NCM-110 Nursing Care of Clients with Life-Threatening Conditions PDF

**PRELIM** **SCOPE OF CRITICAL CARE NURSING IN THE PHILIPPINES** **INTRODUCTION** - The health care industry all over the world has been undergoing great changes over the past two decades and the Philippines has been part of these transformational events having great impact on the q...

**PRELIM** **SCOPE OF CRITICAL CARE NURSING IN THE PHILIPPINES** **INTRODUCTION** - The health care industry all over the world has been undergoing great changes over the past two decades and the Philippines has been part of these transformational events having great impact on the quality of nursing practice. - There are new expectations in the way nurses and the nursing practices are to be delivered particularly now that there are many challenges that besiege the present time as a consequence of the complexities of globalization. - **Professional Regulation Commission** -- Board of Nursing (PRC-BON) is committed to provide need-driven, effective and efficient specialty nursing care services of high standard and at international level within the obtainable resources. - To respond to this mission and commitment, a PRC-BON Working Group in Developing the Nursing Specialty Framework was formed sometime in **1996** to take on the task of setting the process-based framework and guidelines for specialty nursing services. Working Group members comprise **clinical nurse practitioners, nurse educators** and **nurse managers.** - **Critical care nursing** is that specialty within nursing that deals specifically with human responses to life threatening problems. These problems deal dynamically with human responses to actual or potential life-threatening illnesses. - The framework of critical care nursing is a complex, challenging area of nursing practice which utilizes the nursing process applying assessment, diagnosis, outcome identification, planning, implementation, and evaluation. - The critical care nursing practice is based on a scientific body of knowledge and incorporates the professional competencies specific to critical care nursing practice and is focused on restorative, curative, rehabilitative, maintainable, or palliative care, based on identified patient need - It upholds multi and interdisciplinary disciplinary collaboration in initiating interventions to restore stability, prevent complications, achieve and maintain optimal patient responses. The critical care nursing profession requires a clear description of the attributes, guidelines and nursing practice standards in guiding the critical care nursing practice **PHILOSOPHY OF CRITICAL CARE NURSING** **GOALS OF CRITICAL CARE NURSING** **SCOPE CRITICAL CARE NURSING** **QUALIFICATIONS OF CRITICAL CARE NURSE** - Critical care nursing reflects a holistic approach in caring of patients. It places great emphasis on caring the **bio-psycho-social-spiritual** nature of human beings and their responses to illnesses rather than the disease process. It helps to maintain the individual patient\'s identity and dignity. The caring focus includes preventive care, risk factor modification and education to decrease future patient admission to acute care facilities. - The **Critical Care Nurses of the Philippines, Inc. (CCNAPI)** believes that as an organization of critical care nurses, it is conscious of its responsibility for the promotion of man\'s health and welfare for national development and has the desire to give support for professional and personal growth and development. - CCNAPI has organized itself into a national association committed to the ideals of service to the people, equality, justice and social progress - **To promote** optimal delivery of safe and quality care to the critically ill patients and their families by providing highly individualized care so that the physiological dysfunction as well as the psychological stress in the ICU are under control - **To care** for the critically ill patients with a holistic approach, considering the patient\'s biological, psychological, cultural and spiritual dimensions regardless of diagnosis or clinical setting. - **To use** appropriate and up-to-date knowledge, caring attitude and clinical skills, supported by advanced technology for prevention, early detection and treatment of complications in order to facilitate recovery. - **To provide** palliative care to the critically ill patients in situations where their health status is progressing to unavoidable death, and to help. - On the whole, critical care nursing should be **patient-centered, safe, effective, and efficient**. The nursing interventions are expected to be delivered in a timely and equitable manner. - The scope of critical care nursing is defined by the **dynamic interaction of the critically ill patient, the critical care nurse and the critical care environment** in order to bring about optimal patient outcomes through nursing proficiency within an environment conducive to the provision of this highly specialized care. - Constant intensive assessment, timely critical care interventions and continuous evaluation of management through multidisciplinary efforts are required to restore stability, prevent complications and achieve optimal health. Palliative care should be instituted to alleviate pain and sufferings of the patient and family in situations where death is imminent - Critical Care Nurses are registered nurses, who are **trained and qualified to practice critical care nursing**. They possess the **standard critical care nursing competencies** in assuming specialized and expanded roles in caring for the critically ill patients and their family. Likewise, the critical care nurse is personally responsible and committed to continues learning and updating of knowledge and skills. The critical care nurses carry out interventions and collaborates patient care activities to address life-threatening situations that will meet patient\'s biological, psychological, cultural and spiritual needs **INTRODUCTION TO CRITICAL CARE** **CRITICAL CARE NURSING** **CRITICAL CARE** **CRITICAL CARE NURSE** **CRITICALLY ILL CLIENT** It refers to those comprehensive, specialized and individualized nursing care services which are rendered to patients with life threatening conditions and their families. A specialized care of patients whose conditions are life-threatening and who require comprehensive care and constant monitoring - Crucial - Crisis - Emergency - Serious - Requiring immediate action - Thorough and constant observation - The care of seriously ill clients from point of injury or illness until discharge from intensive care. - Deals with human responses to life threatening problems -trauma /major surgery. - Care for clients who are very ill - Provide direct one to one care - Responsible for making life-and death decision - At high risk of injury or illness from possible exposure to infections - Communication skill is of optimal importance - At high risk for actual or potential life threatening health problems - More ill - Required more intensive and careful nursing care - Clinical condition is unstable or potentially unstable. **WHAT ARE THE CONDITIONS CONSIDERED AS CRITICAL?