ABGs & Hypoxia
pH 7.28
PaCO2 55
HCO3 24
Uncompensated respiratory acidosis
FiO2 is the fractions of inspired oxygen
This is the general rule about clamping a chest tube
Do not routinely clamp it and do so for only a few seconds
In this type of ventilation, tidal volume is fixed while airway pressure varies
Volume controlled ventilation (VCV)
Volume is set and pressure changes with resistance and compliance
PEEP keeps thees structures open at the end of expiration
Alveoli
This ABG value primarily tells you how well the patient is ventilating
PaCO2
CO2 rises with inadequate alveolar ventilation
This oxygen delivery system provides flows of 1-40 L/min, can deliver, 21-100% FiO2, and provides humidification.
High Flow nasal Cannula
Continuous/new bubbling in the water seal chamber suggest this.
Air leak
In this mode, the patient initiates spontaneous breaths and the ventilator adds a preset inspiratory pressure boost.
Pressure support ventilation (PSV)
PSV decreases work of breathing and requires spontaneous effort
A High pressure alarm makes you think this.
Obstruction/increased resistance
Restlessness, tachypnea, tachycardia, and accessory-muscle use are early signs of this problem
Hypoxia/hypoxemia
A patient remains severely hypoxemic despite high-level oxygen, is using accessory muscles, and is becoming increasingly lethargic. This intervention may now be necessary.
Intubation and mechanical ventilation
Crackling felt under the skin around the insertion site is called this.
Crepitus/subcutaneous emphysema
This mode provides mandatory breaths but also allows spontaneous breaths between them
SIMV
Spontaneous breaths can also receive pressure support
If a ventilator problem cannot be corrected quickly and the patient is deteroriating, do this immediately
Manually ventilate with a resuscitation bag while the problem is corrected
pH 7.30
PaCO2 30
HCO3 18
Partially compensated metabolic acidosis
This assessment is especially important when determining whether oxygen delivery is adequate at the tissue level?
Hemoglobin level
If the chest tube disconnects from the drainage system what do you temporarily place the patient-connected end in
Sterile Water
This mode targets a tidal volume while adjusting inspiratory pressure breath to breath
PRVC
Pressure regulates to reach the target volume
After the nurse increases a patient’s PEEP, the SpO₂ improves from 88% to 94%, but the blood pressure drops from 118/72 to 82/48. This effect of PEEP explains the hypotension.
Decrease venous return and cardiac output
Name 2 worsening problems that would cause a respiratory patient to have new confusion and somnolence
An ETT advance too deeply commonly enters this bronchus, causing diminished breath sounds on the opposite side.
Right mainstream bronchus
Sudden dyspnea plus absent breath sounds in a patient with a chest tube should make you suspect this emergency
Pneumothorax
This pressure is measured during an inspiratory pause and is kept at or below 30cm H2O in ARDS lung protective ventilation
Plateau pressure (Pplat)
It reflects alveolar distending pressure
A mechanically ventilated patient suddenly develops a high-pressure alarm, severe hypoxemia, and absent breath sounds on one side. The nurse should suspect this life-threatening complication
Pneumothorax