Ventilator Management
Name 3 indications for artificial airways
Neurological
Respiratory
Cardiovascular
Prevent Aspiration
Sepsis
Airway Obstruction
Protect Airway
What non-invasive methods measure hemodynamics?
MAP and urine output
List the SIRS criteria. How do SIRS and sepsis differ?
Temperature > 38 or < 35 degrees Celsius
HR > 90 bpm
RR > 20 breaths/min or PaCO2 of < 32 mmHg
White blood cell count of >12,000 cells/mL, <4,000 cells/mL or
10% immature (band) forms
Sepsis has a known or suspected infection
Signs of organ dysfunction for 3 different organs
Several answers :)
What is PEEP? What are the complications?
Positive End expiratory pressure! Keep alveoli from collapsing, helps with gas exchange/oxygenation. Increased ITP
What is the nurses' role during and following intubation?
Positioning- supine, neck flexed, Hyperoxygenate, meds, monitor VS
Lungs sounds
Monitor for increase in O2 sats
end tidal CO2 monitor
CXR
Explain why MAP is important
Describes PERFUSION. When organs are not being perfused they are not being oxygenated, without oxygen organs experience dysfunction then death
How do you progress from severe sepsis to septic shock?
Hypotension/hypoperfusion remain after fluid resuscitation
In pre-shock, the blood is shunted away from non-vital organs. What organs are they?
Lungs, kidneys, skin, GI
Nursing interventions to prevent VAP
HOB 30, oral care, suction, Sedation vacation, q2 turns
What is ACV mode? What are the nursing considerations?
Assist Control Ventilation. Gives set breath and tidal volume. Patient can take "extra" breaths. Sedate! Consider paralytic. Don't want the patient to "fight" w/ vent.
What does preload mean? What measures the right side of the heart? What measures the left side of the heart?
Volume, CVP, PAWP
Describe the pathophysiology of sepsis
1. inflammation leads to vasodilation and increased capillary membrane permeability
2. coagulation
3. impaired fibrinolysis
Bonus: hyper-metabolic state
The nurse is caring for a client diagnosed with severe sepsis. After an infusion of 30 mL/kg of intravenous fluids the client has a temperature of 101.4°F (38.6°C), a heart rate of 92 beats/minute, respiration rate of 20 breaths/minute, and a blood pressure of 80/50 mm Hg. Which nursing intervention is a priority for this client?
a. Redraw lactic acid.
b. Administer a vasopressor.
c. Insert an indwelling urinary catheter.
d. Obtain a 12-lead echocardiograph (ECG).
Describe what high CVP means
Full tank! Right side of the heart, fluid overload
Describe PSV mode. What must patients have?
PSV supports patient's pressure, if there isn't enough pressure the ventilator will add pressure.
Intrinsic Drive
Describe the nurse's role in pulmonary artery catheter and CVC placement
Position - flat/supine/Trendelenburg, monitor for air embolism, monitor telemetry for dysrhythmias, lung sounds
List priority nursing interventions for the septic patient
fluids, cultures, antibiotics, STOP the progression
The nurse is caring for a client who has respiratory distress and syncope after eating strawberries. Which will the nurse implement first?
a. Start continuous ECG monitoring.
b. Administer epinephrine.
c. Administer diphenhydramine.
d. Draw blood for lactic acid level
List normal values for cardiac output, CVP, and PAWP
CO 4-6
CVP 2-8
PAWP 6-12
What alarms should the RN listen for? What is low peak pressure? High peak pressure? What other alarms?
Low- "leak"
High- "obstruction"
High RR, apnea, SpO2
Describe nursing management for arterial lines and CVC/PAC lines
Monitoring for infection, drsg changes
All:Zero/level at phlebostatic axis
arterial- immobilize, CMS, Allen's test, connections, bleeding!!!
Discuss nursing management for the the septic patient.
Strict I&O
oxygen > 90%- how?
Monitor for bleeding, DVT prophylaxis
GI Function/nutrition
Glucose monitoring
skin integrity
safety
Describe obstructive shock. Common causes? Interventions?
Cardiac tamponade, tension pneumo, PE
Chest tube, percardiocentesis, oxygen/heparin
Signs of poor perfusion
Low urine output, cap refill >3 secs, low BP, low MAP, cool/clammy, pallor, decreased LOC