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resp pt management

respiratory system parient management

ventilatory pump failure (V) hypercapnia, inadequate alveolar ventilation, elevation in carbon dioxide
gas exchange failure (Q) hypoxemia
disorders of the CNS associated with a reduced drive to breathe depressant drugs, brain stem lesions, head tauma, CVA
disorders associated with neuromuscular function polio, myasthenia gravis, gulliain-Barre, SCI, paralytic drugs, electrolyte imbalance
disorders associated with musculoskeletal and pleural functions pleural effusion, flail chest
dissorders of the conducting airways laryngeal edema, asthma, bronchospasm
disorders of the gas exchanging units pneumonia, pulmonary edema, ARDS
acute respiratory failure interventions establish and maintain an airway, oxygenation, promote secretion clearance, optimize cardiac function
Nasal cannula 2 liters to max of 6 liters of O2
At what level of liters do you need to start humidifying the oxygen 4 liters
Simple face mask gives up to how much % of O2 60% O2
the partial rebreathing mask gives up to what % of O2 85% O2
the non-rebreather mask gives up to what % of O2 85% o2
This type of O2 deliverig system gives a very specific amount of O2 to the patient venturi mask
how to measure for an oropharyngeal airway size by measuring device from lips to angle of the jaw
how to measure for a nasophharyngeal airway size by placing device from ear lobe to corner of mouth
endotracheal tube ariway use uncuffed tubes for children younger than 10 years of age
oropharyngeal artifical airway not for use on concious patients
a high low endotrach tube has an extra lumen to use for suction to continusosly aspirate fluid around the trach and the balloon
Post intubation what are the most important nursing actions to initiate in reguard to the artificial airway secure the tube, order a CXR to assess placement, note com marking at front teeth and document, prevent self-extubation
how to prevent ventilator acquired pneumonia elevate head of bed to 35 degrees
suction should not be set greater than 150mm
position to improve diaphragm function and lung volume. What sequence of events should be used supine, sitting, sitting with feet dangling to standing
When a patient is on continuous lateral rotation therapy how many hours a day of rotation is necessary 18 hours
When a patient is on continuous lateral rotation therapy how many hours of rotation are necessary per shift 9 hours
When positioning a patient that has respiratory failure it is best to put the good lung down it gives the best oxygenation
beta 2 agonist albuterol
anticholinergics blocks vagas nerve
bronchodilators albuterol, anticholinergics, methylaxanthines
used to open an airway anti-inflamatory, steroids
breaks the protien bonds in mucus mucomyst
light to deep sedation sedative/hypnotic
sedative/hypnotic benzodiazepines(versed, valum, ativan), propofol, precedex
analgesics morphine, fentanyl
negative pressure ventilation for longterm or homehealth care not used in the acute care setting
forcing gas into lungs positive pressure ventilation
positive pressure ventilation could cause pneumothorax, barro trauma and low preload with low cardiac output
Why do you not want to use normal saline to moisten mucous build up or secretions causes decreased sats and puts bacteria into the lungs
monitor FiO2 changes with pulse oximetry
Goal for vent settings PaO2 greater than 60
Goal for vent settings SaO2 greater than 90
Goal for vent settings FiO2 less than or equal to 0.5
keep peak inspiratory pressure less than 40cm H2O if greater causes injury to lungs
a smaller tidal volume is needed when the lungs are less compliant
on the vent resp rate should be set around 12-20
PEEP hold avoli open to improve oxygenation
Positive end expiratiory pressure PEEP
keep less than 40 cm H2O PIP (pressure inspiratory pressure)
compare to set tidal volume exhaled tidal volume
methods y which the patient and ventilator interact to perform the respiratory cycle Mechanical ventilation MODES
Assist control set number of breaths at a set Vt, patient can take spontanious breaths, assisted breaths at a set Vt, minimal work for the patient
SIMV (synchronized Intermittent Mandatory Ventilation) set number of breaths at a set tidal volume, patient can take spontaneous breaths at their own tidal volume, allows patient to contribute to the work of breathing, also known as the weaning mode
volume control vent modes Assist control and SIMV
Pressure control (PC) patient receives a set number of breaths of a set inspiratory pressure, patient can take spontaneous breaths at a set pressure, minimal work for the patient, guaranteed number of breaths with inspiratory support, used for fullsupport and noncompliant lung
Pressure Support (PS) Patients spontaneous breaths are augmented by the delivery of a preset amount of positive inspiratory pressure patient has to iniciate every breath no rate is set
CPAP (continuous positive airway pressure spontaneous breating with pressure applied at end expiration, weaning mode, for patient that needs to maintain oxygenation
Airway Pressure Release Ventilation (APRV) provides two levels of CPAP, spontaneous breaths at anypoint in resp, starts at an elevated pressure followed by a release pressure, time on high pressure is longer than low pressure time, holds airway open
keeps alveoli open at all times and is for patients wit hvery incompliant lungs APRV (airway pressure release ventilation)
Pressure control vent modes PC, PS, CPAP, APRV
highest priority in the ICU vent alarm
never turn off an alarm
when a patient does not breathe for 20 sec. apnea
what would cause a low inspiratory pressure a break in the circuit
what would cause a high pressure limit coughing secretions kinked tube or biting
pressure injurt to the lungs barotrauma
how to prevent vent pneumonia washing hands, keep head of bed at 30degrees, use sterile procedures, and good oral care
if patient has a decreased cardiac output give volume, dopamine or dobutamine (inotrope)
Created by: dnoyes
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