2070 respiratory

Decreased CO2, Hypotension

Decrease lung perfusion to tissue, decrease gas exchange, decrease arterial blood

Increase ICP, Decrease cerebral perfusion, cerebral hypoxia

Decrease urine output

Guaiac every stool for GI bleed, check bowel sounds, typically hypactive bowel sounds. Decrease perfusion

Decrease BP, Increase HR

1-sudden onset of agitation and cough associated with frequent high pressure alarm
2- BP and ABG quickly deteriorate
3- Breath sounds are suddelnyl diminished or absent
4- subcutaneous emphysema can be palpated on the front of the neck or chest. * one or more of these can occur.

Insert chest tube. No way around it,

Due to use of >50% O2 for >48 hours. 100% O2 can cause changes in 6 hrs.

restlessness, tachycardia, malaise, fatigue, substernal CP/Discomfort.

Tachypnea, severe dyspnea, crackles, cyanosis, cough, nausea, vomiting, confusion.

adventitious breath sounds, changes in sputum color or quantity, fever, elevated HR and RR, increased WBC.

Guaiac all stools and check Hct.

Safe endotracheal cuff pressure = 15-25 mmHg; check every shift!

before suction hyperoxygenate for 1 mintute

Obligation as RN, release restraints Q2 hours and check CMS. *take off one at a time.

Paralyze pt. Give something for pain (morphine) and something to help them forget (versed)

group cares

might have to use a board

explain everything to the family.

Cause- Electricity/ Power out
Nursing Action- learn the location of all emergency power outlets in your unit. check cords and cables and keep out of traffic areas.

cause- pt may be disconnected from machine, or leak in system, or pt is not moving air.
Nursing Action-check all connections. If they are all intact, check pt for low effort and possible fatigue.

Cause- change in RR or Inspiratory time. Pt may not have enough time to inhale.
Nursing Action- check pt effort and ventilator settings. Pt may need more support from the ventilator.

Cause- patient requires more pressure to deliever set tidal volume.
Nursing Action- check tubes for kinks and obstruction. suction pt. Do a full assessment if compliance is falling.

Adequate pt preparation, available equipment, and an interdisciplinary approach to solve pt problems.

signs of distress, rapid or shallow breathing, use of accessory muscles, reduced LOC, incr CO2, decr O2 sats, tachycardia

higher O2 concentration than when receiving mech, ventilation.

203 hours after weaning and allowing spontaneous ventilation by means of a mask with humidified O2

weaning from the tube is considered when the pt can breath spontaneously , maintain an adequate airway be effectively coughing up secretions, swallow and move the jaw.

the pt who has been successfully weaned from the vent, cuff, and tube and has adequate resp function is then weaned from O2.

success in weaning the long term vent dependent pt requires early and aggressive but judicious nutritional support.

removed from the ventilator, then from the tube, and finally oxygen.

Cuased by: elevated ketones, (diabetic ketoacidosis) uremia (w/increased levels of phospahtes and sulfates), ingestion of acidic drugs (such as asparin -ASA- overdose) and lactic acidosis (such as shock or dehydration from fasting) All of this makes your blood pH decrease and makes you acidic.

They increase. Therefore you pH levels will decrease and you become more acidic.

They go down, therefore their H+ levels increase and they become acidic.

Electrolytes

greater than 26 and a pH greater than 7.45

Numbness, restlessness, confusion

Ingestion of alkaline drugs, and go ahead and come up with something else. The notes didn't have anything listed.

It's done after surger to compart to pre-op values. It is also the little bulb thing on the nasal cunnula that is used with PCA devices to monitor respiraitons.

This is used with the Swan Ganz catheter. It gives information about how much O2 is attached to the Hgb when it comes back to the lungs after being used by the tissues. Lets you know how well the tissues are being perfused. Or how much is being used at tissue level.

A decreased supply of oxygen or an increased demand for oxygen.

An increased supply, decreased demand, or a decreased extraction of Oxygen.

Septic shock early warm phase

The mechanical movement of air

The process by which the body's cells are supplied with O2 and eliminate CO2

Movement of gases across the alveolar-capillary membrane.

Movement of gases down a pressure gradient form an area of high pressure to an area of lower pressure.

The arterial oxygen tension. Norm= about 80-100

The arterial carbon dioxide tension. Norm = about 40

The greater the area the more gases can pass in a set period of time.

