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5 rights of delegation
- 1) Right task
- 2) Right circumstance
- 3) Right person
- 4) Right direction and communication
- 5) Right supervision
Acute respiratory distress syndrome (ARDS)
- - A life-threatening lung condition that prevents enough oxygen from getting into the blood..
- s/s= Labored & rapid breathing, Low BP and organ failure, SOB
Chest tubes 3 chambers
- 1) suction control- continuous bubbling, 20cm H2O press (neg)
- 2) titles w/ respirations- little to no bubbling
- 3) collection chamber
How to prevent ventilator associated pneumonia?
- -Use closed suction system
- -Reposition often
- -oral care q2 hrs
- - wash hands
- - raise HOB
-Excessive pressure in lungs that cause damage
- a state in which the heart has been damaged so much that it is unable to supply enough blood to the organs of the body.
Why would increased PEEP cause cardiac arrhythmia? -
Decreased cardiac output
What diagnostic test should be performed prior to d/c vent?
Pressure for intratracheal tube pressure
Role of RN with intubation
- listen to lung sounds on each side
Positive pressure ventilation
Reason for trachea tube?
- Long term vent
- Upper airway obstruction
Facts about ARDS
- -Thicker alveolar walls d/t increase alveolar cap membrane
- - Leads to decreased lung compliance, need more pressure to inflate lungs
- - Can be associated with scarring from COPD and emphysema
- - Can r/o if give pt. increased O2 & sat> 100%
- – 50-60 percent mortality rate.
– upper airway obstructions (narrow airway)
– indicates constriction or spasim in the bronchioles, high pitched and musical
Pleural rub / pleurisy
– friction of pleural and visceral layers rubbing together
– fluid in the larger airways - course
Rales or crackles
– fluid in the smaller airways - finer
- Each individual has responsibility and ability to make own decisions.- Freedom of choice.
Law of Beneficence –
- Act in the best interest of others. The greatest good for the greatest number.
Law of fidelity
– Be committed to the purpose. We understand our professional responsibilities and commit to them and carry them out.
Types of ventilation
- -CMV – Continuous or CONTROLLED Mechanical Ventilation, set res rate regardless of pt.
- -A/C or Assist Control- designed to end when a set VOLUME has been delivered, over-ridden by the patient’s own spontaneous breathing after the set respiratory rate has been delivered.
- -Pressure Control-(Pressure Support), set to deliver each breath (f) at a “peak inspiratory pressure” (PIP)
- SIMV- MOST Common—Synchronized Intermittent Mandatory Ventilation, ventilator is relinquishing some of the control and beginning to allow the patient to take control of their breathing.
- pH= 7.35 – 7.45
- PCO2= 35 – 45
- HCO3= 22-26
Continuous Mandatory Ventilation (CMV)
- -Delivers preset # of breaths/min of a set TV
- - Pt cannot trigger breaths.
- - Pt. has no active role, must be sedated/paralyzed to avoid agitation/anxiety
- - Every breath supported by vent
- - A back-up control rate and tidal volume are set, but the patient may initiate or trigger the delivery of a breath.
- -More comfortable for the awake patient. Guard against apnea or insufficient minute volume.
Synchronized Intermittent Mandatory Ventilation (SIMV)
- - Combines a preset # of mandatory ventilator breaths with preset TV with capability for intermittent patient generated spontaneous breaths
- - Monitors pt. & delivers breath if pt does not initiate a spontaneous breath
- –- Pt.s must be monitored to assure adequate ventilation as the IMV rate is decreased.
Continuous Positive Airway Pressure (CPAP) and BiPAP
- -Applies pos. pressure to airways of spontaneously breathing patient.
- -Used with ET or tight-fitting mask.
- -All breathing spontaneous and pressure controlled.
- -Used to help maintain open airways and alveoli; decreases WORK OF BREATHING.
- -Pt. has to have a Resp. Drive. (Good weaning trial tool and good for sleep apnea)
- -BiPaP functions with independent control of inspiration and expiration and assists in keeping the airways open. (Think of 2 levels of pressure.)