ABGs. Online soft chalk. Make it more specific here in this level. Page of problems you can do with the
answers as well. Compensation and so forth. Thers a link for more problems, with more scenarios.
COPD, obstructive air flow and retention of Co2, club fingers, barrel chest, smoking is number 1 reason.
Acidotic. pH 7.35-7.45 PaCO2 this is arterial, 35-45 the higher the number, the more acidic they are.
Lungs regulate this. It can change quickly. On the vent you can change the Rr rate and they can blow off
or keep more co2. HCO3 22-26. Basic, kidneys. DKA Renal failure and sepsis is Metabolic acidosis. When
we name our gas, the only normal ph is 7.4. when we name it. Normal pao2 is 80-100. Sao2, >95. This is
just your oxygenation.
7.2 acid. 7.48 base. 7.4 normal. 7.37 acid. We only use 7.4 when were calling it out…
This is not a nursing function. If theyre intubatedin the field they need to have placement. Xray. Co2
detector. Stick it on there and it changes color then it is in the lungs. When we intubate it is everyones
responsibility to check that placement. They are going to have equal rise and fall. If they have unequal
rise then its too far. We listen for breath sounds. Bilateral breath sounds. Liste over the epigastrum, that
it is in their stomach. Then were gana get an xray. Most confirmative. Look listen and check co2. We
need to make sure its in the right spot. Indications of endotracheal suctioning. Box 10-7 key points. We
need to know where our markings are for our tube placement. Mark at the teeth. If you have
angioedema then the lips wont be accurate. Mark the tube at the teeth. Glance and see how far the
tube is in. the secretions go to the back of the throat. VAP is something that can happen to this pt from
secretions. Closed suctioning. Hyperoxygenate the pt before they get suctioned. Before during and after.
We do not do routine suctioning. You sould only suction a pt if they need it. Coughing, secretions in the
tubing, changies in vitals. Check the list in the outline. Suction for 10-15 sections. There are
complications, trauma, bloody secretions, increases interthoracic pressure can lead to intracranial
pressure, infection, hypoxia, loss of PEEP. Trach pts will still have suction set up that is similar, but is
different. Clean hand dirty hand. Rass score. Intubated pts don’t have to be sedated. They can be awake
and alert, we want to start with pain control for these pts. Check the depth every time, you donnt want
the tube going out of going in too far.
We need to get the vent settings, people change them often. The easiest place to look is the oxygen.
FiO2. Set from 21% to 100%, 100 can cause problems, atelectasis, toxicity, some people may be on
100%. 4-8 ml/kg of ideal body weight, that’s the volume of air theyre getting. Peep optimal level is 5-8.
Makes your alveoli open and close and close a little later, we use peep to help them oxygenate.
Increasing peep helps with oxygenation issue. Spontanious is breathing their own rate. Pt data. Peak
inspiratory pressure, the amount of force it takes to push a breath in, the resistance, or compliance of
their lungs, as people develop ARDs the lungs get resistant, PIP can be one of the first signs of ARDs. It
could also go up, if the pt bit down on their ET tube. Lots of secretions could make increased PIP. If the
pt needs to be suctioned the PIP could go up. If it goess up gradually, we need to start wondering about
ARDS. Total respiratory rate. If the machine is set to 16 but theyre breathing 20, that’s their total resp
rate. PHARM…. Fentanyl. Prop. Dexmedetomidine (dex. Precedex). Over sedation, they will start to
decline and DRT, bp goes down and the hr goes up, but ithey will both go ahead and start to decline. The
dose has to be just right. Under, restless, fighting the vent. Pull it out. And the vitals would be high.
Optimal sedation , theyre calm in the bed, and easily arouse and follow some easy commands. They
should be able to wake up and do breaths on their own. PROBLEM. VAP. Fight sedation. Pull their et
tube. VAP bundle, things that are important and work well. Part of the checkoff. Page 32 from clinical
manual. Print it and bring it. Chapter 9 in nclex book has a good review of the ABGs.