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What adventitious breath sounds are cleared with suctioning, or coughing?
ABG's that confirm respiratory failure are
- PaO2 <60
- FiO2 60% (amt. of o2 being delivered)
- PaCO2 >50
- Ph <7.25
What is the problem with oxygenation failure?
Oxygen is being inhaled but it cant get across the alveoli membrane
Illness that cause oxygenation failure
- Pulmonary embolism
- acute lung disease
What is the problem with ventilation failure?
perfusion is normal, but ventilation is inadequate cuz thoracic pressure cant be changed enough to move air in and out of the lungs
What is the defining lab of ventilation failure?
Intrapulmonary problems that cause ventilation failure
- Pulmonary fibrosis
- Pulmonary HTN
Extrapulmonary problems that cause ventilation failure
- Head trauma
- spinal cord injury
- over sedation
When a person is in respiratory failure what do I look at to determine if they are being given the proper amount of O2?
Always give the lowest level that will provide the best response
What do anxiety, pain and agitation do to a patient?
increases their O2 demand....so may need to sedate them to decrease O2 demands
Result of not being alert and oriented?
cant keep a patent airway
Where is the ET tube inserted?
through the vocal cords and sits above the carina
Difference between ET intubation and Trach
ET is used when you dont know how long it will take to resolve this problem...or you know if is short term.
Trach is used when you know it will be a long term solution to their problem
Positive End Expiratory Pressure
keeps alveoli open with pressure exerted at the end of expiration
This allows for gas exchange
3 Levels of proof for ET tube placement
- CO2 monitor turns gold
- Auscultate lungs...abdomen
- X ray...definitive check
TV is usually set at around
Common place the ET tube slides to...and how will I know this has happened?
rt main stem bronchus
- rt side rising only
- uneven breath sounds and rise and fall
What does it mean to maintain vent circuits?
ventilator provides humidified air, so there tends to be an accumulation of water in tube.
Need to remove the water away from the patient do decrease likelihood of VAP
What does it mean to have separate suction set ups on a ventilated patient?
to prevent VAP you need to have different suction apparatus for your G tube, oral care and end line
If you have a patient with a facial fracture what kind of ventilator will they be on?
Invasive....cpap and bipap have too large and tight of masks for them
Invasive ET tube ventilators settings are all classified by....
when inspiration ends
Volume cycled ventilator
inspiration ends when a preset volume is delivered
Pressure cycled ventilator
inspiration ends when a preset pressure is reached
Time cycled ventilator
inspiration ends when a preset time has elapsed
- has components of
Who gets controlled mandatory ventilation?
- a person who is having surgery
- or has a spinal cord injury
a set tidal volume is delivered at a set rate...requiring no spontaneous effort from the patient
How do you know a person on an assist control ventilator is ready to be weaned?
they are taking lots of breaths on their own and you will see respiratory alkalosis
Assist control ventilator
ventilator takes over the work of breathing for the client and delivers a set tidal volume
but patient regulates breathing rate
Pressure Regulated Volume Control ventilator
pressure determines how much TV will be delivered
adjustments are made by breath to breath....made by patient or the vent
Which invasive ventilator assists with weaning?
pressure support ventilator....they must be spontaneously breathing on their own
How do you wean a patient off of a ventilator?
- Put on CPAP and turn down the number of breaths per minute and watch.....
- O2 saturations
- HR for increase
- BP for increase or decrease
- How deep are they breathing on their own?
PEEP adds what kind of pressure?
prevents small airway collapse at the end of expiration to increase oxygenation
When a person has high PEEP it is common to have ? Intervention?
Tidal volume tells
the amount of air being delivered with each preset breath
IF a person is on the ventilator and the RR is different from what you are counting...which is right?
the percentage of oxygen delivered with each breath
What is a sigh breath and when is it used?
a breath that is delivered that has 1.5-2.5greater tidal volume than what is set on the vent
given before suctioning
Things done daily when on a ventilator
- ABG (until less chronic)
- and chest x ray
When suctioning how do you know the tube is in as far as it needs to go?
If you are suctioning and you notice the patient is having a dysrhythmia or the O2 falls below 85%....what 2 things do I do?
STOP and give them 100% O2
Best type of feeding for a ventilated patient?
How do you calculate the minute ventilation?
What is normal?
RR x TV
Hypervnetilation and hypoventilation and Tidal volume
hyperventilating causes the TV to decrease cuz breathing too fast to get good O2 in
hypoventilation or normal rate of breathing = good breath and tidal volume
How long does a sedation vacation last....
