Test Bank for Basic Clinical Lab Competencies for Respiratory Care An Integrated Approach 5th Edition by Gary C. White
Test Bank for Basic Clinical Lab Competencies for Respiratory Care An Integrated Approach 5th Edition by Gary C. White
A long time favorite, the fifth edition of BASIC CLINICAL LAB COMPETENCIES FOR RESPIRATORY CARE: AN INTEGRATED APPROACH continues to bring classroom theory to life at the bedside. Known for its integration of theoretical knowledge and practical skills, this text emphasizes the importance of assessment of need, contraindications, hazards/complications, monitoring, and outcomes assessment in respiratory care. Concise, direct, and easy to understand, this fifth edition has been updated to reflect recent advances in the field in order to ensure that students have the knowledge and skills needed to practice the art and the science of respiratory care.
Additional ISBNs
1435453654, 9781133475286
Table of Contents
Half Title
Title
Statement
Copyright
Contents
List of Performance Evaluations
New to This Edition
Dedication
Preface
Introduction to the Text
Acknowledgments
Contributors
Section 1: Patient Assessment
Ch 1: Basics of Asepsis
Introduction
Key Terms
Theory Objectives
Asepsis
Sterility
Hospital-Acquired Infections
Cross-Contamination
Pathogens
Microorganism Transmission
Contact Transmission
Airborne Transmission
Droplet Transmission
Vehicle Transmission
Vector Transmission
Centers for Disease Control and Prevention Guidelines
Standard Precautions
Importance of Hand Hygiene
Respiratory Hygiene/Cough Etiquette
Personal Protective Equipment
Handling of Patient Care Equipment
Handling of Patient Linen
Sharps Precautions
Use of Mask to Mouth Ventilation Devices
Specific TransmissionPrecautions
Airborne Precautions
Droplet Precautions
Contact Precautions
Hand Hygiene
Remove Jewelry, Including Your Watch
Never Contact the Sink with the Hands or Body
Adjust the Water Flow and Temperature
Wet Forearms, Wrists, and Hands
Liberally Apply Soap
Wash Palms with Strong Friction
Wash between the Fingers
Wash the Wrists with a Rotary Motion
Scrub under the Nails and around the Cuticles
Rinse Hands without Touching the Sink
Obtain Towels Aseptically
Dry Hands Using Separate Towels
Turn Off the Water with a Clean, Dry Towel
Aseptic Gowning
Application of a Mask
Application of the Gown
Aseptic Application of Gloves
Aseptic Removal of Isolation Attire
Remove Gloves
Remove Mask
Remove the Gown
Hand Hygiene
Reference
Practice Activities: Basics of Asepsis
Check List: Basics of Asepsis
Self-Evaluation Post Test: Basics of Asepsis
Performance Evaluation: Hand Washing
Performance Evaluation: Isolation Procedures
Ch 2: Basic Patient Assessment: Vital Signs and Breath Sounds
Introduction
Key Terms
Theory Objectives
Body Temperature
Abnormal Body Temperature
Pulse
Abnormal Heart Rates
Rhythm
Respiratory Rate
Tachypnea and Bradypnea
Blood Pressure
Systolic and Diastolic Pressures
Normal Ranges
Abnormal Blood Pressure
Sound
The Effects of Density on Sound Production and Conduction
Stethoscopes
Parts of the Stethoscope
Single Tube Stethoscope
Sprague-Rappaport Stethoscope
Breath Sounds
Normal Breath Sounds
Vesicular Breath Sounds
Bronchial Breath Sounds
Bronchovesicular Breath Sounds
Tracheal Breath Sounds
Abnormal Breath Sounds
Crackles
Wheezes
Rhonchi
Pleural Rub
Anatomical Positions for Auscultation
Environmental Considerations
The Case for a Systematic Method
Measuring Body Temperature
Measuring Oral Temperature
Equipment
Preparation for Use
Checking the Patient
Placement of the Thermometer
Reading the Thermometer
Measuring the Pulse
Common Sites
Assessment of the Pulse
Measuring Respiratory Rate
Assessing Blood Pressure
Equipment
Sphygmomanometer Placement
Measuring Blood Pressure by Palpation
Measuring the Blood Pressure by Auscultation
Auscultation of Breath Sounds
Preparation of the Stethoscope
Preparation and Cleaning
Testing
Warming of the Diaphragm
Patient Positioning
Auscultation of the Chest
General Notes
Anterior Chest
Posterior Chest
Postauscultation
References
Additional Resources
Practice Activities: Basic Patient Assessment
Vital Signs
Breath Sounds
Check List: Vital Signs
Check List: Breath Sounds
Self-Evaluation Post Test: Basic Patient Assessment
Performance Evaluation: Vital Signs
Performance Evaluation: Breath Sounds
Ch 3: Advanced Patient Assessment: Inspection, Palpation, and Percussion
Introduction
Key Terms
Theory Objectives
Chest Landmarks for Assessment
Bony Structures as Anatomical Landmarks
Anterior Chest
Posterior Chest
Vertical Division Lines
Anterior Chest
Lateral Chest
Posterior Chest
Assessment Techniques and Abnormal Findings
Significant Aspects of Inspection of the Chest
Respiratory Rate, Rhythm, and Pattern
Work of Breathing
Abnormalities of the Skeleton
Digital Clubbing
Palpation of the Chest
Areas of Tenderness
Symmetry of Excursion
Tactile Fremitus
Subcutaneous Emphysema
Tracheal Deviation
Percussion of the Chest
Hyperresonance
Resonance
Dullness
Flatness
Preexamination and Other Considerations
Inspection of the Chest
Palpation
Percussion
Recording Your Findings
References
Practice Activities: Advanced Patient Assessment
Check List: Advanced Patient Assessment
Self-Evaluation Post Test: Physical Assessment of the Chest
Performance Evaluation: Physical Assessment
Ch 4: Radiologic Assessment
Introduction
Key Terms
Theory Objectives
Production of a Chest Radiograph
Radiodensity of Common Materials
X-Ray Views of the Chest
The Normal Chest Radiograph
Common Abnormalities on the Chest Radiograph
Extrapulmonary Air
Changes in Lung Volume
Fluid Abnormalities
Foreign Objects
Ventilation-Perfusion Scanning
Pulmonary Angiography
Computed Tomography of the Chest
Chest Film Orientation
Rotation and Penetration
Viewing the Chest Radiograph
References
Practice Activities: Radiographic Evaluation
Check List: Chest X-Ray Evaluation
Self-Evaluation Post Test: Radiographic Imaging of the Chest
Performance Evaluation: Chest X-Ray Interpretation
Ch 5: Pulmonary Function Testing
Introduction
Key Terms
Theory Objectives
American Thoracic Society Indications
Rationale for Bedside Monitoring
Equipment Used in Measuring Bedside Parameters Respirometers
Respirometers
Peak Flowmeters
Types of Spirometers
Bedside Measurements
Minute Volume
Tidal Volume
Frequency
Vital Capacity
Peak Expiratory Flow Rate
Maximal Inspiratory Pressure
Basic Spirometry
Volumes
Tidal Volume
Inspiratory Reserve Volume
Expiratory Reserve Volume
Residual Volume
Capacities and Their Significance
Inspiratory Capacity
Vital Capacity
Functional Residual Capacity
Total Lung Capacity
The Forced Vital Capacity Tracing
Timed Forced Expired Volume
Forced Expired Flow between 200 and 1200
Midexpiratory Forced Expired Flow
Peak Expiratory Flow Rate
Maximum Voluntary Ventilation
ATPS to BTPS Conversion
Flow-Volume Loops
Measurement of Functional Residual Capacity and Residual Volume
Gas Dilution Techniques
Body Plethysmography
Diffusion: Single Breath Carbon Monoxide Test
Hazards of Pulmonary Function Testing
Hyperventilation
Cardiac Stimulation from Bronchodilators
Infection
Bedside Monitoring: Equipment Assembly and Testing
Respirometers
Peak Flowmeters
Preparation of the Collins Water Seal Spirometer
Level the Spirometer and Fill with Water
Check for Excessive Resistance
Adjust the Bell and Pulley System
Attach the Pens to the Recorder
Attach the Paper to the Kymograph
Flush the Spirometer
Attach Clean Tubing, Valve, and Mouthpiece
Patient Factors in Spirometry
Patient Positioning
The Importance of Coaching
Why Multiple Tests or Tracings?
