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334 Cards in this Set
- Front
- Back
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Hb
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Measurment of gas carrying capacity of RBC
Female: 11.7-16.0 Male: 13.2-17.3 |
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Hct
|
Measure of packed cell volume of RBC's expressed as a percentage of total blood volume
Female: 35-47% Male: 39-50% |
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Total RBC count
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count of # of circulating RBC's
Female: 3.8-5.1 X 10^6 Male: 4.3-5.7 x10^6 |
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MCV
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Determination of relative size of RBC's. Hct x10/RBC x 10^6
80-100fL |
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MCH
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measurement of average weight of Hb/RBC. Hb x10/RBC x 10^6
27-34 pg |
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MCHC
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Evaluation of RBC saturation with Hb. Hb x100/Hct
32-37% |
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WBC
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Measurement of total number of WBC
4,000-11,000 |
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platelet count
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measurement of # of platelets available to maintain platelet clotting function
150,000-400,000 |
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Where are blood group antigens found?
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plasma membrane of RBC's
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What are the four blood groups?
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AB, A, B, O
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What antigens does blood group A have?
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A antigens
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What antigens does blood group O have?
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None
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What happens in blood incompatibilities?
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intravascular hemolysis of RBC's
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Agglutination
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clumping of blood cells with introduction of incompatible blood
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How do you evaluate Rh status?
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Coomb's Test
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What antigen give Rh + status
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Antigen D
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How is Rh Status depicted in blood type?
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+ or - after blood type
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tracheostomy
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stoma that results from a tracheotomy
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indications for tracheotomy
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-Bypass upper airway obstruction
-facilitate removal of secretions -permit oral intake and speech -permit long term ventilation |
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Why is a tracheostomy better for long term care?
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-less risk of long term damage to airway
-patient comfort improved -patient can eat -mobility is improved |
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When can a tracheostomy be removed?
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patient can adequately exchange air and expectorate secretions
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indications for endotracheal intubation
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-upper airway obstruction
-apnea -high risk for aspiration -ineffective clearance of secretions -respiratory distress |
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Where can endotracheal tube be in inserted?
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through the mouth or nare
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RSI
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Rapid Sequence intubation
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how long can an intubation attempt last?
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30 seconds
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what is a central venous catheter device (CVAD)?
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catheter placed in large blood vessels of people who require frequent access to the vascular system
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what types of CVAD are there?
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-centrally inserted catheter
-PICC line -implanted port |
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indications for a CVAD
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-suspected long term need for vascular access
-patients with limited peripheral venous access |
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Advantages of CVAD
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-reduced need for multiple venipunctures
-decreased risk of extravasation injury -immediate access to central venous system |
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disadvantages of CVAD
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-increased risk of systemic infection
-invasiveness of placement |
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Where can you insert a central line
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jugular, subclavian or femoral
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where does the central line catheter end?
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distal end of the superior vena cava
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how many lumen does a central line have
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single, double, triple or quad lumen
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how do you verify central line placement?
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x-ray
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what is a PICC Line
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central venous catheter inserted through the arm
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how long can you have a PICC for?
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1-6 months
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advantages of PICC Line
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-lower infection rate than a central line
-fewer insertion related risks -decreased cost -insertion can take place at bedside or in outpatient setting |
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potential complications of PICC Line
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Catheter occlusion or phlebitis
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Implanted infusion port
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consists of central venous catheter connected to an implanted single or double subcutaneous injection port
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What is used to access the port?
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hubert-point needle
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Indication for continuous arterial blood pressure monitoring
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*acute hypertension/hypotension
* Respiratory failure * shock * Neurologic inquiry * Coronary interventional procedures * continuous infusion of vasoactive drugs * frequent ABG sampling |
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Arterial line risks
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* hemorrhage
* infection * thrombus formation * neurovascular impairment * loss of a limb |
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how often should you flush a central line?
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1-4 hours
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nursing management of CVAD's includes:
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assessment
dressing change injection cap changes cleansing flushing |
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when does PAD and PAWP pressure increase?
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heart failure and volume overload
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indications for pulmonary artery catheter?