When you extubate a person what adventitious breath sounds can occur?
no matter how much oxygen you give the patient is staying hypoxic
Seen with ARDS
Putting a patient with ARDS prone it is common to see these VS changes
decrease HR and BP....cant tolerate it. Dont do
What is the problem with a pulmonary embolism?
a problem of PERFUSION....not ventilation
the clot in the capillary prevents gas exchange
- Venous Stasis
- Vessel Damage
VQ lung scan to dx PE
inhale isotope and take pic of lungs
difference btwn ventilation and perfusion shows PE
Collaborative care for PE
- provide respiratory and hemodynamic support
- anti coagulation therapy
- IVC insertion
What will be administered if suspected PE
Heparin IVP...has a short half life so it is ok
Going from heparin to coumadin
give both until coumadin is at a therapeutic level
Drug given if dx of embolis
Normal Cardiac Index
What two interventions increase CO
fluids and vasoactive drugs
#1 way to prevent a PE
OOB ....early and frequent ambulation
Coumadin and green leafy veggies
either teach dont eat at all....or teach if you are going to eat it always be consistent in the amount you consume
Central venous pressure measures pressure where?
in the right atrium
Pulmonary artery pressure measures pressure where?
rt. atrium, pulmonary artery and left ventricle
Which hemodynamic monitor measures overall cardiac function?
Pulmonary artery pressure....cuz looks at left ventricle too
Normal range for central venous pressure
Normal range for pulmonary artery pressure
15-25 over 8-15
Low pulmonary artery pressure means....
High pulmonary artery pressure means....
high volume or impedence to pulmonary blood flow
What does pulmonary capillary wedge pressure measure?
function of the left ventricle by looking at pressures generated by it.....but really tells us how CO is doing.
the volume that fills the L ventricle at the end of Diastole
wall tension generated by the LV during systole to open the aortic valve and eject it's contents
What does SVO2 tell me?
- tells me the balance between oxygen supply and demand.....
- normal is 60-80%
Whats the problem if you have really low SVO2?
- the cells and tissues have used a lot of O2 so they probably have
- infection....but needs more investigation
What does systemic vascular resistance measure?
- normal is 800-1200
not a lot of pressure....so probably vasodilated
lots of pressure....so probably vasoconstricted
How often do I monitor arterial blood pressure and correlate it to cuff BP?
What decreases pre load
- venous dilators
What increases after load
What decreases afterload
- ca channel blockers-anti hypertensives
4 primary goals of intubation
- maintain patent airway
- reduce WOB
- provide a way to remove secretions
- provide ventilation and oxygenation
List the equipment needed for emergency intubation
- ambu bag
- 100% o2 source
- oral airway
Correct ET tube placement is conclusively verified when
breath sounds are equal bilaterally
Nursing care for the client on a vent includes....
- monitor clients response
- apply soft wrist restraints as ordered
- maintain correct placement of ET Tube
NOT suctioning every hour to prevent complications
Number of ventilations delivered per minute
breaths per minute
positive pressure throughout the entire respiratory cycle to prevent alveolar collapse
Set Tidal Volume and Set rate delivered to the client
Pressure needed to deliver a set tidal volume
Peak Airway Inspiratory Pressure
Positive pressure delivered during EXPIRATION to keep lungs partially inflated
Allows client to breathe at own rate and tidal volume, but breathes for client when needed
Synchronized intermittent mandatory pressure
volume of air client receives with each breath
Intervention for normal pH with low PaO2?
Intervention for metabolic acidosis
correct the cause of metabolic acidosis
Intervention for respiratory acidosis
increase ventilation....especially the length of ventilation
pursed lipped breathingg
Intervention for respiratory alkalosis
Intervention for respiratory acidosis with low oxygenation
increase O2 and increase ventilation
When weaning a client from the ventilator the nurse should....
observe the monitoring device regularly from a distance but within the clients sight
An expected assessment finding in a recently extubated client is....
Which electrolytes cause PVC's (vent irregularities)
hypomagnesia and hypokalemia
How do you measure the effectiveness of anti dysrhythmic meds?
- continuous cardiac monitoring
- treadmill test
What lab tells a person is in heart failure?
- Elevated BNP
- b type natriueretic peptide
ICD is used to control....
life threatening dysrhythmias
Person with ARDS will receive
Mechanical Vent with PEEP
V fib and Pulseless V tach
- A Fib...with a wide QRS, asymptomatic
- V fib
- Pulseless V Tach
BB and CCB treat
- A fib
- PAC with underlying heart issues