Measuring the Bedside Pulmonary Function Parameters Aseptic Technique
Aseptic Technique
Measurements
Basic Spirometry: Using the Collins Water Seal Spirometer Kymograph Speeds
Kymograph Speeds
Alignment of the Pen Mechanism to the Paper
Measuring Testing Conditions
Bell Factor
Pulmonary Function Tests
Slow Vital Capacity
Forced Vital Capacity
Measuring Maximal Voluntary Ventilation (MVV) with a Spirometer and Accumulator Pen
Measuring and Calculating Components of a Pulmonary Function Testing Tracing
Tidal Volume
Inspiratory Reserve Volume
Expiratory Reserve Volume
Residual Volume
Measuring and Calculating the Forced Vital Capacity
Forced Vital Capacity (FVC)
Forced Expired Volumein 1 Second (FEV1)
Forced Expired Flow between 200 and 1200 mL
Midexpiratory Forced Expired Flow
Peak Expiratory Flow Rate
Acceptability and Reproducibility Criteria
Maximum Voluntary Ventilation
Measurement Using an Accumulator Pen (Ventilometer)
Calculating the MVV Manually
Calculating the Respiratory Rate
Conversion from Atps to Btps
Calculating Predicted Values
Interpretation of the Results
Reference
Additional Resource
Practice Activities: Pulmonary Function Testing: Bedside Monitoring and Basic Spirometry
Bedside Monitoring
Basic Spirometry
Check List: Pulmonary Function Testing: Bedside Monitoring and Basic Spirometry
Bedside Monitoring
Basic Spirometry
Self-Evaluation Post Test: Pulmonary Function Testing: Bedside Monitoring and Basic Spirometry
Performance Evaluation: Bedside Pulmonary Function Testing
Performance Evaluation: Basic Spirometry
Ch 6: Electrocardiography
Introduction
Key Terms
Theory Objectives
Electrical Physiology of the Heart
Production of Electrical Current in the Heart
Cardiac Conduction System
The Normal ECG and the Electrical Activity of the Heart
The Twelve Leads of an ECG
Einthoven’s Triangle
Augmented Leads
Precordial Leads
Normal Sinus Rhythm
Dangerous and Life-Threatening Arrhythmias
Sinus Bradycardia
Sinus Tachycardia
Atrial Fibrillation
Premature Ventricular Complexes
Ventricular Tachycardia
Ventricular Fibrillation
Ventricular Asystole
ECG Artifact
Patient Motion
Wandering Baseline
60 Hz Artifact
Electrocardiograph Equipment
Equipment Required for an Electrocardiogram
Patient Positioning
Lead Placement
Arrhythmia Recognition
Operating the Electrocardiograph Machine
Artifact Recognition
Proper Handling of an Electrocardiographic Tracing
References
Practice Activities: Electrocardiography
Check List: Performing an ECG
Self-Evaluation Post Test: Electrocardiograms (ECGs)
Performance Evaluation: Electrocardiograms (ECGS)
Ch 7: Phlebotomy
Introduction
Key Terms
Theory Objectives
Obligations Related to Performance of Phlebotomy
Maintaining a Safe Environment
Equipment
Venipuncture Technique
Additional Resources
Practice Activities: Phlebotomy
Check List: Venipuncture
Self-Evaluation Post Test: Phlebotomy
Performance Evaluation: Venipuncture
Ch 8: Arterial Blood Gas Sampling
Introduction
Key Terms
Theory Objectives
Anatomical Locations for Arterial Puncture
Radial Artery
Brachial Artery
Femoral Artery
Complications of Arterial Puncture
The Modified Allen’s Test for Collateral Circulation
Use of Pulse Oximetry to Assess Collateral Circulation of the Hand
Sampling Syringes
Blood Gas Sampling Errors
Bubbles
Delay in Sample Analysis
Use of the Proper Anticoagulant
Venous Sampling
Patient Anxiety
Capillary Blood Gas Sampling
Technique
Capillary Sampling Errors
Poor Blood Flow
Introduction of Air into the Sample
Inadequate Mixing of Heparin
Supplies Needed for Arterial Puncture
Puncture Techniques
Standard Precautions
Patient-Related Considerations
Use of an Anesthetic
Puncture Preparation
Obtaining the Specimen
Radial and Brachial Sites
Femoral Site
Postpuncture Care
Indwelling Arterial Catheter Sampling
Supplies for Capillary Sampling
Capillary Sampling Techniques
Standard Precautions
Arterialization of the Puncture Site
Site Preparation
Obtaining the Sample
Care of the Sample
Care of the Puncture Site
References
Practice Activities: Arterial Blood Gas Sampling
Check List: Arterial Blood Gas Sampling
Check List: Arterial Line Sampling
Check List: Capillary Sampling
Self-Evaluation Post Test: Arterial Blood Gas Sampling
Performance Evaluation: Arterial Puncture
Performance Evaluation: Arterial Line Sampling
Performance Evaluation: Capillary Sampling
Ch 9: Hemodynamic Monitoring
Introduction
Key Terms
Theory Objectives
Pascal’s Law
Transducers
Central Venous Pressure Catheters
Preferred Routes of Access
Central Venous Pressure Waveform and Pressures
Clinical Applications of the Central Venous Pressure Catheter
Pulmonary Artery Catheters or Swan-Ganz Catheters
Parts of a Pulmonary Artery Catheter
Preferred Routes of Access
Pulmonary Artery Catheter Waveform Morphology
Pulmonary Artery Pressure and Pulmonary Artery Wedge Pressure Waveform Morpholog
Pulmonary Artery Pressure Morphology
Pulmonary Artery Wedge Pressure Morphology
Normal Pressure Ranges
Clinical Applications of the Pulmonary Artery Catheter
Fluid Volume and Venous Return
Assessment of Right Ventricular Function
Assessment of Left Ventricular Preload
Assessment of Cardiac Output
Determination of Mixed Venous Oxygen Saturation
Determination of Pulmonary Vascular Resistance
Determination of Systemic Vascular Resistance
Case Studies Illustrating the Application of a Pulmonary Artery Catheter
Determination of Hypovolemia
Interpretation of the Data
Determination of Hypervolemia
Interpretation of the Data
Assessment of Right Ventricular Failure
Interpretation of the Data
Determination of Left Ventricular Failure
Interpretation of the Data
Assessment of the Effects Caused by Positive-Pressure Ventilation
Interpretation of the Data
Arterial Lines
Preferred Routes of Vessel Access
Parts of an Arterial Pressure Waveform
Hazards with Indwelling Vascular Catheters
Equipment Required for Hemodynamic Monitoring
Equipment Setup and Preparation
Medication Preparation
Spiking the Bag and Priming the Tubing
Transducer Preparation
Zeroing the Transducer
Identification of the Phlebostatic Axis
Waveform Damping
Obtaining a Pulmonary Artery Wedge Pressure
Overwedging of the Balloon
Cardiac Output Determination
Arterial Line Maintenance
Zeroing an Arterial Line
References
Additional Resources
Practice Activities: CVP and Pulmonary Artery Catheter Monitoring
Practice Activities: Arterial Line Monitoring
Check List: CVP and Pulmonary Artery Catheter Monitoring
Check List: Arterial Line Monitoring
Self-Evaluation Post Test: Hemodynamic Monitoring
Performance Evaluation: CVP and Pulmonary Artery Catheter Monitoring
Performance Evaluation: Arterial Line Monitoring
Ch 10: Noninvasive Monitoring
Introduction
Key Terms
Theory Objectives
Rationale for Noninvasive Monitoring
Noninvasive Monitoring Equipment
Pulse Oximeters
Transcutaneous CO2 Monitor
Transcutaneous O2 Monitor
Combination PO2 and PCO2 Monitors
End-Tidal CO2 Monitors
Limitations of Noninvasive Monitoring
Limitations of Pulse Oximetry
Limitations of Transcutaneous Monitoring
Limitations of End-Tidal CO2 Monitoring