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intraaortic baloon pump therapy
major trauma/burn MI severe shock states ARDS Resp failure with hx of COPD Cardiac Tamponade evaluation of circulatory syndromes hypotension not responsive to fluid therapy |
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contraindications to pulmonary artery cathetrization
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coagulopathy
endocardial pacemaker endocarditis mechanical tricuspid/pulmonic valve |
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injuries associated with blunt steering wheel injury
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rib fracture, flail chest, pneumothorax, hemopneumothorax, myocardial contusion, pulmonary contusion, vessel tears
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injuries associated with shoulder harness seat belt injury
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clavicle fracture, rib fracture, pericardial contusion, cardiac tamponade, shoulder dislocation, pulmonary contusion
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injuries associated with crush injury
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hemo/pneumothorax, flail chest, decreased blood return to heart, great vessel tears/rupture, decreased cardiac output
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pneumothorax
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air in the pleural space resulting in partial or complete collapse of the lung
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tension pneumothorax
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air in pleural space that does not escape. continued increase in amount of air shifts intrathoracic organs and increases intrathoracic pressure
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tension pneumothorax manifestation
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cyanosis, agitation, air hunger, tracheal deviation, subq emphysema, neck vein, distension, increased resonance to percussion
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emergent management of tension pneumothorax
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needle decompression with chest tube placement and drainage system
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pneumothorax manifestation
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dyspnea, decreased movement of chest wall, decreased breath sounds on the affected side, increased resonance with percussion
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hemothorax
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blood in the pleural space
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hemothorax manifestation
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dyspnea, decreased breath sounds, dullness to percussion, decreased Hgb, shock
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emergent management of hemothorax
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chest tube insertion with drainage system, autotransfusion of collected blood, treatment of hypovolemia
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emergent management of pneumothorax
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chest tube insertion with clutter valve or chest drainage system
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flail chest
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fracture of 2+ adjacent ribs in 2+ places with loss of chest wall stability
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flail chest manifestations
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paradoxical movement of the chest wall, respiratory distress, may be associated with hemp/pneumothorax, or pulmonary contusion
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emergent management of flail chest
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O2 as needed to maintain O2 saturation; analgesia, stabilize flail segment with positive pressure ventilation, intubation or mechanical ventilation and treat associated injuries
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cardiac tamponade
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blood collection in pericardial sac, compresses myocardium, prevents ventricles from filling
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cardiac tamponade manifestation
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muffled distant heart sounds, hypotension, neck vein dissension, increased central venous pressure
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emergency management of cardiac tamponade
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MEDICAL EMERGENCY
pericardiocentesis, surgical repair if necessary |
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chylothorax
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collection of lymphatic fluid in pleural space
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pleurodesis
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artificial production of adhesions between parietal/vsceral pleura, usually with a chemical sclerosing agent
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which ribs are most commonly fractured?
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ribs 5-10
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lobectomy: definition and indication
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removal of one lobe of lung
lung CA, bronchiectasis, TB, emhysematous bullae, benign lung tumors, fungal infection |
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risk secondary to fractured ribs
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atelectasis and PNA because of decreased ventilation and restrained secretions
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pneumonectomy- definition and indication
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removal of entire lung
-lung CA |
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segmental resection- definition and indication
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removal of one lung and lung segments
-lung CA -bronchiectasis |
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wedge resection-definition and indication
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removal of localized lesion
-bx -excision of small nodule |
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What are the criteria to adminster blood?
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Hmorrhage, Severe Anemia, Loss of oxygen carrying capacity, loss of clotting factors
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Nosocomial causes of anemia
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blood draws
surgical blood losses dilution form fluid resuscitation |
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who is the universal blood recipient?
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AB
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who is the universal blood donor
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o
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when do we give type O blood without crossmatching?
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Trauma, GI tract or major vascular tear/hemorrhage
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Therapeutic uses of blood
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Restores blood volume, increases O2 carrying capacity, provides clotting factors, provides nutrients
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How does blood increse oxygen carrying capacity?
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by increasing the ration of hgb in the circulatory system
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Where do clotting factors come from?
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platelets
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what kind of nutrients come from blood and what do they do?
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35 grams of protein in a unit, this increases oncotic pressure and helps control 3rd spacing
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Typing blood
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determining the blood type to ensure tha the correct blood will be given to the patient
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crossmatching blood
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looking at the anitbodies in the recipients blood and the donor's blood and trying to match them as closely as possible
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what are packed RBC's
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whole blood without plasma
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how much can one transfusion of platelets raise a 70 kg adult's platelet count?
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30-50,000
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what is albumin infusion used to treat?
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hypovolemia, shock and chronic liver failure
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cryoprecipatates
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factor 8, fibrinogen and factor 13, used to treat hemophilia and congenital or acquired fibrinogen deficiency
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autologous transfusion
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collection and reinfuion of the patients own blood
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advantages of autologous transfusion?
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elimination of infectious disease transmission
no risk of transfusion reaction provides a source of blood for persons with a rare type or antibodies |
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intraoperative and postoperative blood salvage?
