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Pulmonary Critical Care

Pulmonary Critical Care. NUR 351/352 Diane E. White RN MS CCRN PhD (c). Arterial Blood Gases. Look at PH: 7.40 or< (acidosis ); 7.40 or > (alkalosis ) Look at CO2: 40 or < = 40 or > =

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Pulmonary Critical Care

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  1. Pulmonary Critical Care NUR 351/352 Diane E. White RN MS CCRN PhD (c)

  2. Arterial Blood Gases • Look at PH: 7.40 or< (acidosis ); 7.40 or > (alkalosis ) • Look at CO2: 40 or < = 40 or > = • Interpretation: if arrows go in same direction than it is METABOLIC; if arrows go in opposite directions than it is RESPIRATORY

  3. Assessment of Oxygenation • Pulse Oximetry • Arterial Blood Gases • Patient Assessment ALWAYS!!

  4. Oxygen Administration • Nasal Cannula • Face Mask • Face Mask with Reservoir • Venturi Mask • Bag-Valve Device (Ambu bag) • Mechanical Ventilation

  5. Types of Mechanical Ventilation • Non-invasive positive pressure ventilation: bi-pap versus c-pap masks • Invasive Positive Pressure Ventilation: types Time-cycled ventilators Pressure-cycled ventilators Volume-cycled ventilators

  6. Modes of Ventilator Therapy • Controlled – preset volume and rate • Assist-Control – preset TV at specified rate • Intermittent Mandatory Ventilation & Synchronized Intermittent Mandatory Ventilation – set TV at set RR • Oscillator Ventilators – high frequency ventilation

  7. Adjuncts to Mechanical Ventilation • Positive –End – Expiratory Pressure (PEEP) 3-10 cm H20 • Continuous Positive Airway Pressure (CPAP) • Pressure Support ( PS) 5-10 cm H20

  8. Complications • Barotraumas • Right main stem intubations • OETT out of position • Infection • Aspiration • Ventilator dependency

  9. Nursing Care • Medication Therapy: Pain, anxiety, sedation, & ETOH withdrawal • Awareness of Alarms: volume, pressure, apnea • Prevention of Infections & Ventilator-associated Pneumonia • Communication & teaching • Weaning is a team approach

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