compliance

Continuous positive airway pressureContinuous positive airway pressure (CPAP) is the application (CPAP) is the application of positive airway pressure throughout the entire respiratory cycle of positive airway pressure throughout the entire respiratory cycle for spontaneously breathing clients. CPAP keeps the alveoli open for spontaneously breathing clients. CPAP keeps the alveoli open during inspiration and prevents alveolar collapse during expiration. during inspiration and prevents alveolar collapse during expiration. This process results in increased functional residual capacity (FRC), This process results in increased functional residual capacity (FRC), improved gas exchange, and improved oxygenationimproved gas exchange, and improved oxygenation

Positive end-expiratory pressurePositive end-expiratory pressure (PEEP) is positive pressure (PEEP) is positive pressure exerted during the expiratory phase of ventilation. PEEP improves exerted during the expiratory phase of ventilation. PEEP improves oxygenation by enhancing gas exchange and preventing oxygenation by enhancing gas exchange and preventing atelectasisatelectasis

Ventilator Controls and Ventilator Controls and SettingsSettings

FlowFlow is how fast the ventilator delivers each is how fast the ventilator delivers each breath. It is usually set at breath. It is usually set at 40 40 L/min. If a client L/min. If a client is agitated, is restless, has a widely is agitated, is restless, has a widely fluctuating pressure reading on inspiration, fluctuating pressure reading on inspiration, or has other signs of air hunger, the flow may or has other signs of air hunger, the flow may be set too low. Increasing the flow should be be set too low. Increasing the flow should be tried before using chemical restraints.tried before using chemical restraints.

Other SettingsOther Settings. . Other settings may be Other settings may be used, depending on the type of ventilator used, depending on the type of ventilator and mode of ventilation. Examples of and mode of ventilation. Examples of additional settings include inspiratory and additional settings include inspiratory and expiratory cycle, waveform, expiratory expiratory cycle, waveform, expiratory resistance, and plateauresistance, and plateau

Nursing ManagementNursing Management

First concern is for the client; First concern is for the client; second for the ventilator.second for the ventilator.

Monitor and evaluate response Monitor and evaluate response to the ventilator.to the ventilator.

Manage the ventilator system Manage the ventilator system safely.safely.

Prevent complications.Prevent complications.

Complications Complications

Complications can include:Complications can include:– LungLung– CardiacCardiac– Gastrointestinal and nutritionalGastrointestinal and nutritional

InfectionInfection Muscular complicationsMuscular complications Ventilator dependenceVentilator dependence

Chest TraumaChest Trauma About 25% of traumatic deaths About 25% of traumatic deaths

result from chest injuries:result from chest injuries:– Pulmonary contusionPulmonary contusion– Rib fractureRib fracture– Flail chestFlail chest– PneumothoraxPneumothorax– Tension pneumothoraxTension pneumothorax– HemothoraxHemothorax– Tracheobronchial traumaTracheobronchial trauma