RESPI NOTES

DIAGNOSTIC TESTS:
1. Chest X-Ray
2. Sputum Specimen
Interventions:
- Early morning sterile specimen by
suctioning or expectoration
- Rinse mouth with H20 prior
- Obtain 15 mL of sputum
- Deep breaths then cough
- Transport sputum to laboratory immediately
3. Laryngoscopy/Bronchoscopy
- Informed consent
- NPO midnight prior
- IV access for medication administration
(SEDATIVE)
PostOp
- Semi fowlers postion
- Assess for return of gag reflex; NPO until
then
- Monitor for bloody sputum & respiratory
status
- WOF Bronchospasm/perforation indicated
by Facial or Neck Crepitus, Dysrthymias,
Hemorrhage,
Hypoxemia
and
Pneumothorax, Fever
4. Endobronchial Ultrasound (EBUS)
- Tissue samples are obtained from central
lung masses and lymph nodes using a
bronchoscope with the help of ultrasound
guidelines. For diagnosing and staging lung
cancer
PostOp
- Monitor for signs of bleeding and respiratory
distress
5. Pulmonary Angiography
- Invasive fluoroscopic procedure in which a
catheter is inserted through the antecubital
or femoral vein into the pulmonary artery.
Interventions:
- Informed consent
- Assess for allergy to iodine or seafood
- NPO for 8 hours
- IV access for sedation
PostOp
- V/S
- No BP on insertion side
- Assess site for bleeding

6. Thoracentesis
- Removal of fluid or air from the pleural
space via transthoracic aspiration
Interventions:
- Informed consent
- V/S
- Orthopnic Position or Side lying
UNAFFECTED SIDE with HoB elevated
- Instruct client NOT to cough , breathe
deeply or move during procedure
PostOp:
- Apply pressure dressing and assess puncture
site for bleeding and crepitus
- Monitor for signs of pneumothorax, air
embolism or pulmonary edema
7. Pulmonary Function Test
- Test used to evaluate lung mechanics, gas
exchange, and acid-base disturbance
through spirometric measurements, lung
volumes and ABG levels.
Interventions:
- Check for medications that may affect
respiratory function
- Withhold broncodilators before testing
- Void prior to procedure/ Wear loose
clothing
- Refrain from smoking 4-6 hours prior to test
PostOp:
- Resume normal diet and medications
8. Lung Biopsy
- Transbroncial biopsy and a transbronchial
needle aspiration may be performed to
obtain tissue for analysis
Interventions:
- Informed consent
- NPO
- Inform that local anesthetic will be used
- Analgesics and sedatives prior
PostOp:
- Dressing to biopsy site and monitor
drainage
9. Ventilation Perfusion Lung Scan
- Evaluates blood flow to the lungs
- Determines the patency of the pulmonary
airways and detects abnormality in
ventilation
- A radionuclide may be injected
Interventions:
- Informed Consent
- Allergies to dye/Iodine

PostOp:
-

IV access/Sedate

Instruct dye will leave the system after 8

hours
10. Skin Test
11. ABG
12. Pulse Oximetry

MECHANICAL VENTILATION
Types:
1. Pressure-cycled ventilator
- The ventilator pushes air into the lungs until
a specific airway pressure is reached. Used
for short periods (PACU)
2. Time-cycled ventilator
- The ventilator pushes air into the lungs until
a preset TIME has elapsed. Used for
PEDS/NEONATE
3. Volume-Cycled Ventilator
- The ventilator pushes air into the lungs until
preset VOLUME is delivered.
- Constant tidal volume is delivered
4. Microprocessor Ventilator
- A computer or microprocessor is built into
the ventilator to allow continuous
monitoring of ventilator functions, alarms
and client parameters
Modes of Ventilation
1. Noninvasive positive pressure ventilation or
bilevel positive airway pressure (BiPAP)
- IPAP & EPAP are set on a large ventilator
with a desired pressure support and PEEP
- Can be used for COPD distress, HEART
FAILURE, ASTHMA, PULMONARY
EDEMA
2. Controlled
- Client receives a set TIDAL VOLUME
- Used for clients who CANNOT INITIATE
respiratory effort
3. Assist-Control
- Tidal volume and ventilatory rate are
present
- Ventilator TAKES OVER the work of
breathing for the client
- Ventilator is programmed to respond to
clients inspiratory effort if the client does
initiate breath.

