Exam 2 Flashcards
Arterial Blood Gases
This is from the artery, after they draw hold pressure longer because it is an artery to prevent bleeding.
Respiratory Alkalosis
Increased pH (>7.4) and decreased PCO2, Increased loss of CO2 from lungs
Causes: Hyperventilation Anxiety High altitudes Pregnancy Fever Hypoxia Initial stages of pulmonary emboli
Manifestations: Seizures Deep, rapid breathing Hyperventilation Tachycardia Decreased or normal BP Hypokalemia Numbness and tingling of extremeties Lethargy and confusion Light headedness N/V
Respiratory Acidosis
Decreased pH (<7.4) and increased PCO2, Retention of CO2 by lungs
Causes: Hypoventilation Drug overdose Pulmonary Edema Chest trauma Neuromuscular Disease COPD Airway obstruction Respiratory Depression (Anesthesia, Overdose, Increased ICP) Decreased Alveolar Capillary Diffusion (Pneumonia, COPD, ARDS, PE)
Manifestions Hypoventilation-> hypoxia Rapid, shallow respirations Decreased BP Skin/mucosa pale to cyanotic HA Hyperkalemia Dysrhythmias due to increased potassium Drowsiness, dizziness, disorientation Muscle weakness, hyperreflexia
Metabolic Alkalosis
Increased pH (>7.4) and increased HCO3, Decreased acid or increase in base
Causes: Loss of gastric juices Potassium wasting diuretics Overuse of antacids Severe vomiting Excessive GI suctioning
Manifestations: Restlessness followed by lethargy Dysrhythmias (Tachycardia) Compensatory Hypoventilation Confusion (decreased LOC, dizzy, irritable) N/V/D Tremors, muscle cramps, tingling of fingers and toes Hypokalemia
Metabolic Acidosis
Decreased pH (<7.4) and decreased HCO3, Decreased ability of the kidney to excrete acid or conserve base
Causes: Renal Failure Severe Diarrhea Sepsis Shock Salicylate OD Diabetic Ketoacidosis
Manifestations:
HA, Decreased BP, Hyperkalemia, muscle twitching, warm flushed skin (vasodilation), N/V/D
Changes in LOC
Kussmaul Respirations
Low-Flow Oxygen Delivery Systems
Partial rebreather mask
Non-rebreather mask:
Ensure sufficient oxygen flow so the reservoir doesn’t collapse during inspiration
12-15 liters per minute is recommended
When applying non-rebreather do not forget to set the oxygen to 12-15 or it won’t function correctly
High-flow Oxygen Delivery System
Venturi mask Face tent Aerosol mask Tracheostomy collar T-piece
Thoracic Surgery
Preop: Education, patient on vent, foley, IV, chest tube.
Post-op: Check incision for drainage/bleeding
Pain magement: Monitor
Bleeding precautions/drainage: Monitor
They will have a chest tube, if you have 350 ml of drainage in 1 hour call the provider because that is too much.
Pleural Effusion
Patho: Excess fluid in the pleural space
Manifestations: Caused by underlying disease Determined by the size of effusion Compresses adjacent lung tissue causing: Dyspnea, pain, diminished/absent breath sounds, dull to percussion, limited chest wall movement
Medical Management:
Thoracentesis- Remove fluid from pleural space to obtain sample for analysis, restore lung to full volume, and relieve dyspnea, limit amount removed to 1200-1500 mL to prevent CV collapse
Thoracentesis
Pre-op:
Get consent signed
Assessment and education
Encourage pt to take cough suppressant before, don’t want them to cough or breath deeply.
Post-op:
Assess breathing
Look at insertion site for bleeding and drainage
X-ray to look for complications
Inform provider if they have trouble breathing, cough up blood, fever, chills, pain gets worse
Complications:
Pneumothorax, lung collapse, pain, bleeding, bruising, infiltration, infection
Acute Respiratory Failure
Sudden, life-threatening deterioration of gas exchange
PaO2 <60, PaCO2 > 50, pH < 7.35
Early Signs:
Restlessness, fatigue, HA, Dyspnea, tachypnea, tachycardia, HTN
Hypoxia progression:
Confusion, lethargy, tachypnea, central cyanosis, diaphoresis
Management: Intubation
Nursing Management:
-Intubation:
Hold patient still
HOB elevated 30 degrees to prevent aspiration
Oral care Q2-4 hours
Suction the patient as needed to clear the airway, do not suction on schedule!
Turn Q2 hours
Maintain ventilator
Assess LOC, ABGs, pulse ox, VS
Implement turning schedule, mouth care, skin care, ROM
Care of a patient with an Endotracheal Tube
-Immediate after intubation
-Extubation: Removal of endotracheal tube
Have self-inflating bag and mask ready, suction, remove tape, and deflate cuff
Give 100% oxygen for a few breaths, insert new, sterile suction catheter tube. Have patient inhale at peak inspiration remove the tube and suction the airway while the tube is pulled out
Tracheostomy
Harder to deal with because they aren’t sedated
Do trach care, they have a stoma
Trach care is once per shift, plus as needed
Suction as needed
DVT prophylaxis, HOB elevated, oral care
Assess skin around the trach
Check ABG
Mechanical Ventilation Nursing Management
Frequent assessment Assessment of ventilator equipment Promote effective airway clearance Promote mobility Promote coping Promote communication Prevent complications Participate in weaning: Monitor for respiratory distress to see if they can breath on their own
Acute Respiratory Distress Syndrome (ARDS)
Happens in the small part of the lungs
Manifestations: Pulmonary edema (pink and frothy fluid) Arterial hypoxemia does not respond to oxygen Severe SOB Labored, rapid breathing Confusion, fatigue Tachycardia/arrhythmia Low PaO2
Management: Intubation with PEEP Identify and treat underlying condition Circulatory/fluid support: Trat hypovolemia, hypotension without causing further overload Nutritional support (35-45 kcal/kg/day) Pharm: Inotropic, vasopressor agents Neuromuscular blockers, sedatives
