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29 Cards in this Set
- Front
- Back
What causes the acid base balance of a PaCO2 below 35
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Hyperventilation
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What causes the acid base balance of a PaCO2 above 45
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Pulmonary Edema, Asthma, COPD, Code
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What causes the acid base balance when HCO3 is below 22,
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Lactic acidosis, DKA, Renal Failure, Diarrhea
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What causes the acid base balance of HCO3 above 26
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Vomiting, Gastric Suction, Hypokalemia, Excess Bicarbonate
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What is typical for the initial stage of ARDS
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A pH of 7.48, a PaCO2 of 32, a HCO3 of 23, a PaO2 of 65, an O2 saturation of 84%.
This indicates the initial response to hypoxemia with a low PO2 and respiratory alkalosis due to tachypnea. |
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When is mechanical ventilation needed-what are the typical ABGS?
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Acid 7.31, PaCO2 55, HCO3 24...
In ARDS this is the typical indication that there is less gas exchange and ABG results may be used to determine the need for mechanical ventilation |
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What happens in the late stage of ARDS
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When the FIO2 has been at 100% without an elevation of PaO2, hypoxia results in lactic acidosis. Eventually, the body no longer gets enough perfusion of oxygen to the tissues to maintain aerobic metabolism. When the metabolism changes to anaerobic there is lactic acid produced and will cause an ABG that indicates combined metabolic and respiratory acidosis. The identifying characteristics of this combined or mixed imbalance is that pH, PaCO2 and HCO3 all indicate acid values. For example, the pH would be 7.18, the PaCO2 would be 72, and the HCO3 would be 18
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Intubation supplies
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E-T tube (normal adult about 8-8.5)
Laryngoscope with light (blades are curved or straight) 10 cc syringe for inflating cuff Stethoscope Tape or velcro band Patient with head hyperextended Hyperventilate with 100% O2 |
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Vintilator Settings Ordered (Volume cycled ventilator)
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Fraction of inspired oxygen (FIO2)-50%
Tidal Volume 700 ml Assist Control Mode Rate 16 breaths per min PEEP at 5 mmHg Inspiratory/Expiratory Ratio |
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Vent Modes
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Assist control-If patient initiates a breath then all the tidal volume goes in.
SIMV-if patient initiates a breath those extra breaths are at volume patient controls-used in weaning Pressure Support-Decreases the work of breathing-Makes respirations deeper-Less likely to have a pneumothorax because pressure does not vary much |
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Goals in ARDS
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Maintain adequate ventilation
FIO2 is set at the lowest possible level to maintain a PO2 higher than 60 mmHg and O2 saturation of approximately 90% Avoid PEEP complications Decreases cardiac output Increases risk of barotrauma-pneumothorax |
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Acute Respiratory Distress Syndrome
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AKA noncardiac pulmonary edema
Progressive refractory hypoxemia does not improve with oxygen administration Mortality rate 50% or greater. |
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High pressure Alarms-when do they occur?
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Kinked tubing-needs to be straightened
Secretions present-needs suctioning Patient coughing-question suctioning-maybe Fighting ventilator-Sedation or change vent settings Bronchospasm-happening from bronchodilators Compliance changes (Pneumothorax or atelectasis) -chest x-ray is needed Condensation of humidity in tubing |
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Low pressure alarms-when do they go off?
