Meaning there is space between trachea and et tube

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meaning there is space between trachea and ET tubeFirst 1-2 hours are biggest concernAssess airway for s/s of edemaStridor-BADPt will have sore throatDiscourage talking to encourage vocal rest.oUnplannedextubationPt has pulled out ET tube or in transport the ET tube comes out.Always a bad thing!1st thing: Assess the patient's airway!!!!If showing any s/s of resp distress, immediately bag the patient.Call for helpoTerminalextubationWithdrawing ventilator for a patient dyingPt must have a DNRMust ensure pt is not a donorStop propofol or other continuous infusionWhen ventilator is removedDecreased O2 satsResp distressMay be agitatedKnow and expect these reactions! Treat them withmorphine and ativan!AlarmsoApnea alarmWhen the pt is on CPAP / BIPAP. Pt is not breathing on their own andhave spontaneous breaths. Apnea alarm will sound. Bag the patientoLow pressure alarmProbably due to the ET tube becoming disconnected1st thing - CHECK ALL CONNECTIONSIf you can't solve the problem.. BAG the patientoHigh pressure alarmDue to pt biting the ET tubeInsert bite blockCould be mucus bug at end of ET tubeSomething is obstructing.Assess for kinksIf you can't solve the problem … BAG the patientVentilator SettingsTidal volume: 6-8 mL/kgFiO2 - amount of O2
oAround 40%Rep rate: 12-18Peak: 5-15I/E ratiooInspiration to expiration ratio1:2oWhen pt has ARDS, we will manipulate I/E ratio.Assist controloProblem: pt can overbreathe the machineoResp alkalosisResp distressRestlessness, agitation, tachypnea/ tachycardiaoBradycardia & cyanosis are LATE signs of resp distressoBIGGEST CONCERN WITH ASSIST CONTROL: RESPIRATORY ALKALOSISPressure controloCPAPContinuous air blowing into patients lungsIncreases work of breathingoBIPAP2 levelsHigh level of pressure on inspirationLow level of pressure on expirationoCPAP/ BIPAPPt has to have spontaneous respirationsoBIGGEST CONCERN WITH PRESSURE CONTROL: RESPIRATORYACIDOSISoAPRVAssist control + Pressure controlWe change I/E ratio from 1:2 to 2:1, 3:1, or 4:1Causes of respiratory distressHypoxemic Respiratory FailureoLow PaO2less than 60Pts with ARDS, PE,pneumonia, or pulmonary edemaoProblem: gas exchangeHypercapnic Respiratory FailureopH: less than 7.35oPco2 greater than 50Pt with ALS, & MSoPt will be inrespiratory acidosisoCause: sedatives & opiates. Pt with a spinal cord injury- paralyzed diaphragm -poor ventilationoProblem: VentilationARDSoDecreasing PaO2, increasing FiO2oProblem: gas exchange
oIncreased capillary permeability causes fluid to enter the capillary, alveoli getssticky, and alveoli start to close up.oNon cardiogenicoIncreased work of breathing, decreased complianceoNursing interventionsProne the patientHigh risk for unplanned extubationAPRVClean the patientIncrease PEEP.

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Term
Summer
Professor
N/A
Tags
hypovolemic shock, CNS depression

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