Exam 1 pulmonary blueprint Flashcards
Prevention of complications for mechanical vent
Gastric ulcers = proton pump inhibitors and enteral nutrition
Venous thromboembolism (VTE) = pneumatic compression devices and anticoagulation prophylaxis
Acute Kidney Injury (AKI) = monitor intake and output, weights, and labs, be mindful of fluid status, and administer IV fluids and diuretics
Patient safety-mechanical ventilation
HOB elevated 30-40 degrees
Good hand hygiene
Sterile technique
Thorough oral care
Admin ordered antibiotics
PEEP settings
Prevent barotrauma
Intubation
Provides an endotracheal tube through the nose or mouth into the trachea. Provides patient airway, access for mechanical ventilation, facilities removal of secretions. Maintain cuff pressure between 20 and 25 mmHg. Intubation for no longer than 14 to 21 days (after will require a tracheotomy).
Immediately after intubation
- Check symmetry of chest expansion
- Auscultate breath sounds of anterior and lateral chest bilaterally
- Obtain capnography or end-tidal CO2 as indicated
- Ensure chest x-ray obtained to verify proper tube placement
- Check cuff pressure every 6-8 H
- Monitor for S & S of aspiration
- Ensure high humidity; a visible mist should appear in the T-piece or vent tubing
- Admin O2 concentration as prescribed by the HCP
- Secure the tube to the pts face with tape and mark the proximal end for position maintenance
– Cut proximal end of tub if it is longer than 7.5 cm (3 inches) to prevent kinks
– Insert an oral airway or mouth device if orally intubated to prevent the pt from biting and obstructing the tube - Use sterile suction and airway care to prevent iatrogenic contamination and infection
- Continue to reposition pt every 2 H and as needed to prevent atelectasis and to optimize lung expansion
- Provide oral hygiene and suction the oropharynx whenever necessary
Nurses responsibilities following intubation
Work with RT to ensure that the tube is placed correctly and remains in place.
Remember once the airway is secure, it is the nurses primary job to ensure that the pt is safe. That includes:
– Checking cuff pressure to make sure that we aren’t causing tracheal tissue damage
– Prevent aspiration (often that includes use of a proton pump inhibitor which will also help prevent stress ulcers.
– Ensuring that the tube is secure and that surrounding skin is cared for.
– Proper suctioning technique to prevent infection and tissue injury
– Reposition the pt
– ORAL CARE
normal pH
7.35 (A) -7.45 (B)
normal PaCO2
35 (B) -45 (A)
normal HCO3
22 (A) -26 (B)
A = & B=
acidosis
alkalosis (base)
acidosis &/or alkalosis
if pH is low its acidosis and if it is high it is alkalosis
respiratory &/or metabolic
if pH is acidosis and the CO2 is high = respiratory acidosis, if the pH is alkalosis and the bicarb is high = metabolic alkalosis.
If PaCO2 and HCO3 are both out of range, determine which one is the most out of range to determine if it is respiratory or metabolic.
PaCO2 = respiratory & HCO3 = metabolic.
fully compensated
pH is within normal range (7.35-7.45).
uncompensated
pH is out of range, either the PaCO2 or HCO3 is in range.
partially compensated
pH, PaCO2, and HCO3 are all out of range.
Chest tube management: patient
Ensure that the dressing on the chest around the tube is tight and intact.
Assess for difficulty breathing
Assess breathing effectiveness by pulse ox
Listen to breath sounds for each lung
Check alignment of traces
Check tub insertion site for contain of the skin. Palpate area for puffiness or crackling that may indicate subQ emphysema
Observe site for signs of infection (redness, purulent drainage) or excessive bleeding
Check to see if tube “eyelets” are visible
Assess for pain and its location and intensity, and admin drugs for pain as prescribed
Assist patient to deep breathe, cough, perform maximal sustained inhalations, and use incentive spirometry
Reposition the pt who reports a “burning” pain in chest
chest tube management: drainage system
Do not “strip” the chest tube
Keep drainage system lower than the level of the pt chest
Keep the chest tube as straight as possible, avoiding kinks and dependent loops
Ensure the chest tube is securely taped to the connector and that the connector is taped to the tubing going into the collection chamber
Assess bubbling in the water seal chamber; should be gentle bubbling on pts exhalation, forceful cough, position changes
Assess for “tidaling”
Check h2o level in the h20 seal chamber, and keep at the level prescribed by surgeon
Clamp the chest tube only for brief periods to change the drainage system or when checking for air leaks
Check and document amount, color, and characteristics of fluid in the collection chamber, as often as needed according to the pts condition
Empty collection chamber or change the system before drainage makes contact with the bottom of the tube
When a sample of drainage is needed for culture or other lab test, obtain it from the chest tube; after cleansing chest tube, use 20g or smaller needle and draw up specimen into the syringe
Interventions for ARDS
Early recognition and early intervention improves outcomes:
Raise the HOB
Auscultate lungs
Provide suction of thick secretions
Apply supplemental O2
Call the HCP
Treatment for ARDS
Depends on the underlying condition (bacterial infection = antibiotics, edema = diuretics)
Mechanical ventilation (positive end-expiratory pressure (PEEP), pressure in lungs increase atmospheric pressure)
Moderate/severe ARDS: airway pressure release ventilation (APRV) and High-frequency oscillatory ventilation (HFOV)
Severe ARDS: extracorporeal membrane oxygenation (ECMO)
treating and monitoring respiratory acidosis
Occurs when everything SLOWS down. High CO2 combined with low pH.
Low and slow RR
Sleep apnea
Head trauma “knocked out”
Post-op
Drugs = CNS depressants (opioid overdose, alcohol intoxication, and benzodiazepines (Diazepam)
Pneumonia
COPD or Asthma attack
recognition of pulmonary embolism
Prevention is KEY! VTE prophylaxis, routine anti-platelets (ASA), and anticoagulants (lovenox, heparin)
PE occurs most often when a DVT is ejected into the bloodstream and enters the IVC and occludes a pulmonary vessel.
Pts may experience: pain in the calf or thigh indicating a DVT, chest pain, dyspnea, coughing (with or without blood production) and LOC
post-op lung health
Turn, cough, deep breath
Incentive Spirometer 10x an H while awake
Ambulate early and often
Hydration to loosen secretions
Chest traumas:
blunt force
penetrating
tension pneumothorax
open pneumothorax
traumatic pneumothorax
simple pneumothorax
hemothorax
flail chest
blunt force chest trauma
Sternal rib fractures, flail chest, and pulmonary contusion
Wide mediastinum on chest x-ray, confirmed by CT scan.
BP decreased with beta blocker (esmolol) and endovascular repair
penetrating chest trauma
Gun shot wound, stabbing, and accidental fall
Diagnoses during FAST
Pericardiocentesis and resuscitative thoracotomy
