u The respiratory care plan provides a written description of the care the patient is to receive. u Respiratory care plans include the goals of ther-
apy, the device or procedure to be used, medica- tions to be given, frequency of administration, and duration of therapy.
u SOAP refers to S ubjective, O bjective, A ssess- ment, and P lan.
u Acute respiratory failure (ARF) is defined as a sudden decrease in arterial oxygen levels with or without carbon dioxide retention.
u Acute ventilatory failure (AVF) is defined as a sudden rise Pa 2 with a corresponding decrease in pH.
u Chronic ventilatory failure is defined as a chroni- cally elevated Pa 2 with a normal (compensated) or near-normal pH.
55 Key Points
u Respiratory care plans may be developed for basic and critical respiratory care, diagnostic testing, or specialized procedures.
u Oxygen therapy is indicated for documented or suspected hypoxemia, severe trauma, acute myo- cardial infarction (MI), and immediate postop- erative recovery.
u For delivery of low to moderate concentration of oxygen, the nasal cannula is the device of choice. u With unstable ventilatory patterns or rapid, shal- low breathing, an air-entrainment mask may be considered.
u For moderate to high concentrations of oxygen therapy for short-term use, consider a simple partial-rebreathing or nonrebreathing mask. u The primary indication for bronchodilator ther-
apy is to treat or prevent bronchospasm.
u Bronchodilator therapy is indicated in acute asthma, COPD, and whenever wheezing is due to reversible bronchoconstriction.
u Anti-inflammatory aerosol agents and antiasth- matic drugs include inhaled corticosteroids, cro- molyn sodium, and antileukotrienes.
u Techniques to mobilize or remove secretions include directed cough, suctioning, use of high- volume aerosol therapy, and bronchial hygiene. u Directed cough should be included as an integral
part of bronchial hygiene therapy.
u Forced expiratory technique (FET), also known as a “huff” cough, is a modified version of the directed cough.
u A cool bland aerosol is indicated in the treatment of upper airway edema and for postoperative management of the upper airway.
u Bronchial hygiene techniques include chest phys- iotherapy, kinetic therapy, high-frequency chest wall oscillation (HFCWO), positive airway pres- sure (PAP), the flutter valve, intrapulmonary percussive ventilation (IPV), and mechanical insufflation–exsufflation.
u Nasotracheal (NT) suctioning is indicated in cases where the patient’s spontaneous or directed cough is ineffective.
u The primary indications for lung expansion ther- apy are in the treatment and/or prevention of atelectasis.
u Lung expansion therapy may be used to prevent the development of respiratory failure, particu- larly in postoperative patients.
u The two primary techniques for applying lung expansion therapy are incentive spirometry and intermittent positive pressure breathing (IPPB). u Incentive spirometry should be considered in
patients who are able to perform the maneuver every 1 to 2 hours while awake and are able to achieve an adequate inspired volume.
u IPPB should generally be reserved for patients who have clinically important atelectasis in which other therapy has been unsuccessful.
u PAP is sometimes used to mobilize secretions and treat atelectasis.
u The goals of ventilatory support in the ICU include maintaining adequate tissue oxygenation, ventilation, and acid–base balance.
u Patient assessment and care plan development may require measurement of clinical parameters related to oxygenation, ventilation, and cardio- pulmonary function.
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