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Check for leaks or disconnects
Listen for air escaping Consider leak around cuff or low pressure in cuff Temperature probe off. |
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BIPAP option
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Support Ventilation
Tight fitting mask Must have cooperative Patient No ability to suction Orders -Peak inspiratory pressure -Expiratory pressure (Compares with PEEP) -Rate |
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Define Acute respiratory distress syndrome ARDS
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ARDS is characterized by noncardiac pulmonary edema and progressive refractory hypoxemia
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Conditions associated with the development of ARDS
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Shock-Hemorrhagic shock, septic shock
inhilation injuries-NEAR DROWNING, oxygen toxicity, smoke and toxic gases infections-Gram negative sepsis, viral pneumonias, miliary tuberculosis drug overdose-heroin, methadone, aspirin, trauma-burns, head injury, lung contusion, fat emboli pancreatitis, multiple transfusions, open heart surgery w/ cardiopulmonary bypass |
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Nursing diagnoses for Respiratory Failure
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Impaired Spontaneous ventilation
Dysfunctional ventilatory weaning response Ineffective airway clearance Impaired Gas exchange |
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Nursing interventions for Respiratory Failure
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Respiratory monitoring
Artificial Airway Management Mechanical ventilation Anxiety reduction Mechanical ventilatory weaning Energy management Airway suctioning Airway insertion and stabilization Oxygen therapy |
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Cause of respiratory failure:Impaired Ventilation
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Airway obstruction-Laryngospasm, foreign body, aspiration, airway edema,
Respiratory disease-Asthma, COPD Neurologic causes-Spinal cord injury, poliomyelitis, Guillain-Barre Syndrome, drug overdose, stroke, Chest wall injuy-Flail chest, pneumothorax |
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Cause of Respiratory Failure: Impaired Diffusion
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Alveolar disorders: Pneumonia, pneumonitis, COPD, Heart Failure, Acute respiratory distress syndrome (ARDS), near-drowning
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Cause of respiratory failure: ventilation-perfusion mismatch
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Pulmonary embolism
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Describe respiratory failure and it's relation
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Respiratory failure is not a disease but a consequence of severe respiratory dysfunction. It is often defined by arterial blood gas values. An arterial carbon dioxide level PO2 of less than 50-60 and an arterial carbon dioxide level of PCO2 of greater than 50 mmHg are generally accepted as indicators of respiratory failure
Except for COPD patients, which may be their normal values. |
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Pathophysiology of respiratory failure
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Respiratory failure may be characterized by primary hypoxemia or a combination of hypoxemia and hypercapnia.
Hypoxemia manifestations: Dyspnea, tachypnea, cyanosis, restlessness, apprehension, confusion, impaired judgment, Tachycardia, dysrhythmias, hypertension, Metabolic acidosis Hypercapnia Manifestations: Dyspnea-respiratory depression, headache, papilledema, tachycardia, hypertension, drowsiness, coma, systemic vasodilation, heart failure, respiratory acidosis |
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drugs used in treating respiratory failure
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Beta adrenergic (sympathomimetic) or anticholinergic medications may be administered by inhilation to promote bronchodilation.
Methyxanthine bronchodilators (theophylline derivatives) may be given intravenously. Corticosteroids administered by inhalation or intravenously, may be ordered to reduce airway edema. Antibiotics are given to treat any underlying infection Sedation and analgesia often are required during mechanical ventilation to decrease pain and anxiety. Benzodiazepines such as diazepam (Valium), Ativan, or Versed may be used for sedation to inhibit respiratory drive. IV morphine or fentanyl provide analgesia and also inhibit the respiratory drive allowing more effective mechanical ventilation. |
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Neuromuscular blockers: name and describe effect.
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Rocuronium (Zemuron)
Pancuronium bromide (Pavulon) Atracurium besylate (tracrium) Cisatracurium (Nimbex) These drugs competitively block the action of acetycholine (ACh) at skeletal muscle receptors, preventing muscle depolarization and contraction. Complete muscle paralysis is achieved within minutes. |
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Advantages and Disadvantages + potential complications of Oral Endotracheal tube
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More easily inserted
Larger tube can be used, facilitating work of breathing, suctioning Disadvantages: More difficult to secure, Can be obstructed by biting, Communication and mouth care more difficult Increased risk of lower respiratory infection Potential Complications: Obstruction or displacement Pressure necrosis of lip Tracheoesophageal fistula |
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Advantages, disadvantages, and potential complications of a nasal endotracheal tube
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Advantages:
More easily secured and stabilized Well tolerated by client Facilitate communication and oral hygiene Disadvantages Necessitate smaller tube which may impede removal of secretions Increased risk of lower respiratory infection Potential complications: Obstruction or displacement, Pressure necrosis of nares, Obstructive of sinus drainage, possible sinusitis, Tracheoesphageal fistula |
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Advantage, disadvantages, and potential complications of a tracheostomy
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Advantages:
Easily secured and stabilized Enable swallowing, speech, and oral hygiene, Avoid upper airway complicatons Disadvantages: Requires surgical incision Increased risk of lower respiratory infection Potential Complications: Hemorrhage due to incision or vessel erosion by tube Wound infection Subcutaneous emphysema |