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29 Cards in this Set

  • Front
  • Back
What causes the acid base balance of a PaCO2 below 35
What causes the acid base balance of a PaCO2 above 45
Pulmonary Edema, Asthma, COPD, Code
What causes the acid base balance when HCO3 is below 22,
Lactic acidosis, DKA, Renal Failure, Diarrhea
What causes the acid base balance of HCO3 above 26
Vomiting, Gastric Suction, Hypokalemia, Excess Bicarbonate
What is typical for the initial stage of ARDS
A pH of 7.48, a PaCO2 of 32, a HCO3 of 23, a PaO2 of 65, an O2 saturation of 84%.
This indicates the initial response to hypoxemia with a low PO2 and respiratory alkalosis due to tachypnea.
When is mechanical ventilation needed-what are the typical ABGS?
Acid 7.31, PaCO2 55, HCO3 24...
In ARDS this is the typical indication that there is less gas exchange and ABG results may be used to determine the need for mechanical ventilation
What happens in the late stage of ARDS
When the FIO2 has been at 100% without an elevation of PaO2, hypoxia results in lactic acidosis. Eventually, the body no longer gets enough perfusion of oxygen to the tissues to maintain aerobic metabolism. When the metabolism changes to anaerobic there is lactic acid produced and will cause an ABG that indicates combined metabolic and respiratory acidosis. The identifying characteristics of this combined or mixed imbalance is that pH, PaCO2 and HCO3 all indicate acid values. For example, the pH would be 7.18, the PaCO2 would be 72, and the HCO3 would be 18
Intubation supplies
E-T tube (normal adult about 8-8.5)
Laryngoscope with light (blades are curved or straight)
10 cc syringe for inflating cuff
Tape or velcro band
Patient with head hyperextended
Hyperventilate with 100% O2
Vintilator Settings Ordered (Volume cycled ventilator)
Fraction of inspired oxygen (FIO2)-50%
Tidal Volume 700 ml
Assist Control Mode
Rate 16 breaths per min
PEEP at 5 mmHg
Inspiratory/Expiratory Ratio
Vent Modes
Assist control-If patient initiates a breath then all the tidal volume goes in.
SIMV-if patient initiates a breath those extra breaths are at volume patient controls-used in weaning
Pressure Support-Decreases the work of breathing-Makes respirations deeper-Less likely to have a pneumothorax because pressure does not vary much
Goals in ARDS
Maintain adequate ventilation
FIO2 is set at the lowest possible level to maintain a PO2 higher than 60 mmHg and O2 saturation of approximately 90%
Avoid PEEP complications
Decreases cardiac output
Increases risk of barotrauma-pneumothorax
Acute Respiratory Distress Syndrome
AKA noncardiac pulmonary edema
Progressive refractory hypoxemia
does not improve with oxygen administration
Mortality rate 50% or greater.
High pressure Alarms-when do they occur?
Kinked tubing-needs to be straightened
Secretions present-needs suctioning
Patient coughing-question suctioning-maybe
Fighting ventilator-Sedation or change vent settings
Bronchospasm-happening from bronchodilators
Compliance changes (Pneumothorax or atelectasis) -chest x-ray is needed
Condensation of humidity in tubing
Low pressure alarms-when do they go off?
Check for leaks or disconnects
Listen for air escaping
Consider leak around cuff or low pressure in cuff
Temperature probe off.
BIPAP option
Support Ventilation
Tight fitting mask
Must have cooperative Patient
No ability to suction
-Peak inspiratory pressure
-Expiratory pressure (Compares with PEEP)
Define Acute respiratory distress syndrome ARDS
ARDS is characterized by noncardiac pulmonary edema and progressive refractory hypoxemia
Conditions associated with the development of ARDS
Shock-Hemorrhagic shock, septic shock
inhilation injuries-NEAR DROWNING, oxygen toxicity, smoke and toxic gases
infections-Gram negative sepsis, viral pneumonias, miliary tuberculosis
drug overdose-heroin, methadone, aspirin,

trauma-burns, head injury, lung contusion, fat emboli
pancreatitis, multiple transfusions,

open heart surgery w/ cardiopulmonary bypass
Nursing diagnoses for Respiratory Failure
Impaired Spontaneous ventilation
Dysfunctional ventilatory weaning response
Ineffective airway clearance
Impaired Gas exchange
Nursing interventions for Respiratory Failure
Respiratory monitoring
Artificial Airway Management
Mechanical ventilation
Anxiety reduction
Mechanical ventilatory weaning
Energy management
Airway suctioning
Airway insertion and stabilization
Oxygen therapy
Cause of respiratory failure:Impaired Ventilation
Airway obstruction-Laryngospasm, foreign body, aspiration, airway edema,

