Acid-Base Imbalances
A 36 year-old pregnant woman was admitted to the ER following episodes of hyperventilating with moments of no breathing. What should the nurse's priority action be?
This patient is at risk of developing respiratory alkalosis due to her pregnancy and hyperventilating. Cheyne-stokes breathing is a sign of respiratory alkalosis.
The nurse should manage her hyperventilating by teaching breathing techniques, apply a paper bag, or cup hands to retain Co2.
A 67 year-old male with COPD was admitted to the ER for shortness of breath. What is one worry the patient should keep in mind?
Administering supplemental oxygen might not be indicated as this might interfere with the patient's normal breathing pattern.
In order to reduce barotruama, the nurse should reduce?
Tidal volume and PEEP
A 46-year old male was admitted to the ER for acute respiratory failure. What is the nurses priority action?
Apply supplemental oxygen!
NEVER nasal cannula or venturi mask!
Partial or nonrebreather should be used, but not when there is a V/Q mismatch
Might need to use noninvasive positive pressure ventilation like BiPAP or CPAP.
A 45-year old homeless man was admitted to the ER after being found unresponsive on the street. He has a history of heroine use and alcoholism. The patient has severe bruised throughout the body, an increase in AST/ALT, and a tremor in the wrist. What does the nurse correlate this condition to?
Cirrhosis
The nurse should identify that she might be experiencing metabolic acidosis due to the symptoms and the history of anorexia.
The nurse should encourage eating, monitor vitals signs, and administer fluids (sodium bicarb).
A patient was admitted to the hospital with shortness of breath and anemia. Their SaO2 was at 90% and PaO2 of 58%. What is the priority nursing action?
The nurse should administer supplemental oxygen via nasal cannula.
Most common cause of ARDs?
Sepsis
Correlate the breath sounds
Stridor?
Crackles?
Ronchi?
Absent breath sounds?
Stridor can be seen in patients following extubation, this is a medical emergency.
Crackles can be seen In patient with pulmonary edema, treated with diuretics.
Ronchi can be seen in COPD.
Absent breath sounds can be seen in hypoventilation. Also in acelectactasis and fibrotic changes.
What diet should a person with cirrhosis be on?
What diet should a person with acute pancreatitis be on?
Acute pancreatitis - NPO w/ tube feeds
A 56-year old male was admitted to the ER for complaints of muscle twitching, pins and needles around the mouth, and convulsions. This patient takes diuretics at home. Labs show that he has high levels of aldosterone. He has poor skin turgor, dry mucous membranes, and a cap refill >3 seconds. What is the priority nursing action.
This patient is showing signs of metabolic alkalosis due to the symptoms and signs of fluid loss.
The nurse should administer lactated ringers, sodium/potassium bicarb, and keep assessing vitals. Keep up with continuous assessments of hydration.
A 45 year-old female was admitted to the ER for complaints of fever, shortness of breath, and productive coughing. This patient has been coughing up phlegm the last 3 days and has been getting worse. Their SaO2 is sitting at 90%. This patient was diagnosed with pneumonia. What is the priority nursing action?
The nurse should help manage airways by applying high flow devices like the aerosol mask. This will help loosen the secretions and open the airways.
How often should vitals be assessed for following extubation?
every 15 minutes for 1 hour!
A patient was admitted to the ICU for inability to breathe from pneumonia. An X-ray shows bilateral infiltrates. The patient was intubated after SaO2 dropped. What order should the nurse anticipate?
An order for antibiotics. The pneumonia needs to be treated now that the patient has a stable source of oxygen.
A 50 year-old was admitted to the med/surg floor for cirrhosis. He has a history of drinking 15 beers a can for over 13 years. He was prescribed furosemide, spironolactone, urosodiol, lactulose, and Tylenol. He was put on a restricted sodium, protein diet. What should the next do next?
Question why the Tylenol was given! Tylenol is never given for patients with a damaged liver. This can cause hepatotoxicity.
A 23-year old patient was recently sedated after trying to fight the ventilator. Her EKG is showing signs of occasional PVCs, Widened QRS, Prolonged PR intervals, and tall peak P waves. Her RAAS score is a -4. What is the nursing priority nursing intervention?
The patient is at risk of developing respiratory acidosis due to her symptoms and being over sedated.
The priority nursing action should be stimulating the patient and titrating the sedation down.
A 80-year old male was intubated 3 days ago following a motor vehicle accident. The nurse notices a snoring sound coming from the patient. The patient is awake, but is heavily sedated. What is the priority nursing action?
The sound of snoring is a sign of a pressure cuff leak. Notify the provider immediately.
The purpose of these medications?
Lactulose?
Narcan?
Flumazenil?
Acetazolamide?
Spasmolytics?
Lactulose is used the treating high levels of ammonia associated with cirrhosis.
Narcan is used to treat opioid overdose for respiratory distress
Flumazenil is used to treat benzo overdose for respiratory distress
Acetazolamide is used to treat high levels of bicarbonate in metabolic alkalosis.
Spasmolytics are used to relax sphincter of Oddi, used for acute pancreatitis.
A 84-year old was admitted to the ICU for respiratory distress following severe pneumonia. He was intubated 3 days ago and has been stable since. You walk by the patient and hear constant coughing. What should the nurse do next?
The nurse should assess the patient for aspirating, then move into suctioning.
The nurse should consider putting the patient in a prone position.
This patient was admitted to the ER for severe pain that radiates from the upper left quadrant to the shoulders. They have a fever and feel worse when they eat food. What are some nursing interventions the nurse can implement?
- Administer pain medication
- NPO w/ tube feeds
- NG suction
- Semi-fowlers
- IV fluids, reduce if ascites develops
A 65-year old male was recently admitted to the ER for nausea, vomiting, and hypotension. An anion gap is present with a pH below 7.3 What is the nurses priority action?
These are all signs of DKA.
Administer fluids, electrolyte therapy, then insulin.
A 38-year old female recently intubated has a high pressure alarm going off. The nurse notices secretions in the ETT tube, what should they do next?
Bro if you didn't say suction, I'm going to be disappointed.
Best position for these diseases/disorders/conditions.
ARF?
ARDS?
Intubating?
VAP?
Acute pancreatitis?
ARF you wanna be "good lung down"
ARDS you wanna be prone
Intubating you wanna be sniff
VAP you wanna be 30-45 degrees
Acute pancreatitis you wanna be semi-fowlers
What tests can the nurse do to determine is ARDs is developing into MODS?
The nurse can assess the function of the liver and kidney. Assess the BUN, ALT, AST, and for lactic acid levels.
SIRS criteria:
Presence of any two of the following four signs:
Tachycardia (heart rate greater than 90/min)
Tachypnea (respiratory rate greater than 20/min or PaCO2 less than 32)
Hyperthermia or hypothermia (temperature greater than 100.4°F (38°C) or lower than 96.8°F (36°C)
Leukocytosis (greater than 12,000/mm3), leukopenia (lower than 4,000/mm3), or greater than 10% immature forms