Hazards of Noninvasive Monitoring
Assembly, Troubleshooting, and Calibration
Pulse Oximeter
Assembly
Troubleshooting
Transcutaneous O2 and CO2 Monitors
Assembly
Troubleshooting
End-Tidal CO2 Monitors
Assembly
Troubleshooting
References
Practice Activities: Noninvasive Monitoring
Check List: Pulse Oximeter Monitor
Check List: Transcutaneous CO2 and O2 Monitoring
Check List: End-Tidal CO2 Monitoring
Self-Evaluation Post Test: Noninvasive Monitoring
Performance Evaluation: Pulse Oximeter Monitoring
Performance Evaluation: Transcutaneous Monitoring
Performance Evaluation: End-Tidal Monitoring
Section 2: Therapeutics
Ch 11: Documentation and Goals Assessment
Introduction
Key Terms
Theory Objectives
The Medical Record
Components of the Medical Record
Admission Record
Physician’s Orders
Progress Notes
History and Physical Examination and Consultation Examinations
Nursing Data
Graphic Record
Laboratory Reports
Imaging Reports
Operative Data
Medication Administration Record
Ancillary Services
Discharge Plan
The Medical Record: Legal and Reimbursement Issues
Legal
Reimbursement
The Medical Record Entry
Charting by Exception
Goals Assessment and Documentation
Oxygenation Goals
Ventilation Goals
Bronchial Hygiene
Hyperinflation Goals
Computer-Aided Documentation
Documentation Guidelines and Abbreviations
Identification of the Medical Record
Documentation
Date and Time
What You Performed
Length of Time
Patient’s Response
Unusual Circumstances
Initials and Signature
Charting by Exception
Clinical Goals
References
Practice Activities: Documentation
Check List: Documentation and Goals Assessment
Self-Evaluation Post Test: Documentation and Goals Assessment
Performance Evaluation: Documentation and Goals Assessment
Ch 12: Oxygen Supply Systems
Introduction
Key Terms
Theory Objectives
Medical Gas Cylinders
Cylinder Markings
Common Medical Gas Cylinder Sizes
Color Coding
Cylinder Valves and Cylinder Valve Safety Systems
Safety Precautions with Use of Medical Gas Cylinders
Calculation of Cylinder Contents
Transfilling of Medical Gas Cylinders
Medical Gas Piping Systems
Reducing Valves
Single-Stage Reducing Valve
Modified Single-Stage Reducing Valve
Multistage Reducing Valves
Safety Features
Flowmeters
Bourdon Gauge Flowmeters
Thorpe Tube Flowmeters
Uncompensated Thorpe Tube Flowmeters
Back Pressure–Compensated Flowmeter
Liquid Oxygen Systems
Oxygen Concentrators
Air/Oxygen Blenders
Using Medical Gas Cylinders
Obtaining the Cylinder from Storage
Maneuvering Large Medical Gas Cylinders
Transporting the Cylinder and Cart
Cracking the Cylinder
Attaching a Reducing Valve
Using an H/K Cylinder in a Patient Area
Maneuvering an E Cylinder
Cracking an E Cylinder
Attaching a Reducing Valve to an E Cylinder
Bleeding a Reducing Valve
Use of Portable Liquid Oxygen Systems
Transfilling the Ambulatory System
Primary Liquid Reservoir Use
Portable System Use
Determining Liquid Oxygen Duration
Use of an Oxygen Concentrator
Use of Air/ Oxygen Blenders
Reference
Additional Resources
Practice Activities: Oxygen Supply Systems
Check List: Oxygen Supply Systems
Check List: Portable Liquid Oxygen Systems
Check List: Oxygen Concentrator
Self-Evaluation Post Test: Oxygen Supply Systems
Performance Evaluation: Oxygen Supply Systems
Performance Evaluation: Liquid Oxygen Systems
Performance Evaluation: Oxygen Concentrators
Ch 13: Oxygen Administration
Introduction
Key Terms
Theory Objectives
Indications for Oxygen Therapy
Low-Flow Oxygen Delivery Systems
Low-Flow Oxygen Devices
Nasal Cannula
Oxygen Concentration
Transtracheal Catheter
Simple Oxygen Mask
Partial Rebreathing Mask
Nonrebreathing Mask
Hi-Ox80
OxyMaskTM
High-Flow Oxygen Delivery Systems
Vapotherm Precision Flow High-Flow Cannula
Air Entrainment Masks
Effects of Back Pressure Distal to the Point of Entrainment
Clinical Applications of Low-Flow and High-Flow Oxygen Systems
Humidification
Enclosures
Isolette
Head Box or Oxygen Hood
Hazards Associated with Enclosures
Types of Oxygen Analyzers
Galvanic Oxygen Analyzer
Polarographic Oxygen Analyzers
Use of an Oxygen Analyzer
Hazards of Oxygen Therapy
Absorption Atelectasis
Oxygen-Induced Hypoventilation
Oxygen Toxicity
Retinopathy of Prematurity
Review the Patient’s Chart
Gather the Appropriate Equipment
Assemble Equipment
Explain the Procedure to the Patient
Nasal Cannula
Oxygen Masks
Entrainment Masks
Head Box
Use of an Oxygen Analyzer
Testing and Calibration
Analysis
Dispose of Excess Equipment Properly
Document the Procedure in the Patient Chart
References
Practice Activities: Oxygen Administration
Check List: Oxygen Administration
Self-Evaluation Post Test: Oxygen Administration
Performance Evaluation: Oxygen Administration
Ch 14: Introduction to Respiratory Care Pharmacology
Introduction
Key Terms
Theory Objectives
Receptor Site Theory
Adrenergic Receptor Sites
Alpha Receptors
Beta-1 Receptors
Beta-2 Receptors
Cholinergic Receptors
Mechanisms of Bronchospasm
Mast Cell Degranulation
Leukotrienes
Histamine
Prostaglandins
Acetylcholine
Sympathomimetic Drugs
Action of Sympathomimetic Drugs
Indications for Sympathomimetic Agents
Specific Sympathomimetic Drugs
Salmeterol Xinafoate
Formoterol Fumarate
Pirbuterol Acetate
Albuterol Sulfate
Levalbuterol
Isoproterenol
Epinephrine
Terbutaline Sulfate
Racemic Epinephrine
Arformoterol Tartrate (Brovana)
Phosphodiesterase Inhibitors
Aminophylline
Theophylline
Anticholinergic Drugs
Ipratropium Bromide
Tiotropium Bromide
Corticosteroids in Respiratory Care
Prednisone
Dexamethasone
Budesonide
Beclomethasone Dipropionate
Triamcinolone Acetonide
Flunisolide
Fluticasone Propionate
Mometasone Furoate
Combination Therapy Drugs
Fluticasone Propionate–Salmeterol (Advair)
Albuterol Sulfate–Ipratropium Bromide
Formoterol Fumarate–Budesonide
Cromolyn Sodium and Asthma Management
Nedocromil Sodium
Montelukast (Singulair)
Zarfirlukast
Zileuton
Mucoactive Agents
Acetylcysteine
Dornase Alfa (Pulmozyme)
Use of Bland Aerosols in Respiratory Care
Aerosolized Antimicrobial Agents
Antibiotics
Tobramycin (Tobi)
Antiviral Agents
Antiprotozoal Agents
Metered Dose Inhalers
MDI Spacer Devices
Dry Powder Inhalers (DPI)
Metered Dose Inhaler
Position the Patient
Monitor the Patient
Instruct the Patient
Assemble the Equipment
Administer the Medication
Monitor the Patient following Therapy
Clean the Patient’s Room and Chart Procedure
Use of a Spacer with a Metered Dose Inhaler
Position the Patient
Monitor the Patient
Instruct the Patient
Assemble the Equipment
Administer the Medication
Monitor the Patient following Therapy
Clean the Patient’s Room and Chart Procedure
DRY Powder Inhalers
Diskhaler
Diskus
Turbuhaler
HandiHaler
Aerolizer
Twisthaler
References
Practice Activities: Introduction to Respiratory Care Pharmacology
Check List: Metered Dose Inhaler
Self-Evaluation Post Test: Introduction to Respiratory Care Pharmacology
Performance Evaluation: MDI Administration
Performance Evaluation: DPI Administration
Ch 15: Humidity and Aerosol Therapy
Introduction
Key Terms
Theory Objectives
What Is Humidity and What Is Aerosol?
