OXYGENATION Flashcards
Ventilator Settings (Adult Ventilator Settings)
- Respiratory Rate: # of breaths delivered per minute
— 8-12 bpm - FiO2: amount of O2 delivered. Room Air = 21%
— 21-100% - Tidal Volume (Vt): volumn of air delivered with each breath
— 300 - 3000 - PEEP: pressure on lungs at end of expiration
— 0 - 35 cm H2O - Pip: highest inspiratory pressure applied to the lungs
— 0 - 80 cm H2O - Pressure Support: inspiratory pressure to help with spontaneious breath
Ventilator Modes
- Assist Control (AV): vent supports every breath. pt can breath between vent breaths
- SIMV: spontaneous breath not supported.
in both Assist Control (AC) and Synchronized Intermittent Mandatory Ventilation (SIMV), the ventilator delivers a set tidal volume at a set rate for the mandatory breaths. The main difference between the two modes lies in how they handle spontaneous breaths initiated by the patient:
- In AC mode, the ventilator provides full support by delivering a breath whenever the patient initiates one (assisted breath) and also delivering breaths at the set rate (controlled breaths).
- In SIMV mode, the patient can initiate additional breaths (spontaneous breaths) between the mandatory breaths, but these spontaneous breaths are unsupported by the ventilator. The ventilator synchronizes the mandatory breaths with the patient’s spontaneous breaths.
This difference in how the ventilator handles spontaneous breaths makes SIMV a more gradual weaning mode compared to AC, as it allows the patient to gradually take over more of the work of breathing.
METABOLIC ACIDOSIS:
- related to increased acid (ASA poisoning, lactic, or ketoacidosis, uremia)
- Decreased HCO3: Diarrhea, chlorides, diuretics, hypoproteinemia
- pH: <7.35
- HCO3 <22
METABOLIC ACIDOSIS S/S
- Headache
- Confusion
- Fruity breath
- Increased rate and depth of respirations (Kussmual respirations)= decreased CO2, decreased potassium (shifts into cell)= nausea, and vomiting and dysrhythmias
METABOLIC ACIDOSIS Nursing intervention:
- Monitor S/S and potassium levels
- Give NaHCO3 if ordered
- Supportive care for underlying problem
Metabolic alkalosis
- Secondary to loss of acidic gastric secretions (vomiting or suction)
- Thiazide or loop diuretics (decrease serum, potassium causes potassium to leave cells and hydrogen to enter)
- Increased intake of sodium bicarbonate
- pH: >7.45
- HCO3: >26
Metabolic alkalosis s/s
- Paresthesias
- Tremors
- Shallow respirations= increased CO2, dizziness, confusion, decreased G.I. motility, decreased potassium
Metabolic alkalosis Nursing intervention:
- Monitor S/S
- give NaCl fluids
- KCI replacement
- H2 antagonist (decrease acid loss from G.I. suction) has ordered
Respiratory Acidosis
- Decreased ventilation
- CO2 retention from pulmonary edema
- Pneumonia
- ARDS
- Narcotic overdose
- Aspiration
- Emphysema
- Obstructed airway
- Neuromuscular disease
- Apnea
- pH: <7.35
- PaCO2: >42
Respiratory Acidosis S/S
- SOB
- Increased pulse
- Increased respirations
- Increased blood pressure
- Restlessness
- Disorientation
- Increased potassium
- Signs of increased cranial pressure (secondary to cerebral edema)
Respiratory Acidosis Nursing interventions:
- Monitor S/S
- Care for underlying cause (antibiotics, thrombolytics, bronchodilators)
- Increase oxygenation (suction, airway, power position, mechanical ventilation)
Respiratory Alkalosis
- Caused by hyperventilation (from anxiety)
hypoxemia - Excess mechanical ventilation
- pH: >7.45
- PaCO2:<38
Respiratory Alkalosis S/S
- Increased pulse
- Decreased potassium
- Decreased calcium
- Parenthesisias
- Lightheadedness
- Dysrhythmias
- Decreased LOC
Respiratory Alkalosis Nursing interventions:
- Monitor S/S
- Teach to breathe slowly or breathe in paper bag
- Give Sedative as ordered
- Mechanical ventilator settings (may have two decrease rate and/ or depth)
Clinical Manifestations that lead to intubation/need for mechanical ventilation
- Apnea or bradypnea
- Respiratory distress with confusion
- Increased work of breathing not relieved by other interventions
- Confusion with need for airway protection
- Circulatory shock
- Controlled hyperventilation
