Test 2 Flashcards
Normal Ph for blood?
7.35-7.45
Normal SpCO2 levels?
35-45
Normal HCO3 levels?
22-26
What would be considered respiratory acidosis?
Treatment?
Blood Ph is less than 7.35 and SpCO2 is above 45
What would be considered respiratory alkalosis?
Treatment?
Blood Ph is above 7.45 and SpCO2 is below 35
Treated by using an antianxiety to reduce hyperventilation
Correcting heart rhythms using medication or cardioversion
What would be considered metabolic acidosis?
Treatment?
Blood Ph is below 7.35 and HCO3 is below 22
Treated using sodium bicarbonate or using activated charcoal to detoxify any ingested substances
What would be considered metabolic alkalosis?
Treatment?
Blood Ph is above 7.45 and HCO3 is above 26
What does an assist control ventilator do?
Assist control ventilators (AC) will deliver ventilation at a set rate and will deliver the tidal volume either automatically or when the patient attempts to take a breath themselves. The tidal volume will be delivered in full with this setting no matter if the ventilator is initiating the breath or the patient is
What does a synchronized intermittent mandatory ventilator do?
What is a reason a SIMV may be used over an AC?
Synchronized intermittent mandatory ventilators (SIMV) will deliver the tidal volume at a set rate BUT, if a patient attempts to take a breath the tidal volume will not be delivered and the appropriate intake of tidal volume will be left to the patient
One reason that a SIMV may be used over an AC will be due to the fact that the SIMV allows the patient to use their respiratory muscles to maintain strength. Once the patient is able to take a certain number of unassisted breaths the patient may be viable to be extubated
What is high frequency oscillatory ventilation and what is it used for?
High frequency oscillatory ventilation is mostly used for emergency situations such as patients experiencing ARDS or neonates with meconium aspiration or neonate respiratory distress syndrome. The ventilator is used when other methods of ventilation have failed and maintains high PEEP continuously. This high PEEP can reopen collapsed alveoli but may also cause barotrauma or pneumothorax
What is pneumothorax?
Pneumothorax is a collapsed lung that can be caused by many conditions such as trauma, disease, or surgical procedures
How in pneumothorax treated?
Needle aspiration may be done in order to remove air or a chest tube may be inserted in order to remove air
What is hemothorax?
Hemothorax is where blood has leaked into the chest cavity causing pressure to collapse the lung. Additionally, blood can put pressure on the heart and cause dysrhythmias
What are some ways to treat hemothorax?
Needle aspiration in order to remove fluids as well as a chest tube to drain fluid
Where is a chest tube inserted?
Within the pleural space along the fourth or fifth intercostal space above the rib for pneumothorax
How is a chest tube placement confirmed?
X-ray or ultrasound
How does a wet suction drain work for chest tubes?
Water is placed in the chamber (usually up to -20) while hooked up to wall suction and the suction level is regulated by the amount of water in the chamber at the time
Bubbling will be present while the suction is active but should be intermittent
Water will evaporate eventually so monitoring is required
How does a dry suction drain work for chest tube?
Bellows is used instead of water and suction rate is set using a dial
What should be maintained and monitored after chest tube placement?
Chest tube must remain below patients chest level
Chest tube must be kept free from kinks or clots (water seal will not fluctuate if tubing is clamped or clotted)
Drainage must be monitored. Color should be noted as well as the amount draining which is typically less than 100cc per hour
Monitor the fluctuation of the water seal chamber
With a negative pressure pump the water should rise with inspiration and fall with expiration
Opposite is shown with positive pressure
If the water level does not fluctuate this could mean that the lung could have re-expanded or the tubing has a kink
Intermittent bubbling should be present but constant or excessive bubbling could be an indicator of an air leak
What should be assessed on a patient with a chest tube?
Monitor patient lung sounds and assess for dyspnea
Insertion site should be monitored
SubQ crepitus should be looked for (Co2 escaping below the skin, should feel like crackles)
What should be done if the patients chest tube system breaks?
If the patient system breaks the end of the tube should be placed 1 inch into sterile water in order to maintain the seal and a new system should be obtained
What should be done if the patients chest tube becomes dislodged?
If the patients chest tube becomes dislodged, a sterile dressing must be placed over the insertion site and taped over three sides in order to form a seal which allows air to escape and prevents tension pneumothorax
What should be done at bedside to remove a chest tube?
Chest x-ray must be done to assess the lungs
Sterile gloves and equipment required
Put patient in semi fowlers position
Pre medicate for pain
Monitor respiratory status
