CHAPTER 10 RESPIRATORY FUNCTION AND THERAPY

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ADMINISTERING
PROCEDURE OXYGEN
GUIDELINES BY MANUAL RESUSCITATION
10-21
BAG CONTINUED
Nursing Action Rationale

Transport
1. If hyperinflation is used in transport, 1. Establishes a patent airway before patient
suction patient before disconnection for is moved. Provides information for assessing
transport; monitor heart and respiratory tolerance of transport.
rates and level of consciousness during
procedure.
2. Ventilate at rate of 12 to 15 breaths per
minute.

FOLLOW-UP PHASE
1. In cardiopulmonary arrest, verify return of 1. Establishes patient’s need for definitive
spontaneous pulse and respirations. therapy (drugs, defibrillation, intensive care).
Initiate further support as needed.
2. In suctioning or transport, return to 2. Note Sao2, heart rate, rate and ease of
previous support. Note patient tolerance respirations, arterial blood pressure (if
of procedure. monitored), level of consciousness. Report if
intolerance occurs.
Mechanical Ventilation
The mechanical ventilator device functions as a
substitute for the bellows action of the thoracic
cage and diaphragm. The mechanical ventilator
can maintain ventilation automatically for
prolonged periods. It is indicated when the
patient is unable to maintain safe levels of
oxygen or carbon dioxide by spontaneous
breathing even with the assistance of other
oxygen delivery devices.

Clinical Indications
Mechanical Failure of Ventilation
1. Neuromuscular disease
2. Central nervous system disease
3. Central nervous system depression (drug
intoxication, respiratory depressants, cardiac
arrest)
4. Musculoskeletal disease
5. Inefficiency of the thoracic cage in generating
pressure gradients necessary for ventilation
(chest injury, thoracic malformation)
Disorders of Pulmonary Gas Exchange
1. Acute respiratory failure
2. Chronic respiratory failure
3. Left ventricular failure
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4. Pulmonary diseases resulting in diffusion

abnormality
5. Pulmonary diseases resulting in ventilation-
perfusion mismatch

Underlying Principles
1. Variables that control ventilation and
oxygenation include:
a. Ventilator rate – adjusted by rate
setting
b. Tidal Volume (VT) – adjusted by tidal
volume setting; measured as inhaled
volume
c. Fraction inspired oxygen
concentration (FIO2) – set on ventilator or
with an oxygen blender; measured with an
oxygen analyzer
d. Ventilator dead space – circuitry
(tubing) common to inhalation and
exhalation; tubing is calibrated
e. PEEP – positive end-expiratory
pressure; set within the ventilator or with
the use of external PEEP devices;
measure at the proximal airway
2. CO2 elimination is controlled by tidal volume,
rate, and dead space.
3. Oxygen tension is controlled by oxygen
concentration and PEEP (also by rate and tidal
volume).
4. In most cases, the duration of inspiration
should not exceed exhalation.
a. Rate, tidal volume, gas flow in liters
per minute, and inspiratory pause all control
inspiratory time.
b. Inverse inspiration:exhalation (I:E) ratio
results in “stacking” of breaths or buildup of
pressure within the airway. Barotrauma and
decreased cardiac output can result when
inverse I:E ratio is used.
5. The inspired gas must be warmed and
humidified to prevent thickening of secretions
and decrease in body temperature. Sterile or
distilled water is warmed and humidified by way
of a heated humidifier.
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Types of Ventilators
Negative Pressure Ventilators
1. Applies Negative Pressure around the chest
wall. This causes Intra-airway pressure to
become negative, thus drawing air into the lungs
through the patient’s nose and mouth.
2. No artificial airway is necessary; patient must
be able to control and protect own airway.
3. Indicated for selected patients with respiratory
neuromuscular problems, or as adjunct to
weaning from positive pressure ventilation.
4. Examples are the iron lung and cuirass
ventilator.
Positive Pressure Ventilators
During mechanical inspiration, air is actively
delivered to the patient’s lung under positive
pressure. Exhalation is passive. Requires use of
a cuffed artificial airway.
1. Pressure limited
a. Terminates the inspiratory phase
when a preselected airway pressure achieved.