The thinner the membrane the faster the gases diffuse.

20 times faster

PaO2 less than 50mmHg

The inability of cells to use oxygen properly, despite adequate O2.

cue music (DUN DUN DUN)

HYPOXEMIA!!!

<SCREAM!!>

Exchange of gases on a cellular level or in the tissues.

Vasoconstriction involving the vessels around the lungs.
Expect a ventilator if BP goes too low, and they are hypoxic. Patient WILL code.

Decrease Hgb, decreased CO, hypoemia.

Confusion and restlessness.

Elasticity of the lungs

Keeps the alveoli open, and prevent atelactesis.

You have plenty of air in your lungs, but it isn't getting to your tissue. It's not perfusing.
(PE, VSD, Trauma, Pulm. Infarct. cardiogenic shock)

You have plenty of blood available, but there is a problem with the air in your lungs. (Collapsed alveoli, atelactasis, pneumonia, ARDS, mucous plug)

It is when you you have more perfusion than ventilation. (hypoventilation, bronchospasm) very responsive to O2.

No Bret...just no..

It involves no ventilation and perfustion, or limited ventialtion and perfusion. (Pneumothorax, sever/acute ARDS) inequal V/Q or a V/Q mismatch

You have too much or too little ventilation for the amount of perfusion present. Best detected by evaluating SpO2 (sats).

Infant: bradycardia

Child: tachycardia leading to bradycardia

Newborn - >60bpm

Child - >30bpm

Greater than 12 - >20bpm

Remember: NEPCIW

Nasal flaring
Expiratory grunt
Paradoxical breathing
Chest retractions
Inspiratory stridor
Wheezing

Pale, dusky, possibly cyanotic

Altered or depressed

Decreased Pa02
Increased PaC02

Oxygen
Fluids
Glucose -- if needed
Warmth

Acute ventilatory failure
Acute hypoxemia
RR > 35bpm
Low V/Q ratio
Neurological deterioration

Breathing tube to assist pt with breathing.

Adults require a ET-tube cuff (balloon) to keep in a stable position. Safe cuff measure is 15-25mmhg.

No. No cuff is used since the cricoid cartilate seals around the tube.

Rests 2-4cm above the carina if measuring with an X-ray

Watch for expansion in the stomach, may get stuck in wrong place.

Uses negative pressure to the thorax to expand the lung.

Requires artificial airway to deliver ventilation support

Delivers a constant PRESSURE of gas to the lungs. When preset pressure limit is reached, inspiration is stopped.

This is the best.

Delivers preset VOLUME of gas, regardless of amount of pressure.

More sensitive to the patient.

Controls length of time allowed for inspiration, but volume and pressure vary.

This is used in neonates.

Mode.
FiO2
Rate
TV
Peep

This is the patients RR.

Amount of air that moves in and out of the lungs in one normal breath.

Percent of inpsired 02, what the machine is giving.

This is a constant preset amound of positive pressure in the alveoli at the END of each EXPIRATIOn, forcing the alveoli to stay open.

The amount of pressure the machine is giving at the end of expiraiton.

Oxygen can push into the tissue causing crepitus and crackles on the skin.

Decreases the effort of breathing by giving the patient a preset constant pressure of air at the BEGINNING of each patients INSPIRATION.

Pressure is maintained until the breath reaches a set TV.

This is the setting on the vent that starts the cycling of the ventilator.

Assist: Patient can try to take breaths and if not able to take a full breath, machine will finish it for patient.

Control:Machine gives every breath at a set rate

A set number of machine breaths are given at a set tidal volume. However, the patient may breathe on own BETWEEN breaths.

Ventilator delivers a PRESET amount of positive pressure with each spontaneous breath.

PS can be used with SIMV and CPAP.

Ventilator delivers an amount of positive pressure that is in proportion with the patients inspiratory effort.

Correlates with patients effort.

No vent. Patients ET tube may still be connected.

Used during weaning from a vent.

CONTINUOUS amount of air pushed into lungs, alveoli stay open through cycle, including expiration.

A tube attached to the artificial airway, allowing the patient to breath a mixture of atmospheric pressure and oxygen. NO PRESSURE is given.

The pressure exerted by each individual gas when it is in a total volume of gas.

Partial pressure of OXYGEN and partial pressure of CO2.

Artery, not vein.

V: Ventilator (Air)
Q: Blood flow

Hemoglobin

The amount of O2 bound to hemoglobin.