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collection and reinfuion of blood lost intra and postoperatively
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benefits of allogenic blood transfusion
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increase in oxygen deliver to tissues
increase blood volumes SP hemorrhage alleviate symptoms of anemia relieve cardiac effects of anemia |
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allogenic blood transfusion
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blood from a donor to a recipient
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risks of allogenic transfusion
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fluid overload/alterations in electrolytes
acute febrile rxn increased chance of multi organ failure increased risk of infection human error transfuion related lung injury hypothermia coagulopathy/thrombocytopenia |
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Pre- transfusion nursing responsibilities
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1. check the order, timing and indication
2. obtain transfusion hx/consent 3. obtain right equipment 4. check IV patency 5. retrieve blood 6. carefully check the blood to determine the rights |
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Transfusion nursing responsibilties
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1. second RN check
2. check blood/hospital protocol. 3. VS 4. stay with patient for 15 minutes 5. observe for transfusion rxn 6. chart |
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what diseases can be transmitted through infusion therapy?
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hepatitis b and C
HIV West Nile Virus HTLV-1&2 Syphilis Malaria Mad Cow Dz |
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signs and symptoms of actue hemolytic reaction
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hematuria, back pain, hypotension, tachycardia, chills and fever
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what happens in acute hemolytic reactions?
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1. agglutination of cells obstructs blood flow
2. hemolysis results in free Hgb--> hemoglobinuria resulting in renal failure |
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s/sx's of an allergic reaction to blood transfusion
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wheezing, restlessness, anxiety, progressing to cyanosis, shock and possibly cardiac arrest
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s/sx's of acute febrile reaction to transfusion of blood
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increased pulse, temperature, chills, HA, nausea and vomiting, anxiety, flushing , back pain and muscle aching and stiffness
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hypersensitivity reaction to transfusion
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recipient's antibodies react with proteins in the donor blood
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s/sx's of hypersensitivity reaction to transfusion
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urticaria, itching, wheezing, anxiety, dyspnea
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transfusion related acute lung injury (TRALI)
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sudden onseet of noncardiogenic pulmonary edema
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at what rate should you initiate transfusion?
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30cc/hour initially for the first 15 minutes, if VSS, increase rate of flow to prescribed time
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how often do we repeat vitals during transfusion?
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q15 minutes initially, if no reaction, increase to q30 minutes
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how often should the patient be assessed during transfusion?
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every 15 to 20 minutes
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within what time range does blood need to started after receiving from the blood bank?
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within 30 minutes
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what size IV needs to be used for blood administration?
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<20 guage
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what is the maximum amount of time to infuse blood?
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4 hours
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how long is a hanging bag of medication/fluid good for?
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24 hours
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how long are IV lines good for?
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72-96 hours depending on institution policy
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Can a pulmonary artery port be used for infusion or IVP's of medications?
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no. its purpose is only to meausure pressures
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can you inject into an arterial line?
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Never, they are only used for monitoring systemic pressures and for blood draws.
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how many people are required to change trach tube ties?
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2. one person to work with the ties adn the other to hold the trach in place
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What precautionary equipment do you need at the bedside during trach care?
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1. suction
2. extra sterile tracheostomy tube of the same size or smaller 3. obdurator for replacing tracheostomy tube 4. ambu-bag with a face mask |
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what should wall suction be set at for nasal suctioning?
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80-120 mm hg
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purpose of endotracheal suctioning
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to remove secretions and foreign matter from the airway to improve ventilation
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how do you utilize the Jackson-Pratt Drain?
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open distal cap, compress bulb, recap distal cap and release bulb
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what will happen if a sump gets wet?
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it will not work
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what is a Davol Sump drain used for?
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used as a drain for thliver and pancreatic beds. it also be used to irrigate and lavage an area
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what is a silicone round double drain used for?
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designed to remove serous drainage, usually placed during surgery
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what is a flat drain used for?
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thin serous drainage. placed during surgery to drain surgical site
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what is the dobhoff feeding tube used for?
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it is placed post pylorically for feeding into the small bowel.
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what is the Gastrostomy / bolus feeding tube used for?
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gastrostomy feeding. tube is place percutaneously
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BOne Marrow function
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production of many blood cells including RBC'S, WBC'S and platelets
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Hct normal values
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females: 37-47%
males: 42-52% |
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PT normal values
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11-12.5 seconds
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INR therapeutic range
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2-3
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indications for bone marrow biopsy
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diagnose causes of blood disorders
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what components make up whole blood?
