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Complex Care > Mechanical Vent & ABGs > Flashcards

Mechanical Vent & ABGs Flashcards

1
Q

PH Value

A

7.35-7.45

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2
Q

PH Acidosis

A

<7.35

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3
Q

PH Alkadosis

A

> 7.45

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4
Q

PaO2 Value

A

80-100

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5
Q

PaCO2 Value

A

35-45

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6
Q

HC03 Value

A

22-26

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7
Q

ROME

A

Respiratory
*Opposite
Alkalosis ↑ pH ↓ PaCO2
Acidosis ↓ pH ↑ PaCO2

Metabolic
*Equal
Acidosis ↓ pH ↓ HCO3
Alkalosis ↑ pH ↑ HCO3

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8
Q

Respiratory Alkalosis ABG Data

A

↑ Increased PH
↓ Decreased PaC02

Opposite

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9
Q

Respiratory Acidosis ABG Data

A

Decreased PH
Increased PaC02

Opposite

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10
Q

Metabolic Acidosis ABG Data

A

Decreased PH
Decreased HC03

Same direction

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11
Q

Metabolic Alkalosis ABG Data

A

Increased PH
Increased HC03

Same direction

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12
Q

fully compensated

A

pH normal, both CO2 and HCO3 abnormal

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13
Q

partially compensated

A

all abnormal

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14
Q

Uncompensated

A

pH & either Co2 or HCO3 abnormal

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15
Q

ROOM AIR 21% OR 0.21 FIO2
NASAL CANNULA = 0.24-0.44 FIO2
HIGH-FLOW CANNULA = 0.60-0.90 FIO2
SIMPLE FACE MASK = 0.30-0.60 FIO2
NONREBREATHER = 0.60-0.80 FIO2

A
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16
Q

Pa02/Fi02 Ratio Normal Range

A

300-500mmHg

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17
Q

Pa02/Fi02 Ratio Mild Range

A

200-300 mm Hg
(27% mortality)

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18
Q

Pa02/Fi02 Ratio Moderate Range

A

100-200 mm Hg
(32% mortality)

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19
Q

Pa02/Fi02 Ratio Severe Range

A

<100 mm Hg
(45% mortality

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20
Q

Patho of Respiratory Failure

A

Sudden decrease in PaO2 or rapid increase in PaCO2
Early signs are hypoxemia and hypercapnia
Other signs: dyspnea, tachypnea, prolonged expiration, nasal flaring, intercostal muscle retraction, use of accessory muscles, decreased SpO2, tachycardia, HTN due to compensation, dysrhythmias, hypotension (late sign)

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21
Q

Hypovolemic Shock

A

Bp <90

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22
Q

Low pressure alarms

A

-Cuff pressure
-Check connections (is something displaced)
-Check ET placement
-Leak in system
-Is the vent functioning

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23
Q

High pressure alarms

A

-Pt biting ET tube
-Pt needs suctioning
-Pt coughing or gagging
-Pt having bronchospasm
-Failed equipment

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24
Q

DKA safe BG drop

A

<100 within an hr

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25
Q

3 Indications of mechanical ventilation

A
  1. Support oxygenation
  2. Support C02 clearance
  3. Reduce work of breathing
26
Q

Acidemia

A

An acid condition of the blood (pH<7.35).

27
Q

Alkalemia

A

An alkaline condition of the blood. (pH>7.45)

28
Q

Acidosis

A

The process in the patient which is causing the acidemia.

29
Q

Alkalosis

A

The process in the patient which is causing the alkalemia.

30
Q

Hypoxia

A

Lack of oxygen at tissue and cellular level.

31
Q

Hypoxemia

A

Low oxygen content in the arterial blood.

32
Q

ABG Objective info

A

-Acid-base status
-underlying cause of imbalance
-Body’s ability to regulate pH
-Overall oxygenation status (Sa02, Sp02)

33
Q

Respiratory Acidosis

A

↑ Paco2 = alveolar hypoventilation
-Airway obstruction
-loss of alveolar recoil
-inadequate time for exhalation

34
Q

Respiratory Alkalosis Causes

A

↑ pH
↓ pC02

-Hyperventilation
-Mechanical vent

35
Q

Nasal Cannula Oxygen

A

1-6 L/min, 22-44% or 0.24-0.44 Fi02
*1L/min increases oxygen by approximately 3-4%
Room air 21% so 1L = 24%, 2L = 28%, 3L = 32%

36
Q

Simple Face Mask Oxygen

A

5-12 L/min
30-60% oxygen or 0.30-0.60 Fi02

37
Q

Non-rebreather mask

A

15 L/min, 60-80% or 0.60-0.80 Fi02

*Put oxygen high as possible

38
Q

High-flow cannula

A

0.60-0.90 Fi02

39
Q

Endotracheal

A

‘oral intubation’
Visualize cords
Route of choice

40
Q

Nasotracheal

A

‘Blind approach’ cannot visualize larynx
Requires a smaller ETT, thus ↑ airway resistance & ↑ WOB
Associated with sinus infections
Independent risk factor for VAP

