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Mechanical Vent & ABGs Flashcards

(61 cards)

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1
Q

PH Value

A

7.35-7.45

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2
Q

PH Acidosis

A

<7.35

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3
Q

PH Alkadosis

A

> 7.45

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4
Q

PaO2 Value

A

80-100

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5
Q

PaCO2 Value

A

35-45

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6
Q

HC03 Value

A

22-26

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7
Q

ROME

A

Respiratory
*Opposite
Alkalosis ↑ pH ↓ PaCO2
Acidosis ↓ pH ↑ PaCO2

Metabolic
*Equal
Acidosis ↓ pH ↓ HCO3
Alkalosis ↑ pH ↑ HCO3

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8
Q

Respiratory Alkalosis ABG Data

A

↑ Increased PH
↓ Decreased PaC02

Opposite

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9
Q

Respiratory Acidosis ABG Data

A

Decreased PH
Increased PaC02

Opposite

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10
Q

Metabolic Acidosis ABG Data

A

Decreased PH
Decreased HC03

Same direction

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11
Q

Metabolic Alkalosis ABG Data

A

Increased PH
Increased HC03

Same direction

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12
Q

fully compensated

A

pH normal, both CO2 and HCO3 abnormal

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13
Q

partially compensated

A

all abnormal

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14
Q

Uncompensated

A

pH & either Co2 or HCO3 abnormal

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15
Q

ROOM AIR 21% OR 0.21 FIO2
NASAL CANNULA = 0.24-0.44 FIO2
HIGH-FLOW CANNULA = 0.60-0.90 FIO2
SIMPLE FACE MASK = 0.30-0.60 FIO2
NONREBREATHER = 0.60-0.80 FIO2

A
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16
Q

Pa02/Fi02 Ratio Normal Range

A

300-500mmHg

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17
Q

Pa02/Fi02 Ratio Mild Range

A

200-300 mm Hg
(27% mortality)

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18
Q

Pa02/Fi02 Ratio Moderate Range

A

100-200 mm Hg
(32% mortality)

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19
Q

Pa02/Fi02 Ratio Severe Range

A

<100 mm Hg
(45% mortality

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20
Q

Patho of Respiratory Failure

A

Sudden decrease in PaO2 or rapid increase in PaCO2
Early signs are hypoxemia and hypercapnia
Other signs: dyspnea, tachypnea, prolonged expiration, nasal flaring, intercostal muscle retraction, use of accessory muscles, decreased SpO2, tachycardia, HTN due to compensation, dysrhythmias, hypotension (late sign)

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21
Q

Hypovolemic Shock

A

Bp <90

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22
Q

Low pressure alarms

A

-Cuff pressure
-Check connections (is something displaced)
-Check ET placement
-Leak in system
-Is the vent functioning

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23
Q

High pressure alarms

A

-Pt biting ET tube
-Pt needs suctioning
-Pt coughing or gagging
-Pt having bronchospasm
-Failed equipment