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packed RBC's
plasma prothrombin complex platelets albumin clotting factors cryoprecipitates |
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S/Sx's of circulatory overload related to blood transfusion
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dyspnea, chest tightness, tachycardia, tachypnea, HA, HTN, JVD, peripheral edema, orthopnea, anxiety, basilar crackles
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s/sx's of sepsis related to blood transfusion
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fever, nausea, vomiting, abdominal pain, chills, hypotension
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causes of anemia
|
blood loss
inadequate RBC production -hypoproliferation increased RBC destruction -hemolytic deficiency of nutrient components |
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most common cause of iron deficient anemia prior to menopause
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inadequate dietary intake
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most common cause of iron deficient anemia post menopause
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blood loss- usually GI in origin
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Risk factors for anemia
|
acute or chronic blood loss
increased hemolysis inadequate dietary intake bone marrow suppression |
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medications to treat anemia
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iron supplements
erythropoietin (procrit/epogen) B12 (cyanacobalamin) Folic Acid supplements |
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complications of anemia
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heart failure related to increased cardiac demand
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methods by which fluids move between intra and extra cellular compartments
|
diffusion
active transport filtration osmosis |
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2 types of fluid imbalances
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fluid volume deficit
fluid volume excess |
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2 types of fluid volume deficits
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hypovolemic-isotonic
-water and electrolytes lost dehydration-osmolar -water loss only |
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what lab values increase in dehydration
|
Hct
serum electrolytes urine specific gravity |
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risk factors for hypovolemia
|
GI losses (vomiting/diarrhea)
skin losses (diaphoresis) renal loss (diuretic therapy) 3rd spacing (burns, ascites) hemorrhage altered intake (NPO status) |
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causes of dehydration
|
hyperventilation
DKA enteral feedings |
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complications of dehydration
|
hypovolemic shock
|
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2 types of fluid volume excesses
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hypervolemic-isotonic
-increase in H2O and salt overydration-osmolar -H2o increase> salt increase |
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risk factors for hypervolemia
|
chronic renal stimulation
renal failure fluid shifts increased sodium intake |
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causes of overhydration
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fluid loss with subsequent replacement of only water
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s/sx's of hypervolemia
|
HTN
tachycardia bounding pulses increased CVP tachypnea crackles edema confusion muscle weakness weight gain ascites dyspnea/orthopnea decreased breath sounds JVD |
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s/sx's of pulmonary edema
|
anxiety
tachycardia acute respiratory distress JVD dyspnea at rest change in level of consciousness ascending crackles cough frothy, pink sputum |
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function of electrolytes
|
regulate fluid balance
regulate hormone production catalyze nerve impulses work in muscle contraction catalyze nutrient metabolism |
|
|
electrolyte cations
|
magnesium
potassium sodium calcium |
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electrolyte anions
|
phosphate
sulfate chloride bicarbonate |
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|
Na normal values
|
136-145
|
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K normal values
|
3.5-5.0
|
|
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Cl normal values
|
98-106
|
|
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Ca normal values
|
9.0-10.5
|
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Mg normal values
|
1.3-2.1
|
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Phosphorous normal values
|
3.5-4.5
|
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risk factors of hyponatremia
|
fluid volume deficit
fluid volume excess |
|
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symptoms of hyponatremia
|
HA
confusion lethargy fatigue muscle weakness fatigue decreased DTR's seizures |
|
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vital signs associated with hyponatremia
|
hypothermia
tachycardia thready pulse hypotension orthostatic hypotension |
|
|
risk factors for hypernatremia
|
water deprivation
increased sodium intake sodium retention fluid loss |
|
|
vital signs associated with hypernatremia
