NRNP 6566 final prep 6-12

NRNP 6566 final prep 6-12 Normal pH 7.35-7.45 7.35 Acid 7.45 alkalosis respiratory aklalosis pH 7.45, PaC02 low, HC03 low respiratory acidosis pH 7.35 PaCO2 45 Hc03 normal 22-26 Metabolic alkalosis pH 7.45 HCO3 26 PaC02 45-35 normal oxygen levle 80-100 mild hypoxemia 60-80 moderate hypoxemia 40-60 severe hypoxemia 40 A-a gradiatian calculation is a calculation of what? level of hypoxia PA02-Pa02 A-a gradiant varies with age, calculation 2.5 + 0.21 x age in years 5 causes of hypoxemia VQ mismatch shunt PNA, interstitial lung dz hypoventilation high altitude clinical symptoms that require intubation neuromuscular depression or failure. spinal cord injuries guillain barre syndrome trauma-spinal cord injuries, phrenic nerve injury myasthenia gravis shock status asthmaticus sustained apnea of any kind indications for weaning from vent underlying process that required the vent is corrected maintaining oxygen status no presser support- levophed, epinephrine, etc. Pa02 80, FI02 of 0.5, and PEEP 8.0 cm H20 prior to seperation from the vent proceed with this ...... to determine if pt is able to dc vent trial of spontaneous breathing Volume targeted assist control (AC) mode the clinician determines tidal volume and rate/ pt can still breath over the vent. example: pt gets RR of 12 but has an additional 2 breaths on their own, pt will still breathe 14 breaths/min. tidal volume is based on the vent. Synchronized intermittent mandatory ventilation SIMV clinician sets rate, and tidal volume, and peak inflation pt can also have their own breaths. tidal volume is set based on the patient. VENT doesn't specify tidal volume. Pressure Control A mode of ventilation that is normally patient or time triggered, pressure targeted and time cycled. AC control vent settings how do you determine tidal volume? is based on ideal body weight. careful with obese patients. tidal volume Amount of air that moves in and out of the lungs during a normal breath peep positive end expiratory pressure Static Pressure the pressure of air at rest, or that portion in moving air, if the air stream were to stop Plateau pressure Measures the compliance the entire lung End inspiratory pause button Peak pressure Pressure required to get a volume of air into the lungs, fighting resistance increase in peak pressure is a complication from which patients? ARDS or restrictive airway patients. high peak pressures with normal plateau pressures indicate.... resistance, such as an ET obstruction or bronchospasm Minimal sedation relief of anxiety, minimal affection on sensorium, anti-anixety medications moderate sedation -Depression of consciousness is drug induced -Patient is able to respond to verbal commands -Cardiac and respiratory function not usually affected Deep sedation client cannot be easily aroused, but can respond after repeated stimulation. respiration may need to be supported general anesthesia the blockage of all body sensations, causing un-consciousness and loss of reflexes. cardiac and respiratory monitoring is essential dissociation type of moderate sedation that occurs when using meds such as ketamine. dissociation of the limbic system. ICU delirium a serious problem encountered in the ICU; patients have an increased length of stay & increased mortality treatment for ICU delirium day and night schedule, reorientation, give the patient needed DME such as glasses or hearing aids. treatment for severe agitation and ICU delerium benzodiazepines confusion assessment for ICU CAM-ICU, confusion assessment method for the ICU Rapid Sequence Intubation RSI; Procedure of emergent patient intubation where the patient is quickly given sedatives, paralytics and cricoid pressure. STEPS: prep, preoxygenate, pretreat, paralysis with induction, positioning, placement and post intubation mgmt. Critical Care Pain Observation Tool (CPOT) for the non communicative patient -facial expression -body movements -muscle tension (eval by passive flexion extension and of upper extremities) -compliance with ventilator OR vocalization 0-8 scale - 0 being no movement 8 being most movement sedation for mechanically vented patients propofol drip, and dexmedetomidine drip cardiac surgery patients do not use this for sedation during surgery benzodiazepines do not give this paralytic for CVA patients succinylcholine pain management includes all of the following nerve meds such as gabapentin antidepressants such as amitriptyline anti inflammatories such as ibuprofen pre-treatment drugs for intubation lidocaine, fentanyl, rocuronium do not give this drug for patients who are hypotensive fentanyl do not give to patient with head injuries rocuronium induction drugs thiopental, midazolam, etomidate, ketomine, propofol. do not give this sedating drug in hypertensive patients