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190 Cards in this Set
- Front
- Back
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what is the normal pH in the blood?
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7.35-7.45
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what is the normal PaO2 in the blood?
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80-100
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what is the normal PaCO2 in the blood?
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35-45
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what is the normal HCO3 in the blood?
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22-26
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what does the PaO2 stand for?
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the partial pressure of O2 dissolved in the arterial blood
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what does pH represent in the blood?
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the Hydrogen ion concentration in the blood
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what does PaCO2 represent in the blood?
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the partial pressure of dissolved carbon dioxide in the arterial blood
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what does the HCO3 respresent in the blood?
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bicarbonate; acid-base component that reflects kidney function
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if the PaCO2 is >45, what does this represent?
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respiratory acidosis
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if the PaCO2 is <35, what does this represent?
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respiratory alkalosis
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what are some causes of resp. acidosis?
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alveolar hypoventilation
COPD oversedation head trauma anesthesia drug overdose neuromuscular dx inadequate mechanical vent |
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what are some causes of resp. alkalosis?
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alveolar hyperventilation
hypoxia anxiety PE pregnancy overventilation by mech vent |
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if the HCO3 is <22, what does this represent?
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metabolic acidosis
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if the HCO3 is >26, what does this represent?
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metabolic alkalosis
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what are some causes of metabolic acidosis?
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ketoacidosis
lactic acidosis renal failure diarrhea |
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what are some causes of metabolic alkalosis?
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-fluid loss from upper GI (vomiting, NG suctioning)
-diuretic therapy -severe hypokalemia -alkaline administration |
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if the pH is not within normal limits and PaCO2 or HCO3 is not within normal limits, but the other value of PaCO2 or HCO3 is WNL, what does this reflect?
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uncompensated acidosis or alkalosis (depending what values are where)
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if the pH is not WNL and both PaCO2 and HCO3 are abnormal (opposite of each other), what does this reflect?
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partially compensated acidosis or alkalosis (depending on what values are where)
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if pH is WNL but PaCO2 and HCO3 are abnormal, what does this reflect?
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fully compensated acidosis or alkalosis (depending on what values are where and depending what side of 7.40 the pH lies)
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how many liters of O2 can a pt be on with NC?
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up to 6 L (room air is 20% O2. every liter of O2 adds 4% of O2)
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how many liters of O2 can a pt be on with O2 mask?
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5-6L=40%
6-7L=50% 7-8L=60% |
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how many liters of O2 can a pt be on with venti mask?
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6L and above:
6=60% 7=70% 8=80% 9=90% 10=99%+ |
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what are the two types of acute resp failure (ARF)?
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type I: hypoxemic and normocapnic respiratory failure. PaO2=low PaCO2=normal
type II: hypoxemic hypercapnic respiratory failure. PaO2=low PaCO2=high |
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when is ARF diagnosed?
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PaO2 <60
PaCO2 >45 |
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what is PEEP? what are some characteristics of it?
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peak end-expiratory pressure; increased oxygenation with decreased FiO2.
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what are some benefits of PEEP?
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opening of collapsed alveoli
stabilize flooded alveoli |
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what are some negatives to PEEP?
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-decreased CO
-decreased venous return -barotrauma -alveoli rupture, causing gas escaping into surrounding tissue |
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if the PEEP is too high, what might happen?
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overdistension of alveoli (getting too big) which impedes capillary blood flow, decreased surfactant production
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if the PEEP is too low, what might happen?
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alveolar collapse during expiration causing more damage
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what are the three types of pneumonia?
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-community acquired pneumonia (CAP)-alcoholism, COPD, diabetes, malignancy, CAD
-hospital acquired pneumonia (HAP)-hospital related ventilator assisted pneumonia (VAP)-results from being on the vent for long periods of time |
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what are some ways to help diagnose pneumonia?
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sputum culture
CXR bronchoscopy CBC CMP blood cultures ABG |
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how can pneumonia be treated?