|
hyperthermia
tachycardia orthostatic hypotension |
|
|
symptoms associated with hypernatremia
|
restlessness/agitation
muscle twitching seizures decreased DTR's coma thirst/dry mucus membrane's abdominal cramping diarrhea increased bouwel sounds nausea |
|
|
functions of potassium
|
cell metabolism
transmission of nerve impulse functioning of heart, lung and muscle tissue acid base balance |
|
|
risk factors for hypokalemia
|
abnormal GI loss
abnormal skin loss renal loss inadequate dietary intake prolonged administration of non- electrolyte IVF metabolic alkalosis TPN diuretic/laxative therapy |
|
|
vital signs associated with hypokalemia
|
weak/irregular pulse
hypotension respiratory distress |
|
|
ECG changes associated with hypokalemia
|
PVC
Bradycardia blocks ventricular tachycardia inverted T waves ST depression |
|
|
symptoms of hypokalemia
|
weakness
respiratory collapse paralysis muscle cramping nausea ileus vomiting decreased muscle tone hypoactive reflexes parasthesias confusion constipation abdominal distension |
|
|
function of electrolytes
|
regulate fluid balance
regulate hormone production catalyze nerve impulses work in muscle contraction catalyze nutrient metabolism |
|
|
electrolyte cations
|
magnesium
potassium sodium calcium |
|
|
electrolyte anions
|
phosphate
sulfate chloride bicarbonate |
|
|
Na normal values
|
136-145
|
|
|
K normal values
|
3.5-5.0
|
|
|
Cl normal values
|
98-106
|
|
|
Ca normal values
|
9.0-10.5
|
|
|
Mg normal values
|
1.3-2.1
|
|
|
Phosphorous normal values
|
3.5-4.5
|
|
|
risk factors of hyponatremia
|
fluid volume deficit
fluid volume excess |
|
|
function of electrolytes
|
regulate fluid balance
regulate hormone production catalyze nerve impulses work in muscle contraction catalyze nutrient metabolism |
|
|
electrolyte cations
|
magnesium
potassium sodium calcium |
|
|
electrolyte anions
|
phosphate
sulfate chloride bicarbonate |
|
|
Na normal values
|
136-145
|
|
|
K normal values
|
3.5-5.0
|
|
|
Cl normal values
|
98-106
|
|
|
Ca normal values
|
9.0-10.5
|
|
|
Mg normal values
|
1.3-2.1
|
|
|
Phosphorous normal values
|
3.5-4.5
|
|
|
risk factors of hyponatremia
|
fluid volume deficit
fluid volume excess |
|
|
symptoms of hyponatremia
|
HA
confusion lethargy fatigue muscle weakness fatigue decreased DTR's seizures |
|
|
vital signs associated with hyponatremia
|
hypothermia
tachycardia thready pulse hypotension orthostatic hypotension |
|
|
risk factors for hypernatremia
|
water deprivation
increased sodium intake sodium retention fluid loss |
|
|
vital signs associated with hypernatremia
|
hyperthermia
tachycardia orthostatic hypotension |
|
|
symptoms associated with hypernatremia
|
restlessness/agitation
muscle twitching seizures decreased DTR's coma thirst/dry mucus membrane's abdominal cramping diarrhea increased bouwel sounds nausea |
|
|
functions of potassium
|
cell metabolism
transmission of nerve impulse functioning of heart, lung and muscle tissue acid base balance |
|
|
risk factors for hypokalemia
|
abnormal GI loss
abnormal skin loss renal loss inadequate dietary intake prolonged administration of non- electrolyte IVF metabolic alkalosis TPN diuretic/laxative therapy |
|
|
vital signs associated with hypokalemia
|
weak/irregular pulse
hypotension respiratory distress |
|
|
ECG changes associated with hypokalemia
|
PVC
Bradycardia blocks ventricular tachycardia inverted T waves ST depression |
|
|
symptoms of hypokalemia
|
weakness
respiratory collapse paralysis muscle cramping nausea ileus vomiting decreased muscle tone hypoactive reflexes parasthesias confusion constipation abdominal distension |
|
|
complications of hypokalemia
|
respiratory failure
cardiac arrest |
|
|
risk factors for hyperkalemia
|
IV K infusion
use of salt substitutes decreased insulin acidosis tissue catabolism renal failure severe dehydration ACE-I, Diuretics and NSAIDS use |
|
|
vital signs associated with hyperkalemia
|
slow and irregular pulse
hypotension |
|
|
ECG changes associated with hyperkalemia
|
PVC, V Fib, Peaked T waves, widened QRS
|
|
|
symptoms associated with hyperkalemia
|
restlessness
irratibility weakness parasthesias nausea irratibility ascending paralysis diarrhea vomiting |
|
|
complications of hyperkalemia
|
cardiac arrest
|
|
|
First line of defense in acid base imbalance
|
chemical and protein buffers
|
|
|
second line of defense in acid base imbalance
|
respiratory buffers
|
|
|
how does hyperventilation change H+ concentration
|
decrease concentration of H+ ions
|
|
|
how does hypoventilation change H+ concentration
|
increases concentration of H+ ions
|
|
|
what is the 3rd line of defense in acid base imbalance?
|
renal buffers
|
|
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how do the kidneys respond to increase in H+ concentration
|
increase bicarbonate reabsorption and production
|
|
|
How do kidneys respond to decrease in H+ ion concentration
|
excretion of bicarbonate
|
|
|
what does compensation mean related to acid-base balance?
|
process by which the body tries to correct changes in pH
|
|
|
what are the 4 types of acid-base imbalance?
|
respiratory acidosis
respiratory alkalosis metabolic acidosis metabolic alkalosis |
|
|
what causes respiratory acidosis
|
respiratory depression
inadequate chest expansion airway obstruction alveolar-capillary blockage inadequate mechanical ventilation |
|
|
respiratory acidosis causes
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increase in CO2
increase in H+ |
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what causes respiratory alkalosis?
