Community Health
Explain healthcare disparities vs health status disparities.
Healthcare disparities: Differences in access to services around an individual
Health status disparities: How much disease or disability that is prevalent between different socioeconomic or geographically defined populations.
What causes a shift to the left with the oxyhemoglobin dissociation curve?
Bonus 100: what causes a shift to the right?
shift to the left: hemoglobin holds onto oxygen, doesn’t release it into the tissues. holds onto it in the lungs. hypocapnia - anxiety attack, alkalosis, decreased demand to tissues. hypothermia
Bonus 100: hemoglobin releases more oxygen bc the tissues need more oxygen. exercise, infection, hyperthermia, hypercapnia
what are contraindications to Bipap?
Frequent episodes of emesis
Clients requiring restraints
Inability to achieve a good mask fit
Hemodynamic instability
Inability to clear own secretions
What are 4 symptoms of respiratory alkalosis?
Bonus 100: what causes respiratory alkalosis?
seizures, deep, rapid breathing, hyperventilation, tachycardia, low or normal BP, hypokalemia, numbness/tingling of extremities, lethargy, confusion, N/V
What is the patho of ARDs?
Atelectasis
Refractory hypoxemia
Decreased lung compliance
Surfactant
What is vulnerability?
the degree to which an individual, population or organization is unable to anticipate, cope with, resist and recover from the impact of disease and disasters
Explain shunting and how it affects ARDs and oxygen delivery.
Shunting is the percentage of blood that cannot be exchanged so there is no gas exchange. ARDs occurs when there is 20% or more shunting. This causes refractory hypoxemia, meaning that delivering any amount of oxygen does not help the patient at all.
What is a RASS score and when is it given to a patient?
Richmond Agitation-Sedation Scale (RASS) score should be documented with every change to sedation
A RASS goal should be included in each order for sedation.
How do you treat respiratory acidosis?
tx underlying problem, increase ventilation (increase rate and depth of breathing), BiPaP, intubation, O2
What do you see on imaging and the P/F ratio with ARDs?
Bonus 100: when does the onset of ARDs typically happen?
“White out” , infiltrates, consolidations, low P/F ratio of less than 200 is indicative of moderate ARDS.
P/F ratio of 100 or less is considered severe ARDS
Bonus: 48-72 hrs post injury
What are the three determinants of vulnerability?
Marginalization: person or group is put on the periphery of society
Discrimination: when one group gives unjust or prejudicial treatment to another group
Stigma: stigmatized individuals either possess, or are believed to possess, some attribute that is not valued in a particular social context
A patient has a PO2 of 84 on 4L of oxygen. What is their P/F ratio? Is this an acceptable level? What is the range of clinically accepted levels?
84/ 20+ 4(4L) = 233.33. Not acceptable: must be above 286 but goal is 350-450.
Name the immediate steps post intubation.
Listen to the lungs bilaterally to confirm ETT placement
Observe for color change on CO2 detector
Obtain an order for a chest x-ray to confirm tube placement
Secure airway so it does not dislodge with a bite block.
Obtain ABGs → baseline then serial
What are causes of met alkalosis?
Bonus 100: what electrolyte imbalance is seen with met alkalosis?
excess of bicarb in blood, ph of over 7.35. loss of hydrogen ions. from gi, excretion in urine, suctioning, prolonged vomiting, reabsorption from kidneys, overuse of antacids
Bonus: hypokalemic and hypocalcemic
What position is the patient in with ARDs?
Prone
According to the ANA code of ethics, what is provision 3?
Bonus 100: What is provision 8?
Advocacy for the Patient - The nurse promotes, advocates for, and protects the rights, health, and safety of the patient.
Bonus: Promotion of Community and World Health - The nurse collaborates with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities.
Explain acute ventilatory failure vs acute oxygenation failure including symptoms and diagnostic criteria.
Ventilatory: Hypercapnic failure pH under 7.30, PCO2 over 50 CO2 is not being expelled. altered LOC. tachypnea, flushed wet skin, lethargy, sedation. can cause coma and often need ventilatory support. more fatal than oxygenation.
Oxygenation: PaO2 is less than 60 without hypercapnia. no buildup of CO2 with this one.
HA, SOB, coughing, dec LOC, confusion. there is NO hot flushed wet skin like ventilatory. Instead they are cyanotic and cold and pale.
What does a low pressure alarm indicate?
Bonus 100: what does a high pressure alarm indicate?
Extra bonus 100: why is suction not always advisable with a patient who's intubated?
air leak, cuff leak or failure
Bonus: Need for suction (may be a blockage) - coarse lung sounds or coughing indicate need for suction, biting the tubing, secretions in airway or water in the tubing.
Extra Bonus: risk for hypotension, dysrhythmias, infection, bronchospasm
What conditions cause met acidosis?
DKA, diarrhea, renal failure, shock
Name five symptoms of status asthmaticus.
Bonus 100: what is the most concerning symptom of status asthmaticus?
tripod positioning, can't speak, anxiety, fatigue, dec LOC, ABGs show hypoxemia
no airway sounds at all. the airway has closed up at this point
Name four factors that contribute to health disparities.
Low income
Difficulty access healthcare (uninsured or underinsured)
Poor self esteem
Young or advanced age
Chronic Stress
Environmental factors
Presence of communicable disease
Racial/Ethnic minority status
Discrimination
What position do you want the patient to face when their V/Q ratio is less than 0.8?
Want the good lung down.
Name the steps if a patient accidentally self extubates.
Call for help- someone needs to notify the doctor
Turn off sedation/analgesia
Make sure you have emergency equipment available
Bag valve mask, suction, code cart close by
Administer breaths with bag valve mask with oxygen
Assess the patient’s ability to breathe on their own
They may need to be re-intubated or they remain extubated with supplemental oxygen
After everything is settled, an incident report needs to be filed.
pH: 7.37 PCO2: 33 HCO3: 21
What is the imbalance and compensation?
Fully compensated metabolic acidosis
When we are mechanically ventilating a patient with asthma, what should the settings be at?
Low tidal volumes, low respiratory rate, prolonged expiratory phase to avoid air trapping & barotrauma