Ventilator delivers the preset tidal volume

when client initiates a breath while allowing
the client to control the rate of breathing

4. Synchronized
intermittent
mandatory
ventilation (SIMV)
- Allows the client to breathe spontaneously
at her own rate and tidal volume between
the ventilator breaths
- Can be used as a primary ventilator mode or
as a WEANING MODE
- When used as a weaning mode. The number
of SIMV breaths is decreased gradually and
the client gradually resumes spontaneous
breathing.

If a cause for an alarm cannot be

determined, VENTILATE the client
manually with a resuscitation bag until the
problem is corrected.

VENTILATOR ALARMS
1. High Pressure Alarms
- Increased secretions
- Wheezing/Bronchospasm
- ET tube is displaced
- Kinks
- Client coughs, gags or bites
- Client is anxious
2. Low Pressure Alarms
- Disconnection or Leak
- Client stops spontaneous breathing
COMPLICATIONS
a. Hypotension
b. Pneumothorax
c. GI Alterations
d. Infections
e. Ventilator dependence
Ventilator Controls/Settings
1. Tidal Volume Vol of air the client receives
with each breath
2. FIO2 The oxygen concentration delivered to
the client; determined by the clients condition
and ABG levels
3. Peak Airway Inspiratory Pressure The
pressure needed by the ventilator to deliver set
tidal volume at a given compliance

4. CPAP Keeps the alveoli open during

inspiration and prevents alveolar collapse, used
as a weaning modality
5. PEEP Positive pressure is exerted during the
expiratory phase of ventilation, eich imporves
oxygenation by enhancing gas exchange and
preventing atelectasis
- The need for PEEP indicates a severe gas
exchange
DISEASES:
1. ACUTE RESPIRATORY FAILURE
- Respiratory failure is a sudden and life-threatening
deterioration of the gas exchange function of the lung
and indicates failure of the lungs to provide adequate
oxygenation or ventilation for the blood.
Pathophy:
- Can be caused by impaired function of the
CNS (hemorrhage, drug overdose, head
trauma,
infection)
Neuromuscular
dysfuction (MG, GBS, SC trauma)
- PostOp period after major throcic
surgery/abdominal surgery, inadequate
ventilation
- May be caused by anesthesia, analgesic,
sedative, opioids
S/Sx:
- Restlessness, Fatigue, Headache, Dyspnea,
Tachycardia, Hypertension
- Decrease LOC, confusion, diaphoresis
Interventions:
- Identify and treat underlysing cause
- O2 (PaO2 level higher than 60-70mmHg)
- 30-45 degrees
- Deep breathing
- Bronchodilators
- Standby Intubation kit
2. ACUTE RESPIRATORY DISTRESS SYNDROME
(ARDS)
- Severe form of acute lung injury, SUDDEN AND
PROGRESSIVE pulmonary edema. Major site:
Alveolar capillary membrane

- The interstitial edema causes compression and

obliteration of the terminal airways and leads to
reduced lung volume and compliance.
Pathophy/Causes:
- Diffused alveolar damage
- Sepsis, Fluid overload, shock, trauma, burns
aspiration, inhalation of toxic substances
- Alveoli
collapse
because
of
the
inflammatory infiltrate, blood, fluid and
surfactant dysfunction.
- Small airways are narrowed because of
interstitial fluid and bronchial obstruction.
S/Sx:
- Tachypnea, Dyspnea, decreased breath
sounds,
deteriorating
ABG
levels
(REPIRATORY ACIDOSIS), Hypoxemia,
Pulmonary infiltrates
- Rapid onset of dyspnea that occurs 12-48H
- Xray: Bilateral Infiltrates
Interventions:
- Identify/treat underlying cause
- O2
- Fowlers position
- RESTRICT FLUID INTAKE
- DIURETICS,
ANTICOAGULANTS,
CORTICOSTEROIDS,
SURFACTANT
REPLACEMENT
- Standby Intubation
3. ASTHMA
- Chronic inflammatory disorder of the
airways that causes obstruction, airway
hyperresponsiveness, mucosal edema and
mucus production
- Often occurs at night or early in the
morning
S/Sx:
- Cough
- Dyspnea
- Wheezing
- Generalized chest tightness
Interventions
-