|
hyperventilation
hypoxemia |
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respiratory alkalosis causes
|
decrease in CO2
Decrease in H+ |
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|
causes of metabolic acidosis
|
excessive H+ ion production
inadequate elimination of H+ ions inadequate production of bicarb excessive elimination of bicarb |
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metabolic acidosis causes
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decreased HCO3
Increased H+ |
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causes of metabolic alkalosis
|
base excess
acid deficit -prolonged NG suction -potassium depletion |
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metabolic alkalosis causes
|
increased HCO3
decreased H+ |
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vital signs associated with respiratory acidosis
|
tachycardia
tachypnea |
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s/sx's of respiratory acidosis
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dysrhythmia
anxiety irritability confusion coma shallow/rapid breathing pallor cyanosis |
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s/sx's of respiratory alkalosis
|
anxiety
tetany convulsions tingling numbness palpitations CP dysrhythmia |
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First line of defense in acid base imbalance
|
chemical and protein buffers
|
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second line of defense in acid base imbalance
|
respiratory buffers
|
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how does hyperventilation change H+ concentration
|
decrease concentration of H+ ions
|
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how does hypoventilation change H+ concentration
|
increases concentration of H+ ions
|
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what is the 3rd line of defense in acid base imbalance?
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renal buffers
|
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how do the kidneys respond to increase in H+ concentration
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increase bicarbonate reabsorption and production
|
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How do kidneys respond to decrease in H+ ion concentration
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excretion of bicarbonate
|
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what does compensation mean related to acid-base balance?
|
process by which the body tries to correct changes in pH
|
|
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what are the 4 types of acid-base imbalance?
|
respiratory acidosis
respiratory alkalosis metabolic acidosis metabolic alkalosis |
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|
what causes respiratory acidosis
|
respiratory depression
inadequate chest expansion airway obstruction alveolar-capillary blockage inadequate mechanical ventilation |
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|
First line of defense in acid base imbalance
|
chemical and protein buffers
|
|
|
second line of defense in acid base imbalance
|
respiratory buffers
|
|
|
how does hyperventilation change H+ concentration
|
decrease concentration of H+ ions
|
|
|
how does hypoventilation change H+ concentration
|
increases concentration of H+ ions
|
|
|
what is the 3rd line of defense in acid base imbalance?
|
renal buffers
|
|
|
how do the kidneys respond to increase in H+ concentration
|
increase bicarbonate reabsorption and production
|
|
|
How do kidneys respond to decrease in H+ ion concentration
|
excretion of bicarbonate
|
|
|
what does compensation mean related to acid-base balance?
|
process by which the body tries to correct changes in pH
|
|
|
what are the 4 types of acid-base imbalance?
|
respiratory acidosis
respiratory alkalosis metabolic acidosis metabolic alkalosis |
|
|
what causes respiratory acidosis
|
respiratory depression
inadequate chest expansion airway obstruction alveolar-capillary blockage inadequate mechanical ventilation |
|
|
respiratory acidosis causes
|
increase in CO2
increase in H+ |
|
|
what causes respiratory alkalosis?
|
hyperventilation
hypoxemia |
|
|
respiratory alkalosis causes
|
decrease in CO2
Decrease in H+ |
|
|
causes of metabolic acidosis
|
excessive H+ ion production
inadequate elimination of H+ ions inadequate production of bicarb excessive elimination of bicarb |
|
|
metabolic acidosis causes
|
decreased HCO3
Increased H+ |
|
|
causes of metabolic alkalosis
|
base excess
acid deficit -prolonged NG suction -potassium depletion |
|
|
metabolic alkalosis causes
|
increased HCO3
decreased H+ |
|
|
vital signs associated with respiratory acidosis
|
tachycardia
tachypnea |
|
|
s/sx's of respiratory acidosis
|
dysrhythmia
anxiety irritability confusion coma shallow/rapid breathing pallor cyanosis |
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s/sx's of respiratory alkalosis
|
anxiety
tetany convulsions tingling numbness palpitations CP dysrhythmia rapid and deep respirations (Kussmal) |
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vital signs associated with respiratory alkalosis
|
tachypnea
|
|
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vital signs associated with metabolic acidosis
|
bradycardia
weak pulses hypotension tachypnea |
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s/sx's of metabolic acidosis
|
dysrhythmia
muscle weakness hyporeflexia fatigue confusion kussmaul respirations warm, dry and flushed skin |
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vital signs associated with metabolic alkalosis
|
dysrhythmia
numbness tingling tetany weakness hyperreflexia confusion convulsion ineffective breathing r/t weakness |
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normal pH range:
|
7.35-7.45
if <7.35 --> acidosis if> 7.45 --> alkalosis |
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normal PaCO2 range:
|
35-45
if outside of this range, it is respiratory if partially or fully compensated: <35 --> alkalosis >45 --> acidosis |
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normal HCO3 range
|
22-26
if outside this range, imbalance is metabolic in cause if partially or fully compensated: <22 --> acidosis >26 --> alkalosis |
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what does the PaO2 and SaO2 indicate on ABG?
