Quiz 1 Flashcards
PaO2
80-100
PaCO2
Alkalineacidic
HCO3
Acidicalkaline
SaO2
> 95%
Gas exchange
O2 in and CO2 out
Happens in the alveoli
Gases diffuse across the membrane
Ventilation-perfusion mismatch
Breathing in and diffusion not equal
Results in hypoxemia
Causes of respiratory failure
Ventilation-perfusion mismatch
Impaired gas diffusion
Hypo ventilation
Impaired gas diffusion
How CO2 and O2 move across membrane into blood
Causes hypoxemia and hypercapnia
Hypoventilation
Not enough breathing
Hypoxemia and hypercapnia
Hypoxemia
Low levels of O2 in the blood
Hypercapnia
Increased CO2
If too much CO2 brain stops telling you to breathe
Manifestations of hypoxemia
Hypertension 1st, then hypotension tachypnea Poor tissue perfusion Cyanosis Anxious Dyspnea Change in LOC Diaphoresis
Manifestations of hypercapnia
Dyspnea pH > 7.45 Diminished lung sounds Dizzy, drowsy Tachy Change in LOC
Diagnostic assessment of gas exchange
VS O2 use CXR VQ scan CBC ABGs Sputum
Lactic acidosis
Too much lactic acid Higher the level the longer the problem Anaerobic Cells don't have enough O2 Causes tissue death
Modified aliens test
Put pressure on bilateral sides
See if you can draw blood and they will still have flow
Why intubate a pt
Inability to oxygenated
Inability to ventilate
Mental status
Ventilation allows
Increased lung volume
Fluid redistribution in alveoli
Decreased O2 demand
Positive pressure airway
Nurses responsibility during intubation
Document
Monitor
Supplies
Advocate
Rapid sequence for intubation
Analgesic
Sedative
Paralytic
Sedatives
Benzo
Propofol
Dexmedetomidine
Etomidate
Analgesic
Fentanyl
Hydromorphone
Paralytic S
Vecuronium
Cisatracurium
Complete control
Must be sedated
How to check tube placement
Chest x-Ray
CO2 detector
Listen for bilateral lung sounds
Nursing responsibilities post intubation
NG or Og
Restrain pt
Effectiveness of the intubation
O2 sats stable Lung sounds Vent compliance ABGs Mental status
SAT
Spontaneous awakening trial
Determines how much sedation
Shut off sedation and see if they are breathing
SBT
Done after SAT
RASS scale
Sedation level Allows titration of sedation \+ is crazy - is sedated 0 is normal
Cardio impact of intubation
Tachy
Change in BP
Respiratory impact
Improve gas exchange
Get rid of liquid
Complications of ventilation
Infection
Barotrauma
Ulcer
Imbalanced nutrition
Care of intubated pt
Oral care Reposition Q2hrs DVT, PUD Glucose control HOB 30 degrees Nutrition Communication Assess readiness for SAT and SBT Mobility Assess and treat delirium
FiO2
21-100%
Direct impact on gas exchange
Rate
Number of breaths given by the vent/min
Tidal volume
Amount of air given in each breath
Help with oxygenation
Pressure support
Weaning mode
Positive end expiration you pressure(PEEP)
Positive pressure at the end of expiration
Keeps alveoli open
Critical in oxygenation
Assist control mode
Preset number of breaths
And preset VT on the vent regardless of ventilator or patient initiated breaths
SIMV
Preset number of breaths delivered at VT set on the vent
Patient controls VT of any other breaths
BiPAP
Non-invasive ventilation 2 pressure Inspiratory and expiration Monitor for anxiety FiO2
Pneumothorax
Air in pleural cavity
Absent lung sound where deflated
Tachypnea
Accessory muscles
Hemothorax
Blood in pleural space
Diminished breaths sounds in lower lobe
Hemoglobin
Flail chest
2 or more consecutive ribs broken
See-saw resp.
Painful resp.
Pulmonary contusion
Bruising to lung, alveoli rupture
12-24hrs
Severe dyspnea
Blood tinged sputum
Nursing assessment of chest trauma
Lung sounds
Mental status
Chest X-ray
VS
Chest drainage system
Position below waist
Reestablish negative pressure
Advocate for pain meds
Chest system water level
Bubbling could indicate a leak, check tubing and site
Tidaling is movement of water with breathing
COPD
Chronic airflow obstruction
Exacerbations
Smoking
Chronic bronchitis
Thick excessive secretions Recurrent infections Expiration is difficult Then inspiration Blu bloaters
Emphysema
Progressive destruction of alveoli
Decreased ability to oxygenate blood
Cough, barrel chest, sit forward
Pink puffers
COPD nursing interventions
Wear O2 Bi-pap, c-pap Lung assessment Nutrition Cyanosis Smoking cessation
Bronchodilators
Albuterol-short acting
Aminophyline-long acting
Anticholinergic
Tiotropium
Daily use
Steroid
Fluticasone
Normal pH
Acidic alkaline