Summary NUR265 Exam 2 study guide (NUR265)

NUR265 Exam 2 study guide ACUTE RESPIRATORY FAILURE Patho: Vent Failure (Can’t get enough air in) Oxygen Failure (Air in ok, but poor perfusion) Trauma to diaphragm Hypovolemia Hypotension Low hemoglobin (12g/dL) Hypoventilation Neuro/spinal cord injury -Damage to part of brain that controls drive to breathe -Drugs that decrease drive to breathe Damage to internal structure of lungs: Eg.: Pulm. Edema, COPD, pneumothorax, hemothorax S/S: Doesn’t matter if it’s a vent or oxygen failure, pt will ALWAYS be hypoxemic. -Hypoxemic  low O2 in blood (60mm Hg) = Cyanosis, Δ in mental status, dyspnea, DOE, orthopnea. - As O2 goes down CO2 goes up = hypercapnic. (pCO2 45 mmHg) = h/a, decreased LOC, seizures. Management: - Position pt for comfort + allows for easier breathing (usually upright) - Assess PaO2. Pulse ox is okay but EtCO2 is more reliable - Assess ABGs, LS and changes in resp. rate and pattern - Administer O2. If pt fails to maintain PaO2 60 mm Hg, expect vent/ET placement. ET tube placement: - Explain as quickly + calmly - Each attempt 15-30s (30 max) After 30s manually bag pt. - Once placed pt shouldn’t be able to talk as tube compresses vocal cords. - Assess LS + chest movement. Should be symmetrical. If not and LS absent on left side provider to reposition tube. - Verify placement w/ CRX or EtCO2 - Assess for abd distension. If distended replace tube and decompress after placement w/ NG tube - Secure tube w/ halter technique + mark at level of nares or incisor teeth Extubation: - Hyper oxygenate + suction before procedure. Have pt cough and then remove. - Once removed administer O2 at 10% higher than level on vent. - Monitor VS x Q5 mins - Assess resp. status + assess for mild dyspnea, coughing or inability to expectorate secretions - Any stridor or high-pitched crowing noise on inspiration  Administer Racemic Epi. & RAPID Suctioning: - Suction indicated if secretions present, development of rhonchi, increased PIP or decreased LS. - Sterile procedure in hospital setting, clean outside of hospital. - Preoxygenate w/ 100% O2 for 30s to 3mins - Suction pressure max @ 120. Attempts should be max of 10-15s. Do not attempt multiple suctions in ARDS pts. - Hyper oxygenate after suction x1-5 min or until SaO2 at baseline - If SaO2 drops below 90% d/c suction - Monitor for cardiac dysrhythmias during suction – Vagal stimulation possible = brady/hypoten