acid base
DKA, liver failure
headache, hyperkalemia, N/V/diarrhea, electrolyte imbalances
<7.35; <22
Metabolic Acidosis
Early findings: tachypnea, tachycardia, restlessness
late: confused, bradypnea, bradycardia, hypotension
Hypoxemia/hypoxia
Abnormal inflammatory response; center becomes less sensitive to increased CO2 levels.
Emphysema- Increased WOB, tripod, SOB,
Chronic bronchitis- usually obese, cyanotic, cor pulmonale, clubbing
COPD
suction control chamber: gentle or steady continuous bubbling
water seal chamber: tidling is normal
fluid collection chamber: fluid is collected, greater than 70 is too much
Chest tube systems
hypoxemic: oxygen may reach alveoli but cannot be absorbed or used properly.
Hypercapnic- PaCO2 >50; pH <7.35
Acute respiratory failure
PaO2- partial pressure of oxygen (80-95)
SaO2- % of Hgb in arterial blood; 95-99
Hypoxia: low oxygen in tissues
hypoxemia: low oxygen in blood
Terms for O2
NC: 1-6L, most common, mobile
SFM: 5-10, used short term
NRB: 10-15, one-way valves and bag
venturi: most accurate oxygen, 2-15; 24-60%
Oxygen delivery
Bronchodilators
oral glucocorticoids
ABX if infection
NC, venturi, BIPAP
Treatment of COPD
Bubbling in water seal
apply sterile dressing
what is an air leak?
accidental removal
dyspnea (early)
restlessness (early)
confusion
tachycardia
Decreased LOC (late)
Manifestations of ARF
respiratory depression, brain tumors, inadequate chest expansion
MF: tachycardia, anxiety, shallow breathing/rapid, cyanotic
<7.35; >45
respiratory acidosis
provides positive pressure, most effective for sleep apnea
set positive inspiratory pressure on inspiration, lower on expiration
CPAP
BIPAP
increased HCT, hypoxemia,
Provide O2, high-fowlers, pursed lip breathing, dyspnea
Labs and nursing for COPD
obstruction of the pulmonary artery
thrombus, piece of tumor, amniotic fluid, air, fat, blood clot
Risk factors: pregnancy, obesity, birth control, trauma, PICC
PE
PEEP
occurs as a complication caused by a diffuse lung injury or critical illness
sepsis, fluid overload, shock, trauma, burns, DIC, aspiration
ARDS
hyperventilation, hypoxemia, pregnancy
panic attack, tachycardia, N/V
>7.45; <35
respiratory alkalosis
negative and positive pressure
rate- # of respirations the client receives per minute
PEEP= can lead to hypotension
Mechanical ventilation
Hypoxia and hypoxemia, extreme dyspnea, cyanotic tips, JVD, hepatomegaly
monitor respiratory status, monitor cardiac status
COR Pulmonale: right sided heart failure
hypercoagulability- cancer, oral contraceptives, dehydration
Venous stasis- prolonged bedrest, immobility, obesity, burns, pregnancy, endocarditis
Damage of vessels- trauma, IV drug use, atherosclerosis
What is Virchow's Triad?
tachypnea (early)
dyspnea
decreased breath sounds
pulmonary infiltrates (white out chest)
Manifestations of ARDS
base excess, excessive vomiting, NG tube suctioning
restlessness, dysrhythmias, N/V, diarrhea
>7.45; >20
high pH, high HCO3
metabolic alkalosis
indicates LOW VOLUME, tube disconnection, cuff leak, tube dislodgement
INCREASED PRESSURE, mucous plug/secretions, pt biting tube, kinking, anxiety, coughing
LOW pressure alarm
HIGH pressure alarm
can occur with blunt trauma and pneumothorax; air pockets under the skin "rice kripse"
Subcutaneous emphysema
Night sweats and low-grade fever, purulent sputum, negative air pressure
rifampin, hepatotoxicity
TB
blunt chest trauma, stab wounds, occluded chest tube, older adult clients, COPD
anxiety, pleuritic pain, hypoxia, cyanosis, tracheal deviation to unaffected side, dull percussion, subcutaneous emphysema
Pneumothorax risk factors and manifestations