|
whether or not patient is hypoxic
|
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in uncompensated pH imbalance, what value on the ABG will be abnormal?
|
pH
EITHER PaCO2 or HCO3 Not both!! |
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in partially compenssated pH imbalance, what ABG value will be abnormal?
|
pH
PaCO2 HCO3 |
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in fully compensated pH imbalance what ABG values will be abnormal
|
PaCO2 and HCO3
pH will be normal |
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how do you treat respiratory acidosis?
|
oxygen therapy
maintain airway enhance gas exchange |
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how do you treat respiratory alkalosis?
|
oxygen therapy
anxiety reduction rebreathing techniques |
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how do you treat metabolic acidosis?
|
if DKA--> insulin
if GI--> antidiarrheal and IVF if low bicarb --> bicarb |
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how do you treat metabolic alkalosis?
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if GI--> antiemetics, IVF, electrolyte replacement
if low K--> stop causative therapy |
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complications of acid base imbalances
|
convulsions
coma respiratory arrest |
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how much oxygen does atmospheric air have?
|
21%
|
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what does the FiO2 measure
|
Percentage of oxygen delivered to patient
|
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Range of O2 administration via NC
|
24-44% at 1-6 L/min
|
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advantage of using nasal canula for oxygen administration?
|
safe
easy to apply comfortable patient can eat/talk/ambulate |
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disadvantages of using a nasal canula?
|
FiO2 varies with flow rate and patients respiratory rate/pattern
extended use can cause skin breakdown tubing can be dislodged |
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FiO2 and volume to administered with a simple face mask?
|
40-60% and 5-6 L/min
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advantages of using a simple face mask for oxygen administration?
|
more comfortable than a nasal canula
|
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disadvantages of using a simple face mask for oxygen administration
|
<5 L/min can cause rebreathing
eating/drinking/talking impaired |
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FiO2 and volume range for partial rebreather
|
60-75% at 6-11 L/min
|
|
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advantages of using a partial rebreather for oxygen administration
|
allows client to rebreath up to 1/3 of exhaled air
|
|
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disadvantages of using a partial rebreather mask for oxygen administration
|
can cause CO2 build up
FiO2 varies with patients respiratory pattern Eating/drinking/talking is impaired |
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|
FiO2 and volume range for nonrebreather mask
|
80-95% at 10-15 L/Min
|
|
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advantages of using a nonrebreather mask for oxygen administration
|
delivers highest O2 concentration
|
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disadvantages of using a nonrebreather mask for oxygen administration
|
mask must be fully intact to be functional
eating/drinking/talking impaired |
|
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early signs of hypoxemia
|
tachypnea
tachycardia restlessness pallor HTN accessory muscle use, nasal flaring |
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late signs of hypoxemia
|
confusion/stupor
cyanosis bradypnea bradycardia hypotension cardiac dysrhythmias |
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s/sx's of oxygen toxicity
|
dry cough
substernal pain nasal congestion nausea/vomiting fatigue HA Sore throat hypoventilation |
|
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benefits of positive pressure ventilation
|
forced/enhanced lung expansion
improved gas exchange decreased work of breathing |
|
|
routes to deliver mechanical ventilation
|
endotracheal tube
tracheostomy tube nasal or face mask |
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|
Assist-Control Ventilation (AC)
|
preset rate and tidal volume
patient can initiate breaths patient may require sedation |
|
|
Synchronized Intermittent Mandatory Ventilation (SIMV)
|
preset rate and volume
patient initiated breaths determine the volume based on the effort ventilated breaths are synchronized with patients own respirations used as a regular and weaning mode |
|
|
pressure support ventilation (PSV)
|
