90 likes | 229 Views
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 > =
E N D
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 > = • Interpretation: if arrows go in same direction than it is METABOLIC; if arrows go in opposite directions than it is RESPIRATORY
Assessment of Oxygenation • Pulse Oximetry • Arterial Blood Gases • Patient Assessment ALWAYS!!
Oxygen Administration • Nasal Cannula • Face Mask • Face Mask with Reservoir • Venturi Mask • Bag-Valve Device (Ambu bag) • Mechanical Ventilation
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
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
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
Complications • Barotraumas • Right main stem intubations • OETT out of position • Infection • Aspiration • Ventilator dependency
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