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antibiotics
O2 therapy fluid therapy nutritional support vent if ARF |
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what is aspiration pneumonia?
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pneumonia acquired from aspiration of fluids or food. pH <2.5 is severe chemical pneumonitis and pH >2.5 is lessened damage, but bacterial growth is promoted in the stomach
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if you fix the cause of an acid-base disorder, what are you doing?
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correcting the problem
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if you fix the pH in an acid-base disorder, what are you doing?
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compensating for the problem
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what is a compensatory mechanism for metabolic acidosis?
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hyper ventilation aka Kussmaul's respirations
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what is a compensatory mechanism for metabolic alkalosis?
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compensatory bradyapnea
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what is a compensatory mechanism for resp. acidosis?
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renal system hanging onto bicarb (~40 hrs)
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what is a compensatory mechanism for resp. alkalosis?
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renal system getting rid of bicarb (~48 hrs)
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what is hypocapnia? hypercapnia?
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not enough CO2; too much CO2
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what is upnea? tachypnea? bradypnea?
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normal breathing; increased respirations; decreased respirations
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what is a pulmonary embolism?
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a clot that has formed in the legs or pelvis and travels to the lungs. the clot lodges in the pulmonary artery or arterioles and disrupts blood flow to the lungs
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what is the best diagnostic tool for pulmonary embolism?
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spiral CT
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what is some of the pathophysiology of PE?
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-↑ dead space-lung receives ventilation, without perfusion
-bronchoconstriction- hypocapnia from ↓ CO2 in affected area, constriction of airway, re-dist of ventilation to perfused areas -compensatory shunting-when lungs compensate for entire CO. -hemodynamic consequences-pulm. HTN, rt ventricle failure, ↓ vent. preload, ↓ CO, ↓ BP |
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s/sx of PE?
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tachycardia
tachypnea apprehension fever rales chest pain cough evidence of DVT |
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how is PE diagnosed?
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ABG-↓ PaO2 (hypoxemia) and ↓ PaCO2 (hypocapnia)
DDIQ ECG CXR ECHO spiral CT |
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what are some Tx of PE?
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heparin, LMWH, coumadin (longer term)
SCD, TED hose supp. O2, intubation, vent clot dissolution reversing pulm HTN |
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what is status asthmaticus?
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a severe asthma attack that fails to respond to conventional therapy w/ bronchodilators. could lead to ARF
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what are some causes to status asthmaticus?
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↓ in anti-inflammatory reaction
↑ resp response to allergens environmental |
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how is status asthmaticus Dx?
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ABG-->hypocapnia, resp alkalosis caused by hypervent.
fatigue-->hypoxemia and hypercapnia |
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what are some s/sx of status asthmaticus?
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cough
dyspnea tachycardia & tachypnea ↑ accessory muscle use |
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what are some treatments of status asthmaticus?
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bronchodilators
corticosteroids O2 therapy intubation (if pt. is bad enough) |
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what might indicate that a pt. is going to be on long term mechanical ventilation?
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he/she has failed at least one wean attempt
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what are some physiologic factors for long term ventilation?
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↓ gas exchange
↓ ventilatory drive ↑ ventilatory workload ↑ vent demand ↑ respiratory muschle fatigue |
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what are some psychologic factors for long term vent?
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loss of breathing pattern control
lack of motivation or confidence delirium |
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what does the FiO2 stand for?
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fraction of inspired oxygen
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what should the PaO2 and SaO2 be during rest and exercise in a healthy person?
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PaO2 >60mmHg
SaO2 >90% |
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what are oxygen free radicals and how are they harmful?
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O2 free radicals are metabolites of O2 that are considered toxic. There are enzymes in the body that usually break them down, but when the radicals aren't broken down, injury to the lungs may occur.
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oxygen toxicity occurs at what point?
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if the pt has been on >50% for >24 hrs.
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what does a pharyngeal airway do?
