ABGs
pH 7.3, PaCO2 68 mm Hg, HCO3 28 mmol/L, and PaO2 60 mm Hg.
Partially Compensated Respiratory Acidosis
What are we doing to minimize pain, anxiety and delirium?
Cluster care, decrease stimulation, medications
Difference between volume-cycled ventilation and pressure-cycled ventilation?
Volume cycled delivers preset volume of gas to lungs; volume constant and pressure variable. Pressure cycled delivers preset pressure of gas to lungs and tidal volume will vary depending on lung compliance
What is the purpose of the water-seal chamber in a three chamber chest drainage system?
prevent airflow back into patient
pH 7.0, PaO2 90 mm Hg, PaCO2 23 mm Hg, and HCO3 12 mmol/L
Partially compensated metabolic acidosis
Top three clinical manifestations of ARDs?
Ground glass opacities, decreased lung compliance and refractory hypoxemia
Examples of causes of high pressure alarms?
coughing, biting tube, secretions in airway, and water in tubing.
What should level of water in chamber generally be at?
20 cm H2O or as prescribed.
pH 7.6, PaO2 120 mm Hg, PaCO2 31 mm Hg, and HCO3 25 mmol/L.
Respiratory Alkalosis, Uncompensated
Which condition is the most common indirect predisposing disorder of ARDS?
Pneumonia
Nursing interventions to prevent VAP (ventilator associated pneumonia)
HOB elevated to 30-45 degrees. Use of ET-tube with suction port above cuff. Proper and regular oral care. Oral suctioning pro. Hand washing and proper aseptic/clean technique as indicated.
What should be done if the chest tube becomes dislodged from the drainage chamber?
Submerge in 1 in sterile water or NS until reattachment to maintain pressure balance and notify MD
pH 7.5, PaO2 85 mm Hg, PaCO2 40 mm Hg, and HCO3 34 mmol/L.
Metabolic Alkalosis, Uncompensated
Two important things for mechanically venting an ARDS patient?
Positive pressure mechanical ventilation and PEEP
Once inserted, what is important for the initial nurse to establish concerning the ET tube?
Measurement of the tube (on the tube itself) at a specific point on the patient. If it changes, we know the tube has moved.
Indications for chest tube?
pleural effusion, hem-thorax, pneumothorax
pH 7.39, PaCO2 27 mmHg, and HCO3 19 mEq/L.
Metabolic Acidosis, Fully Compensated
What is ABCDEF Bundle?
Assess pain and agitation, Both SATs and SBTs (awake and breathing trials), Choice of sedation, Assess, prevent and manage delirium (sleep/awake cycles), early mobility and exercise and family engagement and empowerment
Primary nursing concerns with vents?
Regularly auscultate breath sounds and monitor RR for irregularities. Maintain appropriate tube placement and cuff inflation. Prevent skin breakdown. Develop plan for communication (before insertion if possible). Administer sedatives, analgesics and/or paralytics. ET tube suctioning and monitor ABGs.
Indications for chest tube removal
Patient status improved and stable, decreased chest tube drainage (usually less than 100 mL/24hr), air leak resolved, lung reinflated on X-ray and remains inflated