Medications
1st line sedative
Action of medication
One nursing care consideration
Propofol- Rapidly acting hypnotic produces amnesia
Nursing care considerations-
- Dedicated line preferred
- Change tubing and bottle q12hr
Normal range for pH in ABGs
7.35-7.45
Hypercapnic, Hypoxemic or Both?
Pneumonia
Hypoxemic
What is barotrauma?
Too much pressure- popped lung
First assess etCO2 (End tidal CO2)- which allows you to know you are in trachea and not esophagus
Then assess bilateral breath sounds- ensure its not in the R mainstem
CXR is ordered and obtained STAT
What must be given with Cisatracurium (Nimbex)
Must use Adjunctive Sedative (Propofol and Fentanyl)
what is the V/Q mismatch for a shunt
(Ventilation & perfusion= V/Q)
Hypoventilation
Hyperperfusion
*Train Analogy- Circulation is present, trains are pulling into subway but no oxygen (People) to board due to platform being blocked (mucous)
Hypercapnic, Hypoxemic or Both?
ARDS
Both
What is Volutrauma?
Too much volume- popped lung
What is the difference between A/C, Pressure control and Pressure support ventilation?
A/C is Assist control- patient is not breathing on their own, vent is preset to rate
Pressure control- Set pressure and rate of breaths-used with ARDS
Pressure support Ventilation- patient needs to be able to start each breath on their own.
What is important to know about Cisatracurium (Nimbex) *Think Nursing Action*
Medication will only paralyze patient does not sedate them.
What is the V/Q mismatch for dead space
(Ventilation & Perfusion = V/Q)
Hypoperfusion
Hyperventilation
*Train analogy- Oxygen is present, people are coming in and out of train station but no circulation (trains) due to an obstruction (Clot) on the tracks
Hypercapnic, Hypoxemic or Both?
Brainstem injury
Hypercapnic
Risk for O2 Toxicity
What could a high pressure limit alarm signal?
Low pressure limit?
High pressure- fighting the tube, biting the tube, mucous/secretions
Low pressure- Air leak (almost always)
What are 2 main side effects of Dexmedetomidine (Precedex)
Hypotension
Bradycardia
If PaO2 is 30mmhg what would the SaO2 be?
If PaO2 is 60mmhg what would the SaO2 be?
30mmhg = 60% SaO2
60mmhg = 90% SaO2
*30-60-90 rule
What is an important factor in the overall outcome of someone in acute respiratory failure?
Nutrional status
What would the PaO2/FiO2 be with a patient diagnosed with ARDS?
Less than 200
When should perform mouth care/oral hygiene?
Chlorhexidine swab/brush q12hr
Side effects of Propofol
*Decreased BP
*Green Urine
Decreased HR, Dysrhythmias, HA, seizures
ABG Practice=
1. pH 7.14, PCO2 42, PaO2 81, HCO3 18, Sats95% Lactate 6
2. pH 7.28, PCO2 55, PaO2 58, HCO3 24, Sats 88%
1. Metabolic Acidosis
2. Respiratory Acidosis
What can you do for a patient in acute respiratory failure?
*Nursing care
Oxygen
Positive pressure ventilation- noninvasive or invasive
Mobilization of secretion- *Coughing is the goal
Drug therapy
What are the 3 stages of ARDs and when do you see them (Time frames)
Stage 1- Injury or exudative phase (1-7days)
Stage 2- Reparative or proliferative phase (1-2weeks)
Stage 3- Fibrotic or chronic/late phase (2-3 weeks)
When should you suction? and what should you do before and after suctioning?
When should you notify provider regarding secretions?
Suction to need not routine
Provide Pre/post suction oxygenation w 100% O2
Notify provider is secretion are bloody!