RRT

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  1. Ventilation
    • def: moves air in and out of lungs
    • 1st priority( always check ventilation 1st)
    • measured by: RR, Vt, Bs, Chest excursion,PaCo2,Etco2
  2. Oxygenation
    • def:getting O2 in the blood
    • 2nd priority(most common problem)
    • measured by: HR, color, sensorium,PaO2,SaO2
  3. Circulation
    • def: moves blood through the body
    • 3rd priority
    • measured by:heart rate and strength, cardiac output
  4. Perfusion
    • Def: getting o2 in the tissue
    • 4th priority
    • measured by: BP, sensorium, temp, urine output, hemodynamics
  5. Admission Notes
    • Things to keep in mind
    • 1)admitting diagnosis
    • 2)history of present illness
    • 3)past medical history
    • 4)current medication
  6. Signs
    • def: OBJECTIVE info, things you can see or measure
    • ex: color, pulse, edema, Bp
  7. Symptoms
    • def: SUBJECTIVE info, things the patient must tell you
    • ex: dyspnea, pain, nausea, muscle weakness
  8. Vitals
    • 1)RR
    • 2)Bp
    • 3)temp
    • 4)pulse
  9. Advanced Directives
    • def: instructions documenting what treatment a patient would want if they're unable to make medical decisions
    • must be: dated,signed, notarized,witnessed
    • ex of patients:  end stage COPD or terminal illness patients
  10. Types of Advance Directives
    • DNR (Do Not Resuscitate)
    • DNI (Do Not Intubate)
    • living will
    • durable power of attorney of health care
  11. Tobacco Use
    • pack years =# of packs/day (x) # of yrs. smoked
    • ex: 4packs/day (x) 10yrs= 40 pack years
  12. Intake and Output
    • Urine Output: 40-60 ml/hr or 1L a day
    • sensible water loss: urine, vomiting
    • insensible water loss: lungs and skin
    • if intake exceeds output: weight gain, electrolyte imbalance, increase in hemodynamic pressure, decrease in lung compliance
  13. Fluid Balance
    • CVP(central venous pressure) =change in fluid balance
    • normal cvp= 2-6 mmhg
    • decreased cvp <2mmhg indicates hypovelemia
    • fix with: fluid therapy
    • increased cvp >6mmhg indicates hypervolemia
    • fix with: diuretics ex:lasix
  14. Level of Consciousness (LOC)
    • Better----->Worse
    • Normal: alert and responsive
    • Lethargic, Somnolent, Sleepy: sleep apnea or excessive o2 therapy in patients with COPD
    • Stuporous, confused: responds inappropriately, drug overdose, intoxication
  15. Level of Consciousness (LOC) continued
    • Semicomatose: responds to painful stimuli
    • Obtuned: drowsy state, may have decreased cough or gag reflex
    • Coma: does Not respond to painful stimuli
  16. Emotional State
    • Anxiety,nervousness: watching every movement, respiratory distress, hypoxemia
    • Depressed: quiet/denial
    • Anger, Combative, Irritable: electrolyte imbalance
    • Euphoria: drug overdose
    • Panic: severe hypoxemia, tension pnuemo,or status asthmaticus
  17. Subjective Symptoms
    • Orthopnea- difficulty breathing except in the upright position
    • General malaise-run down, nausea, weakness, fatigue, headache (electrolyte imbalance)
    • Dyspnea-difficulty breathing
  18. Dyspnea Grades
    • Grade 1: dyspnea occurs after unusual exertation
    • Grade 2: breathless after going up hills and stairs
    • Grade 3: dyspnea walking at normal speed
    • Grade 4: dyspnea slowly walking short distances
    • Grade 5: dyspnea at rest, shaving, dressing
    • (bigger #= more severe dyspnea)
  19. General Appearance
    • age
    • height
    • weight
    • nourishment
  20. Edema
    • Excessive fluid in tissue aka pitting edema
    • Occurs in arms and ankles
    • Caused by CHF and renal failure
    • fix with diuretics
  21. Digital Clubbing
    • Caused by: hypoxemia
    • Suggest: pulmonary disease
    • the angle of the nail bed is increased
    • the thumb and 1st finger are affected
  22. Venous Distention
    • JVD (jugular vein distention)
    • Occurs with: CHF
    • Seen during exhalation with obstructive lung diseases
  23. Diaphoresis
    • Def: profuse/ heavy sweating
    • Heart failure: fix with--->diuretic(+) inotropic agent
    • Fever/Infection: fix with--->antibiotics
    • Anxiety/Nervousness: fix with---> sedatives
    • TB/night sweats: fix with---> antitubercular drugs
  24. Skin Color
    • Jaundice: increases in bilirubin level in blood/ tissue appears in face and trunk
    • Erythema: redness of skin due to capillary congestion, inflammation, or infection
    • Cyanosis: blue/gray discoloration of mucus membranes caused by hypoxemia from an increase of reduced hemoglobin
  25. Chest Configuration
    • Kyphosis: convex curvature of spine (lean forward)
    • Scoliosis: lateral curvature of the spine (side to side)
    • Kyphoscoliosis: causes restrictive pattern and reduced lung volumes
    • Barrel chest: air trapping in the lungs for a long period of time ex: COPD( increase in A-P diameter)
  26. Chest/ Diaphragm movement
             Symetrical
    • Both sides of chest move equally
    • Abdomen moves out during inspiration
    • Diaphragm descends during inspiration
  27. Chest/ Diaphragm movement         Asymetrical
    • Unequal movement of chest
    • lung removal (post)
    • Atelectasis
    • Post lung resection
    • Pneumothorax
    • Flail chest: paradoxical movement
    • ETT inserted in right/ left mainstem bronchus
  28. Eupnea
    • Normal: respiratory rate, depth, and rhythm
    • Adult: 12-20 bpm
    • Infant: 30-60 bpm
  29. Tachypnea
    • Increase respiratory rate grater than 20(adults)
    • Causes: hypoxia, fever, pain, CNS problem
  30. Bradypnea
    • Decrease in respiratory rate lass than 12 (adult) variable depth and irregular rhythm
    • Cause: sleep(normal), drugs, alcohol, metabolic disorder
  31. Hypercapnea
    • Increase in respiratory rate  and depth with a regular rhythm
    • Causes: metabolic disorder,CNS disoreder
  32. Apnea
    Cessation of breathing
  33. Cheyne Stokes
Author:
KenCan93
ID:
313261
Card Set:
RRT
Updated:
2015-12-16 14:06:02
Tags:
RRT
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RRT flashcards
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