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CHAPTER 1 Introduction to Critical Respiratory Care

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CHAPTER 1 Introduction to Critical Respiratory Care CHAPTER © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION 1NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOTIntroduction FOR SALE OR DISTRIBUTION to CriticalNOT FOR SALE OR DISTRIBUTION Respiratory Care © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE ORDavid DISTRIBUTION C. Shelledy and JayNOT I. PetersFOR SALE OR DISTRIBUTION © Thep © Thep Urai/Shutterstock © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION OUTLINE 7. Explain the importance of interprofessional practice (IPP) in the ICU. Overview © Jones & Bartlett Learning, LLC8. Contrast the design and activities© Jones associated & withBartlett each of Learning, LLC Critical Respiratory Care NOT FOR SALE OR DISTRIBUTIONthe four zones or areas foundNOT in the FORICU. SALE OR DISTRIBUTION Types of Intensive Care Units (ICUs) 9. Explain the differences between an acute care hospital ward, Patients step-down unit, and ICU. Personnel 10. Explain the term long-term acute care (LTAC) to include the Intensive Care Unit Design types of patients seen in an LTAC facility. Other Units 11. Explain the difference between a specialty hospital and a Assessment© Jones of the & Patient Bartlett in the ICU Learning, LLC skilled ©nursing Jones facility &(SNF). Bartlett Learning, LLC ReviewNOT of theFOR Medical SALE Record OR DISTRIBUTION 12. ExplainNOT the importance FOR SALEof assessment OR of DISTRIBUTION the respiratory care Patient History patient in the ICU to include types of assessment procedures Physical Examination and methods used. Laboratory Studies 13. Identify common admitting diagnoses seen in the ICU. Imaging in the ICU 14. Explain the significance of specific physician’s orders in Bronchoscopy and Thoracentesis the ICU to include medication orders for respiratory care, © Jones & BartlettCardiac Monitoring Learning, in the ICU LLC © Jones laboratory& Bartlett testing, Learning, imaging, and special LLC procedures. Types of Respiratory Care Provided in the ICU 15. Describe the elements of the history and physical NOT FOR SALESummary OR DISTRIBUTION NOT FORexamination SALE performedOR DISTRIBUTION in the ICU. 16. Recognize and contrast the signs and symptoms of OBJECTIVES hypoxia, hypercapnea, respiratory failure, and ventilatory failure. 1. Define respiratory care and critical care. 17. Describe the importance of specific laboratory tests and 2. Summarize the disease© Jones states or & conditions Bartlett that oftenLearning, LLC imaging procedures performed© Jonesin the ICU. & Bartlett Learning, LLC require ICU admission and mechanical ventilatory support. 18. Explain the purpose of bronchoscopy and thoracentesis 3. Contrast the typesNOT of patients FOR seen SALE in the medical OR intensiveDISTRIBUTION performed in the intensive careNOT unit. FOR SALE OR DISTRIBUTION care unit (MICU), surgical intensive care unit (SICU), coronary 19. Describe the types of cardiac and hemodynamic monitoring care unit (CCU), pediatric intensive care unit (PICU), and performed in the ICU. neonatal intensive care unit (NICU). 20. Contrast the terms acute respiratory failure and acute 4. Explain the differences between Level I, II, III, and IV neonatal ventilatory failure. levels of care. 21. Recognize the indications for mechanical ventilatory support. 5.© JonesDescribe the & types Bartlett of services Learning, provided in a LLCLevel I Trauma 22. Describe© theJones use of airway& Bartlett clearance therapiesLearning, (ACT) inLLC NOTCenter. FOR SALE OR DISTRIBUTION the ICU.NOT FOR SALE OR DISTRIBUTION 6. Explain the types of personnel and their qualifications needed 23. Summarize the types of care often provided by respiratory to staff the ICU. therapists in the ICU. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 1 © Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. 9781284139860_CH01_001_026.indd 1 22/02/19 11:59 AM 2 CHAPTER 1 Introduction to Critical Respiratory Care © Jones &KEY Bartlett TERMS Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALEacute respiratory OR DISTRIBUTION conduction disorders NOTlong-term FOR SALE acute care OR DISTRIBUTIONrenal failure distress syndrome congestive heart (LTAC) respiratory care (ARDS) failure (CHF) mechanical ventilation respiratory failure acute respiratory coronary artery mechanical ventilatory respiratory therapist failure (ARF) disease (CAD) support sepsis acute ventilatory coronary care unit (CCU) medical intensive shock failure (AVF) © Jonescritical & Bartlett care Learning, LLCcare unit (MICU) ©step-down Jones unit& Bartlett Learning, LLC atelectasis NOT FORendobronchial SALE OR DISTRIBUTIONmusculoskeletal