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keeps the tongue from obstructing the airway. oropharyngeal- the tip sits just above the epiglottis.
nasopharyngeal- measure from tip of nose to ear |
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what are some things that an endotracheal (ET) tube does?
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maintains a patent airway
prevents aspiration application of vent (+ pressure) use of high O2 concentrations |
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what is a tracheostomy tube and what are some things to know about them?
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-long term intubation of more than 2-3 weeks
-avoids oral, nasal, pharyngeal, and laryngeal complications -2 types include single lumen and double lumen: single-tube w/ built in cuff, obturator. double- tube w/ attached cuff, obturator, inner cannula (safer for pts w/ secretion problems |
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what is a minimal leak technique for trach cuffs?
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injected air into cuff until no leak is heard, then releasing air until small leak is heard on inspiration
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what is a minimal occlusion volume technique on trach cuffs?
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injfecting air into cuff until no leak is heard @ peak inspiration. increase cuff pressure for pts @ risk for aspiration
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what do you need to know about suctioning?
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sterile procedure
oxygenate 100% before and after procedure limit to 10-15 seconds per pass limit to 3 passes per suction |
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what is a passy-muir valve?
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allows a pt that is on a trach the ability to talk. there is a 1 way valve that allows for air to enter lungs on inspiration. it then closes and forces air over vocal cords and out of the mouth. cuff must be deflated to work
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how does oral hygiene help a trached pt?
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↓ hospital acquired pneumonia
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what is important to know about extubating a pt?
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clear secretions from above the cuff
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what are negative pressure ventilators?
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applied externall to the pt, causing a negative pressure to start outside the lungs and transmitted internally to expand the lungs
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what are positive pressure ventilators?
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the forcing of air into a pts lungs through ETT or tracheostomy tube
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what are the 4 phases of ventilation?
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1. change from exhalation to inspiration
2. inspiration 3. change from inhalation to expiration 4. exhalation |
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what types of triggers occur for pts on the vent?
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pt triggered-initiated by the pt
machine triggered- initiated by the vent time triggered- vent initiaties breath based on preset time flow triggered-pt assisted breaths initiated by the pt |
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what are some ventilator complications?
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-barotrauma-air leaks into surrounding tissues from excessive pressure or volume in the alveoli
-CV compromise-↑ intrathoracic pressure=↓ venous return to rt side of heart -pt related-vent dyssynchrony, pt is fighting the vent -vent assoc. pneumonia-impairs lungs normal defenses, contaminates lwr airway |
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what is alveolar dead space?
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when the alveoli is receiving ventilation but no perfusion, thus no gas exchange occurring
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what is intrapulmonary shunting?
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alveoli receving perfusiong, but no ventilation leading to no gas exchange
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what is refractory hypoxemia?
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when blood goes to the lungs and returns to the left side of the heart with unoxygenated blood. also known as shunt.
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will supplemental O2 help with refractory hypoxemia?
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not exactly. gas exchange is impaired from alveoli being closed. positive pressure is needed to open alveoli to enhance gas exchange
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what does a high pressure alarm indicate on the vent?
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peak pressure exceeds the limit, ↑airway resistance (secretions, biting tube, kink in tube, water in tube, fighting vent, pneumothorax, bronchoconstriction)
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what should you do when you hear a vent alarm?
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1. respond immediately
2. determine what alarm is going 3. assess pt to make sure they are ok, if not bag a proceed as needed 4. assess tubing 5. reset alarms once all is clear |
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in the event of needing to use the ambu bag, what is some important information to know?
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remove the vent
deliever 12 breaths/min turn O2 up to 10-15L/min |
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according to ABG analysis, what type of adjustments should be made:
↓ PaO2= ↑ PaO2= ↓↑ PaCO2, pH= ↑↓ PaCO2, pH= |
↑ FiO2
↓FiO2 ↓ rate or Vt ↑ rate or Vt |
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if the ETT is too close to the carina (should be 3-4 cm above carina), what is important to know?