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24
Q

DKA safe BG drop

A

<100 within an hr

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25
3 Indications of mechanical ventilation
1. Support oxygenation 2. Support C02 clearance 3. Reduce work of breathing
26
Acidemia
An acid condition of the blood (pH<7.35).
27
Alkalemia
An alkaline condition of the blood. (pH>7.45)
28
Acidosis
The process in the patient which is causing the acidemia.
29
Alkalosis
The process in the patient which is causing the alkalemia.
30
Hypoxia
Lack of oxygen at tissue and cellular level.
31
Hypoxemia
Low oxygen content in the arterial blood.
32
ABG Objective info
-Acid-base status -underlying cause of imbalance -Body's ability to regulate pH -Overall oxygenation status (Sa02, Sp02)
33
Respiratory Acidosis
↑ Paco2 = alveolar hypoventilation -Airway obstruction -loss of alveolar recoil -inadequate time for exhalation
34
Respiratory Alkalosis Causes
↑ pH ↓ pC02 -Hyperventilation -Mechanical vent
35
Nasal Cannula Oxygen
1-6 L/min, 22-44% or 0.24-0.44 Fi02 *1L/min increases oxygen by approximately 3-4% Room air 21% so 1L = 24%, 2L = 28%, 3L = 32%
36
Simple Face Mask Oxygen
5-12 L/min 30-60% oxygen or 0.30-0.60 Fi02
37
Non-rebreather mask
15 L/min, 60-80% or 0.60-0.80 Fi02 *Put oxygen high as possible
38
High-flow cannula
0.60-0.90 Fi02
39
Endotracheal
‘oral intubation’ Visualize cords Route of choice
40
Nasotracheal
‘Blind approach’ cannot visualize larynx Requires a smaller ETT, thus ↑ airway resistance & ↑ WOB Associated with sinus infections Independent risk factor for VAP
41
Tracheal
Tracheotomy ‘surgical procedure’ After 3 days of intubation
42
Immediate Nursing interventions after intubation
-Monitor ventilation with BVM -Assess oxygenation by SpO2 -Suction when necessary -Observe chest for symmetrical rise & fall -Auscultate lungs bilaterally -CO2 detector Yellow good Purple bad -Secure the tube & identify ‘cm’ placement -Inflate the cuff via pilot balloon
43
Respiratory Failure Assessment S/S
-Sudden increase PaO2 or rapid increase PaCO2 -Early signs hypoxemia/hypercapnia -Dyspnea, tachypnea, prolonged expiration, nasal flaring, intercostal muscle retraction, use of accessory muscles, decreased SpO2, tachycardia, hypertension (initially due to compensation), dysrhythmias & hypotension (late)
44
Respiratory failure interventions
-Chest x-ray -pulmonary function tests -lab studies -ABGs -end tidal CO2 (obtained by CO2 nasal cannula or ventilator) -O2 therapy-venturi mask, high flow nasal cannula, or vent, mobilize secretions, positioning (good lung down), suctioning prn, hydration status, bronchodilators, physiotherapy, aerosolized meds, monitor FiO2, monitor for hypermetabolic states-EN/TNP within 48 hrs if warranted, provide rest-decrease O2 demand and prevent delirium
45
VAP Bundle
-Elevate head of bed 30-45 degrees -daily awakening (sedation vacation) -Prophylaxis for DVT -Prophylaxis for peptic stress ulcer disease -Daily oral care
46
VAP prevention
-Intubate oral rather than nasal -Initiate the ventilator bundle -Good hand washing and aseptic suctioning -Oral care for patient q2hrs - Brush twice daily -Chlorhexidine swab 30 seconds, twice daily -Use ETT that allows for continuous suction of subglottic secretions -Nutrition within 24hrs. (Enteral preferred) -Drain condensate away from patient -Watch for infection (high wbcs and fever-sputum) -Do NOT instill NS into the ET tube -Discontinue mechanical ventilation use ASAP
47
ETT Suctioning Complications
-Decreases PaC02 and 02 sats -May cause ECG arrhythmias -Increase arterial blood pressure -Increase intracranial pressure -May cause bronchospasm, tracheal hemorrhage, and tracheal wall damage
48
Respiratory controlled rate
a set frequency of breaths per minute
49
Respiratory Spontaneous rate:
supports breaths initiated by patient
50
Respiratory Combo rate:
both a set rate and spontaneous support
51
TIDAL VOLUME (VT)
Amount of gas to be delivered with each breath
52
Tidal volume Calculation
6-8 ml/kg based upon IDEAL body weight *Example: 70 kg patient should receive between 420 to 560ml
53
Fi02
Fraction or percent of oxygen (O2) delivered to the client
54
AC: Assist/ Control Ventilation
-Patient will receive a breath at a set rate, but the breath can be triggered by the patient or by the machine -Preset tidal volume (Vt) or pressure (PIP) -Ventilator performs most of the WOB -If patient can trigger a spontaneous breath, they will always receive the Vt and can hyperventilate (Respiratory Alkalosis)
55
SIMV
-Preset RR(f) at preset VT - (RR(f) should be low because of patient doing most of the WOB) -In between preset breaths (f), the patient could initiate a spontaneous breath -Vt of spontaneous breaths varies -Helps to prevent respiratory muscle weakness, because the patient contributes to more WOB. but muscle fatigue can occur in the unstable patient -Risk of hypoventilation (Respiratory Acidosis)
56
CPAP
-Continuous positive airway pressure for a client who is spontaneously breathing -Via ET Tube, or nasal pillow, mouth/nose mask, face mask -Similar to PEEP when provided invasively -Used with sleep apnea patients
57
Respiratory Acidosis
Carbonic acid excess caused by: Hypoventilation, Respiratory failure Compensation: Kidneys conserve HCO3– and secrete H+ into urine
58
Metabolic Acidosis Causes
DKA Renal failure Shock Severe diarrhea
59
Metabolic Alkalosis Causes
Severe Vomiting Diuretics Excessive GI suctioning Excessive NaHC03
60
Respiratory Acidosis Causes
Hypoventilation COPD Airway obstruction loss of alveolar recoil inadequate time fo exhalation Sedative overdose
61
Respiratory Alkalosis Causes
hyperventilation mechanical ventilation (A/C)

Complex Care (10 decks)

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