NOTsurgical FOR intensive SALE OR DISTRIBUTION bronchoscopy ultrasound (EBUS) disease care unit (SICU) bronchoalveolar exudate myocardial infarction (MI) thoracentesis lavage (BAL) heart failure neonatal intensive tracheostomy cardiac arrhythmia intensive care unit (ICU) care unit (NICU) transudate cerebral infarction interprofessional neuromuscular disease trauma center chronic© Jones obstructive & Bartlett Learning,education (IPE)LLC pediatric intensive© Jones & Bartlett Learning, LLC pulmonary disease interprofessional care unit (PICU) (COPD)NOT FOR SALE OR DISTRIBUTIONpractice (IPP) pneumonia NOT FOR SALE OR DISTRIBUTION coma intracranial hemorrhage pulmonary edema © Jones & OverviewBartlett Learning, LLC © JonesCritically & Bartlett ill patients Learning, are at high LLC risk for actual or potential life-threatening health problems.2 The purpose of this chapter is to introduce the reader NOT FOR SALE OR DISTRIBUTION NOTCritical FOR SALEcare is a OR term DISTRIBUTION used to refer to the care and to critical respiratory care and mechanical ventilation. management of critically ill patients who require so- We will review the definitions of respiratory care and phisticated support, careful and constant monitoring, critical care, discuss various types of intensive care and complex decision making to ensure that therapy units, and introduce patient assessment as applied to is adjusted as patients’ needs change. Critically ill the intensive care unit© (ICU)Jones patient. & Bartlett Types of respira-Learning, LLC © Jones & Bartlett Learning, LLC patients suffer from a wide range of diseases and dis- tory care provided in the ICU will also be reviewed, to NOT FOR SALE OR DISTRIBUTIONorders that often result in multiorganNOT FOR system SALE failure. OR DISTRIBUTION include ventilatory support, patient monitoring, care Examples include shock, trauma, cardiac disease, plans and protocols, and special procedures. hemodynamic instability, renal failure, neurologic Critical Respiratory Care disease, liver failure, and acute pulmonary disease. © Jones & Bartlett Learning, LLC Critically ill© patients Jones are & often Bartlett physiologically Learning, unstable, LLC Respiratory care may be defined as the healthcare dis- requiring comprehensive care and minute-to-minute ciplineNOT that FOR specializes SALE in ORthe promotion DISTRIBUTION of optimum adjustmentsNOT in the FOR support SALE provided. OR WhileDISTRIBUTION typically cardiopulmonary function and health.¹ Respiratory delivered in an ICU, critical care may be provided in care is specifically focused on the assessment, diag- the prehospital setting, emergency department, or nostic evaluation, treatment, and care of patients with other acute care settings. deficiencies and abnormalities of the cardiopulmonary Critical respiratory care refers to those respiratory © Jones & system.Bartlett Thus, Learning, the treatment LLC and support of patients in © Jonescare techniques & Bartlett and Learning, procedures used LLC in the assess- NOT FOR SALErespiratory OR failure DISTRIBUTION is a core respiratory care competency.NOTment, FOR diagnosis, SALE OR management, DISTRIBUTION support, monitoring, Respiratory care may be provided by physicians, and care of critically ill patients. While the types of nurses, physician assistants, or other healthcare provid- respiratory care provided in the ICU range from diag- ers. The respiratory therapist is specifically trained and nostic and monitoring procedures (e.g., blood gases, educated to deliver respiratory care to patients across © Jones & Bartlett Learning, LLCrespiratory monitoring), maintenance© Jones and & manage Bartlett- Learning, LLC multiple settings, including acute care hospitals and ment of artificial airways (e.g., suctioning and airway ICUs. Respiratory therapistsNOT FOR are trained SALE in ORcardiopul- DISTRIBUTIONcare), and basic respiratory careNOT techniques FOR SALE (e.g., OR DISTRIBUTION monary physiology and pathophysiology, the principles oxygen therapy, aerosolized medication delivery), an of biomedical engineering, and the application of tech- essential respiratory care function is the provision nology to assist in the provision of patient care services. of mechanical ventilatory support (also known as mechanical ventilation Respiratory© Jones therapists & Bartlett apply Learning,scientific principles LLC to © Jones )& to Bartlett patients suffering Learning, from LLCre- prevent, identify, and treat acute or chronic dysfunction spiratory failure. The role of the respiratory therapist in of theNOT cardiopulmonary FOR SALE system.OR DISTRIBUTION Thus, the respiratory the ICU includesNOT patientFOR SALEassessment OR and DISTRIBUTION monitoring, therapist
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