** 1\. Any person with life threatening condition 2\. Patients with - ARF - AMI - cardiac tamponade - severe shock - stroke MEMBERS OF HEALTH CARE TEAM IN ICU **Team Dynamics** **Critical care team** **ICU STAFF** **CRITICAL CARE NURSE** **SPECIALTIES** - A multidisciplinary team to effectively attain specified objective Physician team leader & critical care nurse manager - Members of a highly skilled team consisting of physicians, nurses and other health care professionals will care for your loved one. - Physicians - In addition to attending physicians, there may be other physicians who take care of your family member as consultants. These are physicians who are specifically requested to see the patient to give opinions and provide treatments**.** **Internists** - A physician specializing in nonsurgical diseases. **Cardiologist** - A physician specializing in diseases of the heart. **Nephrologist** - A physician specializing in kidney diseases. **Pulmonologist** - A physician specializing in diseases of the lungs. **Neurologist** - A physician specializing in neurological diseases (i.e. brain and spinal cord). **Surgeon** - A physician who conducts surgery. **Registered nurse** - The registered nurse has advanced education in the care of critically ill patients. - The primary nursing approach promotes continuity and coordination of care by paying attention not only to the physical needs of the patients, but also to the psychological, emotional and spiritual needs that often accompany a serious illness or prolonged hospitalization. **Health unit coordinator** - The health unit coordinator answers phones, transcribes physician orders and assists in receptionist duties. **Nursing assistant** - The nursing assistant assists with patient\'s personal cares under the direction of the RN. - Treats patients with acute, even life-threatening injuries or medical issues. - The critical care nurse has received specialized training that enables him or her to manage and monitor those patients who are the most seriously ill or injured. - To do the job properly, a critical care nurse must have the ability to think and work quickly in stressful conditions and stay alert after many hours of intensive work **Respiratory therapist** - The respiratory therapists work closely with the physician and nurses to provide airway management, deliver oxygen, assist in managing ventilators and administer breathing medication. **Pharmacists** - The pharmacists work closely with the physician and nurses to assure safe and correct medication administration and monitoring for the desired response. They are available to assist with medication information and teaching. **Social worker** - The social workers are available to assist patients and families with financial concerns, discharge plans, home health needs, nursing home arrangement, and transportation needs. - They are also available to assist with organizing family conferences. **Dietician** - The dietician is available to assist patients in meeting their dietary requirements. **Chaplain** - The hospital chaplain provides an interfaith ministry, nurturing patient/family values and beliefs, and encouraging a more holistic approach to health care. Your physician, nurse or social worker can make a referral. **Rehabilitation service** - As your family member\'s condition improves, the physician may order physical and occupational therapy. **Physical therapists** - Address mobility needs. **Occupational therapists** - Assist with activities of daily living training. **Speech language pathologists** - Assess and treat swallowing and communication issues. Interpreter - A free service, available upon request. **Patient representative** - Questions, concerns or complaints about care or related issues should be discussed with your family member\'s physician, nurse or the patient representative. The patient representative is there to help answer questions before they turn into problems. +-----------------------+-----------------------+-----------------------+ | **ICU ROUNDS** | | | +=======================+=======================+=======================+ | The critical care | | | | team does patient | | | | rounds daily. Patient | | | | goals and plan of | | | | care are discussed. | | | | Families are | | | | encouraged to give | | | | any input to the | | | | nurse. | | | +-----------------------+-----------------------+-----------------------+ | **LEVELS & CATEGORIES | **LEVELS OF CARE | | | OF CRITICAL CARE | PROVISION** | | | PROVISIONS WITHIN | | | | PHILIPPINES** | | | +-----------------------+-----------------------+-----------------------+ | With respect to the | The role of a | | | physical set-up and | particular critical | | | supporting facilities | care unit will vary, | | | of critical care | depending on | | | units in the | staffing, facilities | | | Philippines, the | and support services | | | Department of Health | as well as the type | | | (DOH) Standards | and number of | | | requires the critical | patients it has to | | | care units / | manage. Taking into | | | intensive care unit | account the | | | to be a | guidelines of the | | | **self-contained | Society of Critical | | | area**, with the | Care Medicine, the | | | provisions for | critical care service | | | resources that will | provision in | | | support critical care | Philippines can be | | | practice. Currently, | classified into 3 | | | the DOH is reviewing | levels: | | | these standards to | | | | come-up with updated | | | | requirement. | | | | | | | | Sometime **in 2003, | | | | the Philippine | | | | Society