Unit 2-1 Flashcards
Admission to the Critical Care Unit-3
Physiologically unstable
At risk for serious complications
Requires intensive and complicated nursing support
Ethical Issues in the ICU-3
Autonomy
Beneficence
Justice
Acute Respiratory Distress Syndrome (ARDS)
Three Criteria
- PaO2/FiO2 ratio less then 200
- Bilateral infiltrates on CXR
- PAOP less than 18 mm Hg or no clinical evidence of left arterial hypertension
Interventions for ARDS-6
Oxygenation May require high level of PEEP Sedation and Comfort Prone positioning conservative Fluid management enteral Nutrition
Basics of breathing-5
Wob Compliance Control of ventilation Resistance Lung volumes and capacities
End-tidal carbon dioxide monitoring-4
Noninvasive
Normal value-usually 2-5 mmhg less than paco2
Most common pitfall is believing the value reflects only the patient’s ventilatory status
Equipment/nursing responsibilities for patient with ett-4
Indications
Sedation/pain management
Suctioning ett
Ambu bag with mask
Complications of mechanical ventilation-5
Airway issues Pulmonary complications Cardiovascular system Gi system Psychosocial complications
Vap bundle-5
Elevate HOB 30-45 degrees Hand hygiene Subglottic suctioning Oral hygiene Use noninvasive mechanical ventilation when possible
Nutrition with ventilated patient
PPV (positive pressure ventilation) and hypermetabolism associated with critical illness can contribute to inadequate nutrition
ARDS-acute phase 1-4
- inflammation w intravascular thrombi
- pulmonary edema/HTN
- V/Q mismatching
- sufectant production stopped/inactivated
ARDS-proliferative phase 2-3
4-21 days after onset
pulmonary edema resolves
fibrin matrix forms-> progressive hypoxemia
ARDS- fibrotic stage 3-4
- 2-3 weeks after onset
- fibrosis obliterates alveoli, bronchioles, and interstitium
- lungs fibrotic w decreased residual capacity and L to R shunting
- inflammation, edema, resistance to airflow, atelectasis
ARDS assessment
resp distress w dyspnea, tachypnea, and hypoxemia that does not respond to supplemental O2
Interventions for ARDS-oxygenation-3
low tidal vol- 6-7 mL/kg
low end expiration plateau pressure <30
FiO2