preset pressure delivered during spontaneous inspiration to reduce work of breathing
patient controls rate and volume PSV decreased work of breathing and promotes respiratory muscle conditioning |
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|
Positive End Expiratory Pressure (PEEP)
|
increased pressure applied at end of expiration to increase functional residual capacity and increase oxygenation by opening collapsed alveoli
PEEP muse be used in conjunction with AC or SIMV mode |
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|
Continuous positive airway pressure
|
positive pressure applied during spontaneous breaths
no ventilator breaths are delivered unless in conjunctions with SIMV |
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|
risks associated with CPAP oxygen administration
|
volutrauma
decreased cardiac output increased intracranial pressure |
|
|
Bilevel positive airway pressure
|
positive pressure delivered during spontaneous breaths
different levels of pressure delivered during inspiration and expiration no spontaneous breaths delivered bipap is noninvasive* |
|
|
progressive steps toward intubation
|
Nasal Canula--> Venturini mask-->Bipap-->100% NRB--> Ambu-Bagging--> intubation
|
|
|
Focus of therapy for acute respiratory failure related to Pneumonia
|
Antibiotic
IVF |
|
|
focus of therapy for asthma exacerbation
|
steroids
bronchodialators |
|
|
Risks of intubation
|
esophageal intubation
Right Mainstem intubation ruptured trachea/bronchus aspiration of blood/gastric content tooth damage/loss hypoxemia tracheal stenosis, erosion or nec. cardiac arrhythmia |
|
|
controlled mechanical ventilation
|
the machine does all the work
|
|
|
How to increase oxygenation with mechanical ventilation
|
increase FiO2
Increase PEEP Increase PS |
|
|
How to increase ventilation with mechanical ventilation
|
increase Rate
increase tidal volume if patient is hypo ventilating, increasing the rate and/or tidal volume will reduce the pCO2 into normal range |
|
|
What do you include in SBAR for a ventilated patient
|
mode
rate tidal volume FiO2 PEEP PS |
|
|
Criteria for weaning off of mechanical ventilation
|
patient must maintain:
-total minute ventilations>5 L/Min -pO2> 60 mm HG -pCO2 < 45 - pH 7.35-7.45 -Hct normal |
|
|
acute respiratory failure
|
inability of body to meet tissue needs or CO2 removal
PaO2 < 50 mm Hg PaCO2 > 50 mm Hg |
|
|
2 types of respiratory Failure
|
Hypoxemic
Hypercapnic |
|
|
Mild hypoxemia PaO2 levels
|
60-80 mm Hg
|
|
|
moderate hypoxemia PaO2 levels
|
50-60 mm HG
|
|
|
Severe hypoxemia PaO2 levels
|
< 50 mm Hg
|
|
|
low V/Q is caused by
|
secretions/fluid obstructing alveoli
|
|
|
high V/Q is caused by
|
problem with blood flow
|
|
|
Causes of arterial hypoxemia
|
diffusion limitations
alveolar hypoventialtion |
|
|
s/sx's of hypercapnia
|
lethargy
decreased LOC decreased respiratory rate low tidal volume |
|
|
etiology of pulmonary embolism
|
venous stasis
altered coagulation vessel damage |
|
|
s/sx's of pulmonary embolism
|
sudden onset of
dyspnea apprehension syncope hemoptysis tachypnea diaphoresis chest pain cough |
|
|
acute respiratory distress syndrome
|
sudden progressive respiratory failure
severe dyspnea hypoxemia despite increasing FiO2 diffuse infiltrates |
|
|
2 different pathways to ARDS
|
direct
indirect |
|
|
indirect etiology of ARDS
|
pancreatitis
sepsis trauma |
|
|
direct etiology of ARDS
|
PNA
Shock Aspiration Chest trauma |
|
|
Phase 1 of ARDS
|
exudative phase
damage to capillary membrane microemboli inflammatory mediators released |
|
|
phase 2 of ARDS
|
proliferative phase
surfactant cells damaged |
|
|
Phase 3 of ARDS
|
Fibrotic Phase
inflammation causes fibrin to develop in lung tissue causing irreversible damage |
|
|
early s/sx's of ARDS
|
restlessness/change in LOC
increased RR with normal lung sounds dyspnea respiratory alkalosis decreased PaCO2 increased HR increased temperature decreased PaO2/Work of breathing minimal patchy infiltrates if any increased PIP |
|
|
late s/sxs of ARDS
|
decreased PaO2
severe dyspnea and WOB hypercapnia hypoxemia metabolic acidosis increased HR decreased BP cyanosis/pallor crackles/rhonchi white out on CXR increased PIP decreased functional residual capacity |
|
|
treating pulmonary contusion
|
careful assessment
pain relief oxygen therapy |
|
|
s/sx's of flail chest
|
paradoxical chest movement
unequal breath sounds respiratory distress |
|
|
treatment of flail chest
|
position good lung down
provide adequate oxygenation closed chest drainage frequent assessment pain control |
|
|
subQ emphysema
|
air which escapes normal area and goes into interstitial space
|
|
|
what is the purpose of the immune system?
|
prevention
protection destruction of foreign invaders |
|
|
what are the 3 lines of defense
|
1: anatomical barriers
2: nonspecific defense 3: acquired/specific defense |
