TOPIC 7 & TOPIC 8 CRITICAL CARE

Terms in this set (13)

Indications for ventilation
1. PaO2 with FiO2
2. CO2 with Ph
3. deterioration

1. less than 60 with over 50
2. over 50, less than 7.25
3. ↑RR, ↑WOB, ↓Vt

1. maintain airway
2. promote ventilation and oxygenation

Complication of ventilation

1. ETT out of position
2. unexplained intubation
3. laryngeal/tracheal injury
4. damage to oral and nasal mucosa

ETT out of position
-assess this to ensure ETT is in place

-breath sounds, side to side, reassess when repositioning pt.
-confirm poition w x-ray
-if disloged: repositioned by MD/RT

Unexplained intubation

-protect airway, secure tube, know where tube is placed

Laryngeal or tracheal injury

-prevent head injury
-routine monitoring of cuff pressure: no higher than 25-30 cm H2O

Damage to oral and nasal mucosa (skin breakdown)

-move tube to prevent ulcers, routine skin assessment

Psychosocial complications

-stress, anxiety, lack of communication
-vent. dyssynchrony, demands of pt. not met by vent
-noise, no sleep, disturbance

Barotrauma: tension pneumothorax/pneumothorax
-detect it

-manually ventilate: until needle thoracotomy or chest tube is inserted

other pulmonary system complications

1. O2 toxicity
2. acid base disturbance
3. infection: tx-vent bundle
4. dysphagia/aspiration

1. Hypotesion: increase fluid volume /inotropes
2. Ulcers, bleed : ulcer prophylaxis, enteral nutrition, HOB 30 when feeding

1. HOB 30-45
2. prevent drainage from condensate back to pt.
3. GI/pressure ulcer prophylaxis/DVT prophylaxis
4. hand hygiene, oral care
5. ETT with subglottic suction
6. Aspirate secretions from above ETT; non-invasive ventilation preferred

1. communication: reassure, reorient, eye contact, facial expressions, nodding, fam. can help communicate
2. comfort and decrease distress: drugs
3. meds: benzos (ammensia but cause delirium), chemical paralysis, right amount of sedation, keep at lowest dose and highest level of sedation
4. non-pharmacological invs

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