ABGs
PaCO2--49
HCO3--30
Metabolic Alkalosis with full compensation
If your patient is UNDERBREATHING, what acid-base imbalance are they in?
Bonus--Can you name a respiratory disorder in which this occurs?
Hypoventilation; holding onto too much CO2
Pneumonia, COPD, many pulmonary disorders
What is stridor and what does it mean?
Loud, crowing lung sound due to airway obstruction. EMERGENCY
Air in pleural space is called what?
When can you remove a chest tube?
Pneumothorax
Return of breath sounds on effected side, confirm with CXR
Which lung is your patient most likely to aspirate on?
The right side of the lung (bronch is slightly larger leading into the right)
pH: 7.43
PaCO2:15
HCO3-: 10
Respiratory Alkalosis with full compensation
How does your patient use a PEFR meter? What does red zone reading mean?
Blow into the meter.
Red--bad, emergency, impending asthma attack, etc
If ventilator alarms are going off, what do you need to do FIRST?
Check patient, then alarms
Blood in pleural space?
Hemothorax
What is the normal range of a pulse oximetry reading of a patient with COPD?
88-92%
(ATI book)
pH: 7.39
PaCO2: 22
HCO3: 13
Metabolic acidosis with full compensation
What is your postop care for a pulmonary angiogram?
Flat for 3-8 hours as ordered
Monitor VS, bleeding
Sandbag on pressure site
Fluid intake excretion of dye
How long do you suction a patient with a trach?
no longer than 10 seconds
Only apply suction when removing catheter
What is the drainage chamber use for?
Collects blood (hemothorax) or exit for air (pneumothorax)
How do you teach your patient to use an incentive spirometer?
INHALE IN 10x's each hour while awake.
pH: 7.26
PaCO2: 50
HCO3: 22
Respiratory Acidosis
Bronchoscopy pre/post op care?
No narcotics prior to bronch. Pt awake, receives sedative
Postop: NPO until gag reflex returns
What two methods can you teach your patient on how to breathe effectively?
Diaphragmatic and pursed-lip breathing
What is the water seal chamber for?
What level should the water be at?
What does bubbling mean in the water seal chamber?
Holds 2cm of water to prevent atmospheric air from reentering the pleural space creating a "water seal"
2cm
Water should "tidal" (rise/fall) with each breath
Bubbling means there is an air leak
Pre/Post op care of Thoracentesis?
Analgesic before procedure
Void before procedure
Upright, orthopneic, or side lying
Vaseline gauze to site after procedure
pH: 7.25
PaCO2: 63
HCO3: 27
Respiratory Acidosis, partial compensation
A patient comes back from having a lobectomy on the right lung. Which side do we place the patient on post op?
Left (Good lung down)
A high d-dimer is indicative of what?
PE!
What is the suction chamber for?
What level should distilled water be at?
Continuous gentle or vigorous bubbling?
The speeding escape of air/blood
20 cm of distilled water in suction chamber
Should see continuous GENTLE bubbling. Vigorous means too much suction applied
What can happen if we clamp a chest tube for prolonged periods of time?
TENSION pneumo