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ADULT NIV PA, What we'd be looking for on Reassessment: 1) Decrease…

- - - - CONFIRM PT ID
        "I'm just gonna check your wristband & make sure we have all our information correct"
        
        ASSESSMENT
        ”I’m just gonna do a quick assessment here”
        1) WOB - How is their WOB?
        2) Vitals (on monitor)
        -Ask if theres an order for sats - “Do we have an order for sats?”
        -If sats are low, increase flow to acceptable sats
        -COPD = 88%-92%
        -Normal = > 92%
        3) Auscultate - 6 points
        ”I’m just going to have a listen to your lungs if thats okay”
        
        EXPLAIN THERAPY
        ”I’m just going to set up this breathing machine we have here and we’re going to change what you have on right now to this mask & its gonna feel different than what you’re currently on right now because its going to push air into your lungs & its going to help your breathing feel a lot easier & be more effective at providing you some relief”
        
        SET UP THERAPY
        
        Parameters:
        1) Delta P or PS
        a) COPD = 6cmh20 (6-8)
        -gonna use a lower delta P bc already using a higher PEEP to splint the AWs; therefore, they can actually exhale so we might need LESS pressure now
        b) Pulm Fibrosis = 7cmh20 (6-8)
        -aggressive with pressures bc gonna be breathing rapidly & shallowly
        c) CHF = 6cmh20 (6-8)
        -Start with lower delta P bc we’re helping them w/ PEEP
        d) NMD = 3cmh20 (2-5)
        lower end of pressures bc nothing wrong with their lungs, just trying to augment their weak respiratory muscles/efforts
        e) Asthma = 7cmh20 (6-8)
        -Aggressive on pressures
        2) PEEP / EPAP
        a) COPD = 8cmh20 (6-8)
        -higher PEEP to help splint AW’s & stop dynamic compression from occuring
        b) PF = 5cmh20
        -Normal PEEP bc we’re not gonna be able to splint or force open scarred AWs or alveoli
        c) CHF = 8cmh20 (6-8)
        -Higher PEEP to help decrease preload & allow heart to not be so distended; therefore, allowing it to beat more effectively
        -Higher PEEP to increase afterload to make it easier to pump blood out as the thorax has higher pressure compared to other compartments
        d) NMD = 5cmh20, normal PEEP as nothing wrong with their lungs or their CL
        E) Asthma - 5cmh20
        -Normal PEEP as this is smooth muscle contriction so PEEP won’t help to counteract that
        3) FiO2 - Equivalent to what they’re on now or higher to help them tolerate it better
        4) TiMax - 1.2-1.5s
        
        SET ALARMS
        1) Apnea alarms on vent
        -Ensure PC lvl is higher than PS
        -RR of 12
        2) High Pressure Alarm = 20cmh20
        -Prevent air going into the stomach as the LES will open at approx. 20cmh20
        3) Widen out all other alarms and can tighten them afterwards
        
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