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↓ breath sounds will be heard and CXR is needed to confirm
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what happens if the ETT is misplaced; rt main stem bronchus?
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absent breath sounds on the lt with unequal chest expansion.
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if there is a leak in the tube/cuff or a pt self extubates, what type of alarm will sound on the vent?
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low alarm
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if a pt is being weaned off the vent and has spells of resp. depression or no breaths at all, what type of alarm will sound?
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apnea alarm
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what is the functional residual capacity?
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the amount of air left in the lungs between breaths to allow for continuous gas exchange
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what role does surfactant play in the respiratory system?
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keeps the alveoli slippery and from collapsing
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what is ventilation?
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the movement of air in and out of the lungs
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what is respirations?
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the actualy act of gas exchange
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where are vesicular breath sounds heard? bronchovesicular? broncho?
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vesicular- normal sounds in periphery
bronchvesicular-normal sounds heard over sternum broncho-normal sounds heard over the larynx/trachea area |
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how does nitrogen play a role in respirations?
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helps keep the alveoli open (~70% of air)
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what is absorption atelectasis?
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when a pt is on O2 therapy, the decrease in nitrogen collapses the alveoli
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it is very important to have a pt practice deep breathing (IS). why is coughing not something you want a resp pt to do?
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coughing (unless they have secretions) causes atelectasis and changing of air pressure. could collapse the alveoli.
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what is a major cause for the oxyhemoglobin curve to shift right or left?
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resp/metabolic acidosis or alkalosis
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if the oxyhemoglobin curve shifts to the right, what does show?
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there is decrease Hgb affinity for O2. the Hgb is slippery and doesn't want to pick up O2 very easily. It does like to get rid of it quickly. seen with acidosis and fever
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if the oxyhemoglobin curve shifts to the left, what does show?
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an increase in Hgb affinity for O2. Makes the Hgb sticky and pick up O2 very easily, but doesn't want to drop it off at the tissues very easily. seen with alkalosis and hypothermia
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at what point does the Partial pressure of O2 (PaO2) really begin to drop on the oxyhemoglobin curve?
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after 60mmHg
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what is dead space in the lungs?
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air that doesn't participate in gas exchange
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what is a hallmark sign of a shunt?
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V/Q mismatch
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what is the proper positioning for a pt to facilitate oxgen exchange?
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good lung down, unless the pt has had a pneumonectomy. If that's the case, bad lung goes down.
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if a pt has had a pneumonectomy, what is the proper positioning for that pt?
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bad lung down
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if a pt gets extubated and begins having some stridor, what intervention should be implemented before reintubating the pt?
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SVN, most likely a bronchodilator
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what is a VQ mismatch?
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ventilation/perfusion: where the ventilation is less than the amount of perfusion occurring. a number that is less than 1 is considered some type of hypoxemia.
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what causes peripheral cyanosis?
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vasoconstriction
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what causes central cyanosis?
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decreased amount of Hgb carrying O2 in the arterial blood
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what is dyspnea?
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difficulty breathing out of proportion for the amount of work being done
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hyperventilation can lead to:
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resp. alkalosis
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hypoventilation can lead to:
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resp. acidosis
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what is the first indication that a pt. may code?
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increase in HR
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what is the normal P/F ratio in a healthy person?
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>400
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what is the P/F ratio is a pt that has ARDS? ALI?
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ARDS= <200
ALI= 200-300 |
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what time of day is the best time to collect a sputum culture?
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morning
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how long does it take to get results for a sputum culture back?
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~48 hrs
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is it ok to put saline down an ET tube while suctioning or any other time?
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No! this may increase the opportunity for infection. The only time you may use saline for suctioning is to clear the catheter of secretions
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what fuels the Na/K pump?
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O2 and glucose
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what are some extrapulmonary causes of acute respiratory failure?
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brain or spinal cord injury
neuromuscular system thorax pleura upper airways |
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what are some intrapulmonary causes of acute respiratory failure?