Humidifiers and Nebulizers
Humidity
Factors Affecting Humidity Output
Equipment for Humidity and Aerosol Therapy
Bubble Humidifier
Wick Humidifiers
Heated Pass Over Humidifiers
Heat and Moisture Exchanger
Large-Volume Nebulizers
MistyOx Nebulizers
Ultrasonic Nebulizers
Small-Volume Nebulizers
Commonly Administered Medications
Monitoring Therapy for Effectiveness
Hazards and Complications
Humidity and Aerosol Therapy
Wick Humidifier
Heated Pass Over Humidifier
Large-Volume Nebulizers
MistyOx Hi-Fi and GIN Nebulizers
Ultrasonic Nebulizers
Aerosol/Oxygen Delivery Devices
Small-Volume Nebulizer Therapy
References
Additional Resources
Practice Activities: Humidity and Aerosol Therapy
Check List: Humidity and Aerosol Therapy
Check List: Small-Volume Nebulizer Therapy
Self-Evaluation Post Test: Humidity and Aerosol Therapy
Performance Evaluation: Humidity and Aerosol Therapy
Performance Evaluation: Small-Volume Nebulizer Therapy
Ch 16: Bronchial Hygiene Therapy
Introduction
Key Terms
Theory Objectives
Body Alignment and Stance
General Guidelines for Moving Patients
Safety Devices
Bed Rails
Restraints
Nurse Call Button
Code Switch
Chest Percussion and Postural Drainage
Postural Drainage
Equipment Requirements
Position Modifications
Percussion
Areas to Avoid
Adjunctive Devices for Chest Percussion
Mechanical Percussors
Physician’s Order
Contraindications and Hazards
Other Therapies for Bronchial Hygiene
Positive Expiratory Pressure Therapy
Definition and Equipment
Indications
Hazards
Oscillating PEP Therapy
Indications
Hazards
Flutter Valve Therapy
Definition and Equipment
Indications
Hazards
High-Frequency Chest Wall Oscillation Therapy
Indications
Hazards
Adjunctive Breathing Techniques
Indications
Hazards
Respironics CoughassistTM MI-E
Indications
Hazards/Contraindications
General Guidelines Bed Rails
Bed Rails
Positioning of the Practitioner
Patient Positioning
Fowler’s and Semi-Fowler’s Positions
Supine Position
Prone Position
Side-Lying Position
Sims’ Position
Trendelenburg Position
Reverse Trendelenburg Position
Assisting a Patient into a Chair
Use of Restraints
Chest and Waist Restraints
Wrist and Ankle Restraints
Percussion Technique
Positive Expiratory Pressure Therapy
Verify the Physician’s Order
Scan the Chart
Administration of Therapy
Patient Positioning
Appropriate Monitoring before Therapy
Ideal Breathing Pattern
Monitoring the Patient during Therapy
Flutter Valve Therapy
Verify the Physician’s Order
Scan the Chart
Administration of Therapy
Patient Positioning
Appropriate Monitoring before Therapy
Ideal Breathing Pattern
Monitoring the Patient during Therapy
Vibratory Pep (Acapella®) Therapy Administration
Verify the Physician’s Order
Scan the Chart
Administration of Therapy
Patient Positioning
Appropriate Monitoring before Therapy
Ideal Breathing Pattern
Monitoring the Patient during Therapy
High-Frequency Chest Wall Oscillation Therapy Administration
The Vest® Airway Clearance System Assembly
Verify the Physician’s Order
Scan the Chart
Administration of Therapy
Patient Positioning
Technique
Monitoring the Patient during Therapy
CoughassistTM MI-E Administration
CoughassistTM Assembly
Verify Physician’s Order
Scan the Chart
Administration of Therapy
Patient Positioning
Technique
Monitoring the Patient during Therapy
Adjunctive Breathing Techniques
Diaphragmatic Breathing
Unilateral Chest Expansion
Pursed-Lip Breathing
Controlled Coughing
Acute Chest Compression
References
Additional Resources
Practice Activities: Patient Positioning and Chest Physiotherapy
Practice Activities: PEP Mask Therapy
Circuit Assembly
Pressure Adjustment
Activities
Practice Activities: Flutter Valve Therapy
Practice Activities: Vibratory PEP Therapy (Acapella®)
Practice Activities: The Vest® Airway Clearance System
Practice Activities: CoughassistTM Mechanical In-Exsufflator
Practice Activities: Adjunctive Breathing Techniques
Check List: Patient Positioning
Check List: Postural Drainage and Chest Percussion
Check List: PEP Therapy
Check List: Flutter Valve Therapy/Vibratory PEP (Acapella®) Therapy
Check List: HFCWO Therapy—(The Vest® Airway Clearance System)
Check List: CoughassistTM Mechanical In-Exsufflator
Check List: Adjunctive Breathing Exercises
Self-Evaluation Post Test: Bronchial Hygiene Therapy
Performance Evaluation: Patient Positioning
Performance Evaluation: Chest Percussion and Postural Drainage
Performance Evaluation: PEP Mask Therapy
Performance Evaluation: Flutter Valve Therapy/ Vibratory PEP (Acapella®) Therapy
Performance Evaluation: HFCWO (The Vest® Airway Clearance System)
Performance Evaluation: CoughassistTM Mechanical In-Exsufflator
Performance Evaluation: Adjunctive Breathing Techniques
Ch 17: Hyperinflation Therapy
Introduction
Key Terms
Theory Objectives
Hyperventilation Modalities
Incentive Spirometry
Intermittent Positive-Pressure Breathing
Intrapulmonary Percussive Ventilation
Goals of and Indications for Hyperinflation Therapy
Reversal of Atelectasis
Improvement of the Cough or Cough Mechanism
Medication Delivery
Hazards and Complications of Hyperventilation Therapy
Hypocapnea Induced by Hyperventilation
Interruption of Hypoxic Drive
Decreased Cardiac Output
Increased Intracranial Pressure
Pneumothorax
Untreated Pneumothorax
Incentive Spirometers
Voldyne Volumetric Exerciser
Triflow Incentive Spirometer
The Bird Mark 7A Ventilator
Control Function
Pressure
Time/Pressure Trigger Control
Expiratory Timer
Sensitivity
Flow Rate
Apneustic Time Control
Gas Flow through the Breathing Circuit
Inspiration
Expiration
Percussionaire IPV-1
Controls
Operational Pressure
Percussion Control
Manual Inspiration
Phasitron
Changing Tidal Volume Delivery and Ventilatory Frequency
Incentive Spirometry
Patient Instruction
Incentive Spirometry Equipment
IPPB Therapy
Verify the Physician’s Order
Scan the Chart
Administration of Therapy
Patient Positioning
Appropriate Monitoring before Therapy
Ideal Breathing Pattern
Monitoring the Patient during IPPB Therapy
Monitoring the Patient during Bronchodilator Administration
Recognition of Adverse Effects of IPPB Therapy
Hyperventilation
Interruption of the Hypoxic Drive
Decreased Cardiac Output
Increased Intracranial Pressure
Pneumothorax
Post–IPPB Therapy Monitoring
Charting the Procedure
