Pulmonary Critical CarePulmonary Critical Care

NUR 351/352NUR 351/352

Diane E. White RN MS CCRN Diane E. White RN MS CCRN PhD (c)PhD (c)

Arterial Blood GasesArterial Blood Gases

Look at PH: 7.40 or< (acidosis ); 7.40 or > Look at PH: 7.40 or< (acidosis ); 7.40 or > (alkalosis )(alkalosis )

Look at CO2: 40 or < = 40 or > = Look at CO2: 40 or < = 40 or > = Interpretation: if arrows go in same direction Interpretation: if arrows go in same direction

than it is METABOLIC; if arrows go in than it is METABOLIC; if arrows go in opposite directions than it is opposite directions than it is RESPIRATORY RESPIRATORY

Assessment of OxygenationAssessment of Oxygenation

Pulse OximetryPulse Oximetry Arterial Blood GasesArterial Blood Gases Patient Assessment ALWAYS!!Patient Assessment ALWAYS!!

Oxygen AdministrationOxygen Administration

Nasal CannulaNasal Cannula Face MaskFace Mask Face Mask with ReservoirFace Mask with Reservoir Venturi MaskVenturi Mask Bag-Valve Device (Ambu bag)Bag-Valve Device (Ambu bag) Mechanical VentilationMechanical Ventilation

Types of Mechanical VentilationTypes of Mechanical Ventilation

Non-invasive positive pressure ventilation: Non-invasive positive pressure ventilation: bi-pap versus c-pap masksbi-pap versus c-pap masks

Invasive Positive Pressure Ventilation: typesInvasive Positive Pressure Ventilation: types

Time-cycled ventilatorsTime-cycled ventilators

Pressure-cycled ventilatorsPressure-cycled ventilators

Volume-cycled ventilatorsVolume-cycled ventilators

Modes of Ventilator TherapyModes of Ventilator Therapy

Controlled – preset volume and rateControlled – preset volume and rate Assist-Control – preset TV at specified rateAssist-Control – preset TV at specified rate Intermittent Mandatory Ventilation & Intermittent Mandatory Ventilation &

Synchronized Intermittent Mandatory Synchronized Intermittent Mandatory Ventilation – set TV at set RRVentilation – set TV at set RR

Oscillator Ventilators – high frequency Oscillator Ventilators – high frequency ventilationventilation

Adjuncts to Mechanical VentilationAdjuncts to Mechanical Ventilation

Positive –End – Expiratory Pressure (PEEP) Positive –End – Expiratory Pressure (PEEP) 3-10 cm H20 3-10 cm H20

Continuous Positive Airway Pressure Continuous Positive Airway Pressure (CPAP)(CPAP)

Pressure Support ( PS) 5-10 cm H20Pressure Support ( PS) 5-10 cm H20

Complications Complications

BarotraumasBarotraumas Right main stem intubationsRight main stem intubations OETT out of positionOETT out of position InfectionInfection AspirationAspiration Ventilator dependencyVentilator dependency

Nursing CareNursing Care

Medication Therapy: Pain, anxiety, sedation, Medication Therapy: Pain, anxiety, sedation, & ETOH withdrawal& ETOH withdrawal

Awareness of Alarms: volume, pressure, Awareness of Alarms: volume, pressure, apneaapnea

Prevention of Infections & Ventilator-Prevention of Infections & Ventilator-associated Pneumoniaassociated Pneumonia

Communication & teachingCommunication & teaching Weaning is a team approachWeaning is a team approach