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lower airways and alveoli
pulmonary circulation alvoelar-capillary membrane |
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when looking at an electrolyte panel, what does the CO2 number represent?
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bicarbonate
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does an acid donate or accept a H+ ion?
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donates
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does a base donate or accept a H+ ion?
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accepts
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at what point does the PaO2 have to get to start compromising the tissue oxygenation?
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<40mmHg
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what is the difference between hypoxia and hypoxemia?
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hypoxemia is when there is a low amount of O2 in the blood. hypoxia is when there is a low amount of O2 getting to the tissues
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if hypoxia occurs for a long period of time, what can this lead to?
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lactic acidosis
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what are the ABG norms for a COPD pt?
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PaO2--> <60mmHg
PaCO2--> >50mmHg they are also known as the "50/50 club" |
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what is an acceptable O2 saturation for a COPD or really sick pt?
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87%, on a good day
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what is the best way to position a pt that has COPD or is very sick with respiratory problems?
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HOB elevated 45 degrees or tripod position
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what is one of the ways to correct resp acidosis?
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effective oxygenation and ventilation
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what do bronchodilators do and name one type:
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open up the airways; albuterol
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what do mucolytics do and name one type:
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liquify secretions; mucomyst
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what do sedatives do and name one type:
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comfort, decrease WOB; diprivan
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what do analgesics do and name one:
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decrease pain; fentanyl
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what do neuromuscular blockades do and name one:
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decrease WOB; pavulin (must be on vent/resp muscles paralyzed)
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permissive hypercapnia is what?
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when the pt is put on an isolator vent to help them take tiny breaths to keep alveoli open and O2 in, but there isn't enough time to exhale all CO2. This causes resp acidosis.
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how soon should nutrition get involved?
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as soon as possible. if the pt is overfed, they will increase CO2 (byproduct of digestion)
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gastric pH is normall around 2.0. PPI's are usually given to help decrease _______ and increase_______.
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HCl and gastric pH. the only problem with this, is that it promotes more bacterial growth leading to infection.
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if a pt is having residual after a feeding, what complication can this lead to?
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aspiration
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if you are concerned as the nurse that the pt has aspirated some of their feeding, how can you check this?
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check what you have suctioned for sugar
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what is a complication for an artificial airway?
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tracheal esophageal fistula
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what are the 8 types of coping mechanisms from psychosocial?
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1. regression-unconscious defecnse mechanism that involves a retreat in the face of stress.
2. suppression- conscious, intentional retreat from overwhelming issues. 3. denial- conscious and unconscious attempts to disavow the meaning of an event. 4. trust- believing in the medical staff 5. hope- support and helping the pt 6. spiritual beliefs and practices- may help with illness process 7. use of family support 8. sharing concerns |
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how is pneumonia prevented in critically ill pts?
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hand washing
oral care proper disinfecting of resp equipment suctioning of airway above cuff HOB 30 degrees promoting secretiong clearance |
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what is the difference between aspiration pneumonitis and pneumonia?
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aspiration pneumonitis is when abnormal substances get into the airways from aspiration. This may or may not cause an infection. injury to the lung may result. Pn is an acute inflammation of the lung parenchyma caused by an infectious agent, leading to alveolar consolidation
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what receptors are involved in breathing?
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1. controller- includes the brainstem and cerebral cortex. the brainstem includes the medulla and pons, regulating rhythm, inhalation and exhalation, and depth. The cerebral cortex allows for voluntary actions such as crying, laughing, and singing.
2. effectors- muscles of ventilation 3. sensors- chemoreceptors responding to H+ concentration, PaCO2 changes |
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a shift to the left in the oxyhemoglobin curve respresents:
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increased Hgb affinity for O2. The Hgb is "sticky" and easily picks up O2, but doesn't want to get rid of it. caused by alkalosis and hypothermia
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a shift to the right in the oxyhemoglobin curve respresent:
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decreased Hgb affinity for O2. The Hgb is "slippery" and doesn't pick up O2 very easily, but gets rid of it easily. Caused by acidosis and hyperthermia (fever)
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what is the process of breathing?