Intrapulmonary Percussive Ventilation Therapy
Verify the Physician’s Order
Scan the Chart
Administration of Therapy
Patient Positioning
Appropriate Monitoring before Therapy
Ideal Breathing Pattern
Monitoring during Therapy
Monitoring following Therapy
Charting the Procedure
References
Additional Resources
Practice Activities: Bird Mark 7A
Circuit Assembly
Operation of the Ventilator
Activity 1: Pressure Control (1)
Activity 2: Expiratory Timer Control (2)
Activity 3: Sensitivity Control (3)
Activity 4: Flow Rate Control (4)
Tidal Volume Delivery with IPPB Therapy
Activity 1
Activity 2
Oxygen Delivery with IPPB Therapy
Practice Activities: Percussionaire IPV-1 Ventilator
Circuit Assembly
Operation of the Ventilator
Percussion Control
Operational Pressure Control
Practice Activities: Hyperinflation Therapy
Safety Precautions
Check List: Incentive Spirometry
Check List: IPPB Therapy
Check List: Intrapulmonary Percussive Ventilation Therapy
Self-Evaluation Post Test: Hyperinflation Therapy
Performance Evaluation: Incentive Spirometry
Performance Evaluation: IPPB Therapy
Performance Evaluation: Intrapulmonary Percussive Ventilation (IPV)
Ch 18: Bronchoscopy Assisting
Introduction
Key Terms
Theory Objectives
Therapeutic and Diagnostic Bronchoscopy
Therapeutic Bronchoscopy
Diagnostic Bronchoscopy
Indications for Bronchoscopy
Rigid and Flexible Bronchoscopes
Construction of a Flexible Fiberoptic Bronchoscope
Types of Instruments
Types of Sample Testing and Analysis
Solutions Used to Fix or Prepare Samples for Testing
Personal Protective Equipment
Bronchoscopy Room or Suite
Medications Employed for Anesthesia and Analgesia
Hazards and Complications of the Medications Used for Bronchoscopy
Patient Monitoring
Hazards and Complications of Bronchoscopy
Equipment Preparation
Bronchoscope Preparation
Medication Preparation
Sample Solution Preparation
Emergency Equipment
Personal Protective Equipment
Equipment for the Patient
Documentation Preparation
Patient Preparation
Monitoring
Anesthesia and Analgesia
Supplemental Oxygen
Bronchoscopy Assisting
Medication Administration
Tissue Sampling
Forceps
Brushes
Wang Needle
Bleeding Control
Specimen Preparation
Bronchoalveolar Lavage
Patient Monitoring
Bronchoscopy During Mechanical Ventilation
Documentation
Cleaning the Bronchoscope
Sample Delivery
References
Practice Activities: Bronchoscopy Assisting
Check List: Bronchoscopy Assisting
Self-Evaluation Post Test: Bronchoscopy Assisting
Performance Evaluation: Bronchoscopy Assisting
Ch 19: Equipment Processing and Surveillance
Introduction
Key Terms
Theory Objectives
Related Microbiology
Eukaryotic and Prokaryotic Cell Types
Bacterial Shapes
Gram Stain
Capsules and Endospores
Common Causative Organisms
Equipment Processing Terms
Sterilization
Disinfection
Antisepsis
Equipment Processing Methods
Steam Autoclaving
Pasteurization
Ethylene Oxide Processing
Glutaraldehyde Processing
Processing with Quaternary Ammonium Compounds
Gamma Irradiation
Facility Design for Equipment Processing
Bacteriologic Surveillance Programs
Aliquot Culturing
Rinse Sampling
Rodac Plate Sampling
Swab Sampling
Data Utilization
Swab Sampling
Obtain the Required Supplies
Hand Hygiene
Aseptically Withdraw the Swab and Sample the Area
Surveillance Records
Transport the Plate to the Laboratory Facility
Processing Respiratory Care Equipment
Washing
Rinsing
Packaging
Processing the Equipment
Package Equipment Following Disinfection
Label and Store the Equipment
References
Additional Resource
Practice Activities: Equipment Processing and Surveillance
In Your Practice
Check List: Bacteriologic Surveillance
Check List: Equipment Processing
Self-Evaluation Post Test: Equipment Processing and Surveillance
Performance Evaluation: Bacteriologic Surveillance
Performance Evaluation: Equipment Processing
Section 3: Emergency Management
Ch 20: Emergency Airway Management
Introduction
Key Terms
Theory Objectives
Anatomy of the Upper Airway
Tongue
Vallecula
Epiglottis
Arytenoid Cartilages
Vocal Cords
Reflexes of the Upper Airway
Swallow
Gag
Laryngeal
Tracheal
Carinal
Reflexes and Loss of Consciousness
Upper Airway Obstruction
Causes
Clinical Findings
Positional Maneuvers to Open the Airway
Head Tilt
Anterior Mandibular Displacement
Triple Airway Maneuver
Resuscitators
Gas-Powered Resuscitators
Valve Types Used in Self-Inflating Manual Resuscitators
Importance of Inspiratory-Expiratory Ratio During Resuscitation
Hazards of Manual Resuscitation
Pharyngeal Airways in Manual Resuscitation
Nasopharyngeal Airway
Oropharyngeal Airway
Laryngeal Mask Airway (LMA)
Combitube Airway
Intubation: What Is It?
Oral Route
Nasal Route
Equipment for Endotracheal Intubation
Laryngoscopes
Blades
Characteristics of Endotracheal Tubes
Murphy Eye Endotracheal Tube
Endotracheal Tube Cuff
Pilot Tube and Balloon
Markings
Complications of Intubation
Early Complications
Late Complications
Extubation
Patient Positioning to Relieve Upper Airway Obstruction
Airway Insertion
Insertion of the Nasopharyngeal Airway
Insertion of the Oropharyngeal Airway
Preparation of Manual Resuscitators
Ventilation with a Manual Resuscitator
Patient Positioning
Mask Placement
Ventilation
Patient Assessment during the Procedure
Equipment Preparation and Assembly for Intubation
Preparation of the Laryngoscope
Oropharyngeal Airways
Yankauer Suction
10 mL (or Larger) Syringe
Commercial Endotracheal Tube Holder
Water-Soluble Lubricant
Magill Forceps
Endotracheal Tubes
Stylet
General Notes
Patient Positioning
Hyperinflation and Oxygenation
Intubation Techniques
Oral Intubation
Miller Blade (Straight Blade)
Macintosh Blade (Curved Blade)
Evaluation
Use of End-Tidal CO2 Detectors or Esophageal Detectors
Nasal Intubation
Extubation
Extubation Technique
Monitoring after Extubation
References
Additional Resource
Practice Activities: Manual Resuscitation
Intubation Practice Activities
Check List: Manual Resuscitation
Check List: Intubation
Check List: Extubation
Self-Evaluation Post Test: Emergency Airway Management
Performance Evaluation: Manual Resuscitation
Performance Evaluation: Intubation
Performance Evaluation: Extubation
Ch 21: Artificial Airway Care
Introduction
Key Terms
Theory Objectives
Suctioning
Rationale for Suctioning
What Is Suctioning?