41
Q

Tracheal

A

Tracheotomy ‘surgical procedure’

After 3 days of intubation

42
Q

Immediate Nursing interventions after intubation

A

-Monitor ventilation with BVM
-Assess oxygenation by SpO2
-Suction when necessary
-Observe chest for symmetrical rise & fall
-Auscultate lungs bilaterally
-CO2 detector Yellow good Purple bad
-Secure the tube & identify ‘cm’ placement
-Inflate the cuff via pilot balloon

43
Q

Respiratory Failure Assessment S/S

A

-Sudden increase PaO2 or rapid increase PaCO2
-Early signs hypoxemia/hypercapnia
-Dyspnea, tachypnea, prolonged expiration, nasal flaring, intercostal muscle retraction, use of accessory muscles, decreased SpO2, tachycardia, hypertension (initially due to compensation), dysrhythmias & hypotension (late)

44
Q

Respiratory failure interventions

A

-Chest x-ray
-pulmonary function tests
-lab studies
-ABGs
-end tidal CO2 (obtained by CO2 nasal cannula or ventilator)
-O2 therapy-venturi mask, high flow nasal cannula, or vent, mobilize secretions, positioning (good lung down), suctioning prn, hydration status, bronchodilators, physiotherapy, aerosolized meds, monitor FiO2, monitor for hypermetabolic states-EN/TNP within 48 hrs if warranted, provide rest-decrease O2 demand and prevent delirium

45
Q

VAP Bundle

A

-Elevate head of bed 30-45 degrees
-daily awakening (sedation vacation)
-Prophylaxis for DVT
-Prophylaxis for peptic stress ulcer disease
-Daily oral care

46
Q

VAP prevention

A

-Intubate oral rather than nasal
-Initiate the ventilator bundle
-Good hand washing and aseptic suctioning
-Oral care for patient q2hrs - Brush twice daily
-Chlorhexidine swab 30 seconds, twice daily
-Use ETT that allows for continuous suction of subglottic secretions
-Nutrition within 24hrs. (Enteral preferred)
-Drain condensate away from patient
-Watch for infection (high wbcs and fever-sputum)
-Do NOT instill NS into the ET tube
-Discontinue mechanical ventilation use ASAP

47
Q

ETT Suctioning Complications

A

-Decreases PaC02 and 02 sats
-May cause ECG arrhythmias
-Increase arterial blood pressure
-Increase intracranial pressure
-May cause bronchospasm, tracheal hemorrhage, and tracheal wall damage

48
Q

Respiratory controlled rate

A

a set frequency of breaths per minute

49
Q

Respiratory Spontaneous rate:

A

supports breaths initiated by patient

50
Q

Respiratory Combo rate:

A

both a set rate and spontaneous support

51
Q

TIDAL VOLUME (VT)

A

Amount of gas to be delivered with each breath

52
Q

Tidal volume Calculation

A

6-8 ml/kg based upon IDEAL body weight

*Example: 70 kg patient should receive between 420 to 560ml

53
Q

Fi02

A

Fraction or percent of oxygen (O2) delivered to the client

54
Q

AC: Assist/ Control Ventilation

A

-Patient will receive a breath at a set rate, but the breath can be triggered by the patient or by the machine
-Preset tidal volume (Vt) or pressure (PIP)
-Ventilator performs most of the WOB
-If patient can trigger a spontaneous breath, they will always receive the Vt and can hyperventilate (Respiratory Alkalosis)

55
Q

SIMV

A

-Preset RR(f) at preset VT - (RR(f) should be low because of patient doing most of the WOB)
-In between preset breaths (f), the patient could initiate a spontaneous breath
-Vt of spontaneous breaths varies
-Helps to prevent respiratory muscle weakness, because the patient contributes to more WOB. but muscle fatigue can occur in the unstable patient
-Risk of hypoventilation (Respiratory Acidosis)

56
Q

CPAP

A

-Continuous positive airway pressure for a client who is spontaneously breathing
-Via ET Tube, or nasal pillow, mouth/nose mask, face mask
-Similar to PEEP when provided invasively
-Used with sleep apnea patients

57
Q

Respiratory Acidosis

A

Carbonic acid excess caused by: Hypoventilation, Respiratory failure
Compensation: Kidneys conserve HCO3– and secrete
H+ into urine

58
Q

Metabolic Acidosis Causes

A

DKA
Renal failure
Shock
Severe diarrhea

59
Q

Metabolic Alkalosis Causes

A

Severe Vomiting
Diuretics
Excessive GI suctioning
Excessive NaHC03

60
Q

Respiratory Acidosis Causes

A

Hypoventilation
COPD
Airway obstruction
loss of alveolar recoil
inadequate time fo exhalation
Sedative overdose

61
Q

Respiratory Alkalosis Causes

A

hyperventilation
mechanical ventilation (A/C)

Complex Care (10 decks)

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