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1. gas exchange occurs in the terminal bronchioles
2. the diaphragm contracts and moves lower, chest enlarges, reducing pressure outside of lungs. 3. air enters lungs 4. diaphragm relaxes, moving back up, pushing air out. 5. work of breathing is done solely by diaphragm, no skeletal muscles involved. 6. diaphragm is innervated by phrenic nerve at C3 and C5 |
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how does gas move in and out of the alveoli?
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vessels of the alveolar-capillary membrane form a network around each alveoli that is so dense it forms a continuous sheet of blood covering the alveoli. RBCs squeeze by single file and pick up O2 and drop of CO2
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what is the venous O2 saturation?
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75%
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what is the arterial O2 saturation?
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>96%
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the right ventricle contains what type of blood?
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deoxygenated
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the left ventricle contains what type of blood?
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oxygenated
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how is the heart affected by breathing?
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hypoxemia increases HR and pulmonary HTN which increases workload of the heart
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how does hypoxia affect the relatiohship between the CV system and the lungs?
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heart tries to compensate for decreased O2 by increasing HR and CO. As PaO2 decreases, acidosis increases and heart may become dysfunctional and CO may decrease. this may cause angina and dysrhythmias, further decreasing O2 delivery
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what can cause problems with diffusion of oxygen from the alveoli into the RBCs?
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1. high altitude
2. thickness of alveolar-capillary membrane from pulm edema and fibrosis 3. decreased surface area 4. CO2 has greater affinirty for Hgb than O2 |
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how does the work of breathing differ from a normal person to someone in respiratory distress?
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normal- respirations 12-20 bpm
respiratory distress- pt would have tachypnea, central cyanosis, resltessness, anxiety, flaring of nares, accessory muscle use, and intercostal retractions. positioning would include HOB 45 degrees or tripod. |
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what's the difference between tachypnea and hyperventilation?
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tachypnea is fast and shallow breaths from lung dz acute lung injury.
hyperventilation is fast and deep breaths from anxiety or panic. |
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how would a pt with tension pneumothorax present?
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trachea would deviate to unaffected side, chest pain extending to shoulders, diminished breath sounds, tachycardia, and hypotension
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what does the initial assessment of a pt in resp failure from pneumonia include?
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restless, agitated, tachycardia, HTN, tachypnea, dyspnea, accessory muscles, JVD, N/V, pallor, cyanosis, cold and clammy
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how does a pt with emhysema appear different from the pt with chronic bonchitis?
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emphysema pt will have productive cough, underweight, fatigued and characteristic barrel chest
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how is ARDS diagnosed?
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1. P/F ratio: <200
2. acute onset 3. refractory hypoxemia 4. bilateral infiltrates on xray |
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who gets ARDS?
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direct injury: aspiration, near drowning, toxic inhalation, pulmonary contusion, Pn
indirect injury: sepsis (primary cause), hypertransfusion, severe pancreatitis |
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how is ARDS treated?
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oxygenation to keep O2 sats >90%, PEEP: positive pressure blast to keep alveoli open, and permissive hypercapnia
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what is pleural effusion?
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transudate- non-inflammatory condition; accumulation of protein poor fluid
exudative- fluid and cells in an area of inflammation w/protein accumulation of fluid between the layers of tissue that line the lungs and chest cavity |
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how is pleural effusion diagnosed?
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cxr, pleural fluid analysis, CT, ultrasound
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how is pleural effusion treated?
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remove fluid, CHF=diuretics, infection=antibiotics, CA=chest tube to drain
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what is empyema?
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collection of pus in the space between the lung and the inside of the chest wall (pleural space). Caused by infection that spreads to the lungs
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how do you troubleshoot a pulse ox?
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change the site routinely
is the skin clean/dry fingers cold? moving? too much light in the room HTN vasoconstriction of extremities |
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besides oxygen saturation, what lab value is used to determine oxygenation status (not PaO2)?