Suction Catheter Designs
Whistle Tip
Coudé Tip
Closed Suction Systems
Complications and Hazards of Suctioning
Tissue Trauma
Hypoxemia
Cardiac Arrhythmias
Pneumonia
Oxygenation and Hyperinflation Using Mechanical Ventilation
Positive End-Expiratory Pressure
Prevention of Ventilator-Associated Pneumonia (VAP)
Elevation of the Head of the Bed
Subglottic Secretion Drainage
Maintenance of Cuff Pressures
Humidification of Inspired Gases
Cuff Pressure Monitoring
Indications for a Tracheostomy
Tracheostomy and Stoma Care
Purpose of Tracheostomy and Stoma Care
Hazards and Complications of Tracheostomy Care
Displacement and Decannulation of the Tracheostomy Tube
Infection
Types of Tubes
Single Cannula Tracheostomy Tube
Single Cannula Tracheostomy Tube with a Disposable or Removable Inner Cannula
Single Cannula Fenestrated Tracheostomy Tube
Silver Holinger Tracheostomy Tube
Bivona Foam Cuff
Specialized Tracheostomy Tubes and Appliances
Communi-Trach
Tracheostomy Button
Kistner Button
Olympic Trach-Talk
Passy-Muir Valve
Suctioning Procedure
Equipment Needed for Suctioning
Equipment Preparation
Positioning for Artificial Airway Aspiration
Preaspiration Patient Assessment
Oxygenation of the Patient
Nasotracheal Suctioning Procedure
Use of a Nasopharyngeal Airway
Artificial Airway Aspiration
Use of a Closed Suction System
Cuff Pressure Measurement
Pressure Manometer and Three-Way Stopcock
Posey Cufflator
Tracheostomy Care Procedure
Equipment Required for Tracheostomy Care
Cuff Deflation and Inflation
Components of Tracheostomy Care Procedure
Physician’s Order for Care
Auscultate the Chest
Prepare a Sterile Field and Apply Sterile Gloves
Remove and Clean the Inner Cannula
Reinsert the Inner Cannula
Stoma Care Procedure
Assess the Tracheostomy Tube Position
Remove the Old Dressing and Ties
Clean the Stoma Site
Apply a Clean Dressing and New Ties
Reassess the Tracheostomy Tube Position
References
Additional Resource
Practice Activities: Suctioning
Practice Activities: Tracheostomy and Stoma Care
Check List: Nasotracheal Suctioning
Check List: Artificial Airway Aspiration
Check List: Cuff Pressure Monitoring
Check List: Tracheostomy and Stoma Care
Self-Evaluation Post Test: Artificial Airway Care
Performance Evaluation: Nasotracheal Suctioning
Performance Evaluation: Endotracheal Suctioning
Performance Evaluation: Monitoring Cuff Pressures
Performance Evaluation: Tracheostomy and Stoma Care
Ch 22: Chest Tubes
Introduction
Key Terms
Theory Objectives
Chest Tubes: Basic Principles
Indications for Chest Tube Placement
Chest Drains versus Chest Tubes
Rationale for Placement
Chest Drainage System
Components of a Chest Drainage System
Important Principles of Operation
Effects of Water Level in the Water Seal Chamber
Effects of Water Level in the Suction Control Chamber
Vacuum Regulation
Assessment for Leaks
Emergency Management of the Chest Drainage System
Heimlich Valve
Assisting with Chest Tube Placement
Equipment Required for Chest Tube Placement
Assisting the Physician with the Procedure
Assessment of Chest Tube Placement
Setup and Maintenance of the Chest Drainage System
Setting up the Drainage System
Monitoring and Troubleshooting the Drainage System
Identifying and Correcting Leaks
References
Practice Activities: Chest Tubes
Check List: Chest Tubes
Self-Evaluation Post Test: Chest Tubes
Performance Evaluation: Chest Tubes
Ch 23: Insertion and Maintenance of Intravenous Lines
Introduction
Key Terms
Theory Objectives
The Principles of Intravenous Therapy
Intravenous Fluid Properties
Locating Acceptable Sites for Intravenous Needle Placement
Complications of Intravenous Therapy
Infiltration
Thrombosis
Phlebitis and Cellulitis
Air Embolism
Catheter Shear or Catheter Fragment Embolism
Maintenance of Intravenous Infusions
Drip Rate Calculations
Supplies Needed for Intravenous Cannulation
Needle Selection
Other Supplies
Venipuncture Procedure
Standard Precautions
General Considerations
Local Anesthetic Use
Site Preparation
Technique
Maintenance of Intravenous Infusions
Discontinuing Intravenous Therapy
References
Additional Resources
Practice Activities: Intravenous Line Insertion and Maintenance
Check List: Peripheral IV Insertion
Self-Evaluation Post Test: Intravenous Line Insertion and Maintenance
Performance Evaluation: Intravenous Line Insertion and Maintenance
Section 4: Ventilation
Ch 24: Noninvasive Positive-Pressure Ventilation
Introduction
Key Terms
Theory Objectives
Definition of Noninvasive Positive-Pressure Ventilation
Indications for Noninvasive Positive-Pressure Ventilation
Assessment of the Patient for Noninvasive Positive-Pressure Ventilation
Patient–Ventilator Interface in Noninvasive Positive-Pressure Ventilation
Hazards and Complications of Noninvasive Positive-Pressure Ventilation
How Resistance and Compliance Affect Noninvasive Positive-Pressure Ventilation
Modes of Noninvasive Positive-Pressure Ventilation
Bilevel Ventilators
Supplemental Oxygen Delivery
Acute Care Ventilators
Mode
Ventilator Circuit
Patient Monitoring
Patient Assessment for NPPV
Assembly and Testing of the Ventilator
Mask Selection
Ventilator Settings
Patient Monitoring
Patient Charting
References
Practice Activities: Respironics BiPAP® Vision
Circuit Assembly
Ventilator Preparation
Ventilator Operation Verification
Activities
Practice Activities: Respironics V60 Ventilator
Circuit Assembly
Using The Graphical User Interface
Ventilator Preparation
Activities
Check List: Initiation of NPPV
Self-Evaluation Post Test: Noninvasive Positive-Pressure Ventilation (NPPV)
Performance Evaluation: Initiation of Noninvasive Positive-Pressure Ventilation (NPPV)
Ch 25: Continuous Mechanical Ventilation
Introduction
Key Terms
Theory Objectives
What Is Continuous Mechanical Ventilation?