Respiratory disease-Asthma, COPD
Neurologic causes-Spinal cord injury, poliomyelitis, Guillain-Barre Syndrome, drug overdose, stroke,
Chest wall injuy-Flail chest, pneumothorax
Cause of Respiratory Failure: Impaired Diffusion
Alveolar disorders: Pneumonia, pneumonitis, COPD, Heart Failure, Acute respiratory distress syndrome (ARDS), near-drowning
Cause of respiratory failure: ventilation-perfusion mismatch
Pulmonary embolism
Describe respiratory failure and it's relation
Respiratory failure is not a disease but a consequence of severe respiratory dysfunction. It is often defined by arterial blood gas values. An arterial carbon dioxide level PO2 of less than 50-60 and an arterial carbon dioxide level of PCO2 of greater than 50 mmHg are generally accepted as indicators of respiratory failure
Except for COPD patients, which may be their normal values.
Pathophysiology of respiratory failure
Respiratory failure may be characterized by primary hypoxemia or a combination of hypoxemia and hypercapnia.
Hypoxemia manifestations: Dyspnea, tachypnea, cyanosis, restlessness, apprehension, confusion, impaired judgment, Tachycardia, dysrhythmias, hypertension, Metabolic acidosis
Hypercapnia Manifestations: Dyspnea-respiratory depression, headache, papilledema, tachycardia, hypertension, drowsiness, coma, systemic vasodilation, heart failure, respiratory acidosis
drugs used in treating respiratory failure
Beta adrenergic (sympathomimetic) or anticholinergic medications may be administered by inhilation to promote bronchodilation.

Methyxanthine bronchodilators (theophylline derivatives) may be given intravenously.

Corticosteroids administered by inhalation or intravenously, may be ordered to reduce airway edema.

Antibiotics are given to treat any underlying infection
Sedation and analgesia often are required during mechanical ventilation to decrease pain and anxiety.

Benzodiazepines such as diazepam (Valium), Ativan, or Versed may be used for sedation to inhibit respiratory drive.
IV morphine or fentanyl provide analgesia and also inhibit the respiratory drive allowing more effective mechanical ventilation.
Neuromuscular blockers: name and describe effect.
Rocuronium (Zemuron)
Pancuronium bromide (Pavulon)
Atracurium besylate (tracrium)
Cisatracurium (Nimbex)
These drugs competitively block the action of acetycholine (ACh) at skeletal muscle receptors, preventing muscle depolarization and contraction. Complete muscle paralysis is achieved within minutes.
Advantages and Disadvantages + potential complications of Oral Endotracheal tube
More easily inserted
Larger tube can be used, facilitating work of breathing, suctioning
Disadvantages: More difficult to secure, Can be obstructed by biting, Communication and mouth care more difficult
Increased risk of lower respiratory infection
Potential Complications:
Obstruction or displacement
Pressure necrosis of lip
Tracheoesophageal fistula
Advantages, disadvantages, and potential complications of a nasal endotracheal tube
More easily secured and stabilized
Well tolerated by client
Facilitate communication and oral hygiene
Necessitate smaller tube which may impede removal of secretions
Increased risk of lower respiratory infection
Potential complications:
Obstruction or displacement, Pressure necrosis of nares, Obstructive of sinus drainage, possible sinusitis, Tracheoesphageal fistula
Advantage, disadvantages, and potential complications of a tracheostomy
Easily secured and stabilized
Enable swallowing, speech, and oral hygiene,
Avoid upper airway complicatons
Requires surgical incision
Increased risk of lower respiratory infection
Potential Complications:
Hemorrhage due to incision or vessel erosion by tube
Wound infection
Subcutaneous emphysema