Summary NUR 453 Role Transition Exam 3 Study Guide All Latest Material

Role Transition Exam 3 Study Guide Respiratory Ventilator emergencies • Should NEVER be turned off. • Don’t know what is causing the alarm? What action is next? o Manually bag the patient o Can still mechanically ventilate when breathing on their own – bag WITH the pt • Three Types of ventilator Alarms o Volume (low pressure) alarms - pt disconnected, low volume o Pressure (high pressure) alarms - biting tube, secretions/fluid in tubing, pneumo o Apnea alarms – not breathing • WHAT CAUSES THE ALARM? • Positive End Expiratory Pressure PEEP o 15 is high PEEP – can cause peumo, damage to lung tissue/barotrauma  Positive pressure decreases CO2 and compresses venous return Assessment findings emphysema • Loss of lung elasticity leading to air trapping • Barrel shaped chest • Dyspnea – tachypnea, use of accessory muscles, pursed lip breathing • Pink puffers (high CO2) • Diminished breath sounds • Tripod position Signs/symptoms of hypoxia o Acute – hyperventilation, H/A, AMS (restlessness, anxious, irritability), diaphoresis  Tx: Oxygen administration, morphine sulfate to control breathing o Chronic - clubbing, cyanosis, diminished oxygenation to vital organs POSTOP care priorities Oxygen administration devices - COPD patients • Nasal cannula o Approximately 24-40% O2, 1-4Là meant for someone that is stable  If you give more than 4 L, you need to use humidifier o SOB—start with nasal cannula • Masks: Simple; Partial rebreathing; Non-rebreathing o Simple Mask: Can deliver ~40-60% O2; Flow meter- 5-8 L  Pro-more stable and higher concentration  Con—claustrophobic; assess for skin breakdown  Rearrange frequently and oral hygiene o Partial Rebreathing: 60-75%, turn flow meter to minimum of 6 L  O2 in the bag (reservoir of O2)  Valves disallow re-inhalation of CO2 o Non-rebreather: Give close to 100% O2  Unstable patient or patient just recovering from anesthesia - ALL the way to 15 L  Must have airway and breathing on their own  Anticipate: 1. start to get better quickly 2. get advanced airway (intubated)  Assess frequently