Volume Control and Pressure Control Ventilation
Respiratory Failure
Indications for Mechanical Ventilation
Apnea and Impending Respiratory Failure
Acute Exacerbation of COPD
Acute Asthma
Neuromuscular Disease
Acute Hypoxemic Failure
Heart Failure and Cardiogenic Shock
Noninvasive Positivepressure Ventilation and Invasive Positive-Pressure Ventilation
Noninvasive Ventilation
Advantages and Disadvantages of Noninvasive Ventilation
Applications of Noninvasive Ventilation
Invasive Positive-Pressure Ventilation
Advantages of Invasive Positive-Pressure Ventilation
Disadvantages of Invasive Positive-Pressure Ventilation
Control Variable and Mode of Ventilation
Control Variable
Mode of Ventilation
Ventilator Settings
Volume Control Ventilation
Volume Control/Assist-Control Ventilation
Pressure Control Ventilation
Pressure Control/Assist Control
Alarm Settings for Volume and Pressure Control Ventilation
Volume Control and Volume Control/Assist-Control Ventilation
Pressure Limit/Alarm
Low Minute Volume/Low Tidal Volume
Low Peak Pressure/Low PEEP Pressure
High Rate/Low Rate
Pressure Control and Pressure Control/Assist Control
High and Low Tidal Volume
High and Low Minute Volume
Spontaneous Ventilation Modes
Continuous Positive Airway Pressure (CPAP)
Pressure Support
Patient Ventilator System Checks
Equipment Requirements
Equipment Preparation
Ventilator Operational Verification Procedure
Establishing Ordered Ventilator Settings
Type of Ventilation or Control Variable
Volume Control Ventilation
Pressure Control Ventilation
Monitoring the Patientventilator System
The Patient
Pulmonary
Cardiac
Neurologic
The Ventilator
Documentation of Ventilator Settings
Control Variable
Tidal Volume or Inspiratory Pressure
Frequency
FIO2
PEEP
Flow Rate
I:E Ratio
Temperature
Alarms
Documentation of Patient Values
Peak Pressure
End-Expiratory Pressure
Plateau Pressure
Measured Tidal Volume
Dynamic Compliance
Static Compliance
Airway Resistance
Frequency
Arterial Blood Gases and SpO2
Ventilator Disinfection and Preparation for Use
References
Additional Resources
Practice Activities: BEAR 1000
Circuit Assembly
Testing the Ventilator before Use (Quick Checkout)
System Leak Test
Tubing Compliance
Activities
Initial Settings
Peak Flow Control
Tidal Volume Control
Rate Control
Triggering
Pressure Control Ventilation
Inspiratory Pressure Control
Inspiratory Time Control
Alarm Systems
Total Breath Rate
Peak Inspiratory Pressure
Baseline Pressure
Practice Activities: Bird 8400ST
Circuit Assembly
Preoperational Performance Check
Practice Activities:
Initial Settings
Peak Flow Control
Tidal Volume Control
Rate Control
Triggering
Pressure Control Ventilation
Inspiratory Pressure Control
Inspiratory Time Control
Alarm Systems
Practice Activities: Nellcor Puritan Bennett 840
Circuit Assembly
Testing the Ventilator before Use
Using the Keyboard Entry System
Activities
Lung Simulator Setup
Volume Control Exercises
Patient Monitoring
Peak Flow Control
Tidal Volume Control
Normal Rate Control (Cycles or Breathsper Minute)
Changes in Resistance and Compliance
Triggering Adjustment
Pressure Control Ventilation
Initial Ventilator Settings
Inspiratory Pressure Control
Inspiratory Time Control
Rate Control
Spontaneous Ventilation
PEEP (CPAP Level)
Pressure Support
Alarm Functions
Apnea Ventilation
Practice Activities: Maquet SERVO-i Ventilator
Circuit Assembly
Testing the Ventilator before Use
Using the Maquet SERVO-i User Interface
Activities
Lung Simulator Setup
Volume Control Exercises
Patient Monitoring
Tidal Volume Control
Respiratory Rate Control
Inspiratory Time Control
Inspiratory Pause Control
Inspiratory Rise Time
Trigger Sensitivity
Changes in Resistance and Compliance
Pressure Control Ventilation
Initial Ventilator Settings
PC above PEEP (Pressure)
Inspiratory Time Control
Rate Control
Inspiratory Rise Time Control
Trigger Sensitivity
Spontaneous Ventilation
Initial Ventilator Settings
CPAP Mode
Pressure Support
Backup Ventilation
Alarm Functions
Practice Activities: Viasys Avea Ventilator
Circuit Assembly
Testing the Ventilator before Use
Activities
Lung Simulator Setup
Volume Control Exercises
Patient Monitoring
Peak Flow Control
Tidal Volume Control
Rate Control
Changes in Resistance and Compliance
Triggering Adjustment
Pressure Control Ventilation
Initial Ventilator Settings
Inspiratory Time Control
Rate Control
Spontaneous Ventilation
PEEP (CPAP Level)
Pressure Support
Alarm Functions
Apnea Backup
Check List: Initiation of Volume Control Ventilation
Check List: Initiation of Pressure Control Ventilation
Check List: Initiation of CPAP or Pressure Support Ventilation
Check List: Monitoring Ventilation
Self-Evaluation Post Test: Continuous Mechanical Ventilation
Performance Evaluation: Initiation of Volume Control Ventilation
Performance Evaluation: Initiation of Pressure Control Ventilation
Performance Evaluation: Initiation of CPAP or Pressure Support Ventilation
Performance Evaluation: Monitoring Mechanical Ventilation
Ch 26: Advanced Modes of Mechanical Ventilation
Introduction
Key Terms
Theory Objectives
The Control Variable
Dual Control Within a Breath
Application
Dual Control Breath to Breath
Pressure Limited, Time Cycled
Application
Pressure Limited, Flow Cycled
Application
Inverse Ratio Ventilation
Pressure Control Inverse Ratio Ventilation
Volume Control Inverse Ratio Ventilation
Application
Airway Pressure Release Ventilation
Application
Intermittent Mandatory Ventilation (IMV)
Application
Additional Mechanical Ventilation Modes
Mandatory Minute Volume
Application
Automatic Tube Compensation
Application
Proportional Assist Ventilation
Application
Automode
Application
Patient Assessment and Monitoring
Ventilation
Oxygenation
Cardiovascular
Work of Breathing
Setting Ventilator Modes
Airway Pressure Release Ventilation
Automatic Tube Compensation
Tube Compensation Setup
Automode
Automode Setup
Synchronized Intermittent Mandatory Ventilation
Inverse Ratio Ventilation
Pressure Regulated Volume Control
Proportional Assist Ventilation
Volume Support Ventilation
Hazards and Precautions
References
Practice Activities: Nellor Puritan Bennett 840
Circuit Assembly
Testing the Ventilator before Use
Using The Keyboard Entry System
Activities
Lung Simulator Setup
Volume Control Plus (VC+)
Bilevel Ventilation
Rate Control
High PEEP (PEEPH) Control
Time PEEPH Control
Low PEEP (PEEPL) Control
Pressure Support
Practice Activities: SIMV
Pressure Control with SIMV
Tube Compensation
Proportional Assist Ventilation (PAV) Practice Activities
Volume Support Practice Activities
Practice Activities: Maquet SERVO-i Ventilator
Circuit Assembly
Testing the Ventilator before Use
Using the Maquet SERVO-i User Interface
Pressure Regulated Volume Control
Patient Monitoring
Volume Support Ventilation (VSV)
Pressure Control Inverse RatioVentilation (PCIRV)
Bi-Vent
Volume SIMV Practice Activities
Pressure SIMV Practice Activities
Automode
Practice Activities: Viasys Avea Ventilator
Circuit Assembly
Testing the Ventilator before Use
Extended Systems Test (EST)
Activities
Lung Simulator Setup
Pressure Regulated Volume Control A/c (Prvc A/c)
Pressure Regulated Volume Control SIMV (PRVC SIMV)
Volume SIMV Practice Activities
Pressure SIMV Practice Activities
Airway Pressure Release Ventilation Biphasic
Check List: Advanced Ventilation Modes
Self-Evaluation Post Test: Advanced Ventilator Modes
Performance Evaluation: Advanced Ventilation Modes
Ch 27: Waveform Analysis
Introduction
Key Terms
Theory Objectives
Common Waveforms
Waveform Morphologies
Analysis of Specific Waveforms
Pressure versus Time
Flow versus Time
Volume versus Time
Combined Waveforms
