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TMC study
Troubleshooting Changes in Vital Signs
Question | Answer |
---|---|
Hypotension | Decreased venous return (caused by positive pressure) Evaluate fluid balance and possible need for filling of vascular bed |
Hypertension | Anxiety response to decreased PaO2, decreased PaCO2 Reassure, alleviate fear Check patient-ventilator system; If not easily corrected obtain and evaluate ABG value |
Respiratory swing of blood pressure | Decreased venous return (caused by positive pressure) systolic/diastolic pressures indicate inadequate perfusion, evaluate fluid balance; consider filling vascular bed |
New arrhythmias | Anxiety Decreased PaO2 Decreased PaCO2 Increased PaCO2 Decreased venous return Reassure, alleviate fear |
Large swings in CVP or PCWP | Decreased venous return Check other hemodynamics parameters for adequacy of perfusion |
Decreased urinary output | Decreased renal perfusion Increased ADH Evaluate other hemodynamics parameters for adequacy of perfusion |
Fever | infection Atelectasis Increased metabolic rate caused by fighting the ventilator Overheated humidifier Treat infection/review precautions Check for mucous plugs, ET position Check sensitivity and patient triggering effort settings Check temp |
Changes in respiratory rate | Altered settings Change in metabolic needs Anxiety Sleep Check patient-ventilator settings Evaluate patient's metabolic rate Reassure, alleviate fears Normal observation |
Accessory muscle use/paradoxical breathing | Increased work of breathing Patient-ventilator dyssynchrony auto-PEEP Increase support level Provide pressure support ventilation Increase insp flow or sensitivity Eliminate auto-PEEP |