of Critical | | | | Care Medicine | | | | (PSCCM)**, Society of | | | | Pediatric Critical | | | | Care Medicine (SPCCM) | | | | and the **CCNAPI | | | | stratified into | | | | different levels and | | | | categories the care | | | | provisions in | | | | critical care | | | | practice to make it | | | | similar to its | | | | counterparts overseas | | | | with the goal** of | | | | having effective | | | | utilization and | | | | organization of | | | | resources. | | | +-----------------------+-----------------------+-----------------------+ | **LEVEL 1** | **LEVEL 2** | **LEVEL 3** | +-----------------------+-----------------------+-----------------------+ | - Should be capable | - Should be capable | - Is a tertiary | | of providing | of providing a | referral unit, | | immediate | high standard of | capable of | | resuscitation for | general critical | managing all | | the critically | care for patients | aspects of | | ill and short | who are stepping | critical care | | term | down from higher | medicine (This | | cardio-respirator | levels of care or | does not only | | y | requiring single | include the | | support because | organ | management of | | the patients are | support/support | patients | | at risk of | post-operatively; | requiring | | deterioration; | | advanced | | | - Capable of | respiratory | | - Has a major role | providing | support but also | | in monitoring and | sustainable | patients with | | preventing | support for | multi-organ | | complications in | mechanical | failure); | | \"at risk\" | ventilation, | | | medical and | renal replacement | - Has a medical | | surgical | therapy, invasive | director with | | patients; | hemodynamic | specialist | | | monitoring and | critical / | | - Must be capable | equipment for | intensive care | | of providing | critically ill | qualification and | | mechanical | patients of | a duty specialist | | ventilation and | various | available | | simple invasive | specialties such | exclusively to | | cardiovascular | as medicine, | the unit and | | monitoring; | surgery, trauma, | medical staff | | | neurosurgery, | with an | | - Has a formal | vascular surgery; | appropriate level | | organization of | | of experience | | medical staff and | - Has a | present in the | | at least one | **designated | unit at all | | registered | medical | times; | | medical officer | director** with | | | available to the | appropriate | - A nurse in-charge | | unit at all | intensive care | and the majority | | times; | qualification and | of nursing staff | | | a duty specialist | have intensive | | - A certain number | available | care | | of nurses | exclusively to | certification; | | including the | the unit at all | and A nurse: | | nurse in-charge | times; The nurse | patient ratio is | | of the unit | in-charge and a | at least 1:1 for | | should possess | significant | all patients at | | post-registration | number of nursing | all times | | qualification in | staff in the unit | | | critical care or | have critical | | | in the related | care | | | clinical | certification; | | | specialties; and | and | | | | | | | - Has a nurse: | - A nurse: patient | | | patient ratio of | ratio is 1:1 for | | | 1:1 for all | all critically | | | critically ill | ill patients. | | | patients. | | | | | | | | - Level 1 (PATIENTS | | | | at risk of their | | | | condition | | | | deteriorating, or | | | | those recently | | | | relocated from | | | | higher levels of | | | | care, whose needs | | | | can be met on an | | | | acute WARD with | | | | additional advice | | | | and support from | | | | the critical care | | | | team.) | | | | | | | | - This level | | | | includes all | | | | complex PATIENTS | | | | requiring support | | | | for multi organ | | | | failure.) | | | +-----------------------+-----------------------+-----------------------+ +-----------------------+-----------------------+-----------------------+ | ICU EQUIPMENTAND USES | | | +=======================+=======================+=======================+ | **ICU EQUIPMENT AND | | | | THEIR USES** | | | +-----------------------+-----------------------+-----------------------+ | **Name** | **Uses** | **image** | +-----------------------+-----------------------+-----------------------+ | **Ventilator** | A machine that helps |  | | | you breath when you | | | | are sick, injured, or | | | | sedated for an | | | | operation | | +-----------------------+-----------------------+-----------------------+ | **Portable | Lightweight and can | | | Ventilator** | be moved easily from | | | | one place to another | | | | within the hospital | | +-----------------------+-----------------------+-----------------------+ | **3 Way Stopcock** | Specialized |  | | | with three distinct | | | | channels, allowing | | | | healthcare | | | | professionals to | | | | simultaneously | | | | administer | | | | medications, infuse | | | | fluids, and withdraw | | | | blood samples without | | | | requiring multiple | | | | needle insertions. | | +-----------------------+-----------------------+-----------------------+ | **Chest Tube | Plastic tube that is | | | Drainage** | used to drain fluid | | | | or air from the chest | | +-----------------------+-----------------------+-----------------------+ | **Defibrillator** | Devices that send |  | | | electric pulse or | | | | shock to the heart to | | | | restore a normal | | | | heartbeat | | +-----------------------+-----------------------+-----------------------+ | **ECG Machine** | Used to investigate | | | | symptoms of a | | | | possible heart | | | | problem, such as | | | | chest pain, | | | | palpitations, | | | | dizziness, and | | | | shortness of breath | | +-----------------------+-----------------------+-----------------------+ | **Syringe Pump** | Used to deliver a |  | +-----------------------+-----------------------+-----------------------+ | **Suction Machine** | Used for removing | 9e-a portable Phlegm | | | obstruction-like | Suction Unit, | | | mucus, saliva, blood, | Surgical Suction | | | or secretion from a | Machine | | | person's airway | | +-----------------------+-----------------------+-----------------------+ | **ICU Bed** | Specially designed |  | +-----------------------+-----------------------+-----------------------+ | **Patient Monitor** | Show heart rate, | Lepu Medical UP-7000 | | | blood pressure, body | Multi-parameter | | | temperature, and SpO2 | Patient Monitor | | | | Manufacturer/Supplier | | | | /Company | +-----------------------+-----------------------+-----------------------+ | **Volumetric Infusion | Used to control the |  | +-----------------------+-----------------------+-----------------------+ | **Dialysis Machine** | Mixes and monitors | Hemodialysis machine | | | the dialysate. | with | | | | hemodiafiltration - | | | **Dialysate** | SWS-4000A - SWS | | | | Hemodialysis Care | | | - the fluid that | Co., Ltd. - mobile | | | helps remove the | | | | unwanted waste | | | | products from | | | | your blood | | +-----------------------+-----------------------+-----------------------+ | | Use the differing |  | | | between blood and the | | | | surrounding tissue to | | | | show users where | | | | blood is flowing | | +-----------------------+-----------------------+-----------------------+ | **Central Monitor** | Used for checking the | Central patient | | | study data and risk | monitoring station - | | | reports on a | All medical device | | | real-time basic using | manufacturers | | | appropriate | | | | technology to monitor | | | | data quality, patient | | | | safety and relevant | | | | risks | | +-----------------------+-----------------------+-----------------------+ | **Bed Side Pulse | Use for detection of |  | +-----------------------+-----------------------+-----------------------+ | **X-Ray Viewer LED** | A tool for observing | Buy MCP X-Ray View | | | the results of x-ray | Box (Silver) Online | | | films using ray | At Best Price @ Tata | | | lighting | CLiQ | +-----------------------+-----------------------+-----------------------+ | **DVT (Deep Vein | Used to help prevent |  | +-----------------------+-----------------------+-----------------------+ | **Crash Cart** | Used in hospitals to | Mobile Medical | | | transport and | Emergency Crash Cart | | | dispense emergency | with Cardiac | | | medication and | Philippines \| Ubuy | | | equipment at the site | | | | of a medical | | | | emergency for life | | | | support protocols to | | | | potentially save | | | | someone's life. | | +-----------------------+-----------------------+-----------------------+ | **Oxygen | A medical device that |  | +-----------------------+-----------------------+-----------------------+ | **Ultrasonic | Used in treatment of | Inhalation \| | | Nebulizers** | a number of | Ultrasonic nebulizer | | | respiratory diseases | \| PROFI SONIC | | | and disorders like | | | | cystic fibrosis and | | | | asthma | | +-----------------------+-----------------------+-----------------------+ | **High Flow Nasal | Used in spontaneously |  | | | rates | | +-----------------------+-----------------------+-----------------------+ | **Video | Used to improve the | Video Laryngoscope | | Laryngoscope** | success rate of | System \| US \| | | | tracheal intubation | Teleflex | +-----------------------+-----------------------+-----------------------+ | **BiPap machine** | Can help push air |  | +-----------------------+-----------------------+-----------------------+ | **ETCO2 Monitor** | Provides valuable | Avante Echo | | | information about Co2 | Capnography Monitor ( | | | production and | ETCO2 ) | | | clearance | | | | (ventilation) | | +-----------------------+-----------------------+-----------------------+ | **Glucometer** | Used to measure how |  | +-----------------------+-----------------------+-----------------------+ | **Air Mattress** | Used to prevent | Supply Medical Air | | | pressure injuries | Mattress Wholesale | | | from occurring | Factory - Guangdong | | | | Dayang Medical | | | | Technology Co.,Ltd | +-----------------------+-----------------------+-----------------------+ | **Blood and Fluid | Used to warm blood or |  | +-----------------------+-----------------------+-----------------------+ | **Color Doppler | Used to assess the | 3D 4D Color Doppler | | Machine** | flow of blood in a | Machine/Color Doppler | | | vessel, helping to | Ultrasound Scanner | | | determine the blood | Price/Trolley Color | | | velocity and the | Doppler Ultrasound | | | obstructions in the | Machine for | | | blood pips | | +-----------------------+-----------------------+-----------------------+ | **Anesthesia | Used to administer |  | +-----------------------+-----------------------+-----------------------+ | **AMBU Bag** | Used to deliver | MEDBUDDY Silicone | | | positive pressure | ADULT 1600ml Ambu Bag | | | ventilation to any | Green Self-Inflating | | | subject with | autoclavable Ambu Bag | | | insufficient or | Respiratory Exerciser | | | ineffective breaths | Price in India - Buy | | | | MEDBUDDY Silicone | | | | ADULT 1600ml Ambu Bag | | | | Green Self-Inflating | | | | autoclavable Ambu Bag | | | | Respiratory Exerciser | | | | online | +-----------------------+-----------------------+-----------------------+ +-----------------------------------------------------------------------+ | RESPONSES TO ALTERED VENTILATORY FUNCTIONS | +=======================================================================+ | ASSESSMENT | +-----------------------------------------------------------------------+ | 1st step in nursing process for the establishment of data base. | +-----------------------------------------------------------------------+ | 1. **Subjective Data**- history (nursing) taking | | | | 2. **Objective Data** | | | | | | | | a. **Physical assessment** | | | | b. **Diagnostic assessment**- often includes laboratory studies, | | radiology studies and other diagnostic procedures to look at | | certain organs, and the physical exam itself. | +-----------------------------------------------------------------------+ +-----------------------------------+-----------------------------------+ | **DIAGNOSTIC ASSESSMENT FOR | | | ALTERED VENTILATORY FUNCTION** | | +===================================+===================================+ | **NON --INVASIVE** | **INVASIVE** | +-----------------------------------+-----------------------------------+ | Any medical procedures not | Procedure in which the body is | | requiring the introduction of | \"invaded\", or entered by a | | instruments into the body | needle, tube, device, or scope. | +-----------------------------------+-----------------------------------+ | **PULSE OXIMETRY** | **ABG (ARTERIAL BLOOD GAS)** | | | **ANALYSIS** | | - a non-invasive and painless | | | test that measures oxygen | - A blood test that is | | saturation level, or the | performed using blood from an | | oxygen levels in your blood | artery. | | | | | **OXYGEN SATURATION** | - It involves puncturing an | | | artery with a thin needle and | | - A measure of the amount of | syringe and drawing a small | | hemoglobin that is bound to | volume of blood. The most | | molecular oxygen at a given | common puncture site is the | | time point. It is an | radial artery at the wrist, | | important parameter for | but sometimes the femoral | | managing patients in a | artery in the groin or other | | clinical setup. | sites are used. | | | | | - Values of **95% to 100%** are | - A blood test that measures | | generally considered | the acidity, or pH, and the | | **normal.