Basic Guidelines for Safe Care of the Patient Receiving Pulmonary Therapeutic Management Flashcards
included on pulmonary assessment
- history
smoker or past diagnosis
pulmonary assessment
- insepction
respiratory rate
accessory muscles
sputum
skin color
skin turgor
Palpation
subcutaneous emphysema (crepitus)
pulmonary assessment
- auscultation
bilateral lung sounds
pulmonary assessment
last ABG
SpO2
O2 delivery system
airway
WBC
weaning parameters
bands
immature forms of neutrophils
what do bands indicated
infection
shift to the left is
6% or greater
where is a ABG usually drawn from
radial artery
ABG is a measurement of
gases (oxygenation and ventilation)
ABG normal values
pH: 7.35-7.45
PO2: 80-100
PCO2: 35-45
HCO3: 22-26
hypoxemia value
O2 less than 80
severe hypoxemia value
less than 60
why might respiratory alkalosis happen
hyperventilation
anxiety
fear
why might respiratory acidosis happen
decrease is respiratory rate or volume
hypoventilation
CNS depression
airflow obstruction: OSA, COPD, asthma
why might metabolic acidosis happen
decrease in perfusion
sepsis
cardiac arrest
hypovolemia
diarrhea
why might metabolic alkalosis happen
vomiting
NGT suction
excessive diuretics
why might mixed metabolic and respiratory acidosis happen
anoxia
cardiac arrest
how to we know the ET is placed above the carina
CXR
how far above the carina do we want the ET
4 cm
what information might a chest Xray provide
chest infiltrates
heart failure
pneumothorax
pleural effusuon
pneumonia
ARDS
will atelectasis require intubation?
maybe, it will help pop open the alveoli
for safety what do we want to check on the ET
well secured at the lip line
what is the lip line
number at lips to make sure tube didn’t move in or out
when do we auscultate
baseline
after treatments
after intubation
after repositioning ET
suspected hypoxemia
sudden detonation in patient or new onset dyspnea
what would we do if the patient has sudden deterioration in patient
auscultate
what do we do if the patient has new onset dyspnea
auscultate
which side is the bulk of the lung tissue on
posterior
we should listen on inspiration, expiration, or both
both
crackles may represent
fluid
how might we treat crackles
diuretics
rhonchi and wheezes is smaller or larger airways
larger
nasal cannula can deliver
1-6L
when will we humidifiy nasal canal
above 2 L
high flow NC can deliver
100% heated and humidified
high flow NC can deliver how many liters
60
what is the most accurate delivery of oxygen
venturi mask
what patient might we use a Venturi mask on
COPD
what is the highest delivery of oxygen using low flow
non rebreather mask
what should the O2 meter be set at for a non reabreather
10-15L
what type of breathing can lead to drying of secretions and then cause obstruction
open mouth breathing
how might we help eliminate airway issues
oral care
when might we suction
based on assessed need
suctioning the ET might help prevent
hypoxemia
the ET cuff should be inflated to
20-25 mm
what happens if the ET cuff is inflated above 20-25
could cause ischemia from loss of blood flow which can lead to necrosis
what is the average lip line for men and women
women is 21
men is 23
when might we use mechanical ventilation
prevent airway obstruction
prevent aspiration
guarantee FIo2
Glasgow under 8
reduce ICP
tidal volume setting
6-8mL/kg
we want the FIo2 to be set to highest or lowest? why?
lowest to prevent hypoxemia
ventilator rate settings
8-14
assist control is
same tidal volume with each breath
synchronized intermittent mandatory ventilation
same TV with breaths established rate
what is positive end expiration pressure (PEEP)
extra pressure to pop open alveoli which leads to better oxygenation
what is important to have in the room
bag valve mask
symptoms of acute respitrory distress in a mechanically ventilated patient
agitation
anxiety
chest pain
mental changes
bucking
arrhythmias
if you advance the ET too far, what might happen
right main stem intubation since the left lung is on an angle because of the heart so you will have absent left lung sounds
barotrauma
trauma due to the expansion of the lungs, over expanded
how to prevent ventilator associated pneumonia
oral care with antiseptics
maintain HOB at 30-45
vesicular breath sounds
inspiratory sounds longer than expiratory
soft intensity
low pitch
over most of both lungs
bronchovesicular breath sounds
inspiratory and expiratory are equal
intermediate intensity
intermediate pitch
1st and 2nd intercostal and between scapula
bronchial breath sounds
expiratory sounds longer than inspiratory
loud intensity
high pitch
mandibrum
tracheal breath sounds
equal
loud intensity
high pitch
over trachea and neck
fine crackles
discontinuous
high pitched
end of inspiration
course crackles
discontinuous
low pitch
early in inspiration and extend into expiration
wheeze
continuous
high pitch
more common in expiration
rhonci
continuous
low pitch
expiration
plural friction rub
low pitch
course rubbing
inspiration and expiration
risk factor for HAP
- host related
advanced age
altered LOC
COPD
altered immune system
severity of illness
poor nutrition
hemodynamic compromise
trauma
smoking
dental plaque
risk factors for HAP
- treatment related
mechanical ventilation
endotracheal intubation
unintentional extubation
bronchoscopy
Ng tube
previous antibiotic theapy
elevated Gastric pH
upper abdominal surgery
thoracic surgery
supine position
risk factors for HAP
- infection control related
poor handwashing practices
why do we want to monitor the patient closely after giving a reverseal agent
they can have shorter half lives compared to the sedative
