NUR 455 Respiratory Exam

Normal ABG values - -pH: 7.35-7.45 PaCO2: 35-45 PaO2: 80-100 Bicarb: 22-26 sp02: greater than 92% abnormal ABG names - -pH less than 7.35 is acidosis pH greater than 7.45 is alkalosis Pa02 less than 80 is hypoxemia Pa02 greater than 100 is hyperoxygenation low sp02 is hypoxic PaC02 less than 35 is hypocarbic PaCo2 greater than 45 is hypercarbic acid base compensation- kidneys vs lungs - -kidneys: bicarb HC03 determines blood pH, and kidneys compensate in respiratory failure Lungs: carbon dioxide determines blood pH, and in renal failure lungs compensate Metabolic alkalosis - --base excess -risk factors: HCL loss from vomiting, Metabolic acidosis - -base depletion -risk factors: ketoacidosis, lactic acidosis, renal failure, hypovolemic shock Treat with sodium bicarb IV hypercarbia - -C02 excess occurs in hypoventilation from C02 trapped in blood -PaCo2 is higher than 50 -COPD, pneumonia, ARDS, asthma, drug OD, neuromuscular disease, chest wall abnormalities/ trauma, CNS depression -results in: altered consciousness, death hypoxemia - -Pa02 less than 50mmHg and normal or low paC02 -respiratory alkalosis -most common type of respiratory failure - found in pneumonia, pneumothorax, pulmonary edema/ emboli, ARDS, bleeding, tumors, trauma, infection hypoxemia early signs vs late signs - -early- restlessness & irritablity anxious ^RR ^HR NUR 455 NUR 455 ^BP high AP pale skin increased WOB Adventitious lung sounds late - Cyanosis, circumoral cyanosis, purplish hue in darker-skinned ppl What should you assess for after an insertion of a central line - --pneumothorax Assess respiratory status S/s of pulmonary embolism - --dyspnea -hypoxemia -hemoptysis -pleuritic chest pain S/s of hypercarbia - -decreased RR, fatigue, inability to focus, decreased respiratory, mental status changes, less responsive -think respiratory acidosis (hypoventilation) respiratory alkalosis - -Arise in blood pH due to hyperventilation (excessive breathing) and a resulting decrease in CO2. nursing interventions for respiratory acidosis - -- maintain airway - bronchodilators - reduce amount of opioids to encourage breathing - give oxygen PRN - monitor potassium levels (hyperkalemia) - help patient cope -mechanical ventilation Nursing interventions for respiratory alkalosis - -- Teach patient breathing techniques to slow down breathing, holding breath..." rebreathing into a paper bag or re-breather mask - Watch potassium levels (hypokalemia) - Closely watch patients on mechanical ventilation to ensure breaths are not hyperventilating the patient Composition of room air - -20.8% is oxygen, every liter of oxygen increases o2 % by 4 Breathe cycle is ___ with inspiration and ____ with exhalation in comparison to ________ - -negative posistive Atmospheric pressure NUR 455 NUR 455 Ventilation is controlled by the - -brain Why would a patient need mechanical ventilation? - -respiratory failure; unable to supply oxygen to maintain metabolism or cannot eliminate carbon dioxide or at a high rsk for developing respiratory failure goals of mechanical ventilation - -reverse hypoxia reverse acte respiratory acidosis relieve respiratory distress prevent/ reverse atelectasis relieve fatigue permit sedation/ anesthesia decrease myocardial o2 needs reduce ICP stabilize chest wall Noninvasive positive pressure ventilation - -BiPAP: used for COPD, asthma, pneumonia CPAP: used for obstructive sleep apnea Negative vs positive pressure ventilation - -•Normal breathing is negative pressure ventilation •Initiate breath and the pressure in the pleural space becomes negative as chest moves out. Air moves from higher (air) to lower (lungs) concentration. •Mechanical ventilation is positive pressure ventilation •Each breath delivered to the patient under positive (above atmospheric) pressure Nursing consideration with NIPPV - --pt cannot be restrained -masks can cause nausea, vomitting, anxiety -adequate mental status needed for Bipap/cpap Nursing considerations with intubation - --look at dentition= lose teeth can cause aspiration -ambu bag -suction -iv access w/ free flowing saline -ecg/o2/BP monitoring -stethoscope (auscultate for bilateral breath sounds) -secure with ETT tape -document size and cm location -cuff pressure (20) -know recent electrolytes -code cart nearby -intubation kit -sedation and pain meds NUR 455 NUR 455 Short term complications vs long term complications with intubation - -short term: bleeding, pneumothorax, air embolism, pneumonia, damage to laryngeal Long term: tracheal dilation, tracheal esophageal fistula, tracheal ischemia Nursing care of the ventilated patient - --respiratory assessment -size, location, security of tube -document ventilator settings -manage ventilator settings -sedation/ analgesia -emergency equipment -suction -oral care -mobility -skin care -support pt/ family -assess for anxiety/ pain -communication assistance What is the number one reason for mechanical ventilation - -respiratory acidosis Important ventilator parameters - -tidal volume: volume delivered per breathe rate: number of breaths per min (if CO2 elevated turn up rate) what causes ventilator associated pneumonia - --decrease mobility -aspiration of secretions around the cuff -aspiration of gastric contents -microorganisms in the ventilator circuit -decrease in oral care -supine position Prevention of VAP - --oral care q2hrs (chlorohexadine mouth was BID) -HOB 30 degrees -PUD prophylaxis (proton x iv) -dvt prophylaxis -spontaneous awakening trials: try to extubate as early and often as possible ARDS causes treatment - --severe acute lung injury -sepsis, trauma, aspiration, severe lack of 02 (hypoxia is origin) -mechanical ventilation is done on the lowest tidal volume to avoid overstretching alveoli to avoid hypoxemia assessment findings with ARDS - --tachypnea, increased WOB, hypoxemia, pulmonary edema, rails, increased respiratory rate, fluid in airways, decreased mental status, decreased breath sounds, cool extremities