Airway
#1 Indication for Tracheostomy
What is Upper Air Obstruction
WHAT IS PIP AND PEEP FOR?
PIP - Prevents Alveolar Collapse during expiration
PEEP - OPENS alveoli to prevent atelectasis
Late s/sx of RF?
Cyanosis, confusion, disorientation, delirium, decreased breath sounds, cold, sweating, accessory muscle use, unable to speak, dysrhythmias
Prone position benefits
+PaO2, O2+, mobilize secretions, decrease atelectasis, reduce accumulation of fluids in airway.
Every patient gets a nutrition screen in first ___ hours of hospitalization?
24 hours (And again after 1 week)
Obturator, Extra trach (Same size and one smaller), Bag and Suction
What to assess on vent patient?
Respiratory Distress, RR, Rhythm, Depth, Lung Sounds, Chest movement is synced with vent, RECORD PLACEMENT OF ETT OR TRACH (every hour), s/sx of hypoxia, suction PRN, Urine output, ABGS, Make sure they are taking a PPI to prevent GERD
Refractory Hypoxemia (Even at 100% they are still hypoxemic)
ARDS puts you are RISK FOR....
Multiple organ dysfunction syndrome
TPN is WHAT kind of solution?
Hypertonic (high solute)
When you plug a trach what do you do first and second?
Vent associated pneumonia bundle
HOB 30 degrees, daily sedation vacation (assess for readiness to extubate), DVT/Stress ulcer prophylaxis, oral care, suction PRN, hang hygiene
What would a Chest Xray of someone with refractory hypoxemia look like?
White out, ground glass appearance, infiltrates, white lung
Infection
When is TPN needed?
1) Non-functional GI 2) Weight loss of 10-15% 3) Can't eat for 5-7 days
ALWAYS do this before you suction!
Hyperoxygenate
ABG's for RF
PaO2?
O2?
CO2?
pH?
PAo2 < or equal to 60
02 < 90%
Co2 > 45 (Hypercapnia, hypercarbia)
pH < 7.35
#1 Indirect lung injury is....
Malnutrition s/sx
Dry eyes, beefy tongue, night blindness, brittle, dry, tired, cachexia, anorexia, decreased cardiac output, dysrhythmias
What to give Central if you don't have a replacement TPN?
Peripheral?
D10
D5
What to do pre, intra and post ETT insertion?
1) Pre - Hyper oxygenate 3-5 minutes
2) Intra - Limit intubation attempts to 30 seconds (ROLE OF THE NURSE)
3) Post - Auscultate Breath Sounds
(R BS only = too far in R mainstem bronchi, L BS only = Tension Pneumothorax)
Early S/SX or RF are?
Dyspnea, Orthnopenea, +Co2, HR+, RR+, Restless, BP+, Tired, combative, h/a, SOB
Earliest s/sx of ARDS
Tachypnea, +RR, Refractory Hypoxemia, CXR infiltrates, SOB, Crackles, -LOC, Change in Mental Status
Albumin lab value?
Pre Albumin Lab value?
Albumin = 3.5-5
Pre albumin = 15-36
Check for what allergies before giving TPN?
Egg and Soy