** Values **under | levels of oxygen (O2) and | | 90%** could quickly lead to a | carbon dioxide (CO2) from an | | serious **deterioration** in | artery. | | **status**, and **values** | | | | - The test is used to check the | | **PURPOSE OF PULSE OXIMETRY** | function of the patient\'s | | | lungs and how well they are | | - measure oxygenation of blood | able to move oxygen into the | | | blood and remove carbon | | - assess the effectiveness of | dioxide | | oxygen administration | | | | **ACIDS** | | - assess effectiveness of any | | | other airway or breathing | - can be defined as a proton | | interventions | (H+) donor | | | | | **INDICATIONS FOR PULSE | - hydrogen containing | | OXIMETRY** | substances which dissociate | | | in solution to release H+ | | - should be routine vital sign | | | | **BASES** | | - so have a reading with every | | | set of vitals | - Can be defined as: --A proton | | | (H+) acceptor Molecules | | - continued monitoring should | capable of accepting a | | occur in anyone having | hydrogen ion. | | respiratory compromise | | | | **pH** | | - such as those with: **COPD , | | | emphysema, pulmonary edema, | - Indicator of Hydrogen ion | | airway obstruction, etc** | concentration in the blood | | | | | **NOTES!** | Note! | | | | | The probe uses **2 light sources, | Before performing ABG analysis | | red light**, and **infrared | procedure Allen's test should be | | light**, which are absorbed by | done. | | the **blood**. | | | | **ALLEN's TEST** | | **Higher absorption** of | | | **infrared light** indicates | - A test done to determine that | | **good oxygen saturation**, | collateral circulation is | | | present from the ulnar artery | | **Higher absorption** of **red | in case thrombosis occur in | | light** indicates **poor | the radial | | saturation.** | | | | Note! | | Readings obtained from a pulse | | | oximeter are expressed in | Contraindications to using radial | | **percentage.** | artery include absent ulnar | | | circulation or impaired | | **HOW DOES THE PULSE OXIMETER | circulation and an AV fistula. | | WORK?** | | | | **COMPLICATIONS** | | - The pulse oximeter works out | | | the oxygen saturation by | - Thrombosis, Embolization, | | shining light through finger | Hematoma, Ischaemia, | | | Infection. | | - The sensors detect how much | | | oxygen is in your blood by | | | comparing how much red light | | | and infra-red light is | | | absorbed by the blood. | | | | | | - Depending on the amounts of | | | oxygenated Hb and | | | deoxygenated Hb present, the | | | ratio of the amount of red | | | light absorbed compared to | | | the amount of infrared light | | | absorbed changes | | +-----------------------------------+-----------------------------------+ | **NORMAL VALUE** | | +-----------------------------------+-----------------------------------+ | **pH** | **7.35-7.45** | +-----------------------------------+-----------------------------------+ | **pCO2** | **35-45** | +-----------------------------------+-----------------------------------+ | **HCO3** | **22-26** | +-----------------------------------+-----------------------------------+ | **pO2** | **80-100** | +-----------------------------------+-----------------------------------+ | **SaO2** | **95-100%** | +-----------------------------------+-----------------------------------+ +-----------------------------------+-----------------------------------+ | **COMPENSATED VS. UNCOMPENSATED** | | +===================================+===================================+ | - When PaCO2 and HCO3 values | - If pH is abnormal and if the | | are high but pH is acidic, | value of either PaCO2 or HCO3 | | then it indicates **partial | is abnormal, it indicates | | compensation** | that the system is | | | **uncompensated** | | - **Fully compensated**- if the | | | blood pH is normal | - **HCO3**-increased/decreased- | | | **metabolic | | - **PCO2**-increased/decreased- | (kidney**) | | **respiratory(lungs)** | | | | - **Uncompensate**d -when they | | - **Compensated-** the body\'s | have an **imbalance** | | attempt at **correcting** an | | | i**mbalance** | | +-----------------------------------+-----------------------------------+ +-----------------------+-----------------------+-----------------------+ | **PLEURAL FLUID | | | | ANALYSIS** | | | +=======================+=======================+=======================+ | - Test that | | | | examines a sample | | | | of fluid that has | | | | collected in the | | | | pleural space. | | | | | | | | - This is the space | | | | between the | | | | lining of the | | | | outside of the | | | | lungs (pleura) | | | | and the wall of | | | | the chest. | | | | | | | | - When fluid | | | | collects in the | | | | pleural space, | | | | the condition is | | | | called pleural | | | | effusion. | | | +-----------------------+-----------------------+-----------------------+ | **THORACENTESIS( | **NURSING CARE POST | | | PLEURAL TAP)** | THORACENTESIS** | | +-----------------------+-----------------------+-----------------------+ | - Removal of fluid | - Observe client | | | in the pleural | for signs of | | | space and sent | pneumothorax: | | | for analysis to | | | | help determine | - Pallor | | | the cause | | | | (pleural fluid | - Dyspnea | | | cytology). | | | | | - Chest pain | | | - The pleural space | | | | is the small | - Vertigo. | | | space between the | | | | lungs and the | | | | chest wall | | | | | | | | - This space | | | | typically | | | | contains | | | | approximately 4 | | | | teaspoons of | | | | fluid. | | | | | | | | - **Best done with | | | | the