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Hgb
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what is a shunt?
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the alveolus is receiving perfusion but not receiving ventilation=intrapulmonary shunting. alveoli are completely collapsed, refractory hypoxemia may occur
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what is a V/Q mistmatch?
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mild form of a shunt, alveoli are partially collapsed or partially filled with fluid. some gas exchange is being done, but is less than normal.
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how is shunting treated?
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supplemental O2 and PEEP to keep alveoli open
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how is V/Q mismatch treated?
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supplemental O2
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what is the physical care for a pt who is hypoxic?
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supplemental O2 and PEEP if shunting is present
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what is the physical care of the pt who has had surgery on his/her chest?
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splinting
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how should a pt be positioned if they have resp dysfunction?
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1. good lung down (except with pneumonectomy)
2. right lung down with diffuse lung dz. rt lung is bigger w/ more surface area 3. proning- improves perfusion to less damaged areas of the lungs and improves ventilation/perfusion mismatching and decreases intrapulmonary shunting. |
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what is a pulmonary embolism (PE)?
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clot that lodges in the pulmonary arterial system, disrupting the blood flow to certain parts of the lungs.
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what are some outcomes and how do they occur?
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occlusion of more than 50% leads to pulmonary HTN, vasoconstriction and hypoxia. workload increases, making pulm. htn worse. as pulm htn increases, workload of rt ventricles increases leading to right sided heart failure. eventually leading to shock, then death
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how do you place an oral airway?
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tongue depressor to displace downward. insert oral tip to just above epiglottis at base of tongue.
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how do you place a nasopharyngeal airway?
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measure from tip of nose to ear lobe. insert at base of nares to pharynx. tip of airway sits just above epiglottis at base of tongue.
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how is the suctioning procedure done?
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1. sterile procedure
2. oxygenate 100% for 2 min 3. limit each pass to 10-15 sec 4. intermittent suctioning 5. DO NOT use saline into ETT. can cause hypoxemia or hospital acquired pneumonia |
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who would you manage the pt who self extubates?
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1. evaluate the pt
2. complete extubation as necessary 3. give 100% O2 w/ ambu bag 4. call for help 5. stay with pt |
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how do mechanical vents affect cardiac output?
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1. increases intrathoracic pressure, decrease venous return to the rt side of heart
2. impaired venous return, decrease preload=decrease in CO 3. important to prevent hypovolemia bvecause it can further compromise venous return and CO |
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what is management of the pt receiving neuromuscular blockade?
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1. do not have analgesic, amnesic, anxiolytic or sedative effects
2. monitor RR and pattern until pt able to cough, maintain patent airway, have reversal agents available |
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what does a high alarm on the vent represent?
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airway obstruction, pt bucking the vent, tubing kinked, ET tube against carina, bronchospasms, secretions, water in tubing, tension pneumothorax, ALI, edema
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what does a low alarm on the vent represent?
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anattached tubing, leak around ET tube, ET tube displaced into pharynx or esophagus, poor cuff inflation or leak, peak flows are too low.
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what is weaning?
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gradual withdrawal of mechanical ventilator to reestablish spontaneous breathing
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who should be weaned from the vent?
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conscious pt, physiologic and hemodynamically stable, adequacy of oxygenation and ventilation, spontaneous breawthing capability
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how do you know if a pt is tolerating weaning or not?
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restless, agitated, increased BP and HR
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what is the diagnosis and management of a pt with TB?
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culture and sensitivity, mantoux test, cxr
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what is the management for a pt with TB?
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drugs: INH, rifampin, ethambutol, streptomycin, pyrazinamide
isolation, follow-up, vaccine, prevent spread |
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bronchodilator?
sedatives? neuromuscular blockade? TB? |
1. smooth muscle relaxation
2. sedation for pts on vent 3. paralytic that halts skeletal muscle movement 4. inh/rifampin for 6 months |