Pressure versus Volume
Flow versus Volume
Waveform Interpretation
Clinical Criteria for Appropriate Waveform Selection
References
Practice Activities: Waveform Analysis
Check List: Waveform Analysis
Self-Evaluation Post Test: Waveform Analysis
Performance Evaluation: Waveform Analysis
Ch 28: Weaning and Discontinuation of Mechanical Ventilation
Introduction
Key Terms
Theory Objectives
Reasons for Ventilator Dependence
Neurologic Causes for Ventilator Dependence
Respiratory Causes for Ventilator Dependence
Cardiovascular Causes for Ventilator Dependence
Psychological Causes for Ventilator Dependence
Determining Readiness for Weaning
Evidence of Reversal of Underlying Cause for Respiratory Failure
Evidence of Adequate Oxygenation
Evidence of Hemodynamic Stability
Evidence of Ability to Generate an Inspiratory Effort
The Spontaneous Breathing Trial (SBT)
Duration of the Spontaneous Breathing Trial
Determination of Tolerance in a Spontaneous Breathing Trial
Failure of a Spontaneous Breathing Trial
Extubation and Ventilator Liberation
Protocols and the Weaning and Discontinuation of the Mechanically Ventilated Patient
Closed-Loop, Knowledge-Based Weaning
Determining Readiness to Wean
Placing the Patient into a Spontaneous Breathing Trial
Concluding the Spontaneous Breathing Trial
Planning for Extubation
References
Additional Resources
Practice Activities: Weaning and Discontinuation of Mechanical Ventilation
Determining Readiness for Entry into a Spontaneous Breathing Trial
Scenario 1
Scenario 2
Placing a Patient into a Spontaneous Breathing Trial
Scenario 3
Scenario 4
Check List: Spontaneous Breathing Trial
Self Evaluation Post Test: Weaning and Discontinuation of Mechanical Ventilation
Performance Evaluation: Spontaneous Breathing Trial
Ch 29: Neonatal Mechanical Ventilation
Introduction
Key Terms
Theory Objectives
Basics of Neonatal Mechanical Ventilation
Modes of Ventilation
Continuous Positive Airway Pressure
Synchronized Intermittent MandatoryVentilation (SIMV)
Pressure SIMV
Volume SIMV
Assist Control (AC)
Pressure Assist Control
Volume Assist Control
Time-Cycled, Pressure-Limited (TCPL) Ventilation
Pressure Support (PS)
Volume Support (VS)
Volume Guarantee (VG)
Pressure Regulated Volume Control (PRVC)
Indications for Mechanical Ventilation in the Neonate
Apnea
Refractory Hypoxemia
Hypercapnia (Elevated PaCO2)
Underlying Conditions That May Contribute to Respiratory Failure
Newborn Ventilatory Support Concepts
Time Constants
Time Cycling
I:E Ratio and Inspiratory Time
Pressure Limiting
Flow Rate
Proximal Sensing
Hazards and Complications of Newborn Mechanical Ventilation
Assessing the Need for Mechanical Ventilation
Equipment Requirements
Ventilator Preparation
Establishing Ordered Ventilator Settings
Mode
Rate
Flow Rate
Inspiratory Time
I:E Ratio
Peak Inspiratory Pressure
Tidal Volume
Oxygen Percent
PEEP/CPAP Level
Alarms
High and Low Inspiratory Pressure Alarms
High and Low Minute Volume Alarms
High and Low Tidal Volume Alarms
High and Low PEEP/CPAP Alarms
High and Low Respiratory Rate Alarms
Gas Pressure Failure
Ventilator Inoperative Alarms
Patient Monitoring and Assessment
Pulmonary
Cardiac
Renal
Ventilator Monitoring
Mode
FIO2
Airway Pressures
Respiratory Rate
Flow Rate
Inspiratory Time and I:E Ratio
Temperature
Alarm Settings
Noninvasive Neonatal Mechanical Ventilation
Indications for Nasal CPAP
Oxygenation Failure
Increased Work of Breathing
Disease Processes that Respond to Nasal CPAP
Contraindications for Nasal CPAP
Hazards and Complications of Nasal CPAP
Limitations of Nasal CPAP
Outcomes of Nasal CPAP
Necessary Equipment
Commercially Available CPAP Systems
Monitoring
High-Frequency Ventilation (HFV)
High-Frequency Oscillatory Ventilation (HFOV)
Gas Exchange Mechanisms
Ventilator Controls
Indications
Management Strategies
References
Practice Activities: Viasys AVEA
Circuit Assembly
Testing the Ventilator Before Use
Power-On Self Test (POST)
Extended Systems Test (EST)
Using the Keyboard Entry System
Activities
Lung Simulator Setup
Mode Selection
Alarm Setting
Patient Monitoring
Inspiratory Time Control
Inspiratory Pressure Control
Flow Rate
Changes in Resistance and Compliance
Volume Control Ventilation
Test Lung Setup
Initial Ventilator Settings
Tidal Volume Control
Respiratory Rate Control
Neonatal Practice Activities: Nellcor Puritan Bennett 840
Circuit Assembly
Testing the Ventilator Before Use
Power-On Self Test (POST)
Short Self Test (SST)
Using the Keyboard Entry System
Activities
Lung Simulator Setup
Patient Setup
Alarm Setting
Patient Monitoring
Inspiratory Time Control
Peak Pressure Control
Changes in Resistance and Compliance
Volume Control Ventilation
Test Lung Setup
Initial Ventilatory Settings
Alarm Setting
Tidal Volume Control
Respiratory Rate Control
Changes in Resistance and Compliance
Noninvasive Ventilation (NASAL CPAP)
Alarm Setting
Adjusting Settings Based On Clinical Data
Alarm Setting
Neonatal Practice Activities: Maquet SERVO-i
Circuit Assembly
Pre-use Check
Activities
Lung Simulator Setup
Patient Setup
Alarm Setting
Patient Monitoring
Inspiratory Time Control
Peak Pressure Control
Changes in Resistance and Compliance
Test Lung Setup
Initial Ventilator Settings
Alarm Setting
Tidal Volume Control
Respiratory Rate Control
Changes in Resistance and Compliance
Pressure Regulated Volume Control
Test Lung Setup
Initial Ventilator Settings
Alarm Setting
Changes in Compliance
Adjusting Settings Based on Clinical Data
Alarm Setting
Neonatal Practice Activities: Dräger Babylog 8000 plus
Circuit Assembly
Using the Controls on the Dräger Babylog 8000 Plus
Testing the Ventilator Before Use
Flow Sensor Configuration/Calibration
Leak Test
Airway Pressure
Apnea Monitoring
Minute Volume Monitoring
Airway Pressure Monitoring
Activities
Lung Simulator Setup
Mode Selection
Alarm Setting
Patient Monitoring
Inspiratory Time Control
Inspiratory Pressure Control
Flow Rate
Changes in Compliance
Volume Guarantee
Changes in Compliance with Volume Guarantee
Neonatal Practice Activities: Arabella Nasal CPAP System
Circuit Assembly
Using the Controls on the Arabella Nasal CPAP System
Testing the Arabella Nasal CPAP System before Use
Oxygen Analyzer Functional Test
Blender Alarm Functional Test
Pressure Functional Test
Alarms
Patient Interface
Activities
Circuit Assembly and Pre-Use Check
Device Operation
Alarms
Practice Activities: Viasys Sensor Medics 3100A High-Frequency Oscillatory Ventilator
Circuit Assembly
Operational Verification Testing before Use
Control Operation
Delta P (ΔP) and Frequency
Piston Centering
% Inspiratory Time Control
Mean Airway Pressure
Check List: Initiation of Neonatal Mechanical Ventilation
Check List: Monitoring Neonatal Mechanical Ventilation
Check List: Initiation of Neonatal Nasal CPAP
Check List: Monitoring of Neonatal Nasal CPAP
Self-Evaluation Post Test: Neonatal Mechanical Ventilation
Performance Evaluation: Initiation of Neonatal Mechanical Ventilation
Performance Evaluation: Monitoring Neonatal Mechanical Ventilation
Performance Evaluation: Initiation of Neonatal Nasal CPAP
Performance Evaluation: Monitoring of Neonatal Nasal CPAP
Performance Evaluation: High-Frequency Oscillatory Ventilation
Appendix: Answers to Self-Evaluation Post Tests
Chapter 1
Chapter 2
Chapter 3
Chapter 4
Chapter 5
Chapter 6
Chapter 7
Chapter 8
Chapter 9
Chapter 10
Chapter 11
Chapter 12
Chapter 13
Chapter 14
Chapter 15
Chapter 16
Chapter 17
Chapter 18
Chapter 19
Chapter 20
Chapter 21
Chapter 22
Chapter 23
Chapter 24
Chapter 25
Chapter 26
Chapter 27
Chapter 28
Chapter 29
Glossary
A
B
C
D
E
F
G
H
I
K
L
M
N
O
P
Q
R
S
T
U
V
W
Z
Index
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