patient | | | | sitting upright | | | | and leaning | | | | slightly forward | | | | with arms | | | | supported because | | | | it provides good | | | | access to the | | | | intercostal | | | | spaces and | | | | facilitates fluid | | | | removal** | | | +-----------------------+-----------------------+-----------------------+ | **PULMONARY | | | | ANGIOGRAPHY** | | | +-----------------------+-----------------------+-----------------------+ | - Medical | | | | fluoroscopic | | | | procedure used to | | | | visualize the | | | | pulmonary | | | | arteries and much | | | | less frequently, | | | | the pulmonary | | | | veins. | | | | | | | | - Conventional | | | | pulmonary | | | | angiography is a | | | | minimally | | | | invasive | | | | procedure | | | | performed most | | | | frequently by an | | | | interventional | | | | radiologist or | | | | interventional | | | | cardiologist | | | +-----------------------+-----------------------+-----------------------+ | **VENTILATION | **CAPNOGRAPHY** | **INDICATIONS** | | --PERFUSION SCAN** | | | +-----------------------+-----------------------+-----------------------+ | - **Ventilation | - Capnography | - Evaluation of | | (V)-** refers to | refers to the | maximum exhaled | | the **flow of | non-invasive | CO2 concentration | | air** into and | measurement of | as a reflection | | out of the | the partial | of the PaCO2. | | **alveoli** | pressure of | | | | carbon dioxide | - Evaluation of the | | - **Perfusion (Q)** | (CO2) in exhaled | severity of | | - | breath expressed | pulmonary | | refers to the | as the CO2 | disease. | | **flow of blood** | concentration | | | to alveolar | over time. | - Monitoring the | | **capillaries**. | | integrity of the | | | - Capnography | ventilator | | - The **ventilation | provides | circuit and | | scan** is used to | instantaneous | artificial airway | | see how well | information about | | | **air moves** and | ventilation (how | - Monitoring the | | blood flows | effectively CO2 | adequacy of | | through the lung. | is being | pulmonary blood | | | eliminated by the | flow | | - The **perfusion | pulmonary | | | scan** measures | system), | | | the **blood | perfusion (how | | | supply** through | effectively CO2 | | | the lungs | is being | | | | transported | | | | through the | | | | vascular system), | | | | and metabolism | | | | (how effectively | | | | CO2 is being | | | | produced by | | | | cellular | | | | metabolism). | | | | | | | | - It's a window | | | | into the | | | | patient's | | | | ventilatory | | | | status | | +-----------------------+-----------------------+-----------------------+ | **NURSING DIAGNOSES | **PLANNING FOR HEALTH | | | RELATED TO | RESTORATION AND | | | VENTILATORY | MAINTENANCE** | | | FUNCTION** | | | +-----------------------+-----------------------+-----------------------+ | - Ineffective | 1. Client | | | airway clearance | positioning -- | | | related to | **high fowlers, | | | excessive and | low fowlers | | | tenacious | position** | | | secretions | | | | | 2. Preventing | | | - Impaired gas | desaturation | | | exchange related | (decrease in | | | to activity | **the SpO2** of | | | intolerance | **3%** or **4%** | | | | or more from | | | - Anxiety due to | baseline.) | | | breathlessness | | | | | 3. Maintaining | | | - Powerlessness | oxygen on | | | related to | | | | feeling of loss | 4. Promoting | | | of control | secretion | | | | clearance- | | | - High risk for | suctioning, | | | ineffective | postural drainage | | | therapeutic | | | | regimen | 5. Patient education | | | | | | | - Management | 6. Optimizing | | | related to lack | oxygenation and | | | of knowledge | ventilation | | | | | | | | 7. Preventing | | | | atelectasis | | +-----------------------+-----------------------+-----------------------+ +-----------------+-----------------+-----------------+-----------------+ | **RESPONSES TO | | | | | ALTERED | | | | | VENTILATORY | | | | | FUNCTIONS** | | | | +=================+=================+=================+=================+ | **RESPIRATORY | | | | | ACIDOSIS** | | | | +-----------------+-----------------+-----------------+-----------------+ | a clinical | | | | | condition in | | | | | which the pH is | | | | | less than 7.35 | | | | | and the PaCO2 | | | | | is greater than | | | | | 45 mm | | | | +-----------------+-----------------+-----------------+-----------------+ | **PATHOPHYSIOLO | **PREDISPOSING | **SIGNS** | **TREATMENT** | | GY** | FACTORS** | | | +-----------------+-----------------+-----------------+-----------------+ | - Respiratory | - Lung | - Hypoventila | - Treatment | | acidosis | disease | tion | is directed | | typically | like | -- hypoxia | as | | occurs due | | | improving | | to failure | - Acute | - Rapid, | ventilation | | of | pulmonary | shallow |. | | ventilation | edema | respiration | | | and | | s | - Mechanical | | accumulatio | - Atelectasis | | ventilation | | n | | - BP with | (if pco2 is | | of carbon | - Pneumothora | vasodilatio | high (\>50 | | dioxide. | x | n | mm Hg). | | | | | | | - The primary | - COPD | - Dyspnea | **Pharmacologic | | disturbance | | | al | | is an | - Impaired | - Headache | agents :** | | elevated | respiratory | | | | arterial | muscles(mus | - Hyperkalemi | - Bronchodila | | partial | cular | a | tors | | pressure of | dystrophy, | | | | carbon | myasthenia | - Dysrhythmia | - Antibiotics | | dioxide | gravis, | s | , | | (pCO2) and | GBS) | (increase K | | | a decreased | | ) | - Thrombolyti | | ratio of | | | cs. | | arterial | | - Drowsiness, | | | bicarbonate | | dizziness, | - Pulmonary | | to arterial | | disorientat | hygiene | | pCO2, which | | ion | measure | | results in | | | (placement | | a decrease | | - Muscle | in semi | | in the pH | | weakness. | fowler's | | of the | | Hyperreflex | position) | | blood. | | ia | | | | | | - Adequate | | - High level | | **Causes:** | hydration | | of CO2 in | | | | | the blood | | - Decrease | - Supplement | | stimulate | | respiratory | oxygen | | the parts | | stimuli | | | of the | | (anesthesia | | | brain that | | drug | | | regulates | | overdose) | | | breathing | | | | | which in | | - COPD | | | turn | | | | | stimulate | | - Pneumonia | | | faster and | | | | | deeper | | - Atelectasis | | | breathing | | | | +-----------------+-----------------+-----------------+-----------------+ | **RESPIRATORY | | | | | ALKALOSIS** | | | | +-----------------+-----------------+-----------------+-----------------+ | A clinical | | | | | condition in | | | | | which the | | | | | arterial pH is | | | | | greater than | | | | | 7.45 and the | | | | | PaCO2 is less | | | | | than 35 mm Hg. | | | | +-----------------+-----------------+-----------------+-----------------+ | **CAUSES** | **TREATMENT** | | | +-----------------+-----------------+-----------------+-----------------+ | Respiratory | - Treat | | | | alkalosis is | underlying | | | | always caused | cause | | | | by | | | | | hyperventilatio | - If the | | | | n, | causes is | | | | which causes | anxiety, | | | | excessive | the patient | | | | "**blowing | is | | | | off**" of CO2. | instructed | | | | | to breath | | | | - Extreme | more slowly | | | | anxiety, | to allow | | | | Hypoxemia | co2 to | | | | | accumulate | | | | - Early phase | or to | | | | of | breath in | | | | salicylate | closed | | | | intoxicatio | system | | | | n. | (such as a | | | | | paper bag). | | | | - Inappropria | | | | | te | - A sedative | | | | ventilator | may be | | | | settings, | required to | | | | CNS trauma | relieve | | | | | hyperventil | | | | | ation | | | | | in very | | | | | anxious | | | | | patients. | | | | | | | | | | - Adjustment | | | | | of | | | | | ventilator | | | | | settings. | | | +-----------------+-----------------+-----------------+-----------------+ | | | | | +-----------------+-----------------+-----------------+-----------------+ | - A common | | | | | clinical | | | | | disturbance | | | | | characteriz | | | | | ed | | | | | by a low pH | | | | | (increased | | | | | H | | | | | concentrati | | | | | on) | | | | | and a low | | | | | plasma | | | | | bicarbonate | | | | | concentrati | | | | | on. | | | | | | | | | | - Any | | | | | acid-base | | | | | imbalance | | | | | not | | | | | attributabl | | | | | e | | | | | to CO2 is | | | | | classified | | | | | as | | | | | metabolic. | | | | +-----------------+-----------------+-----------------+-----------------+ | **CAUSES** | **TREATMENT** | | | +-----------------+-----------------+-----------------+-----------------+ | - Those | - Treating | | | | associated | the | | | | with | underlying | | | | increased | cause: | | | | production | | | | | of organic | - For | | | | acids:- | example | | | | | , | | | | - Lactic | control | | | | acidosis(co | diabete | | | | mmon | s | | | | in | with | | | | anesthesia | insulin | | | | ,hypoxia) | or | | | | | treat | | | | - Ketoacidosi | poisoni | | | | s | ng | | | | | by | | | | - Renal | removin | | | | failure. | g | | | | | the | | | | - Drug | toxic | | | | intoxicatio | substan | | | | n | ce | | | | (esp. | from | | | | methanol, | the | | | | ethanol, | blood. | | | | salicylates | | | | | etc.) | - Occasio | | | | | nally | | | | - Those | dialysi | | | | associated | s | | | | with a loss | is | | | | of HCO3 | needed | | | | | to | | | | - Severe | treat | | | | diarrhea | severe | | | | | overdos | | | | - Prolonged | es | | | | deep (from | and | | | | duodenum) | poisoni | | | | vomiting | ngs. | | | | | | | | | | - When | | | | | acidosis is | | | | | severe, | | | | | bicarbonate | | | | | may be | | | | | given | | | | | intravenous | | | | | ly | | | | | **Bicarbona | | | | | te** | | | | | provides | | | | | only | | | | | temporary | | | | | relief | | | +-----------------+-----------------+-----------------+-----------------+ | | | | | +-----------------+-----------------+-----------------+-----------------+ | - A clinical | | | | | disturbance | | | | | characteriz | | | | | ed | | | | | by a high | | | | | pH and a | | | | | high plasma | | | | | bicarbonate | | | | | concentrati | | | | | on | | | | +-----------------+-----------------+-----------------+-----------------+ +-----------------------------------+-----------------------------------+ | **CAUSES** | **TREATMENT** | +===================================+===================================+ | - Vomiting | - Treat underlying disorder | | | | | - Diuretics(furosemide, | - Treatment involves provision | | thiazides) | of adequate intravenous | | | fluid, especially isotonic | | - Renal failure | sodium chloride. | | | | | - Hypovolemia | - Simultaneous **potassium | | | chloride** may be needed in | | - Diarrhea | critical ill patients. | | | | | - Hypokalemia | - Severe alkalosis (pH \< 7.55) | | | may require treatment with | | | acidifying agents like NH4Cl, | | | HCl or acetazolamide. | +-----------------------------------+-----------------------------------+ +-----------------+-----------------+-----------------+-----------------+ | **ALTERATIONS | | | | | IN | | | | | VENTILATION** | | | | +=================+=================+=================+=================+ | **Acute and | | | | | Chronic | | | | | Obstructive | | | | | Lung Disease** | | | | | | | | | | **CHRONIC LUNG | | | | | DISEASES** ( | | | | | long standing, | | | | | gradual onset, | | | | | progressive) | | | | | | | | | | **Chronic | | | | | obstructive | | | | | pulmonary | | | | | disease | | | | | (COPD)** | | | | | | | | | | - The name | | | | | for a group | | | | | of lung | | | | | conditions | | | | | that cause | | | | | breathing | | | | | difficultie | | | | | s. | | | | | | | | | | | | | | | | | | | | - | | | | | | | | | | | | | | | | | | | | - | | | | +-----------------+-----------------+-----------------+-----------------+ | **SYMPTOMS** | **ETIOLOGY** | **MANAGEMENT** | **MEDICAL | | | | | MANAGEMENT** | +-----------------+-----------------+-----------------+-----------------+ | - shortness | - Exposure to | **Goal of | - Bronchodila | | of breath, | irritants | Management:** | tors | | especially | (gases, | | | | during | allergen, | Improve a | - Antibiotic | | physical | chemicals, | patient's | | | activities | fumes, ) | functional | - Corticoster | | | | status and | oids | | - Wheezing | - Cigarette | quality of life | | | | smoke | by preserving | - Mucolytics | | - Chest | /second | optimal lung | | | tightness | hand smoke | function, | | | | | improving | | | - Chronic | | symptoms, and | | | cough that | | preventing the | | | may produce | | recurrence of | | | mucus | | exacerbations | | | (sputum) | | | | | that may be | | **S**moke | | | clear, | | cessation | | | white, | | | | | yellow or | | **M**edication | | | greenish | | -- inhaled | | | | | bronchodilators | | | - Frequent | | , | | | respiratory | | vaccines | | | infections | | (influenza, | | | | | pneumococcus), | | | - Lack of | | stop | | | energy | | unnecessary | | | | | treatment | | | - COPD are | | (nebuliser, | | | also likely | | inhaled | | | to | | corticosteroids | | | experience | | ) | | | episodes | | | | | called | | **O**xygen | | | exacerbatio | | therapy | | | ns | | | | | (increase | | **K**omorbidity | | | in | | --cardiac | | | severity) | | dysfunction, | | | | | sleep apnea, | | | | | osteoporosis, | | | | | depression, | | | | | asthma | | | | | | | | | | **E**xercise | | | | | and | | | | | rehabilitation/ | | | | | education | | | | | | | | | | **S**urgery -- | | | | | lung volume | | | | | reduction | | | | | surgery, | | | | | single-lung | | | | | transplantation | | +-----------------+-----------------+-----------------+-----------------+ +-----------------------+-----------------------+-----------------------+ | **PULMONARY | | | | EMBOLISM** | | | +=======================+=======================+=======================+ | - A blockage in one | | | | of the pulmonary | | | | arteries in your | | | | lungs. | | | | | | | | - It occurs when | | | | deep venous | | | | thrombi detach | | | | and embolize to | | | | the pulmonary | | | | circulation. | | | | | | | | - Pulmonary | | | | vascular | | | | occlusion occurs | | | | and impairs gas | | | | exchange and | | | | circulation. | | | +-----------------------+-----------------------+-----------------------+ | **CAUSES** | **SYMPTOMS** | **MANAGEMENT** | +-----------------------+-----------------------+-----------------------+ | - Smoking | - SOB | - Anticoagulant | | | | | | - Being overweight. | - Chest pain | - Compression | | Excess weight | | stockings-helping | | increases the | - Cough | veins and leg | | risk of blood | | muscles move | | clots | - Rapid or | blood more | | ---Supplemental | irregular | efficiently. | | estrogen. | heartbeat- | | | | | - Leg elevation | | - The estrogen in | - Light headedness | | | birth control | or dizziness | - Physical activity | | pills and in | | limited | | hormone | - Excessive | | | replacement | sweating | - **Pneumatic | | therapy can | | compression.** | | increase clotting | - Fever | | | factors in your | | - A devices are | | blood. | - Leg pain or | used to help | | | swelling, or | prevent blood | | - Pregnancy. The | both, usually in | clots in the | | weight of the | the calf caused | deep veins of | | baby pressing on | by a deep vein | the legs. | | veins in the | thrombosis | | | pelvis can slow | | - The devices | | blood return from | - Clammy or | use cuffs | | the legs. Clots | discolored skin | around the | | are more likely | | legs that | | to form when | | fill with air | | blood slows or | | and squeeze | | pools. | | your legs. | | | | | | | | - This | | | | increases | | | | blood flow | | | | through the | | | | veins of your | | | | legs and | | | | helps prevent | | | | blood clots. | +-----------------------+-----------------------+-----------------------+ | **ACUTE RESPIRATORY | | | | DISTRESS SYNDROME | | | | /ACUTE LUNG INJURY** | | | +-----------------------+-----------------------+-----------------------+ | - Occurs when fluid | | | | builds up in the | | | | tiny, elastic air | | | | sacs (alveoli) in | | | | your lungs. | | | | | | | | - The fluid keeps | | | | your lungs from | | | | filling with | | | | enough air, which | | | | means less oxygen | | | | reaches your | | | | bloodstream. | | | | | | | | - This deprives | | | | your organs of | | | | the oxygen they | | | | need to function | | | +-----------------------+-----------------------+-----------------------+ +---------+---------+---------+---------+---------+---------+---------+ | **CAUSE | **SYMPT | **COMPL | **MANAG | **DIAGN | **TREAT | **MEDIC | | S** | OMS** | ICATION | EMENT** | OSTIC | MENT** | ATION** | | | | ** | | TEST** | | | +=========+=========+=========+=========+=========+=========+=========+ | - Sep | - Sev | - Blo | - Oxy | **CHEST | The | **ANTIB | | sis | ere | od | gen | X-RAY** | first | IOTIC** | | | sho | clo | the | | goal in | | | - Inh | rtness | ts | rapy | A chest | treatin | Prevent | | alation | of | | | X-ray | g | and | | of | bre | - Col | - Mec | can | ARDS is | treat | | har | ath | lapsed | hanical | reveal | to | infecti | | mful | | lun | Ven | which | improve | ons | | sub | - Lab | g | tilatio | parts | the | | | stances | ored | (pn | n | of your | levels | **ANALG | | | and | eumotho | | lungs | of | ESIC** | | - Sev | unu | rax). | **MECHA | and how | oxygen | | | ere | sually | | NICAL | much of | in your | Relieve | | pne | rap | - Inf | VENTILA | the | blood. | pain | | umonia | id | ections | TOR** | lungs | Without | and | | | bre | | | have | oxygen, | discomf | | - Hea | athing | - Sca | Mechani | fluid | your | ort | | d, | | rring | cal | in them | organs | | | che | - Low | (pu | ventila | and | can\'t | **ANTIC | | st | blo | lmonary | tion | whether | functio | OAGULAN | | or | od | fib | is a | your | n | T** | | oth | pre | rosis) | form of | heart | properl | | | er | ssure | | life | is | y. | Prevent | | maj | | - Bre | support | enlarge | | blood | | or | - Con | athing |. | d. | **OXYGE | clots | | inj | fusion | pro | | | N** | in the | | ury. | and | blems | A | **COMPU | | legs | | | ext | | mechani | TERIZED | **SUPPL | and | | - Cor | reme | - Dep | cal | TOMOGRA | EMENTAL | lungs | | onaviru | tir | ression | ventila | PHY | OXYGEN. | | | s | edness | | tor | (CT).** | ** | **SEDAT | | dis | | | is a | | | IVE** | | ease | | | machine | A CT | For | | | 201 | | | that | scan | milder | | | 9 | | | takes | combine | symptom | | | | | | over | s | s | | | | | | the | X-ray | or as a | | | | | | work of | images | tempora | | | | | | breathi | taken | ry | | | | | | ng | from | measure | | | | | | when a | many | , | | | | | | person | differe | oxygen | | | | | | is not | nt | may be | | | | | | able to | directi | deliver | | | | | | breathe | ons | ed | | | | | | enough | into | through | | | | | | on | cross-s | a mask | | | | | | their | ectiona | that | | | | | | own. | l | fits | | | | | | | views | tightly | | | | | | The | of | over | | | | | | mechani | interna | your | | | | | | cal | l | nose | | | | | | ventila | organs. | and | | | | | | tor | CT | mouth. | | | | |