MORE oxygen is released INTO the tissue. Hemoglobin does NOT want.

Acidosis, Hyperthermia, Hypercapnia

LESS oxygen is released to the tissue. Hemoglobin wants to HOLD O2.

AlkoLosis. Hypothermia. Hypocapnia.

LLLeft--LLLLess O2. hoLLLd O2. aLLLkolosis.

Build up a H+

Respiratory excretion in Co2 blowing off, metabolic excretion in urine and vomit.

Can accept a H+ ion.

7.35-7.45

35-45

Elevated: Hypoventilation
Decreased: Hyperventilation

22-26

The partial pressure of oxygen dissolved in the arterial blood.

Normal 80-100mmhg at sea level

DIRECT measurment of bloods oxygen content via ABG.

Normal 95-100%

Similar to pulse ox, but DIRECTLY measured.

Women: 12-16

Men: 13-18

PaCO2 > 45
pH < 7.35

HyPOventilation

Decreased respiratory rate, anxiety, disorientated, confused, coma.

Respiratory depression.
Decreased ventilation.
Altered diffusion.
COPD.

PaCO2 < 35
pH > 7.45
HyPERventilation

Tingling, carpal pedal spasm, tetany, increased reflexes, palpitations, lightheaded, numb, decreased LOC

Increased respirations.
Damage to respiratory center in brain.
Overventilated mechanically
Fever

HCO3 < 22
PH < 7.35

Malaise. H/A. Confusion. Unconscious. Rapid/deep respirations

Inadequate movement of airflow and an increase in CO2 retention.

PaCO2 > 45
PH < 7.30

Not enough oxygen in the blood.

PaO2 < 50

Dyspnea.
Tachypnea.
High BP.
Arrhythmias. Cynosis.

Pulmonary function tests.

Amount (VOLUME) of gas present in the lungs AFTER maximal inspiration.

Deepest breath possible

Amount of air moving in and out of the lungs with each NORMAL breath

Maximum amount of air EXPIRED after a maximum inspiration.

Restrictive.

Decreased lung expansion.

High RR. Decreased TV. SOB. Cough. Fatigue.

Broken ribs.
Obesity.
Burns.
ALS. MS.

Obstructive.

Increased lung compliance, loss of elastic recoil.

Barrel chest.
Hypercapnia.
Acidosis.
Wheeze/rhonci
Accessory muscle use
Emphysema

1) Airway narrowing - Bronchospasm

2) Airway obstruction - COPD, asthma

R ventricle hypertrophies, leads to pulmonary disease

Juggular Vein Distention
Edema
Ascities
High BP

OXYGEN!!
Mechanical ventilation.
Bed rest.
Hold sodium/water
Digoxin

PaCO2 > 50
PaO2 < 50

Too much Co2, too little O2

When exchange of gases in lungs can't keep up.

Use too much 02 and make too much Co2.

Pneumonia

PAP Systolic > 30 (measured with catheter)
Mean > 25

Too much pressure in the lungs will cause pulmonary edema.

Idiopathic.
Familial.
Congenital.

MOST COMMON

Casued by left-sided heart failure.

Caused by COPD.
Lung disease.
Sleep disorders.
Alveolar hypoventilation.
High altitude

PE.

Sarcoidosis.
Histiocytosis.
Lymphangiomatosis.
Pulmonary vessel compression.

Physical exam.
CXR.
ECG.
CARDIAC CATH!!

Splinting chest.
Shallow breaths.
Avoids moving.
Severe pain.

Free floating rib section.

Severe resp distress.
Acidosis.
Decreased CO.
Hypotension.

Air is trapped in pleural space. Breathe in and can't exhale.

Tracheal deviation to unaffected side.

Air moves in during inspiration and out during expiration.

Hear a sucking sound.
Lung collapses.
Mediastinal futter.

Cover hole with hand/gauze, insert chest tube.

Surgical opening of the chest cavity to treat pulmonary problems.

Lung biopsy, pneumonectomy, lobectomy, resection, reduction, thorascopy

Increased permeability of the alveolar-capillary membrane, causing pulmonary edema.

Give oxygen, not respond.

Uhhh, everything.

Aspiration. OD. DIC. Bypass. Transfusions. Oxygen toxicity. Sepsis. Uremiea. Shock.

OXYGEN - Vent and Peep
PA catheter to determine balance. Elevate BP.