ABGs
What is the normal range for HC03?
22-26
What are trachs used for?
Hint 4 reasons.
Ventilation, airway obstruction, airway protection, and secretions.
What is the purpose of a chest tube in the pleural space?
To facilitate drainage and promote lung re-expansion.
How many sets of ribs does a person have?
12 pairs
Besides CHF/pulmonary edema and PNA, what could cause crackles in the lungs?
Fibrosis.
What is the normal Pa02 range?
80-100
What is the purpose of a cuffed trach?
A cuffed trach seals the area between the tube and the trachea to prevent escape of air and to prevent aspiration of secretions.
What do you do if the chest tube is dislodged from the patient?
Place an occlusive dressing on patient and tape 3 sides, notify provider.
What is the lung hilum? (hilus, hilar, pl. hili)
An area (groove) in the lung where the blood vessels enter the organ.
What type of mask does a patient with TB wear when going for a test?
Normal surgical mask. Guests visiting the TB patient wear N95. Staff wear PAPR.
pH 7.15
PaC02 75
Pa02 80
HCO3 25
What disorder does the above show?
Respiratory Acidosis
Your patient can't breathe...
You tried suctioning with no effect.
They are becoming hypoxic, lips are turning blue.
What is the first thing you do besides call for help(code RRT)?
Remove the inner cannula and assess for mucus plugs.
What do you do if the chest tube drainage system is knocked over and starts leaking on the floor?
Disconnect chest tube, place in sterile water container. Retrieve new drainage system and connect. Notify provider.
What is interstitium?
A network of tissue that extends throughout the lungs (between airway and alveoli). Includes blood vessels and this is not normally not seen on CXR.
What is an obturator used for?
It is a tool to help insert a tracheostomy.
pH 7.50
PaC02 45
Pa02 85
HC02 30
What disorder does the above show?
Metabolic Alkalosis
True or False.
It is ok to use a PMV during meals with a trach with the cuff inflated.
False. Cuff must be deflated with a PMV and for eating.
What determines the amount of suction for a wet suction water sealed closed chest tube system?
The water level. -20cmH20
What are the two types of pleura in the thoracic cavity?
Visceral pleura and parietal pleura.
Name 3 nursing interventions for patients being treated with COPD.
Smoking cessation teaching.
Education on flu and PNA vaccines.
Nutrition education. Multiple small meals.
Light exercise with rest periods.
Tripod positioning, pursed lip breathing.
Medication education.
What would you expect normal values of venous blood to be?
pH 7.33- 7.41
PaC02 41-51
paO2 - 35-40
HCO3 - 22-26
What do you do when a trach comes out?
Monitor airway, respirations, Oxygen sats.
Call for help. Call ENT.
Use a new trach the same size or smaller and reinsert. The stoma can close up very quickly.
What does constant bubbling in the water seal chamber mean? What do you do?
Assess for air leak. Start by clamping chest tube at insertion site and work your way down to locate leak, check connections.
Hint there are 5.
Larynx, trachea, bronchi, bronchioles, alveoli of the lungs
Why do we give morphine to patients who are not in pain but have difficulty breathing?
It alters perception & decreases anxiety.
It acts on medullary respiratory center and reduces respiratory drive.
It reduces respiratory rate and prolongs time in exhalation.